Cáscara de Health Dictionary

Cáscara De : From 1 Different Sources


Typically means “bark or fruit rind of (plant name)”; look up the plant name which follows this description of the plant part used.
Health Source: Medicinal Plants
Author: Health Dictionary

Demulcent

Soothing... demulcent

Dermatitis

Irritation or inflammation of the skin... dermatitis

Black Death

An old name for PLAGUE.... black death

Cot Death

See SUDDEN INFANT DEATH SYNDROME (SIDS).... cot death

Debility

A state of weakness.... debility

Decoction

An aqueous extract of one or a few herbs ; a common method for preparing tea (té) or tizana; typically 2 teaspoons of dried plant material (1/4 cup if fresh) are boiled in hot water, either in a covered pot to trap volatile oils or with the cover removed so that the water boils off for a more concentrated brew; typically, roots and woody, fibrous plant matter are boiled for a longer period of time and flowers or leaves are boiled for a shorter period of time because less time is needed to extract their properties; most Dominican herbal remedies are prepared as decoctions; see also infusion and té.... decoction

Deafness

Impairment of hearing, which affects about 2 million adults in the UK. In infants, permanent deafness is much less common: about 1–2 per 1,000. It is essential, however, that deafness is picked up early so that appropriate treatment and support can be given to improve hearing and/or ensure that the child can learn to speak.

In most people, deafness is a result of sensorineural hearing impairment, commonly known as nerve deafness. This means that the abnormality is located in the inner ear (the cochlea), in the auditory nerve, or in the brain itself. The prevalence of this type of hearing impairment rises greatly in elderly people, to the extent that more than 50 per cent of the over-70s have a moderate hearing impairment. In most cases no de?nite cause can be found, but contributory factors include excessive exposure to noise, either at work (e.g. shipyards and steelworks) or at leisure (loud music). Anyone who is exposed to gun?re or explosions is also likely to develop some hearing impairment: service personnel, for example.

Conductive hearing impairment is the other main classi?cation. Here there is an abnormality of the external or middle ear, preventing the normal transmission of sound waves to the inner ear. This is most commonly due to chronic otitis media where there is in?ammation of the middle ear, often with a perforation of the ear drum. It is thought that in the majority of cases this is a sequela of childhood middle-ear disease. Many preschool children suffer temporary hearing loss because of otitis media with e?usion (glue ear). Wax does not interfere with hearing unless it totally obstructs the ear canal or is impacted against the tympanic membrane. (See also EAR; EAR, DISEASES OF.)

Treatment Conductive hearing impairment can, in many cases, be treated by an operation on the middle ear or by the use of a hearing aid. Sensorineural hearing impairments can be treated only with a hearing aid. In the UK, hearing aids are available free on the NHS. Most NHS hearing aids are ear-level hearing aids – that is, they ?t behind the ear with the sound transmitted to the ear via a mould in the external ear. Smaller hearing aids are available which ?t within the ear itself, and people can wear such aids in both ears. The use of certain types of hearing aid may be augmented by ?ttings incorporated into the aid which pick up sound directly from television sets or from telephones, and from wire loop systems in halls, lecture theatres and classrooms. More recently, bone-anchored hearing aids have been developed where the hearing aid is attached directly to the bones of the skull using a titanium screw. This type of hearing aid is particularly useful in children with abnormal or absent ear canals who cannot therefore wear conventional hearing aids. People with hearing impairment should seek audiological or medical advice before purchasing any of the many types of hearing aid available commercially. Those people with a hearing impairment which is so profound (‘stone deaf’) that they cannot be helped by a hearing aid can sometimes now be ?tted with an electrical implant in their inner ear (a cochlear implant).

Congenital hearing loss accounts for a very small proportion of the hearing-impaired population. It is important to detect at an early stage as, if undetected and unaided, it may lead to delayed or absent development of speech. Otitis media with e?usion (glue ear) usually resolves spontaneously, although if it persists, surgical intervention has been the traditional treatment involving insertion of a ventilation tube (see GROMMET) into the ear drum, often combined with removal of the adenoids (see NOSE, DISORDERS OF). Recent studies, however, suggest that in many children these operations may provide only transient relief and make no di?erence to long-term outcome.

Advice and information on deafness and hearing aids may be obtained from the Royal National Institute for Deaf People and other organisations.... deafness

Dehydration

A fall in the water content of the body. Sixty per cent of a man’s body weight is water, and 50 per cent of a woman’s; those proportions need to be maintained within quite narrow limits to ensure proper functioning of body tissues. Body ?uids contain a variety of mineral salts (see ELECTROLYTES) and these, too, must remain within narrow concentration bands. Dehydration is often accompanied by loss of salt, one of the most important minerals in the body.

The start of ‘dehydration’ is signalled by a person becoming thirsty. In normal circumstances, the drinking of water will relieve thirst and serious dehydration does not develop. In a temperate climate an adult will lose 1.5 litres or more a day from sweating, urine excretion and loss of ?uid through the lungs. In a hot climate the loss is much higher – up to 10 litres if a person is doing hard physical work. Even in a temperate climate, severe dehydration will occur if a person does not drink for two or three days. Large losses of ?uid occur with certain illnesses – for example, profuse diarrhoea; POLYURIA in diabetes or kidney failure (see KIDNEYS, DISEASES OF); and serious blood loss from, say, injury or a badly bleeding ULCER in the gastrointestinal tract. Severe thirst, dry lips and tongue, TACHYCARDIA, fast breathing, lightheadedness and confusion are indicative of serious dehydration; the individual can lapse into COMA and eventually die if untreated. Dehydration also results in a reduction in output of urine, which becomes dark and concentrated.

Prevention is important, especially in hot climates, where it is essential to drink water even if one is not thirsty. Replacement of salts is also vital, and a diet containing half a teaspoon of table salt to every litre of water drunk is advisable. If someone, particularly a child, suffers from persistent vomiting and diarrhoea, rehydration therapy is required and a salt-andglucose rehydration mixture (obtainable from pharmacists) should be taken. For those with severe dehydration, oral ?uids will be insu?cient and the affected person needs intravenous ?uids and, sometimes, admission to hospital, where ?uid intake and output can be monitored and rehydration measures safely controlled.... dehydration

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

Dengue

Also known as dengue fever, breakbone fever, and dandy fever, dengue is endemic and epidemic in tropical and subtropical regions. It is an acute infection caused by a ?avivirus (family togaviridae) transmitted by mosquitoes – especially Aedes aegypti. Incubation period is 5–8 days, and is followed by abrupt onset of symptoms: fever, facial ERYTHEMA with intense itching (which spreads throughout the body), sore throat, running eyes, and painful muscles and joints are common accompaniments. The symptoms subside within a few days and are frequently succeeded by a relapse similar to the ?rst. Further relapses may occur, and joint pains continue for some months. In uncomplicated dengue the mortality rate is virtually zero. Diagnosis is by virus isolation or demonstration of a rising antibody-concentration in the acute phase of infection. There is no speci?c treatment, but mild analgesics can be used to relieve the pains, and calamine lotion the itching. Prevention can be achieved by reduction of the mosquito-vector population.

Dengue haemorrhagic fever This is a more severe form of the disease which usually occurs in young children; it is largely con?ned to the indigenous population(s) of south-east Asia. It is accompanied by signi?cant complications and mortality. Immunological status of the host is considered important in pathogenesis.... dengue

Deodorant

Removing the odour... deodorant

Depression

Depression is a word that is regularly misused. Most people experience days or weeks when they feel low and fed up (feelings that may recur), but generally they get over it without needing to seek medical help. This is not clinical depression, best de?ned as a collection of psychological symptoms including sadness; unhappy thoughts characterised by worry, poor self-image, self-blame, guilt and low self-con?dence; downbeat views on the future; and a feeling of hopelessness. Su?erers may consider suicide, and in severe depression may soon develop HALLUCINATIONS and DELUSIONS.

Doctors make the diagnosis of depression when they believe a patient to be ill with the latter condition, which may affect physical health and in some instances be life-threatening. This form of depression is common, with up to 15 per cent of the population suffering from it at any one time, while about 20 per cent of adults have ‘medical’ depression at some time during their lives – such that it is one of the most commonly presenting disorders in general practice. Women seem more liable to develop depression than men, with one in six of the former and one in nine of the latter seeking medical help.

Manic depression is a serious form of the disorder that recurs throughout life and is manifested by bouts of abnormal elation – the manic stage. Both the manic and depressive phases are commonly accompanied by psychotic symptoms such as delusions, hallucinations and a loss of sense of reality. This combination is sometimes termed a manic-depressive psychosis or bipolar affective disorder because of the illness’s division into two parts. Another psychiatric description is the catch-all term ‘affective disorder’.

Symptoms These vary with the illness’s severity. Anxiety and variable moods are the main symptoms in mild depression. The sufferer may cry without any reason or be unresponsive to relatives and friends. In its more severe form, depression presents with a loss of appetite, sleeping problems, lack of interest in and enjoyment of social activities, tiredness for no obvious reason, an indi?erence to sexual activity and a lack of concentration. The individual’s physical and mental activities slow down and he or she may contemplate suicide. Symptoms may vary during the 24 hours, being less troublesome during the latter part of the day and worse at night. Some people get depressed during the winter months, probably a consequence of the long hours of darkness: this disorder – SEASONAL AFFECTIVE DISORDER SYNDROME, or SADS – is thought to be more common in populations living in areas with long winters and limited daylight. Untreated, a person with depressive symptoms may steadily worsen, even withdrawing to bed for much of the time, and allowing his or her personal appearance, hygiene and environment to deteriorate. Children and adolescents may also suffer from depression and the disorder is not always recognised.

Causes A real depressive illness rarely has a single obvious cause, although sometimes the death of a close relative, loss of employment or a broken personal relationship may trigger a bout. Depression probably has a genetic background; for instance, manic depression seems to run in some families. Viral infections sometimes cause depression, and hormonal disorders – for example, HYPOTHYROIDISM or postnatal hormonal disturbances (postnatal depression) – will cause it. Di?cult family or social relations can contribute to the development of the disorder. Depression is believed to occur because of chemical changes in the transmission of signals in the nervous system, with a reduction in the neurochemicals that facilitate the passage of messages throughout the system.

Treatment This depends on the type and severity of the depression. These are three main forms. PSYCHOTHERAPY either on a one-to-one basis or as part of a group: this is valuable for those whose depression is the result of lifestyle or personality problems. Various types of psychotherapy are available. DRUG TREATMENT is the most common method and is particularly helpful for those with physical symptoms. ANTIDEPRESSANT DRUGS are divided into three main groups: TRICYCLIC ANTIDEPRESSANT DRUGS (amitriptyline, imipramine and dothiepin are examples); MONOAMINE OXIDASE INHIBITORS (MAOIS) (phenelzine, isocarboxazid and tranylcypromine are examples); and SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) (?uoxetine – well known as Prozac®, ?uvoxamine and paroxetine are examples). For manic depression, lithium carbonate is the main preventive drug and it is also used for persistent depression that fails to respond to other treatments. Long-term lithium treatment reduces the likelihood of relapse in about 80 per cent of manic depressives, but the margin between control and toxic side-effects is narrow, so the drug must be carefully supervised. Indeed, all drug treatment for depression needs regular monitoring as the substances have powerful chemical properties with consequential side-effects in some people. Furthermore, the nature of the illness means that some sufferers forget or do not want to take the medication. ELECTROCONVULSIVE THERAPY (ECT) If drug treatments fail, severely depressed patients may be considered for ECT. This treatment has been used for many years but is now only rarely recommended. Given under general anaesthetic, in appropriate circumstances, ECT is safe and e?ective and may even be life-saving, though temporary impairment of memory may occur. Because the treatment was often misused in the past, it still carries a reputation that worries patients and relatives; hence careful assessment and counselling are essential before use is recommended.

Some patients with depression – particularly those with manic depression or who are a danger to themselves or to the public, or who are suicidal – may need admission to hospital, or in severe cases to a secure unit, in order to initiate treatment. But as far as possible patients are treated in the community (see MENTAL ILLNESS).... depression

Dermatomyositis

A rare disease, possibly caused by an autoimmune reaction, in which muscle in?ammation and weakness is associated with a characteristic heliotrope ERYTHEMA of the face and backs of the hands. In adults it may be associated with underlying malignancy. Tissue changes are similar to those in POLYMYOSITIS.... dermatomyositis

Vas Deferens

A canal connecting vas efferens to cirrus.... vas deferens

Atrial Septal Defect

See HEART, DISEASES OF – Congenital heart disease.... atrial septal defect

Cascara Sagrada

Rhamnus purshiana. N.O. Rhamnaceae.

Synonym: Sacred Bark, Chittem Bark.

Habitat: California and British Columbia. Features ? Bark in quills about three-quarter inch wide by one-sixteenth inch thick,

furrowed-longitudinally, purplish-brown in colour. Inner surface longitudinally

striated, transversely wrinkled. Fracture pale brown, or dark brown when older.

Persistently bitter taste, leather-like odour.

Older bark is preferred, younger sometimes griping. Part used ? Bark.

Action: Tonic laxative.

In habitual constipation due to sluggishness and atony of the lower bowel, and for digestive disorders generally. Doses for chronic constipation, firstly 1/2 to 1 teaspoonful at bedtime, afterwards 5-10 drops before each meal, of the fluid extract.... cascara sagrada

Death Rate

The proportion of deaths in a specified population. The death rate is calculated by dividing the number of deaths in a population in a year by the midyear resident population. Death rates are often expressed as the number of deaths per 100 000 persons. The rate may be restricted to deaths in specific age, race, sex, or geographic groups or deaths from specific causes of death (specific rate), or it may be related to the entire population (crude rate).... death rate

Debridement

The surgical removal of foreign material and damaged tissue from a wound.... debridement

Decongestant

Relieving congestion, as of the mucous membrane... decongestant

Degeneration

A change in structure or in chemical composition of a tissue or organ, by which its vitality is lowered or its function interfered with. Degeneration is of various kinds, the chief being fatty, where cells become invaded by fat globules; calcareous, where calcium is deposited in tissue so that it becomes chalky in consistency; and mucoid, where it becomes semi-lique?ed.

Causes of degeneration are, in many cases, very obscure. In some cases heredity plays a part, with particular organs – for example, the kidneys – tending to show ?broid changes in successive generations. Fatty, ?broid, and calcareous degenerations are part of the natural change in old age; defective nutrition may bring them on prematurely, as may excessive and long-continued strain upon an organ like the heart. Various poisons, such as alcohol, play a special part in producing the changes, and so do the poisons produced by various diseases, particularly SYPHILIS and TUBERCULOSIS.... degeneration

Dehiscence

The breaking open of a wound that is partly healed, usually after surgery.... dehiscence

Déjà Vu

A feeling of having already experienced an event which the person is doing or seeing at the moment. French for ‘already seen’, déjà vu is quite common but no satisfactory explanation for the phenomenon has yet been discovered.... déjà vu

Delirium

A condition of altered consciousness in which there is disorientation (as in a confusional state), incoherent talk and restlessness but with hallucination, illusions or delusions also present.

Delirium (confusion) In some old people, acute confusion is a common e?ect of physical illness. Elderly people are often referred to as being ‘confused’; unfortunately this term is often inappropriately applied to a wide range of eccentricities of speech and behaviour as if it were a diagnosis. It can be applied to a patient with the early memory loss of DEMENTIA – forgetful, disorientated and wandering; to the dejected old person with depression, often termed pseudo-dementia; to the patient whose consciousness is clouded in the delirium of acute illness; to the paranoid deluded sufferer of late-onset SCHIZOPHRENIA; or even to the patient presenting with the acute DYSPHASIA and incoherence of a stroke. Drug therapy may be a cause, especially in the elderly.

Delirium tremens is the form of delirium most commonly due to withdrawal from alcohol, if a person is dependent on it (see DEPENDENCE). There is restlessness, fear or even terror accompanied by vivid, usually visual, hallucinations or illusions. The level of consciousness is impaired and the patient may be disorientated as regards time, place and person.

Treatment is, as a rule, the treatment of causes. (See also ALCOHOL.) As the delirium in fevers is due partly to high temperature, this should be lowered by tepid sponging. Careful nursing is one of the keystones of successful treatment, which includes ensuring that ample ?uids are taken and nutrition is maintained.... delirium

Delivery

The ?nal expulsion of the child in the act of birth. (See PREGNANCY AND LABOUR.)... delivery

Deltoid

The powerful triangular muscle attached above to the collar-bone and shoulder-blade, and below, by its point, to the humerus, nearly halfway down the outer side of the upper arm. Its action is to raise the arm from the side, and it covers and gives roundness to the shoulder. (See also MUSCLE.)... deltoid

Dementia

An acquired and irreversible deterioration in intellectual function. Around 10 per cent of people aged over 65 and 20 per cent of those aged 75 or over are affected to some extent. The disorder is due to progressive brain disease. It appears gradually as a disturbance in problem-solving and agility of thought which may be considered to be due to tiredness, boredom or DEPRESSION. As memory failure develops, the affected person becomes bewildered, anxious and emotional when dealing with new surroundings and complex conversations. In professional skilled workers this is frequently ?rst recognised by family and friends. Catastrophic reactions are usually brief but are commonly associated with an underlying depression which can be mistaken for progressive apathy. The condition progresses relentlessly with loss of recent memory extending to affect distant memory and failure to recognise even friends and family. Physical aggression, unsocial behaviour, deteriorating personal cleanliness and incoherent speech commonly develop. Similar symptoms to those in dementia can occur in curable conditions including depression, INTRACRANIAL tumours, SUBDURAL haematoma, SYPHILIS, vitamin B1 de?ciency (see APPENDIX 5: VITAMINS) and repeated episodes of cerebral ISCHAEMIA. This last may lead to multi-infarct dementia.

Treatment If organic disease is identi?ed, it should, where possible, be treated; otherwise the treatment of dementia is alleviation of its symptoms. The affected person must be kept clean and properly fed. Good nursing care in comfortable surroundings is important and sedation with appropriate drugs may be required. Patients may eventually need institutional care. (See ALZHEIMER’S DISEASE.)... dementia

Demography

The study of populations, especially with reference to size and density, fertility, mortality, growth, age distribution, migration and vital statistics, and the interaction of all of these with social and economic conditions.... demography

Demyelination

Destruction of the fatty MYELIN sheath around nerve ?bres (see NERVE: NEURON(E)) which interferes with the nerve function. It can occur after injury to the nerve, but is particularly associated with MULTIPLE SCLEROSIS (MS).... demyelination

Dendritic Ulcer

A branching ULCER on the surface of the cornea of the eye, caused by HERPES SIMPLEX infection.... dendritic ulcer

Dentifrice

Any liquid, paste or powder used for cleansing the teeth.... dentifrice

Dentine

See TEETH.... dentine

Dentition

See TEETH.... dentition

Denture

A plate or frame bearing false teeth. It may be complete (replacing all the teeth in one jaw) or partial.... denture

Deoxyribonucleic Acid

See DNA.... deoxyribonucleic acid

Dependence

Physical or psychological reliance on a substance or an individual. A baby is naturally dependent on its parents, but as the child develops, this dependence lessens. Some adults, however, remain partly dependent, making abnormal demands for admiration, love and help from parents, relatives and others.

The dependence that most concerns modern society is one in which individuals become dependent on or addicted to certain substances such as alcohol, drugs, tobacco (nicotine), caffeine and solvents. This is often called substance abuse. Some people become addicted to certain foods or activities: examples of the latter include gambling, computer games and use of the Internet.

The 28th report of the World Health Organisation Expert Committee on Drug Dependence in 1993 de?ned drug dependence as: ‘A cluster of physiological, behavioural and cognitive phenomena of variable intensity, in which the use of a psychoactive drug (or drugs) takes on a high priority. The necessary descriptive characteristics are preoccupation with a desire to obtain and take the drug and persistent drug-seeking behaviour. Psychological dependence occurs when the substance abuser craves the drug’s desirable effects. Physical dependence occurs when the user has to continue taking the drug to avoid distressing withdrawal or abstinence symptoms. Thus, determinants and the problematic consequences of drug dependence may be biological, psychological or social and usually interact.’

Di?erent drugs cause di?erent rates of dependence: TOBACCO is the most common substance of addiction; HEROIN and COCAINE cause high rates of addiction; whereas ALCOHOL is much lower, and CANNABIS lower again. Smoking in the western world reached a peak after World War II with almost 80 per cent of the male population smoking. The reports on the link between smoking and cancer in the early 1960s resulted in a decline that has continued so that only around a quarter of the adult populations of the UK and USA smokes. Globally, tobacco consumption continues to grow, particularly in the developing world with multinational tobacco companies marketing their products aggressively.

Accurate ?gures for illegal drug-taking are hard to obtain, but probably approximately 4 per cent of the population is dependent on alcohol and 2 per cent on other drugs, both legal and illegal, at any one time in western countries.

How does dependence occur? More than 40 distinct theories or models of drug misuse have been put forward. One is that the individual consumes drugs to cope with personal problems or diffculties in relations with others. The other main model emphasises environmental in?uences such as drug availability, environmental pressures to consume drugs, and sociocultural in?uences such as peer pressure.

By contrast to these models of why people misuse drugs, models of compulsive drug use – where individuals have a compulsive addiction

– have been amenable to testing in the laboratory. Studies at cellular and nerve-receptor levels are attempting to identify mechanisms of tolerance and dependence for several substances. Classical behaviour theory is a key model for understanding drug dependence. This and current laboratory studies are being used to explain the reinforcing nature of dependent substances and are helping to provide an explanatory framework for dependence. Drug consumption is a learned form of behaviour. Numerous investigators have used conditioning theories to study why people misuse drugs. Laboratory studies are now locating the ‘reward pathways’ in the brain for opiates and stimulants where positive reinforcing mechanisms involve particular sectors of the brain. There is a consensus among experts in addiction that addictive behaviour is amenable to e?ective treatment, and that the extent to which an addict complies with treatment makes it possible to predict a positive outcome. But there is a long way to go before the mechanisms of drug addiction are properly understood or ways of treating it generally agreed.

Effects of drugs Cannabis, derived from the plant Cannabis sativa, is a widely used recreational drug. Its two main forms are marijuana, which comes from the dried leaves, and hashish which comes from the resin. Cannabis may be used in food and drink but is usually smoked in cigarettes to induce relaxation and a feeling of well-being. Heavy use can cause apathy and vagueness and may even cause psychosis. Whether or not cannabis leads people to using harder drugs is arguable, and a national debate is underway on whether its use should be legalised for medicinal use. Cannabis may alleviate the symptoms of some disorders – for example, MULTIPLE SCLEROSIS (MS) – and there are calls to allow the substance to be classi?ed as a prescribable drug.

About one in ten of Britain’s teenagers misuses volatile substances such as toluene at some time, but only about one in 40 does so regularly. These substances are given o? by certain glues, solvents, varnishes, and liquid fuels, all of which can be bought cheaply in shops, although their sale to children under 16 is illegal. They are often inhaled from plastic bags held over the nose and mouth. Central-nervous-system excitation, with euphoria and disinhibition, is followed by depression and lethargy. Unpleasant effects include facial rash, nausea and vomiting, tremor, dizziness, and clumsiness. Death from COMA and acute cardiac toxicity is a serious risk. Chronic heavy use can cause peripheral neuropathy and irreversible cerebellar damage. (See SOLVENT ABUSE (MISUSE).)

The hallucinogenic or psychedelic drugs include LYSERGIC ACID DIETHYLAMIDE (LSD) or acid, magic mushrooms, ecstasy (MDMA), and phencyclidine (PCP or ‘angel’ dust, mainly used in the USA). These drugs have no medicinal uses. Taken by mouth, they produce vivid ‘trips’, with heightened emotions and perceptions and sometimes with hallucinations. They are not physically addictive but can cause nightmarish bad trips during use and ?ashbacks (vivid reruns of trips) after use, and can probably trigger psychosis and even death, especially if drugs are mixed or taken with alcohol.

Stimulant drugs such as amphetamine and cocaine act like adrenaline and speed up the central nervous system, making the user feel con?dent, energetic, and powerful for several hours. They can also cause severe insomnia, anxiety, paranoia, psychosis, and even sudden death due to convulsions or tachycardia. Depression may occur on withdrawal of these drugs, and in some users this is su?ciently deterrent to cause psychological dependence. Amphetamine (‘speed’) is mainly synthesised illegally and may be eaten, sni?ed, or injected. Related drugs, such as dexamphetamine sulphate (Dexedrine), are prescribed pills that enter the black market. ECSTASY is another amphetamine derivative that has become a popular recreational drug; it may have fatal allergic effects. Cocaine and related drugs are used in medicine as local anaesthetics. Illegal supplies of cocaine (‘snow’ or ‘ice’) and its derivative, ‘crack’, come mainly from South America, where they are made from the plant Erythroxylon coca. Cocaine is usually sni?ed (‘snorted’) or rubbed into the gums; crack is burnt and inhaled.

Opiate drugs are derived from the opium poppy, Papaver somniferum. They are described as narcotic because they induce sleep. Their main medical use is as potent oral or injectable analgesics such as MORPHINE, DIAMORPHINE, PETHIDINE HYDROCHLORIDE, and CODEINE. The commonest illegal opiate is heroin, a powdered form of diamorphine that may be smoked, sni?ed, or injected to induce euphoria and drowsiness. Regular opiate misuse leads to tolerance (the need to take ever larger doses to achieve the same e?ect) and marked dependence. A less addictive oral opiate, METHADONE HYDROCHLORIDE, can be prescribed as a substitute that is easier to withdraw.

Some 75,000–150,000 Britons now misuse opiates and other drugs intravenously, and pose a huge public-health problem because injections with shared dirty needles can carry the blood-borne viruses that cause AIDS/HIV and HEPATITIS B. Many clinics now operate schemes to exchange old needles for clean ones, free of charge. Many addicts are often socially disruptive.

For help and advice see APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELF-HELP – National Dugs Helpline.

(See ALCOHOL and TOBACCO for detailed entries on those subjects.)... dependence

Depurative

An agent that purifies blood... depurative

Dermographism

Dermographism, or factitious URTICARIA, refers to transient ERYTHEMA and wealing caused by trauma to the skin.... dermographism

Dermoid Cyst

See CYSTS.... dermoid cyst

Desferrioxamine

An agent which binds to heavy metals, used in the treatment of iron poisoning and THALASSAEMIA.... desferrioxamine

Dexamethasone

A CORTICOSTEROIDS derivative. As an antiin?ammatory agent it is approximately 30 times as e?ective as cortisone and eight times as e?ective as prednisolone. On the other hand, it has practically none of the salt-retaining properties of cortisone.... dexamethasone

Dextrocardia

A condition in which a person’s heart is situated on the right of the chest in a mirror image of its usual position. This may be associated with similar inversion of the abdominal organs – situs inversus.... dextrocardia

Dextrose

Another name for puri?ed grape sugar or glucose. A common constituent of intravenous ?uids.... dextrose

Senile Dementia

DEMENTIA was traditionally divided into presenile and senile types; this is increasingly recognised as an arbitrary division of a condition in which there is a general and often slow decline in mental capabilities. Around 10 per cent of people over 65 years of age and 20 per cent over 75 are affected by dementing illness, but people under 65 may also be affected. Treatable causes such as brain tumour, head injury, ENCEPHALITIS and alcoholism are commoner in younger people. Other causes such as cerebrovascular disease – which is a major factor, especially among older people – or ALZHEIMER’S DISEASE are not readily treatable, although ANTIHYPERTENSIVE DRUGS for the former disorder may help, and symptomatic treatment for both is possible.

Individuals with dementia suffer a gradual deterioration of memory and of the ability to grasp what is happening around them. They often cover up their early failings and the condition may ?rst become apparent as a result of emotional outbursts or uncharacteristic behaviour in public. Eventually personal habits and speech deteriorate and they become thoroughly confused and di?cult to look after. Treatment is primarily a matter of ameliorating the symptoms, coupled with a sympathetic handling of the sufferer and the relatives. Admission to hospital or nursing home may be necessary if relatives are unable to look after the patient at home. (See also MEDICINE OF THE AGEING.)... senile dementia

Sensory Deprivation

A substantial reduction in the volume of SENSORY information impinging on the body – for instance, sitting in a dark, silent room. Prolonged deprivation is potentially harmful as the body needs constant stimulation in order to function normally. The main input organs are the eyes, ears, skin and nose. The absence of sensations disorients a person and results in neurological dysfunction. Some interrogation techniques involve sensory deprivation to ‘soften up’ the individual being questioned.... sensory deprivation

Septal Defect

A congenital abnormality of the HEART affecting about 260 babies in every 100,000, in which there is a hole in the septum – the dividing wall – between the left and right sides of the heart. The effects of the defect depend upon its size and position. A defect in the wall between the atria (upper chambers of the heart) is called an atrial septal defect, and that between the ventricles, a ventricular septal defect – the most common form (25 per cent of all defects). Both defects allow blood to circulate from the left side of the heart, where pressures are highest, to the right. This abnormal ?ow of blood is described as a ‘shunt’ and the result is that too much blood ?ows into the lungs. PULMONARY HYPERTENSION occurs and, if the shunt is large, heart failure may develop. A small septal defect may not need treatment but a large one will need to be repaired surgically.... septal defect

Sexual Deviation

Any type of pleasurable sexual practice which society regards as abnormal. Deviation may be related to the activity, such as EXHIBITIONISM or sadomasochistic sex (see SADISM; MASOCHISM); or to the sexual object, for example, shoes or clothes (fetishism). Di?erent cultures have di?erent values, and treatment is probably not required unless the deviation is antisocial or harmful to the participant(s). Aversion therapy, or the conditioning of a person’s behaviour, may help if treatment is considered necessary.... sexual deviation

Standard Deviation

A measure of the amount by which each value deviates from the mean; equal to the square root of the variance, i.e. the square root of the average of the squared deviations from the mean. It is the most commonly used measure of dispersion of statistical data.... standard deviation

Ventricular Septal Defect

An inherited defect of the HEART. The septum (partition) separating the two ventricles is pierced by a hole which, if large, results in blood being diverted to the LUNGS at a greater pressure than normal. This may lead to irreversible PULMONARY HYPERTENSION, which early surgical intervention (repair of the septal defect) should prevent. A quarter of patients with VSD have other cardiac defects. Half of the defects seal themselves spontaneously.... ventricular septal defect

Death

“Death is often, at the start, in a particular organ, i.e. local. If the part can be saved in time life may be preserved. At the approach of death the value of a particular organ strikes one forcibly. There may be no need for constitutional medication. The one suffering part may be the whole case. In many chronic cases certain organs claim and must have special attention.” (Dr J. Compton Burnet)

Most important of such organs are the heart, which can be sustained by a few grains of Cayenne; the brain (Ginkgo, Skullcap, Kola); stomach (Peppermint); liver (Dandelion); spleen (New Jersey tea). See: LIFE DROPS.

When all desire for food has ceased, sips of honey-water or Balm tea sweetened with honey offer a comforting and sustaining support. ... death

Drug Dependence

One third of those taking tranquillisers become addicted. One of the problems of psychological dependence is the discomfort of withdrawal symptoms.

Symptoms. Tremors, restlessness, nausea and sleep disturbance. The greater potency of the drug, the higher the rebound anxiety. Many drugs create stress, weaken resistance to disease, tax the heart and raise blood sugar levels.

Drugs like Cortisone cause bone loss by imperfect absorption of calcium. Taken in the form of milk and dairy products, calcium is not always absorbed. Herbs to make good calcium loss are: Horsetail, Chickweed, Slippery Elm, Spinach, Alfalfa.

Agents to calm nerves and promote withdrawal may augment a doctor’s prescription for reduction of drug dosage, until the latter may be discontinued. Skullcap and Valerian offer a good base for a prescription adjusted to meet individual requirements.

Alternatives. Teas: German Chamomile, Gotu Kola, Hops, Lime flowers, Hyssop, Alfalfa, Passion flower, Valerian, Mistletoe, Oats, Lavender, Vervain, Motherwort. 1 heaped teaspoon to each cup boiling water; infuse 5-15 minutes; half-1 cup thrice daily.

Decoctions: Valerian, Devil’s Claw, Siberian Ginseng, Lady’s Slipper. Jamaica Dogwood, Black Cohosh.

Tablets/capsules. Motherwort, Dogwood, Valerian, Skullcap, Passion flower, Mistletoe, Liquorice. Powders. Formulae. Alternatives. (1) Combine equal parts Valerian, Skullcap, Mistletoe. Or, (2) Combine Valerian 1; Skullcap 2; Asafoetida quarter. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily. Formula No 2 is very effective but offensive to taste and smell.

Practitioner. Tincture Nucis vom. once or twice daily, as advised.

Aloe Vera gel (or juice). Russians tested this plant on rabbits given heavy drug doses and expected to die. Their survival revealed the protective property of this plant: dose, 1 tablespoon morning and evening. Aromatherapy. Sniff Ylang Ylang oil. Lavender oil massage for its relaxing and stress-reducing properties.

Diet. Avoid high blood sugar levels by rejecting alcohol, white flour products, chocolate, sugar, sweets and high cholesterol foods.

Supplements. Daily. Multivitamins, Vitamin B-complex, B6, Vitamin C 2g, Minerals: Magnesium, Manganese, Iron, Zinc. Change of lifestyle. Stop smoking. Yoga.

Notes. “Do not withdraw: insulin, anticoagulants, epileptic drugs, steroids, thyroxin and hormone replacement therapy (the endocrine glands may no longer be active). Long-term tranquillisers e.g., Largactil or any medicament which has been used for a long period. Patients on these drugs are on a finely-tuned medication the balance of which may be easily disturbed.” (Simon Mills, FNIMH)

Counselling and relaxation therapy.

The Committee on Safety of Medicines specifically warns against the abrupt cessation of the Benzodiazepines and similar tranquillisers because of the considerable risk of convulsions. ... drug dependence

Accidental Death

In 2000, more than 12,000 people died in or as a result of accidents in the UK, nearly half occurring at home and around a third in motor vehicle incidents. Many of these deaths would have been preventable, had appropriate safety measures been taken. A high proportion of deaths from accidents occur in males between ?ve and 34 years of age; alcohol is a signi?cant factor. Since the introduction of compulsory use of car seatbelts in the UK in the 1980s, the incidence of deaths from driving has fallen. With employers more aware of the risks of injury and death in the work place – with legislation reinforcing education – the number of such incidents has fallen over the past 50 years or more: this group now accounts for less than 2 per cent of all accidental deaths. Accidental deaths in the elderly are mainly caused by falls, mostly at home. In infants, choking is a signi?cant cause of accidental death, with food and small objects presenting the main hazards. Poisoning (often from drug overdose) and drowning are notable causes between the mid-20s and mid-40s.

See www.rospa.com... accidental death

Alcohol Dependence

Alcohol dependence, or alcoholism, is described under ALCOHOL but a summary of the symptoms may be helpful in spotting the disorder. Behavioural symptoms vary but include furtiveness; aggression; inappropriately generous gestures; personality changes (sel?shness, jealousy, irritability and outbursts of anger); empty promises to stop drinking; poor appetite; scru?y appearance; and long periods of drunkenness.... alcohol dependence

Birth Defects

See CONGENITAL.... birth defects

Breech Delivery

See BREECH PRESENTATION.... breech delivery

Consensus Development

Various forms of group judgement in which a group (or panel) of experts interacts in assessing an intervention and formulating findings by vote or other informal or formal means, involving such techniques as the nominal group and Delphi techniques.... consensus development

Deamination

The process of removal of the amino group, NH2, from amino acids not required for building up body PROTEIN. This is carried out mainly in the liver by means of an enzyme, deaminase. The fatty acid residue is either burnt up to yield energy, or is converted into glucose.... deamination

Decay, Dental

See TEETH, DISORDERS OF – Caries of the teeth.... decay, dental

Decibel

The unit of hearing. One decibel is the least intensity of sound at which a given note can be heard. The usual abbreviation for decibel is dB.... decibel

Decidua

The soft coat which lines the interior of the womb during pregnancy and which is cast o? at birth.... decidua

Decompensation

The failure of the heart to maintain full and adequate circulation.... decompensation

Death, Sudden

If deaths from accidents are excluded, this term means the unexpected death of an apparently healthy person. CARDIAC ARREST is the most common cause of sudden death. Older people (35 years or above) who suffer cardiac arrest commonly have coronary artery disease (see HEART, DISEASES OF) with restriction or stoppage of blood supply to part of the heart which causes INFARCTION (heart attack). Irregularity of the heartbeat (cardiac ARRHYTHMIA) is another cause. MYOCARDITIS, PNEUMONIA and STROKE can also result in sudden death, as can ASTHMA, anaphylactic shock (see ANAPHYLAXIS), ruptured aortic ANEURYSM and SUICIDE, the incidence of which is rising, especially among young people, and is over 4,000 a year in the UK.

Sudden death sometimes occurs in infants, usually in the ?rst year of life: this is called SUDDEN INFANT DEATH SYNDROME (SIDS) or, colloquially, cot death, the possible causes of which are an ongoing subject for research and debate.

When a person dies unexpectedly the event must be reported to a CORONER, who has the power to decide whether an AUTOPSY is necessary.... death, sudden

Decubitus

Decubitus refers to the positions taken up in bed by patients suffering from various conditions such as pneumonia, PERITONITIS, or severe exhaustion. Such patients are liable to develop bed sores, or decubitus ulcer (see ULCER).... decubitus

Decussation

Any point in the nervous system at which nerve ?bres cross from one side to the other: for example, the decussation of the pyramidal tracts in the medulla (see BRAIN), where the motor ?bres from one side of the brain cross to the other side of the spinal cord.... decussation

Defaecation

Opening the bowels. (See CONSTIPATION; DIARRHOEA.)... defaecation

Degenerative Disorders

An umbrella description for a wide variety of conditions in which there is increased deterioration of the structure or function (or both) of the body. Ageing causes a steady degeneration of many tissues and organs – for example, wrinkling of the skin, CATARACT and poor neuromuscular coordination. In degenerative disorders the changes occur earlier in life. The nervous system, muscles, arteries, joints and eyes are all susceptible. Specialised tissues are replaced by CONNECTIVE TISSUE. The commonest example in the nervous system is ALZHEIMER’S DISEASE, which causes dementia; while in HUNTINGTON’S CHOREA, a genetic disorder, dementia is accompanied by incoordination of movements.... degenerative disorders

Deglutition

Deglutition means the act of swallowing. (See CHOKING.)... deglutition

Delhi Boil

Delhi boil is a form of chronic body sore occurring in Eastern countries, caused by a protozoan parasite, Leishmania tropica. (See LEISHMANIASIS.)... delhi boil

Delinquency

Behaviour by a young person that would be judged a crime if carried out by an adult. Delinquency may also include non-criminal activities – for example, running away from home, missing school lessons, drug or alcohol abuse, and unruly behaviour in public places. Delinquency is now a serious social problem in the UK, especially in deprived areas, and it is increasingly accompanied by alcohol and drug abuse.... delinquency

Demi

(Greek) A petite woman; half Demie, Demee, Demy, Demey, Demye, Demia, Demiana, Demiane, Demianne, Demianna, Demiann, Demea, Demeah... demi

Denervation

Interruption of the nerve supply to an organ or other structure.... denervation

Denominator

1 The lower portion of a fraction used to calculate a rate or ratio. In a rate, the denominator is usually the population at risk. 2 For a performance measure, the sample of cases that will be observed (e.g. the number of patients discharged alive with a confirmed diagnosis of acute myocardial infarction, excluding patients with bleeding or other specified conditions). See “numerator”.... denominator

Dental Caries

Decay of teeth... dental caries

Dental Emergencies

See TEETH, DISORDERS OF.... dental emergencies

Dentist

See DENTAL SURGEON.... dentist

Deodorants

Substances which remove or lessen objectionable odours. Some, which have a powerful odour, simply cover other smells, but the most e?ective act by giving o? oxygen, so as to convert the objectionable substances into simple and harmless ones.

Varieties Volatile oils of plants, such as eucalyptus and turpentine, chlorine water and chlorinated lime, peroxide of hydrogen and charcoal have been used as deodorants. There are now many commercial products available.... deodorants

Depilatory

A chemical hair remover, such as barium sulphide, used in the form of a cream or paste for cosmetic reasons and to treat hirsutism.... depilatory

Depot Injection

An intramuscular injection of a drug that gives a slow, steady release of its active chemicals into the bloodstream. Release of the drug is slowed by the inclusion of substances such as oil or wax. The release of the active drug can be made to last for hours, days, or weeks.

A depot injection is useful for patients who may not take their medication correctly.

It also prevents the necessity of giving a series of injections over a short period.

Hormonal contraceptives (see contraception, hormonal methods of), corticosteroid drugs, and antipsychotic drugs may be given by depot injection.

Side effects may arise due to the uneven release of the drug into the bloodstream.... depot injection

Derealization

Feeling that the world has become unreal.

It usually occurs together with depersonalization and may be caused by fatigue, hallucinogenic drugs, or disordered brain function.... derealization

Dermis

The inner layer of the skin.... dermis

Desensitization

A technique, used in behaviour therapy for treating phobias, in which the patient is gradually exposed to the cause of the fear.... desensitization

Desmoid Tumour

A growth, usually in the abdominal wall.

The tumour is hard, with a well-defined edge.

The tumours occur most frequently in women who have had children.

They may also arise at the sites of old surgical incisions.

Surgical removal is the usual treatment.... desmoid tumour

Desmopressin

A synthetic form of ADH (antidiuretic hormone) that is used to treat diabetes insipidus and bed-wetting (see enuresis).... desmopressin

Desogestrel

A progestogen drug used with ethinylestradiol as an ingredient of some combined oral contraceptives.

Desogestrel is reported to have a slightly higher risk of venous thromboembolism than older drugs. Side effects of desogestrel include weight changes and fluid retention. There may also be nausea, vomiting, headache, depression, and breast tenderness.... desogestrel

Developmental Delay

A term used if a baby or young child has not achieved new abilities within the normal time range. Normally, new abilities and new patterns of behaviour appear at given ages, and existing patterns of behaviour change and sometimes disappear (see child development).

Delays vary in severity and may affect the development of hand–eye coordination, walking, listening, language, speech, or social interaction. Delay may first be noticed by parents or detected during a routine developmental check.

There are many causes of developmental delay. A child who is late in most aspects of development usually has a generalized problem. This may be due to severe visual or hearing impairment, limited intellectual abilities (see learning difficulties), or damage to the brain before, during, or after birth.

Specific areas of delay may occur in movement and walking. Often there is no serious cause. However, specific causes may include muscular dystrophy and spina bifida. Delay in developing manipulative skills is often due to lack of adequate stimulation.

A lack of response to sound may be due to deafness. Autism is a rare cause of unresponsiveness to the human voice although hearing is normal. A hearing problem may cause delayed speech. Twins are often late talkers. Any generalized difficulty with muscle control can affect speech production; this may occur in children with cerebral palsy. Damage to, or structural defects of, the speech muscles, larynx (voice box), or mouth may also cause speech difficulties, as may any disorder affecting the speech area of the brain (see aphasia; dysarthria; dysphonia; speech disorders). Delay in bladder and bowel control have many possible causes (see encopresis; enuresis; soiling).

A child who shows signs of developmental delay should undergo a full assessment by a paediatrician.... developmental delay

Dexamfetamine

A central nervous system stimulant (see amfetamine drugs; stimulant drugs) sometimes used to treat narcolepsy. It is also used in children with attention deficit hyperactivity disorder. Because of its stimulant properties, dexamfetamine has become a drug of abuse. With prolonged use, the stimulant effects lessen and a higher dose must be taken to produce the same effect.... dexamfetamine

Depressor

(1) A muscle that lowers or ?attens a part of the body.

(2) The name given to a nerve by whose stimulation motion, secretion, or some other function is restrained or prevented: for example, the depressor nerve of the heart slows the beating of this organ.... depressor

Dermabrasion

Dermabrasion, or ‘skin planing’, is a method of removing the super?cial layers of the skin, useful in the treatment of tattoos and acne scars.... dermabrasion

Dermatoglyphics

Dermatoglyphics is the study of the patterns made by the ridges and crevices of the hands and the soles of the feet.... dermatoglyphics

Dermatology

In essence, this is the study of the skin. As well as being an organ in its own right, the skin is a stage on which other organs as well as the emotions most visibly play out their roles. Changes in its blood vessels – and hence blood ?ow through the skin – may indicate a major immunological response to a range of potential factors (see SKIN, DISEASES OF).... dermatology

Dermatome

(1) Embryological tissue which has developed from the somites to become the dermis and subcutaneous tissue. The cutaneous area that is derived from each dermatome is supplied by a single dorsal spinal nerve root.

(2) A surgical instrument for removing very thin slices of skin for grafting.... dermatome

Dermatophyte

Mould fungi belonging to the genera Microsporum, Trichophyton or Epidermophyton. Cause tinea or ringworm.... dermatophyte

Designer Drugs

A group of chemical substances produced illegally whose properties and effects are similar to those of drugs of abuse. They may be derived from narcotic ANALGESICS, AMPHETAMINES or HALLUCINOGENS. Ecstasy is a widely used designer drug and has caused deaths among teenagers. Designer drugs are potentially dangerous, especially if taken with alcohol.... designer drugs

Desquamation

The scaling-o? of the super?cial layer of the epidermis (see SKIN).... desquamation

Detached Retina

Separation of the retina from the choroid in the EYE. It may be due to trauma or be secondary to tumour or in?ammation of the choroid, and causes blindness in the affected part of the retina. It can be treated surgically using PHOTOCOAGULATION.... detached retina

Deviance

Variation from normal. Often used to describe unusual sexual behaviour.... deviance

Devil's Bit

Scabiosa succisa. N.O. Compositae.

Synonym: Ofbit.

Habitat: Heaths and pastures.

Features ? Stem up to eighteen inches, slender, hairy, well-branched. Leaves opposite, oval-lanceolate, slightly serrate, nearly sessile ; root leaves stalked, ovoid, smooth at margins. Flowers dark purple, on long stalk, florets bunched together.

The common name is derived from the root. which appears to have been bitten off at the end, with which vandalism "the devil" is credited.

Part used ? Herb.

Action: Demulcent, diaphoretic.

Included in formulae for coughs and feverish conditions generally. A 1 ounce to 1 pint infusion may be taken warm in wineglassful doses frequently.... devil's bit

Dextran

The name given to a group of polysaccharides ?rst discovered in sugar-beet preparations which had become infected with certain bacteria. A homogenous preparation of dextran, with a consistent molecular weight and free from PROTEIN, is in appropriate clinical circumstances used as a substitute for plasma for TRANSFUSION purposes. Dextran is often used as an immediate transfusion measure to treat severe bleeding or certain types of shock until properly cross-matched blood is available. A blood sample for cross-matching must be taken before intravenous dextran is given.... dextran

Fatty Degeneration

As a result of ANAEMIA, interference with blood or nerve supply, or because of the action of various poisons, body cells may undergo abnormal changes accompanied by the appearance in their substance of fat droplets.... fatty degeneration

General Dental Council

A statutory body set up by the Dentists Act which maintains a register of dentists (see DENTAL SURGEON), promotes high standards of dental education, and oversees the professional conduct of dentists. Membership comprises elected and appointed dentists and appointed lay members. Like other councils responsible for registering health professionals, the General Dental Council now comes under the umbrella of the new Council for Regulatory Excellence, a statutory body. (See APPENDIX 7: STATUTORY ORGANISATIONS.)... general dental council

General Dental Services

See DENTAL SURGEON.... general dental services

High Dependency Unit

A hospital unit equipped and sta?ed to nurse patients who require a high level of technically supported care. Patients are usually moved to such units when they have made satisfactory progress in an INTENSIVE THERAPY UNIT (ITU) and do not require the one-to-one nursing necessary in ITUs. Patients who have undergone major surgery are often transferred from the recovery ward to a high dependency unit until they are well enough to be cared for in a standard ward.... high dependency unit

Manic Depression

Manic depression, or CYCLOTHYMIA, is a form of MENTAL ILLNESS characterised by alternate attacks of mania and depression.... manic depression

Neural Tube Defects

Congenital abnormalities resulting from the failure of the NEURAL TUBE to form normally. The resulting conditions include SPINA BIFIDA, MENINGOCELE and defects in the bones of the SKULL.... neural tube defects

Osteitis Deformans

See PAGET’S DISEASE OF BONE.... osteitis deformans

Subacute Combined Degeneration Of The Cord

A degenerative condition of the SPINAL CORD which most commonly occurs as a complication of PERNICIOUS ANAEMIA. The motor and sensory nerves in the cord are damaged, causing spasticity of the limbs and an unsteady gait. Treatment is with vitamin B12 (see APPENDIX 5: VITAMINS).... subacute combined degeneration of the cord

Defecation

Another term for a bowel movement to expel wastes from the body. Also applies to a colostomy where faeces are voided through an artificial opening. ... defecation

Delhi Belly

Treatment same as for irritable bowel or diarrhoea. ... delhi belly

Detergent

A herb of strong cleaning properties such as Soapwort for use on the skin. Balmony, Southernwood, Marigold, Chickweed, Goldenseal, Daisy. ... detergent

Alpha-antitrypsin Deficiency

A rare genetic disorder in which a person is missing the enzyme alpha1-antitrypsin, which protects the body from damage by other enzymes.

The disease mainly affects tissues in the lungs, resulting in emphysema, and the liver, causing cirrhosis.

The effects of alpha1-antitrypsin deficiency may not become apparent until after the age of 30.

There is no cure, but symptoms can be relieved by drug treatment.

In severe cases, a liver transplant may be a possibility.... alpha-antitrypsin deficiency

Brain Death

The irreversible cessation of all functions of the brain, including the brainstem. (See also death.)... brain death

Attention Deficit Hyperactivity Disorder

(ADHD) A behavioural disorder in which a child has a consistently high level of activity and/or difficulty in attending to tasks. Attention deficit hyperactivity, or hyperkinetic, disorder affects up to 1 in 20 children in the. The disorder, which is more common in boys, should not be confused with the normal boisterous conduct of a healthy child. Children with consistently show abnormal patterns of behaviour over a period of time. An affected child is likely to be restless, unable to sit still for more than a few moments, inattentive, and impulsive.

The causes of are not fully understood, but the disorder often runs in families, which suggests that genetic factors may be involved. is not, as popularly believed, a result of poor parenting or abuse.

Symptoms develop in early childhood, usually between the ages of 3 and 7, and may include inability to finish tasks; short attention span; inability to concentrate in class; difficulty in following instructions; a tendency to talk excessively, frequently interrupting other people; difficulty in waiting or taking turns; inability to play quietly alone; and physical impulsiveness. Children with may have difficulty in forming friendships. Self-esteem is often low because an affected child is frequently scolded and criticized.

Treatment includes behaviour modification techniques, both at home and at school. In some children, avoidance of certain foods or food additives seems to reduce symptoms. In severe cases, stimulant drugs, usually methylphenidate, may be prescribed. Paradoxically, the use of stimulants in reduces hyperactivity and improves concentration. In general, the condition improves by adolescence but may be followed by antisocial behaviour and drug abuse or substance abuse.... attention deficit hyperactivity disorder

Decerebrate

The state of being without a functioning cerebrum, the main controlling part of the brain. It occurs if the brainstem is severed, which effectively isolates the cerebrum.... decerebrate

Deciduous Teeth

See primary teeth.... deciduous teeth

Decompression Sickness

A hazard of divers and of others who work in or breathe compressed air or other gas mixtures. Decompression sickness is also called “the bends”, and it results from gas bubbles forming in the tissues and impeding the flow of blood. At depth, divers accumulate inert gas in their tissues from the high-pressure gas mixture that they breathe (see scubadiving medicine). Problems can usually be avoided by allowing the excess gas in their tissues to escape slowly into the lungs during controlled, slow ascent or release of pressure. If ascent is too rapid and pressure falls too quickly, gas can no longer be held within a tissue. Resulting bubbles may block blood vessels, causing symptoms such as skin itching and mottling and severe pain in and around the larger joints. Symptoms of nervous system impairment (such as leg weakness or visual disturbances) are particularly serious, as is a painful, tight feeling across the chest.

Divers with decompression sickness are immediately placed inside a recompression chamber. Pressure within the chamber is raised, causing the bubbles within the tissues to redissolve. Subsequently, the pressure in the chamber is slowly reduced, allowing the excess gas to escape safely via the lungs. If treated promptly, most divers with the “bends” make a full recovery. In serious, untreated cases, there may be long-term problems, such as paralysis.... decompression sickness

Decubitus Ulcer

See bedsores.... decubitus ulcer

Deep Vein Thrombosis

See thrombosis, deep vein.... deep vein thrombosis

Delusion

A fixed, irrational idea not shared by others and not responding to reasoned argument. The idea in a paranoid delusion involves persecution or jealousy. For instance, a person may falsely believe that he or she is being poisoned (see paranoia). Persistent delusions are a sign of serious mental illness, most notably schizophrenia and manic–depressive illness. (See also hallucination; illusion.)... delusion

Defibrillation

Administration of one or more brief electric shocks to the heart, usually via 2 metal plates, or paddles, placed on the chest over the heart. It is performed to return a heart’s rhythm to normal in some types of arrhythmia (irregular or rapid heartbeat), such as atrial fibrillation or ventricular fibrillation. Defibrillation can be carried out as an emergency procedure to treat ventricular fibrillation, which is a cause of cardiac arrest and most commonly occurs after a heart attack (see myocardial infarction).

It can also be used as a planned treatment, in which case it is performed under a brief general anaesthesia.

Breathing may be maintained artificially during the procedure.... defibrillation

Dentistry

The science or profession concerned with the teeth and their supporting structures. Most dentists work in general dental practice; others practise in a specialized branch of dentistry.

Dentists in general practice undertake all aspects of dental care. They may refer patients to a consultant in one of the specialized branches of dentistry, such as orthodontics, prosthetics, endodontics, and periodontics. Dental hygienists carry out

scaling (removal of calculi) and advise on oral hygiene methods.... dentistry

Depersonalization

A state of feeling unreal, in which there is a sense of detachment from self and surroundings.

Depersonalization is often accompanied by derealization.

It is rarely serious and usually comes on suddenly and may last for moments or for hours.

Depersonalization most often occurs in people with anxiety disorders.

Other causes include drugs and temporal lobe epilepsy.... depersonalization

Folie à Deux

A French term that is used to describe the unusual occurrence of 2 people sharing the same psychotic illness (see psychosis). Commonly, the 2 are closely related and share one or more paranoid delusions. If the sufferers

are separated, one of them almost always quickly loses the symptoms, which have been imposed by the dominant, and genuinely psychotic, partner.... folie à deux

High Density Lipoprotein

One of a group of proteins that transport lipids in the blood. High levels of high density lipoprotein can help protect against atherosclerosis. (See also fats and oils; low density lipoprotein.)... high density lipoprotein

Intrauterine Contraceptive Device

See IUD.... intrauterine contraceptive device

Low Density Lipoprotein

One of a group of proteins that are combined with lipids in the plasma. Low density lipoproteins (LDLs) are involved in the transport of

cholesterol in the bloodstream. An excess of LDLs (see hyperlipidaemias) is associated with atherosclerosis. (See also high density lipoprotein.)... low density lipoprotein

Macular Degeneration

A progressive, painless disorder affecting the macula. The result is a roughly circular area of blindness that increases in size until it is large enough to obscure 2 or 3 words at reading distance. Macular degeneration does not cause total blindness as vision is retained around the edges of the visual fields. This condition is a common disorder in elderly people.

Of the 2 types of macular degeneration that may occur, one type is usually remedied by laser treatment.

There is no treatment for the other form, although the affected person may benefit from aids such as magnifying instruments.... macular degeneration

Postnatal Depression

Depression in a woman after childbirth. The cause is probably a combination of sudden hormonal changes and psychological and environmental factors. The depression ranges from an extremely common and mild, shortlived episode (“baby blues”) to a rare, severe depressive psychosis.

Most mothers first get the “blues” 4–5 days after childbirth and may feel miserable, irritable, and tearful. The cause is hormonal changes, perhaps coupled with a sense of anticlimax or an overwhelming sense of responsibility for the baby. With reassurance and support, the depression usually passes in 2–3 days. In about 10–15 per cent of women, the depression lasts for weeks and causes a constant feeling of tiredness, difficulty in sleeping, loss of appetite, and restlessness. The condition usually clears up of its own accord or is treated with antidepressant drugs.

Depressive psychosis usually starts 2–3 weeks after childbirth, causing severe mental confusion, feelings of worthlessness, threats of suicide or harm to the baby, and sometimes delusions.

Hospital admission, ideally with the baby, and antidepressant drugs are often needed.... postnatal depression

Preventive Dentistry

An aspect of dentistry concerned with the prevention of tooth decay and gum disease.

It consists of the encouragement of good oral hygiene, fluoride treatment, and scaling.... preventive dentistry

Retinal Detachment

Separation of the retina from the outer layers at the back of the eye. Detachment may follow an eye injury but usually occurs spontaneously. It is usually preceded by a retinal tear, and is more common in highly myopic (shortsighted) people and in people who have had cataract surgery.

The detachment is painless. The first symptom is either bright flashes of light at the edge of the field of vision, accompanied by floaters, or a black “drape” obscuring vision.

Urgent treatment is required and usually involves surgical repair of the underlying tear. If the macula (site of central vision) has not been detached, the results can be excellent.... retinal detachment

Sudden Infant Death Syndrome

The sudden, unexpected death of an infant that cannot be explained.

Possible risk factors include: laying the baby face-down to sleep; overheating; parental smoking after the birth; prematurity and low birth weight; and poor socioeconomic background.

Preventive measures include: ensuring that the baby sleeps on its back at the foot of the cot; regulating the baby’s temperature (using the same amount of clothing and blankets that an adult would need); and stopping smoking.... sudden infant death syndrome

Derm

(derma-, dermo-, dermat(o)-) combining form denoting the skin.... derm

Dermal

adj. relating to or affecting the skin, especially the *dermis.... dermal

Aconitum Deinorrhizum

Stapf.

Family: Ranunculaceae.

Habitat: Alpine regions of Chat- tadhar and Bhalesh ranges of Bhadarwah district in Jammu and Kashmir.

Ayurvedic: Vatsanaabha (related sp.).

Folk: Bashahr-Mohra, Dudhiyaa Bish, Safed Bikh.

Action: Roots and leaves are used in rheumatism, rheumatic fever and acute headache.

The roots contain 0.9% total alkaloids, of which 0.51% is pseudoaconi- tine.... aconitum deinorrhizum

Acquired Immune Deficiency Syndrome (aids)

A severe manifestation of infection with the Human immunodeficiency virus (HIV).... acquired immune deficiency syndrome (aids)

Assistive Device

Equipment that enables an individual who requires assistance to perform the daily activities essential to maintain health and autonomy and to live as full a life as possible. Such equipment may include, for example, motorized scooters, walkers, walking sticks, grab rails and tilt-and-lift chairs.... assistive device

Attention Deficit Disorder (hyperactivity Syndrome)

A lifelong disorder characterised by overactive behaviour, short attention span and poor concentration. It is thought to be caused by a minor abnormality that affects the part of the brain that allows us to concentrate and focus on tasks. Some scientists have suggested that it may be caused by particular foods, particularly processed foods containing arti?cial additives, and recommend special diets. In some countries, attention de?cit disorder is diagnosed in up to a tenth of all children; this may re?ect di?erences in paediatric practice and diagnosis rather than a real variation in prevalence of the disorder. Behaviour therapy is the main treatment. Those children with very severe symptoms of restlessness, short attention span and disturbed behaviour may respond to additional treatment with methylphenidate (Ritalin®). This is an amphetamine-like drug that is thought to stimulate the part of the brain that is not working properly. Use of this drug has, however, been controversial.... attention deficit disorder (hyperactivity syndrome)

Average Incidence Density

The ratio of the number of new cases of the disease and the amount of population-time of follow-up (e.g. person-year) of the disease-free population.... average incidence density

B Nosed. The Test For Brain-stem Death Are:

Fixed dilated pupils of the eyes

Absent CORNEAL REFLEX

Absent VESTIBULO-OCULAR REFLEX

No cranial motor response to somatic (physical) stimulation

Absent gag and cough re?exes

No respiratory e?ort in response to APNOEA despite adequate concentrations of CARBON DIOXIDE in the arterial blood.... b nosed. the test for brain-stem death are:

Blackberry, Raspberry, And Dewberry

Rubus species

Description: These plants have prickly stems (canes) that grow upward, arching back toward the ground. They have alternate, usually compound leaves. Their fruits may be red, black, yellow, or orange.

Habitat and Distribution: These plants grow in open, sunny areas at the margin of woods, lakes, streams, and roads throughout temperate regions. There is also an arctic raspberry.

Edible Parts: The fruits and peeled young shoots are edible. Flavor varies greatly.

Other Uses: Use the leaves to make tea. To treat diarrhea, drink a tea made by brewing the dried root bark of the blackberry bush.... blackberry, raspberry, and dewberry

British Dental Association

See APPENDIX 8: PROFESSIONAL ORGANISATIONS.... british dental association

Capital Depreciation

The decline in value of capital assets (assets of a permanent or fixed nature, such as goods and plant) with use over time. The rate and amount of depreciation is calculated by a variety of different methods (e.g. straight line, sum of the digits, declining balance), which often give quite different results.... capital depreciation

Blumea Densiflora

DC.

Family: Compositae; Asteraceae.

Habitat: Sub-tropical Himalayas, Nepal, Sikkim, Assam and Khasia hills.

English: Ngai Camphor.

Ayurvedic: Kukundara (var.).

Action: Juice of fresh leaves— insecticidal, mosquito repellant. The plant yields an essential oil which yields camphor.

Aerial part contains sesquiterpene lactones, tagitinin A, tirolundin ethyl ether and iso-alantolactone derivatives.... blumea densiflora

Brain-stem Death

Brain damage, resulting in the irreversible loss of brain function, renders the individual incapable of life without the aid of a VENTILATOR. Criteria have been developed to recognise that ‘death’ has occurred and to allow ventilation to be stopped: in the UK, these criteria require the patient to be irreversibly unconscious and unable to regain the capacity to breathe spontaneously. (See also GLASGOW COMA SCALE and PERSISTENT VEGETATIVE STATE (PVS).)

All reversible pharmacological, metabolic, endocrine and physiological causes must be excluded, and there should be no doubt that irreversible brain damage has occurred. Two senior doctors carry out diagnostic tests to con?rm that brain-stem re?exes are absent. These tests must be repeated after a suitable interval before death can be declared. Imaging techniques are not required for death to be diag-... brain-stem death

Canscora Decussata

Schult.

Family: Gentianaceae.

Habitat: Throughout India, ascending to 1,500 m.

Ayurvedic: Daakuni (used as a substitute for Shankhapushpi in West Bengal)

Unani: Sankhaahuli.

Folk: Daankuni.

Action: Anticonvulsant, CNS depressant, anti-inflammatory, hepatoprotective.

The plant contains calcium 0.38; magnesium 0.16; potassium 1.66 and iron 0.23 g/100 g; copper 18.97, zinc 70.50; manganese 9.60, cobalt 3.15 and chromium 0.60 mcg/g.

Roots contain beta-amyrin, friede- lin, genianine and 16 xanthones including mangiferin. Mangiferin is protective activity against induced liver injury in albino rats. Xanthones also showed activity against Mycobacterium tuberculosis.

Dried crude powder of the whole plant exhibited anticonvulsant activity in albino rats.

Canscora diffusa (Vahl) R. Br. ex Roem. & Schultes (synonym C. lawii Wt.), found throughout India at 1,100 m, is used as a substitute for C. decussata.... canscora decussata

Cardiac Depressant

Slowing the action of the heart... cardiac depressant

Care-dependent

Persons with chronic illnesses and/or impairments which lead to long-lasting disabilities in functioning and reliance on care (personal care, domestic life, mobility, self direction).... care-dependent

Cause Of Death

For the purpose of national mortality statistics, every death is attributed to one underlying condition, based on information reported on the death certificate and using the international rules for selecting the underlying cause of death from the reported conditions. See “International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10)”.... cause of death

Conjugate Deviation

The term for describing the persistent and involuntary turning of both eyes in any one direction, and is a sign of a lesion in the brain.... conjugate deviation

Dead Fingers

See RAYNAUD’S DISEASE.... dead fingers

Dead Space

Gas exchange only occurs in the terminal parts of the pulmonary airways (see LUNGS). That portion of each breath that is taken into the lungs but does not take part in gas exchange is known as dead space. Anatomical dead space describes air in the airways up to the terminal BRONCHIOLES. Physiological dead space also includes gas in alveoli (air sacs) which are unable to take part in gas exchange because of structural abnormalities or disease.... dead space

Deadly Nightshade

The popular name of Atropa belladonna, from which ATROPINE is procured. Its poisonous black berries are sometimes eaten by children.... deadly nightshade

Cascara Sagrada Tea - A Powerful Laxative

Cascara Sagrada Tea has been known since ancient times as a great stimulant and laxative agent. In fact, the ones to discover its medical benefits were the American. The first proofs of this fact date from the 17th century, when American practitioners used Cascara Sagrada bark to treat many bacterial ailments of the digestive system. Cascara is a small shrub that grows mainly in the North America, in states like Idaho, California or Montana. Cascara never grows taller than 50 centimeters and has pale yellow greenish leaves and deep green leaves. Also known as rhamnus purshiana, Cascara has purple fruits or black berries that hide usually three hard seeds. Cascara Sagrada is harvested in the fall and can only be used dried (one year apart from the harvesting time) in order to release its curative benefits. Many people in Northern America specialize in Cascara Sagrada harvesting and herb processing (the plant needs to be properly dried and according to a list of specifications). Cascara Sagrada Tea Properties Cascara Sagrada Tea is known for its strong, stimulant and laxative properties. The main substances of this tea are very efficient in cases of nervous system failures and intestinal tract ailments. Cascara Sagrada Tea has a very bitter and therefore unpleasant taste. That’s why most people prefer to take it as capsules or extracts. Cascara Sagrada Tea Benefits Aside from its use as a constipation treatment, Cascara Sagrada Tea can also cure a variety of diseases involving the digestive tract, such as intestinal parasites or bacterial infections. However, make sure that you take this tea responsibly and don’t forget that this is a medical treatment wich only should be taking while you’re sick. Don’t try to replace your morning coffee with Cascara Sagrada Tea or you’ll face a series of complications! How to make Cascara Sagrada Tea Infusion When preparing Cascara Sagrada Tea, you have to make sure that you only use ingredients from a trusted provider. Nowadays, there are many illegal substances on the market sold as tea. Also, the herb you bought may be exactly what the label says it is, but not properly dried, in which case you’ll suffer from unwanted complications as well. Once you have the right ingredients, use a teaspoon of dried herbs for every cup of tea you want to make, add boiling water and wait 20 minutes for the wonderful benefits to be released. Strain the decoction and drink it hot or cold. You may also add honey or even sugar if the taste feels a bit unpleasant. Cascara Sagrada Tea Side Effects When taken in small amounts, Cascara Sagrada Tea is a safe treatment. However, high dosages may lead to various problems, such as urine discoloration, blood in stools, pain and vomiting. Make sure the dosage you’re using is the appropriate one or ask your doctor before making any moves: it’s better to be safe than sorry! Cascara Sagrada Contraindications Cascara Sagrada Tea is not recommended for pregnant or breastfeeding women, patients suffering from appendicitis or ulcerative colitis. Also, if you are on blood thinners or anticoagulants, avoid taking a treatment based on Cascara Sagrada Tea. To gather more information, talk to an herbalist or to your doctor! If he gives you the green light and you happen to be in a teashop, add Cascara Sagrada Tea to your shopping cart and enjoy its wonderful benefits responsibly!... cascara sagrada tea - a powerful laxative

Cause-of-death Ranking

Cause-of-death ranking for adults is based on the List of 72 Selected Causes of Death, HIV Infection, and Alzheimer’s Disease. The List was adapted from one of the special lists for mortality tabulations recommended for use with the International Classification of Diseases, ninth revision. Two group titles – “Major cardiovascular diseases” and “Symptoms, signs, and ill-defined conditions” – are not ranked based on the list of 72 selected causes. In addition, category titles that begin with the words “other” and “all other” are not ranked. The remaining category titles are ranked according to number of deaths to determine the leading causes of death. When one of the titles that represents a subtotal is ranked (for example, unintentional injuries), its component parts are not ranked (in this case, motor vehicle crashes and all other unintentional injuries).... cause-of-death ranking

Cedrus Deodara

(Roxb.) Loud.

Synonym: C. libani Barrel. var. deodara Hook. f.

Family: Pinaceae.

Habitat: North-western Himalayas from Kashmir to Garhwal, from 1,000 to 3,500 m.

English: Himalayan Cedar, Deodar.

Ayurvedic: Devadaaru, Suradru- ma, Suradaaru, Devakaashtha, Devadruma, Saptapatrika, Daaru, Bhadradaaru, Amarataru, Ama- radaaru, Daaruka, Devaahvaa, Surataru, Surabhuruha.

Unani: Deodaar.

Siddha/Tamil: Thevathaaram.

Action: Bark—decoction is used internally as astringent, antidiarrhoeal and febrifuge. Essential oil—antiseptic (used in skin diseases).

The Ayurvedic Pharmacopoeia of India indicated the use of the heart- wood in puerperal diseases.

The wood contains sesquiterpeno- ids; exhibits sapasmolytic activity. Alcoholic extract of the wood showed marked anti-inflammatory activity in mice; alcoholic extract showed antibacterial activity.

The wood possesses diaphoretic, diuretic and carminative properties, and is used in fevers and in pulmonary and urinary disorders.

Himalayan Cedarwood Oil contains two major sesquiterpenoids—alpha- and beta-himchalenes. Presence ofbu- tyric and caproic acids is also reported. The oil shows in vitro antibacterial and antifungal activity. It increases vascular permeability. Needles, on steam distillation, yield a volatile oil, rich in borneol and its esters. An alcoholic extract of the needles shows significant antibacterial activity against diptheria bacteria. The juice shows antiviral activity against tobacco mosaic virus and potato virus.

The bark contains 8-C methyltaxi- foline, dihydroquercetin, 8-C methyl- quercetin, quercetin, sitosterol, and tannins 8.25%, non-tannins 6.95% (varies with the age of the tree). An alcoholic extract of the bark shows significant activity against diptheria bacteria; aqueous extract of the dried bark showed anti-inflammatory activ ity against acute and chronic inflammations. Aqueous extract of the bark is found effective in reducing sugar content of diabetic patient's urine and blood to normal levels.

Dosage: Heartwood—3-6 g powder. (API Vol. IV.)... cedrus deodara

Ceratophyllum Demersum

Linn.

Family: Ceratophyllaceae.

Habitat: All over India from temperate to tropics, in ponds and lakes.

English: Coontail, Hornwort.

Ayurvedic: Shaivaala (also equated with Vallisneria spiralis Linn., Hydrocharitaceae), Jalnili, Jalaja.

Unani: Tuhlub, Pashm Vazg.

Siddha/Tamil: Velampasi.

Folk: Sevaar.

Action: Purgative, antibilious, antibacterial.

The herb is rich in protein, calcium and magnesium; contains ferre- doxin and plastocyanin. EtOH (50%) extract—antimicrobial.

Dosage: Whole plant—10- 20 ml juice; 50-100 ml decoction. (CCRAS.)... ceratophyllum demersum

Chest, Deformities Of

The healthy chest is gently rounded all over, its contour being more rounded in women by the breast tissue. In cross-section it is oval-shaped with a longer dimension from side to side than from back to front.

Barrel chest is found in long-standing ASTHMA or chronic BRONCHITIS and EMPHYSEMA, when the lungs are chronically enlarged. The anterio-posterior dimension of the chest is increased and the ribs are near horizontal. In this position they can produce little further expansion of the chest, and breathing often relies on accessory muscles in the neck lifting up the whole thoracic cage on inspiration.

Pigeon chest is one in which the cross-section of the chest becomes triangular with the sternum forming a sort of keel in front. It may be related to breathing problems in early life.

Rickety chest is uncommon now and is caused by RICKETS in early life. There is a hollow down each side caused by the pull of muscles on the softer ribs in childhood. The line of knobs produced on each side where the ribs join their costal cartilages is known as the rickety rosary.

Pectus excavatum, or funnel chest, is quite a common abnormality where the central tendon of the diaphragm seems to be too short so that the lower part of the sternum is displaced inwards and the lower ribs are prominent. When severe, it may displace the heart further to the left side.

Local abnormalities in the shape of the chest occur when there is a deformity in the spine such as scoliosis which alters the angles of the ribs. The chest wall may be locally ?attened when the underlying lung is reduced in size locally over a prolonged period. (See SPINE AND SPINAL CORD, DISEASES AND INJURIES OF.) This may be seen over a scarred area of lung such as that observed in pulmonary TUBERCULOSIS.... chest, deformities of

Computerised Decision-support Systems

Also known as ‘expert systems’, these are computer software systems intended to help doctors make clinical decisions. Primary care medicine is especially noted for its uncertainty by virtue of being most patients’ ?rst point of contact with health care, confronting the clinician with many ‘undi?erentiated’ health problems. So far, these systems have not been as e?ective as expected because of a failure to ana-lyse the needs of primary care. Simple procedures to prompt the delivery of treatment to patients with chronic conditions have improved care quality, but work needs to be done on their cost-e?ectiveness. The aim of more complex computerised support systems will be to forecast likely future events and the possible e?ectiveness of proposed interventions, based on available information about the patient and an understanding of the risks and e?cacy of interventions by doctors and other experts.

One example, called ISABEL, can be accessed by paediatricians to check on their diagnosis and management of many childhood disorders.... computerised decision-support systems

Debonnaire

(French) One who is suave; nonchalant

Debonair, Debonaire, Debonnayre, Debonayre, Debonaere, Debonnaere... debonnaire

Deborah

(Hebrew) Resembling a bee; in the Bible, a prophetess Debbera, Debbey, Debbi, Debbie, Debbra, Debby, Debee, Debera, Deberah, Debi, Debor, Debora, Debra, Debrah, Debralee, Debreanna, Debriana, Debs, Devora, Devorah, Deb, Debb, Debbee, Dobra, Devoria, Debira, Debiria, Devorit, Devra, Devri... deborah

December

(American) Winter’s child; born in December

Decimber, Decymber, Decembar, Decimbar, Decymbar... december

Dechtere

(Celtic) In mythology, a virgin mother

Dechtire, Dechtyre... dechtere

Deciduous

A plant that drops its leaves in the fall or, in some cases, during drought.... deciduous

Decima

(Latin) The tenth-born child Decimah, Decema, Decyma, Decia, Decemah, Decymah... decima

Decision Analysis

An approach to decision-making that involves modelling the sequences or pathways of multiple possible strategies (e.g. of diagnosis and treatment for a particular clinical problem) to determine which is optimal. It is based upon available estimates (drawn from the literature or from experts) of the probabilities that certain events and outcomes will occur and the values of the outcomes that would result from each strategy.... decision analysis

Child Development Teams (cdts)

Screening and surveillance uncover problems which then need careful attention. Most NHS districts have a CDT to carry out this task – working from child development centres – usually separate from hospitals. Various therapists, as well as consultant paediatricians in community child health, contribute to the work of the team. They include physiotherapists, occupational therapists, speech therapists, psychologists, health visitors and, in some centres, pre-school teachers or educational advisers and social workers. Their aims are to diagnose the child’s problems, identify his or her therapy needs and make recommendations to the local health and educational authorities on how these should be met. A member of the team will usually be appointed as the family’s ‘key worker’, who liaises with other members of the team and coordinates the child’s management. Regular review meetings are held, generally with parents sharing in the decisions made. Mostly children seen by CDTs are under ?ve years old, the school health service and educational authorities assuming responsibility thereafter.

Special needs The Children Act 1989, Education Acts 1981, 1986 and 1993, and the Chronically Sick and Disabled Persons Legislation 1979 impose various statutory duties to identify and provide assistance for children with special needs. They include the chronically ill as well as those with impaired development or disabilities such as CEREBRAL PALSY, or hearing, vision or intellectual impairment. Many CDTs keep a register of such children so that services can be e?ciently planned and evaluated. Parents of disabled children often feel isolated and neglected by society in general; they are frequently frustrated by the lack of resources available to help them cope with the sheer hard work involved. The CDT, through its key workers, does its best to absorb anger and divert frustration into constructive actions.

There are other groups of children who come to the attention of child health services. Community paediatricians act as advisers to adoption and fostering agencies, vital since many children needing alternative homes have special medical or educational needs or have behavioural or psychiatric problems. Many see a role in acting as advocates, not just for those with impairments but also for socially disadvantaged children, including those ‘looked after’ in children’s homes and those of travellers, asylum seekers, refugees and the homeless.

Child protection Regrettably, some children come to the attention of child health specialists because they have been beaten, neglected, emotionally or nutritionally starved or sexually assaulted by their parents or carers. Responsibility for the investigation of these children is that of local-authority social-services departments. However, child health professionals have a vital role in diagnosis, obtaining forensic evidence, advising courts, supervising the medical aspects of follow-up and teaching doctors, therapists and other professionals in training. (See CHILD ABUSE.)

School health services Once children have reached school age, the emphasis changes. The prime need becomes identifying those with problems that may interfere with learning – including those with special needs as de?ned above, but also those with behavioural problems. Teachers and parents are advised on how to manage these problems, while health promotion and health education are directed at children. Special problems, especially as children reach secondary school (aged 11–18) include accidents, substance abuse, psychosexual adjustment, antisocial behaviour, eating disorders and physical conditions which loom large in the minds of adolescents in particular, such as ACNE, short stature and delayed puberty.

There is no longer, in the UK, a universal school health service as many of its functions have been taken over by general practitioners and hospital and community paediatricians. However, most areas still have school nurses, some have school doctors, while others do not employ speci?c individuals for these tasks but share out aspects of the work between GPs, health visitors, community nurses and consultant paediatricians in child health.

Complementing their work is the community dental service whose role is to monitor the whole child population’s dental health, provide preventive programmes for all, and dental treatment for those who have di?culty using general dental services – for example, children with complex disability. All children in state-funded schools are dentally screened at ages ?ve and 15.

Successes and failures Since the inception of the NHS, hospital services for children have had enormous success: neonatal and infant mortality rates have fallen by two-thirds; deaths from PNEUMONIA have fallen from 600 per million children to a handful; and deaths from MENINGITIS have fallen to one-?fth of the previous level. Much of this has been due to the revolution in the management of pregnancy and labour, the invention of neonatal resuscitation and neonatal intensive care, and the provision of powerful antibiotics.

At the same time, some children acquire HIV infection and AIDS from their affected mothers (see AIDS/HIV); the prevalence of atopic (see ATOPY) diseases (ASTHMA, eczema – see DERMATITIS, HAY FEVER) is rising; more children attend hospital clinics with chronic CONSTIPATION; and little can be done for most viral diseases.

Community child health services can also boast of successes. The routine immunisation programme has wiped out SMALLPOX, DIPHTHERIA and POLIOMYELITIS and almost wiped out haemophilus and meningococcal C meningitis, measles and congenital RUBELLA syndrome. WHOOPING COUGH outbreaks continue but the death and chronic disability rates have been greatly reduced. Despite these huge health gains, continuing public scepticism about the safety of immunisation means that there can be no relaxation in the educational and health-promotion programme.

Services for severely and multiply disabled children have improved beyond all recognition with the closure of long-stay institutions, many of which were distinctly child-unfriendly. Nonetheless, scarce resources mean that families still carry heavy burdens. The incidence of SUDDEN INFANT DEATH SYNDROME (SIDS) has more than halved as a result of an educational programme based on ?rm scienti?c evidence that the risk can be reduced by putting babies to sleep on their backs, avoidance of parental smoking, not overheating, breast feeding and seeking medical attention early for illness.

Children have fewer accidents and better teeth but new problems have arisen: in the 1990s children throughout the developed world became fatter. A UK survey in 2004 found that one in ?ve children are overweight and one in 20 obese. Lack of exercise, the easy availability of food at all times and in all places, together with the rise of ‘snacking’, are likely to provoke signi?cant health problems as these children grow into adult life. Adolescents are at greater risk than ever of ill-health through substance abuse and unplanned pregnancy. Child health services are facing new challenges in the 21st century.... child development teams (cdts)

Death Certificate

A certi?cate required by law to be signed by a medical practitioner stating the main and any contributary causes of a person’s death.... death certificate

Dead, Disposal Of The

Practically, only three methods have been used from the earliest times: burial, embalming and cremation. Burial is perhaps the earliest and most primitive method. It was customary to bury the bodies of the dead in consecrated ground around churches up until the earlier half of the 19th century, when the utterly insanitary state of churchyards led to legislation for their better control. Burials in Britain take place usually upon production of a certi?cate from a registrar of deaths, to whom notice of the death, accompanied by a medical certi?cate, must be given without delay by the nearest relatives.

When a death occurs at sea, the captain of the ship has authority to permit burial at sea. If, however, there are any doubts about cause of death, the captain may decide to preserve the body and refer the case to the relevant authorities at the next port of call.

Embalming is still used occasionally. The process consists in removing the internal organs through small openings, and ?lling the body cavities with various aromatics of antiseptic power – the skin being swathed in bandages or otherwise protected from the action of the air. Bodies are also preserved by injecting the blood vessels with strong antiseptics such as perchloride of mercury.

Cremation or incineration of the body is now the commonest method of disposal of the dead in the UK, where land for burials is increasingly scarce; today it accounts for around 75 per cent of disposals. The process of incineration takes 1–2 hours. Something in the range of 2·3 to 3·2 kg (5–7 lbs) of ash result from the combustion of the body, and there is no admixture with that from the fuel.

Cremation of a body means that it is almost impossible to conduct any meaningful forensic tests should any subsequent doubts be raised about the cause of death. So, before cremation can take place, two doctors have to sign the cremation forms. The ?rst is usually the doctor who was caring for the patient at the time of death – an important exception being cases of sudden death, when the coroner holds an inquest into the cause and authorises the necessary approval for cremation. In 1999, fewer than 3,500 deaths were certi?ed following a post-mortem, out of a total number of deaths in England and Wales of more than 556,000. When the coroner is not involved, the second doctor must have been quali?ed for ?ve years; he or she must be unconnected with the patient’s care and not linked professionally with the ?rst doctor. (For example, if the ?rst doctor is a general practitioner – as in the majority of cases they are – the second doctor should be from another practice.) Before signing the cremation certi?cate the second doctor must conduct an external examination of the dead person and discuss the circumstances of death with the ?rst doctor.

The two cremation forms are then inspected by crematorium medical referees who must be satis?ed that the cause of death has de?nitely been ascertained. The present death and cremation certi?cation system has been in place in the UK for many years – the legislative framework for cremation was set up in 1902 – and death certi?cation procedures were last reviewed by the government-appointed Brodrick committee in 1971, with no fundamental changes proposed. The case of Harold Shipman, a general practitioner convicted of murdering more than 15 patients, and suspected of murdering many more, has revealed serious weaknesses in the certi?cation system. A comprehensive review of the present procedures was in place at the time of writing (2004).... dead, disposal of the

Death, Causes Of

The ?nal cause of death is usually the failure of the vital centres in the brain that control the beating of the heart and the act of breathing. The important practical question, however, is what disease, injury or other agent has led to this failure. Sometimes the cause may be obvious – for example, pneumonia, coronary thrombosis, or brain damage in a road accident. Often, however, the cause can be uncertain, in which case a POST-MORTEM EXAMINATION is necessary.

The two most common causes of death in the UK are diseases of the circulatory system (including strokes and heart disease) and cancer.

Overall annual death rates among women in the UK at the start of the 21st century were

7.98 per 1,000 population, and among men,

5.58 per 1,000. Comparable ?gures at the start of the 20th century were 16.3 for women and

18.4 for men. The death rates in 1900 among infants up to the age of four were 47.9 per 1,000 females and 57 per 1,000 males. By 2003 these numbers had fallen to 5.0 and 5.8 respectively. All these ?gures give a crude indication of how the health of Britain’s population has improved in the past century.

Death rates and ?gures on the causes of deaths are essential statistics in the study of EPIDEMIOLOGY which, along with information on the incidence of illnesses and injuries, provides a temporal and geographical map of changing health patterns in communities. Such information is valuable in planning preventive health measures (see PUBLIC HEALTH) and in identifying the natural history of diseases – knowledge that often contributes to the development of preventive measures and treatments for those diseases.... death, causes of

Decision Support System

See “decision analysis”.... decision support system

Decompression Illness (dci)

An illness suffered by divers when diving too deep, or too long and characterised bynitrogen bubbles forming in the tissues of the body. This may cause a multitude of symptoms although joint pains are those most-commonly encountered. Confusion may be caused in divers that have suffered an Irukandji sting as the symptoms have some similarities. See also, cerebral gas embolism.... decompression illness (dci)

Decongestants

Drugs which relieve nasal congestion and stu?ness. They may be given orally or by nasal spray, and most are SYMPATHOMIMETIC DRUGS which cause vasoconstriction in the nasal mucosa. Too frequent use reduces their e?ectiveness, and there is a danger of ‘rebound’ worsening if they are used for more than 10–14 days. A safer option for babies is simple sodium chloride drops. Warm moist air is also a traditional e?ective decongestant.... decongestants

Deductible

The amount of loss or expense that must be incurred by an insured individual before an insurer will assume any liability for all or part of the remaining cost of covered services. Deductibles may be either fixed monetary amounts or the value of specified services (such as two days of hospital care or one medical practitioner visit). Deductibles are usually tied to some reference period over which they must be incurred.... deductible

Deep Vein Thrombosis (dvt)

See THROMBOSIS; VEINS, DISEASES OF.... deep vein thrombosis (dvt)

Deerstongue

Lust, Psychic Powers... deerstongue

Deet

Diethyltoluamide. An effective insect repellant used on the skin.... deet

Defective Blood Formation

This is the main cause of anaemia in infections. The micro-organism responsible for the infection has a deleterious e?ect upon the blood-forming organs, just as it does upon other parts of the body.

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

Death, Signs Of

There are some minor signs, such as: relaxation of the facial muscles (which produces the staring eye and gaping mouth of the ‘Hippocratic countenance’), as well as a loss of the curves of the back, which becomes ?at by contact with the bed or table; discoloration of the skin, which takes on a wax-yellow hue and loses its pink transparency at the ?nger-webs; absence of blistering and redness if the skin is burned (Christison’s sign); and failure of a ligature tied round the ?nger to produce, after its removal, the usual change of a white ring, which, after a few seconds, becomes redder than the surrounding skin in a living person.

The only certain sign of death, however, is that the heart has stopped beating. To ensure that this is permanent, it is necessary to listen over the heart with a stethoscope, or directly with the ear, for at least ?ve minutes. Permanent stoppage of breathing should also be con?rmed by observing that a mirror held before the mouth shows no haze, or that a feather placed on the upper lip does not ?utter.

In the vast majority of cases there is no dif?culty in ensuring that death has occurred. The introduction of organ transplantation, however, and of more e?ective mechanical means of resuscitation, such as ventilators, whereby an individual’s heart can be kept beating almost inde?nitely, has raised diffculties in a minority of cases. To solve the problem in these cases the concept of ‘brain death’ has been introduced. In this context it has to be borne in mind that there is no legal de?nition of death. Death has traditionally been diagnosed by the irreversible cessation of respiration and heartbeat. In the Code of Practice drawn up in 1983 by a Working Party of the Health Departments of Great Britain and Northern Ireland, however, it is stated that ‘death can also be diagnosed by the irreversible cessation of brain-stem function’. This is described as ‘brain death’. The brain stem consists of the mid-brain, pons and medulla oblongata which contain the centres controlling the vital processes of the body such as consciousness, breathing and the beating of the heart (see BRAIN). This new concept of death, which has been widely accepted in medical and legal circles throughout the world, means that it is now legitimate to equate brain death with death; that the essential component of brain death is death of the brain stem; and that a dead brain stem can be reliably diagnosed at the bedside. (See GLASGOW COMA SCALE.)

Four points are important in determining the time that has elapsed since death. HYPOSTASIS, or congestion, begins to appear as livid spots on the back, often mistaken for bruises, three hours or more after death. This is due to the blood running into the vessels in the lowest parts. Loss of heat begins at once after death, and the body has become as cold as the surrounding air after 12 hours – although this is delayed by hot weather, death from ASPHYXIA, and some other causes. Rigidity, or rigor mortis, begins in six hours, takes another six to become fully established, remains for 12 hours and passes o? during the succeeding 12 hours. It comes on quickly when extreme exertion has been indulged in immediately before death; conversely it is slow in onset and slight in death from wasting diseases, and slight or absent in children. It begins in the small muscles of the eyelid and jaw and then spreads over the body. PUTREFACTION is variable in time of onset, but usually begins in 2–3 days, as a greenish tint over the abdomen.... death, signs of

Decalepis Hamiltonii

Wight & Arn.

Family: Asclepiadaceae.

Habitat: Deccan Peninsula; common in the forest areas of Western Ghats.

Unani: Desi Ushbaa.

Siddha/Tamil: Mahali kizhangu.

Action: Root—appetizer, blood purifier, bacteriostatic. Used as a substitute for Shveta Saarivaa (Hemidesmus indicus). Sold as Saarivaa in Kerala, Tamil Nadu and Karnataka. The root powder is given to diabetics.

The root contains quercetin, kaempferol, coumarin and rutin. It has a sweet sarsaparilla-like taste; contains 92% fleshy matter and 8% woody core.

The root can be stored for longer periods and remains unaffected by microorganisms and insects, apparently due to the presence of the volatile principle which possesses bacteriostat- ic and toxic properties.

The root, on steam distillation, gave 4-O-methyl-resorcylaldehyde in a concentration of 0.8%. (The growth of E. coli was arrested by the aldehyde in 0.041% concentration; fish died within 4 min in 0.02% solution.) The sterols consists mainly of stagma and brassica sterols. Alpha-amyrin and lupeol, both free and as esters are also present in the root.

The plant contains lupeol, beta- amyrin 2-hydroxy, 4-methoxy benzaldehyde, and ferulic acid.... decalepis hamiltonii

Defibrillation

If a heart is ?brillating (see VENTRICULAR FIBRILLATION), the application of a large electric shock via paddles applied to the chest wall causes simultaneous electrical depolarisation of all the cardiac cells, and may allow the heart’s natural pacemaker to re-establish sinus rhythm. One paddle is placed below the right clavicle and the other over the cardiac apex. Care must be taken that no one is in contact with the patient or the bed when the shock is given, to avoid electrocution.... defibrillation

Defibrillator

Apparatus that delivers a controlled electric shock to restore normal heart rhythm in patients whose hearts have developed VENTRICULAR FIBRILLATION or have stopped beating. The shock is delivered by electrodes placed on the chest wall or directly to the heart after the chest has been surgically opened. De?brillators are a standard item of equipment for paramedical sta? in ambulances, and aeroplanes of some airlines now routinely carry the apparatus. (See also HEART, DISEASES OF.)... defibrillator

Deficiency Disease

Any disease resulting from the absence from the diet of any substance essential to good health: for example, one of the vitamins.... deficiency disease

Definitive Or Final Host

An animal wherein the adult stage of the parasite resides.... definitive or final host

Deformities

Malformations or distortions of part of the body. They may be present at birth, or they may be the result of injuries, or disease, or simply produced by bad posture, like the curved spine occasionally found in children. (See BURNS AND

SCALDS; CHEST, DEFORMITIES OF; TALIPES; FLAT-FOOT; JOINTS, DISEASES OF; KNOCK-KNEE; LEPROSY; PALATE, MALFORMATIONS OF; PARALYSIS; RICKETS; SCAR; SKULL; SPINE AND SPINAL CORD, DISEASES AND INJURIES OF.)... deformities

Deianira

(Greek) In mythology, the wife of Heracles

Deianeira, Deianiera, Deianyra, Deianeera, Deianeara... deianira

Deidamea

(Greek) In mythology, the mother of Achilles’ only son Deidameia, Deidamia, Deidameah, Deidameiah, Deidamiah... deidamea

Deidre

(Gaelic) A brokenhearted or raging woman

Deadra, Dede, Dedra, Deedra, Deedre, Deidra, Deirdre, Deidrie, Deirdra, Derdre, Didi, Diedra, Diedre, Diedrey, Dierdre, Deardriu, Dierdra... deidre

Deiene

(Spanish) Born on a religious holiday

Deiena, Deine, Deina, Deikun... deiene

Deifilia

(Latin) Daughter of God Deifiliah, Deiflea, Deifileah... deifilia

Deinstitutionalization

A policy which calls for the provision of supportive care and treatment for medically and socially dependent individuals in the community rather than in an institutional setting.... deinstitutionalization

Deiondre

(American) From the lush valley Deiondra, Deiondria, Deiondrea, Deiondriya... deiondre

Deja

(French) One of remembrance Daejah, Daejia, Daija, Daijah, Daijaah, Daijea, Daijha, Daijhah, Dayja, Dajah, Deija, Deijah, Dejah, Dejanae, Dejanee, Dejanique, Dejanira, Deyanira... deja

Deka

(African) A pleasing woman Decca, Decka, Dekah, Deccah, Deckah... deka

Dekla

(Latvian) In mythology, a trinity goddess

Decla, Deckla, Deklah, Decklah, Declah... dekla

Delana

(German) One who is a noble protector

Dalaina, Dalainah, Dalaine, Dalanah, Dalanna, Dalannah, Dalayna, Dalaynah, Delanah, Dalinah, Dalinda, Dalinna, Delania, Delanna, Delannah, Delanya, Deleina, Deleinah, Delena, Delenya, Deleyna, Deleynah, Dellaina... delana

Delancey

(French) Named for a street in New York City

Delancie, Delancy, Delanci, Delancea, Delanceah, Delancee... delancey

Delaney

(Irish / French) The dark challenger / from the elder-tree grove Delaina, Delaine, Delainey, Delainy, Delane, Delanie, Delany, Delayna, Delayne, Delani, Delainie, Delanea, Delainea, Delaeny, Delaeni, Delaenie, Delaenee, Delaenea... delaney

Delaware

(English) From the state of Delaware

Delawair, Delaweir, Delwayr, Delawayre, Delawaire, Delawaer, Delawaere... delaware

Delayed Discharge

A prolonged hospital stay due to non-medical conditions, such as a lack of, or delayed start of, community care arrangements.... delayed discharge

Delbine

(Greek) Resembling a flower Delbina, Delbin, Delbyne, Delbyn, Delbyna, Delbeene, Delbeena, Delbeina, Delbeine, Delbiena, Delbiene, Delbeana, Delbeane... delbine

Delia

(Latin) Woman from Delos; form of Cordelia, meaning “a good-hearted woman; a woman of honesty” Delya, Deliya, Delea, Deelia, Deelea, Deelya, Deliah, Deleah, Deliyah, Delyah... delia

Delicia

(Latin) One who gives pleasure Delice, Delisa, Delisha, Delissa, Deliza, Delyssa, Delicea, Deliciae, Delight, Delite, Delit, Deliz, Deliciah, Deliceah... delicia

Delilah

(Hebrew) A seductive woman; in the Bible, the woman who discovered the source of Samson’s strength Dalila, Delila, Delyla, Dalyla, Dalilah, Delylah, Dalylah... delilah

Delima Scandens

Burkill.

Tetracera scandens

Family: Dilleniaceae.

Habitat: Forests of Bengal, Assam and the Andamans.

Ayurvedic: Paaniya Valli.

Action: A decoction of the plant is given in dysentery and coughs. Leaves—used for the treatment of boils. Root—astringent, used as external application for burns.... delima scandens

Delivered Meals

See “meals on wheels”.... delivered meals

Della

(German) Born of the nobility Delle, Dell, Dellene, Delline, Dellah, Dela, Delah

... della

Delling

(Scandinavian) One who is sparkling and witty Dellyng, Delleng... delling

Delma

(German) A noble protector Delmi, Delmy, Delmira, Delmah... delma

Delmara

(English) Feminine form of Delmar; woman of the sea Delmaria, Delmare, Delma, Delmia, Delmarra, Dellmara, Dellmarra... delmara

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

Delonix Regia

Rafin.

Synonym: Poinciana regai Bojer ex Hook.

Family: Caesalpiniaceae.

Habitat: Native to Madagascar; grown in gardens and avenues for ornamental purposes and for shade.

English: Flamboyant Flame tree, Gold Mohur.

Ayurvedic: Gulmohar (var.) White Gold Mohur is equated with Delonix elata Gamble, synonym Poinciana elata Linn.

Siddha: Vadanarayana, Pe- rungondrai, Mayarum. White Gulmohar. (Tamil)

Action: Bark—antiperiodic, febrifuge. Plant—antirheumatic, spasmogenic. Flowers (aqueous and alcoholic extract)—active against roundworm.

White Gulmohar trunk-bark yielded asparagine and aspartic acid. Flowers gave iso-quercetin.

Delonix regia bark gave leucocyani- din; bark and leaves contain tannin, lu- peol and beta-sitosterol, and free OH- proline as major amino acid. Flower anthers are a rich source of zeaxanthin.... delonix regia

Delphina

(Greek) Woman from Delphi; resembling a dolphin

Delphine, Delphinea, Delphinia, Delfa, Delfin, Delfine, Delfyne, Delpha, Delfina, Delphia... delphina

Delphinium Brunonianum

Royle.

Family: Ranunculaceae.

Habitat: Native to China; distributed in West Himalayas.

English: Musk Larkspur.

Ayurvedic: Sprikkaa. (Melilotus officinalis, known as Aspurka or Naakhunaa, is also equated with Sprikkaa.) Used as a substitute for Tagara (valerian).

Action: Himalayan species act as cardiac and respiratory depressant. All the species of Delphinium are poisonous; find use in indigenous medicine for destroying maggots in wounds, particularly in sheep. The flowers are considered acrid, bitter and astringent; seeds are cathartic, anthelmintic, emetic and insecticidal.... delphinium brunonianum

Delphinium Cashmirianum

Royle.

Family: Ranunculaceae.

Habitat: Kashmir (Himalayan species).

English: Kashmir Larkspur.

Ayurvedic: Used as a substitute for Tagara (valerian).

Action: See D. brunonianum.... delphinium cashmirianum

Delphinium Consolida

Linn.

Synonym: D. ajacis Linn.

Family: Ranunculaceae.

Habitat: Cultivated in gardens.

English: Forking Larkspur, Larkspur, Lark's Claw, Knight's Spur.

Action: Parasiticide. A tincture is used to destroy lice in hair.

The toxicity of the seeds is due to diterpene alkaloids (delcosine, delso- line, consolidine). Delsonine and an- thranoyllycoctonine are amorphous alkaloids.

The alkaloids lead to bradycardia, lowering of blood pressure, and cardiac arrest. Also, they have a central paralyzing and curare-like effect on the respiratory system. (German Commission E.)

Entire plant, including roots and seeds, is used topically. Not to be used on abraded skin.

Seeds contain 1.01-1.06% alkaloids and 28.7% of a fixed oil. A digly- coside pigment, delphonin and kaem- pferol have been isolated from the flowers.... delphinium consolida

Delphinium Denudatum

Wall.

Synonym: D. pauciflorum Royle.

Family: Ranunculaceae.

Habitat: The temperate Himalayas from Kashmir to Kumaon at altitudes of 2,400-3,600 m.

English: Larkspur. Ayurvedic: Nirvishaa, Nirvishi. (Kyllinga triceps Rottb. is used as a substitute for Nirvishaa.)

Unani: Jadwaar Khataai, Maatiryaaq.

Folk: Root—astringent, vulnerary, deobstruent, alterative. Used for painful piles, muscular atrophy, gout and as a nervine tonic. Also used as an adulterant for aconite.

Oral administration of the aqueous extract of the plant to rats with CCl4- induced hepatotoxicity revealed hepa- toprotective property of the plant.

The roots contain campesterol, stig- masterol, sitosterol, cholesterol, delta- avenasterol and alkaloids including de- nudatine, denudatidine, condelphine, talatizidine and iso-talatizidine.... delphinium denudatum

Delta

(Greek) From the mouth of the river; the fourth letter of the Greek alphabet Dellta, Deltah, Delltah... delta

Delta Waves

Abnormal electrical waves observed in the electroencephalogram (see ELECTROENCEPHALOGRAPHY (EEG)). The frequency of the normal alpha waves is 10 per second; that of the delta waves is 7 or fewer per second. They occur in the region of tumours of the brain, and in the brains of patients with EPILEPSY.... delta waves

Delu

(African) The sole daughter Delue, Deloo... delu

Delusions

An irrational and usually unshakeable belief (idée ?xe) peculiar to some individuals. They fail to respond to reasonable argument and the delusion is often paranoid in character with a belief that a person or persons is/are persecuting them. The existence of a delusion, of such a nature as to in?uence conduct seriously, is one of the most important signs in reaching a decision to arrange for the compulsory admission of the patient to hospital for observation. (See MENTAL ILLNESS.)... delusions

Delphinium Staphisagria

Linn.

Habitat: Native to Mediterranean region.

English: Stavesacre.

Unani: Muvizaj.

Action: Parasiticide. Used for destroying lice. Contains poisonous alkaloids. Seeds are violently emetic and cathartic; used as an external application in obstinate skin diseases and eruptions under medical supervision.

Seeds contain diterpene alkaloids; delphidine, delphinine, delphirine, del- phisine and neoline.

Stavesacre has a similar effect to aco- nitine. Extract from the seeds is used in homoeopathic dilutions.... delphinium staphisagria

Delphinium Vestitium

Wall. ex Royle.

Synonym: Delphinium elatum auct. non Linn.

D. speciosum Janka ex Nym.

Family: Ranunculaceae.

Habitat: The temperate Himalaya from Kashmir to Nepal to 2,7004,700 m.

English: Candle Larkspur, Bee Larkspur.

Ayurvedic: Nirvisha.

Action: Whole plant—cardiac and respiratory depressant, emetic, diuretic, anthelmintic. Seed— insecticidal. Used in skin eruptions. Powdered flowers, mixed with mustard oil, are used for destroying lica.

The plant contains beta-sitosterol and alkaloid delpheline; aerial parts contain an alkaloid, elatine.

Seeds are very poisonous; contain several aconitine-like alkaloids. Del- phinidine, isolated from seeds, causes drastic gastro-enteric irritation.... delphinium vestitium

Delphinium Zalil

Aitch. & Hemsl.

D. semibarbatum Blenert

Family: Ranunculaceae.

Habitat: Persia and Afghanistan.

English: Zalil Larkspur.

Ayurvedic: Sprikkaa. (Melilotus officinalis, known as Aspurka or Naakhunaa, is also equated with Sprikkaa.)

Unani: Zarir, Zalil, Asbarg, Gul-Zalil (flower).

Action: Diuretic, anodyne, anti- inflammatory, detergent. Used in jaundice, dropsy and diseases of the spleen. Ash—used externally on wounds and skin diseases.

The seeds contain norditerpenoid alkaloid, zaliline, besides anhweidel- phinine, browniine, desacetylnudi- cauline, lycoctonine, methyllycaconi- tine and nudicauline. The medicinal properties of the plant are attributed to desacetylnudicauline, methyllycaconi- tine and nudicauline.... delphinium zalil

Delyth

(Welsh) A pretty young woman Delythe, Delith, Delithe... delyth

Demand (for Health Services)

Willingness and/or ability to seek, use and, in some settings, pay for services. Sometimes further subdivided into expressed demand (equated with use) and potential demand or need.... demand (for health services)

Demelza

(English) From the hill’s fortress Demelzah, Demelzia, Demelziah, Demelzea, Demelzeah... demelza

Demeter

(Greek) In mythology, the goddess of the harvest

Demetra, Demitra, Demitras, Dimetria, Demetre, Demetria, Dimitra, Dimitre, Dimitria, Dimiter, Detria, Deetra, Deitra... demeter

Demos

(Greek) Of the common people... demos

Denali

(Indian) A superior woman Denalie, Denaly, Denally, Denalli, Denaley, Denalee, Denallee, Denallie, Denalley, Denalea, Denallea... denali

Dendara

(Egyptian) From the town on the river

Dendera, Dendaria, Denderia, Dendarra... dendara

Dendrobium Ovatum

(Willd.) Kranzl.

Habitat: The Western Ghats.

Ayurvedic: Jivanti (substitute.)

Folk: Nagli (Maharashtra)

Action: Juice of fresh plant—stomachic, carminative, antispasmodic, laxative, liver tonic. (excites the bile). A related species, Dendrobium crumenatum Sw., occurs in Andaman Islands. Pounded leaves are used in Malaya for poulticing boils and pimples. Traces of alkaloids have been reported to be present in the pseudobulbs and leaves.

D. macraei Lindl. and D. normale Face. are also known as Jivanti.... dendrobium ovatum

Dendrophthoe Falcata

(Linn. f.) Etting.

Family: Loranthaceae.

Habitat: Throughout India.

Ayurvedic: Bandaaka, Vrkshaadani, Vrkshruuhaa.

Siddha: Pulluri, Plavithil (Tamil).

Folk: Baandaa.

Action: Bark—astringent and narcotic; used in menstrual disorders, consumption, asthma, also for treating wounds.

The plant contains several flavo- noids. Being parasitic, different flavo- noids have been recorded in plants growing on different host plants. Quer- citrin has been found to be the major common constituent. The plant also contains gallic, ellagic and chebulinic acids.

Aqueous and alcoholic extracts of the plant were tested in rats for their diuretic and anti-lithiatic activities. Alcoholic extract was found to be more effective than aqueous extract.

Dosage: Leaf, flower—10-20 ml juice. (CCRAS.)

Essential oil from leaves—antibacterial, antifungal.

Dosage: Bark—50-100 ml decoction; leaf—10-20 ml juice. (CCRAS.)... dendrophthoe falcata

Dengue Fever

(Syn. “Breakbone fever”) A flavivirus, dengue virus types 1-4, transmitted by infected specific Aedes spp mosquitoes. Sudden abrupt onset of high fever, headache, retrobulbar pain and lumbosacral pain. Fever lasts 6-7 days and may be ‘saddleback’. Initial symptoms followed by generalised myalgia, bone pain, anorexia, nausea, vomiting and weakness. A transient mottled rash may appear on 1st/2nd day and a second rash appears with resolution of fever - at first on trunk, spreading outward. WCC and platelet count depressed. Mild haemorrhagic phenomena in a few.... dengue fever

Dengue Haemorrhagic Fever

Usually a second infection with a different serotype of the dengue virus (see dengue fever). A primary infection at a young age is common finding. Age of patient with DHF is often less than 5 years, but young adults may be affected. Severe illness with abnormal vascular permeability, hypovolaemia and abnormal clotting mechanisms. Bleeding into skin or internally. Dengue shock syndrome may also be a complication.... dengue haemorrhagic fever

Denim

(American) Made of a strong cloth Denym, Denem, Denam... denim

Denise

(French) Feminine form of Denis; follower of Dionysus Deneigh, Denese, Dennet, Dennette, Deney, Deni, Denice, Deniece, Denisa, Denissa, Denisse, Denize, Denni, Dennie, Denisse, Dennise, Denny, Denyce, Denys, Denyse, Dinnie, Dinni, Dinny, Denisha... denise

Dental Hygienist

A person quali?ed to carry out the scaling (removal of calculus [deposits]) from the teeth and to advise patients on how to keep their teeth and gums healthy. Hygienists usually work in a quali?ed dentist’s surgery.... dental hygienist

Dental Surgeon

A dental surgeon, or dentist, is an individual trained to diagnose and treat disorders of the teeth and gums, as well as to advise on preventive measures to ensure that these areas remain healthy. Dentists qualify after a four-year course at dental school and then register with the GENERAL DENTAL COUNCIL, which is responsible for maintaining educational and professional standards. Around 25,000 dentists practise in the NHS and private sector.

Over the past four decades the ?nancial outlay on NHS dental services has been around 5 per cent of total NHS funding. This contrasts with 10 per cent during the service’s early years, when the NHS was coping with decades of ‘dental neglect’. The population’s dental health has, however, been steadily improving: in 1968 more than one-third of people had no natural teeth; by the late 1990s the proportion had fallen to 13 per cent.

Dentistry is divided into several groupings.

General dental practitioners Concerned with primary dental care, the prevention, diagnosis and treatment of diseases of the gums and teeth – for example, caries (see TEETH, DISORDERS OF). They also deal with diffculties in biting and the effects of trauma, and are aware that oral disorders may re?ect disease elsewhere in the body. They will refer to the hospital dental services, patients who require treatment that cannot be satisfactorily carried out in a primary-care setting.

Most routine dental prevention and treatment is carried out in general dental practitioners’ surgeries, where the dentists also supervise the work of hygienists and dental auxiliaries. Appliances, such as dentures, crowns, bridges and orthodontic appliances are constructed by dental technicians working in dental laboratories.

There are around 18,800 dentists providing general dental services in the UK. These practitioners are free to accept or reject any potential patient and to practise where they wish. Those dentists treating patients under an NHS contract (a mixture of capitation fees and items of service payments) can also treat patients privately (for an appropriate fee). Some dentists opt for full-time private practice, and their numbers are increasing in the wake of changes in 1990 in the contracts of NHS general dental practitioners.

Community dental practitioner Part of the public-health team and largely concerned with monitoring dental health and treating the young and the handicapped.

In the hospitals and dental schools are those who are involved in only one of the specialities.

Around 2,800 dentists work in NHS hospitals and 1,900 in the NHS’s community services. In some parts of the UK, people wanting NHS treatment are having diffculties ?nding dentists willing to provide such care.

Restorative dentist Concerned with the repair of teeth damaged by trauma and caries, and the replacement of missing teeth.

Orthodontist Correction of jaws and teeth which are misaligned or irregular. This is done with appliances which may be removable or ?xed to the teeth which are then moved with springs or elastics.... dental surgeon

Dentalgia

Toothache... dentalgia

Denver

(English) From the green valley... denver

Deobstruent

Relieving or removing obstruction... deobstruent

Deoch

(Celtic) In mythology, a princess of Munster... deoch

Deolinda

(Portuguese) God is beautiful Deolynda, Deolenda... deolinda

Deora

(American) From a small town in Colorado... deora

Dependency

Reliance on others to provide physical, mental and/or social support.... dependency

Dependency Ratio

An indicator used in population studies to measure the portion of the population which is economically dependent on active age groups. It is calculated as the sum of the 0-14 year-olds and the over 60 or 65 year-olds, depending on the working age limit considered, divided by the number of people aged between 15 and 59 or 64, respectively.... dependency ratio

Dependent Variable

In a statistical analysis, the outcome variable(s) or the variable(s) whose values are a function of, or dependent on the effect of other variable(s) (called independent variables) in the relationship under study.... dependent variable

Depigmentation

Also called hypo-pigmentation, this congenital or acquired disorder is one in which the skin loses its pigmentation because of reduced MELANIN production. It can be classi?ed into three groups: VITILIGO, ALBINISM and post-in?ammatory hypopigmentation.... depigmentation

Depilation

The process of destroying hair – substances and processes used for this purpose being known as depilatories. The purpose may be e?ected in three ways: by removing the hairs at the level of the skin surface; by pulling the hairs out (epilation); and by destroying the roots and so preventing the growth of new hairs.

Shaving is the most e?ective way of removing super?uous hairs. Rubbing morning and night with a smooth pumice-stone is said to be helpful. Electrolysis and diathermy are also used.... depilation

Dermatome, Surgical

A surgical instrument for cutting varying thicknesses of skin for use in skin grafting.... dermatome, surgical

Dermatophyte Infections

A group of common fungal infections affecting the skin, h air, and nails, also known as tinea and, popularly, as ringworm.... dermatophyte infections

Dermoid Tumour

See dermoid cyst.... dermoid tumour

Desensitization, Allergy

See hyposensitization.... desensitization, allergy

Detergent Poisoning

The toxic effects that occur as a result of swallowing the cleaning agents in shampoos, laundry powders, and cleaning liquids.... detergent poisoning

Development

The process of growth and change by which an individual matures physically, mentally, emotionally, and socially. Development takes place in major phases: during the first 2 months of pregnancy (see embryo); to a lesser extent, during the rest of pregnancy

(see fetus); during the first 5 years of life (see child development); and during puberty and adolescence.... development

Deviated Nasal Septum

See nasal septum.... deviated nasal septum

Deviation, Sexual

A form of sexual behaviour, most common in men, in which intercourse between adults is not the final aim. Forms of sexual deviation include exhibitionism, fetishism, paedophilia, and transvestism.... deviation, sexual

Deprivation Score

A measure of an individual’s or group’s lack of normal social amenities such as proper housing, diet and warmth. It was devised in the 1980s to help assess the medical services needed by a socially deprived population.... deprivation score

Derica

(American) Feminine form of Derek; a gifted ruler

Dereka, Dericka, Derrica, Derika, Derecka, Derecca, Deryca, Deryka, Derycca, Derycka... derica

Dericia

(American) An athletic and active woman

Dericiah, Derisea, Dericea, Derisia, Derycia, Derysia, Dericeah, Dericiyah, Dericiya... dericia

Derinda

(English) Ruler of the people Darinda, Derynda, Darynda, Derenda, Darenda... derinda

Derine

(German) Feminine form of Derek; a gifted ruler

Deryne, Derina, Deryna, Deriena, Deriene, Dereina, Dereine, Dereena, Dereene, Dereana, Dereane... derine

Dermatofibroma

Also known as histiocytoma. A ?rm, painless nodule in the skin, typically on a leg, due to excessive formation of COLLAGEN. A common disorder, it is often a slow response to an insect bite and persists inde?nitely.... dermatofibroma

Dermatologist

A medically quali?ed specialist who diagnoses and treats disorders of the skin (see SKIN, DISEASES OF).... dermatologist

Dermatomes

As spinal chord nerves branch out into the body, some segments fan out across the skin; these are the nerves that monitor the surface and are the source of senses of touch, pain, hot, cold and distension. All this information is funneled back in and up to the brain, which learned early on to correlate WHAT information comes from WHERE. Think of the brain as the CPU, with the spinal chord nerves uploading raw binary data; the brain has to make a running program out of this. It must form a three-dimensional hologram or homunculus from the linear input, and retranslate it outwards as binary data. The surface of the forearm, as an example, has sensory input gathered from several different and very separate spinal chord nerves. The brain will origami-fold these separate data streams into FOREARM. If you were to inject novacaine into the base of the left first sacral nerve (LS1), you would find that a whole section of skin became numb. So well defined a section that you could outline in charcoal the demarcation between sensation and numbness. This section would be a long oval of of numbness around the left buttock, under to the groin, perhaps part of the thigh...and the left heel. That spinal nerve is solely responsible for carrying sensation from that zone of skin...that dermatome; your brain mixes all the dermatomes together to get a working hologram of your total skin surface. That particular nerve also brings and sends information about the uterus, abdominal wall and pelvic floor. If you are a woman suffering pelvic heaviness and suppressed menses, a hot footbath might be enough S1 (heel dermatome) stimulation to cross-talk over to the referred S1 pelvic functions...and heat up the stuck uterus. Much of acupuncture, Jinshinjitsu, and zone and reflex therapy (not to mention Rolfing) uses various aspects of this dermatome crossover phenomena (by whatever name) and zone counterirritation was widely used in American standard medicine up until...penicillin. It was still being described in clinical manuals as late as 1956, although with the mention that it was only used infrequently and a “mechanism not understood” disclaimer.... dermatomes

Dermatopathy

Any skin disorder... dermatopathy

Dermatophytes

Fungi which can infect skin, hair and nails. About 30 species in three genera are PATHOGENIC to humans (see RINGWORM).... dermatophytes

Dermatophytosis

A superficial infection of the skin caused by a fungus... dermatophytosis

Derora

(Hebrew) As free as a bird Derorah, Derorra, Derorit, Drora, Drorah, Drorit, Drorlya, Derorice... derora

Derry

(Irish) From the oak grove Derrey, Derri, Derrie, Derree, Derrea, Derreah... derry

Derval

(Irish) One’s true desire; a poet’s daughter

Dervala, Dervilia, Dervalia, Dervla, Dearbhail... derval

Dervorgilla

(Irish) A servant girl Dervorgila, Derforgal, Derforgala

... dervorgilla

Deryn

(Welsh) A birdlike woman Derran, Deren, Derhyn, Deron, Derrin, Derrine, Derron, Derrynne, Derynne... deryn

Derris Uliginosa

Benth. Derris indica (Lamk.) Bennet.

Synonym: Pongamia pinnata Pierre.

Family: Fabaceae.

Habitat: Native to the Western Ghats. Found all over India on the banks of rivers and streams.

English: Indian Beech. Pongamia oil tree.

Ayurvedic: Naktmaal, Guchpush- pak, Ghritpuur, Udkirya, Karanja.

Siddha/Tamil: Pungu.

Action: Used for skin diseases— eczema, scabies, leprosy, and for ulcers, tumours, piles, enlargement of spleen, vaginal and urinary discharges. Juice of root—used for closing fistulous sores and cleaning foul ulcers. Flowers— used in diabetes. Powder of seeds— used for whooping and irritating coughs of children. Seed oil—used in cutaneous affections, herpes and scabies.

The tree is rich in flavonoids and related compounds. These include simple flavones, furanoflavonoids, chro- menoflavones, chromenochalcones, coumarones, flavone glucosides, sterols, triterpenes and a modified pheny- lalanine dipeptide.

Synonym: D. trifoliate Lour.

Family: Fabaceae.

Habitat: Costal forests of India and the Andamans.

Folk: Paan-lataa (Bengal), Kitani (Maharashtra).

Action: Stimulant, antispasmodic, counter-irritant. Bark—alterative in rheumatism. An oil prepared from the plant is used externally as an embrocation.

The roots contain dehydrorotenone, lupeol and a ketone. Bark contains 9.3% tannic acid. Stems contain tan- nic acid, hexoic, arachidic and stearic acids, ceryl alcohol, isomerides of cholesterol, potassium nitrate, gums and resins.... derris uliginosa

Descriptive Study

A study concerned with and designed only to describe the existing distribution of variables, without regard to causal or other hypotheses.... descriptive study

Descurainia Sophia

(Linn.) Webb ex Prantl.

Synonym: Sisymbrium sophia L.

Family: Brassicaceae.

Habitat: Temperate Himalaya from Kashmir to Kumaon at 2,200-4,100, also in eastern Himalaya.

English: Flix Weed, Flax Weed.

Action: Leaf and flower—astringent, antiscorbutic. Seed—expectorant, anti-inflammatory, febrifuge, antidysenteric. Aerial parts— antiviral, hypoglycaemic.

The plants has been used externally for ulcers, seeds are used as substitute or adulterant of the seeds of Sisymbrium iro Linn. (The source of Khaakasi, Khubb, Tukhm-e-Shahuh, Khuubkalaan of Unani medicine, known as Hedge Mustard or London Rocket.)... descurainia sophia

Desdemona

(Greek) An ill-fated woman Dezdemona, Desmona, Dezmona... desdemona

Desensitisation

In psychiatry, a method for treating phobias used in BEHAVIOUR THERAPY. The affected individual is slowly acclimatised to the cause of his or her fear. (See also ALLERGY.)... desensitisation

Desiccating

Depriving of moisture... desiccating

Desiree

(French) One who is desired Desaree, Desirae, Desarae, Desire, Desyre, Dezirae, Deziree, Desirat, Desideria, Desirata, Des, Desi, Dezi, Dezie, Dezy, Dezey, Dezee, Dezea, Desirai, Dezirai... desiree

Desma

(Greek) Of the binding oath Desme, Dezma, Dezme, Desmiah, Desmia, Desmea, Desmeah... desma

Despina

(Greek) The mistress; in mythology, the daughter of Demeter and Poseidon Despoina, Despinna, Despyna, Despena, Despona, Despeina, Despiena, Despeena, Despeana... despina

Despojo

Energetic cleansing; literally, “dispossession”; often done ritually, using the recitation of prayers, burning of incense and bundles of herbs which are swept or shaken over the body or in ones’ living space to dispel negative or unwanted energy. This can also be accomplished through using a medicinal bath (baño) and/or washing ones living area with an herbal preparation.... despojo

Dessa

(Greek) Feminine form of Odysseus; one who wanders; an angry woman Dessah... dessa

Desta

(German) Hardworking woman Destah... desta

Destiny

(English) Recognizing one’s certain fortune; fate

Destanee, Destinee, Destiney, Destini, Destinie, Destine, Destina, Destyni, Destany, Destinea, Destanea, Destynea... destiny

Determinant

Any factor, whether event, characteristic or other definable entity, that brings about change in a health condition or other defined characteristic.... determinant

Desmodium

Desmodium gangeticum

Fabaceae

San: Anshumati, Salaparni;

Hin,

Ben: Salpani;

Mal: Orila;

Tam:Pulladi;

Tel: Gitanaram

Kan: Murelehonne; Mar: Darh;

Guj: Salwan; Ori: Salaparni Pun: Shalpurhi

Importance: Desmodium is a small shrub which is the chief of the ten ingredients in the Dasamula kwatha of Hindu medicine. Roots are useful in vitiated conditions of vata, anorexia, dyspepsia, haemorrhoids, dysentery, strangury, fever, gout, inflammations, cough, asthma, bronchitis, cardiopathy and debility. The unani preparation “Arq dashmul” contains these roots. It is considered a curative for leucorrhoea and for pains due to cold (Warrier et al, 1995).

Distribution: The plant is widely distributed in the tropics and subtropics. It grows wild in the forests of India up to 1500m. It is also cultivated in the plains and in the lower Himalayas.

Botany: Desmodium gangeticum (Linn.) DC. syn. Hedysarum gangeticum Linn., Desmodium gangeticum var. maculatum (Linn.) Baker., belongs to the family Fabaceae (Papilionaceae). It is an erect diffusely branched undershrub, 90-120cm in height with a short woody stem and numerous prostrate branches provided with soft grey hairs. Leaves are unifoliate, ovate- lanceolate, membranceous and mottled with grey patches. Flowers are white, purple or lilac in elongate lax, terminal or axillary racemes. Fruits are moniliform, 6-8 jointed, glabrescent pods, joints of pods separately pubescent with hooked hairs, joint separating when ripe into indehiscent one seeded segments. Seeds are compressed and reniform.

Agrotechnology: Desmodium can grow in a variety of climate and soils. However, it prefers tropical and subtropical climatic conditions. Although it can grow on all types of soils, waterlogged and highly alkaline soils are not suitable. Light sandy loam is preferred for commercial cultivation.

It is propagated through seeds. Seeds can be planted directly in the field or seedlings raised on the nursery beds and transplanted. Transplanting always gives better results in commercial cultivation, as it gives assured crop stand. Planting is done at a spacing of 40x20cm on flat beds or ridges. Organic manures are applied at the time of land preparation and thoroughly mixed with the soil. A little quantity of phosphatic and nitrogenous fertilizers are also applied for better crop growth. The inter-row spaces between plants, both in the field and nursery should be kept free from weeds by frequent weeding and hoeing as the plant suffers from weed competition, especially during early stages of growth. Manual hand weeding is usually done. Irrigation of seedlings just after planting is good for crop establishment. Although it can be cultivated as a rainfed crop under humid tropical conditions, irrigation every month is beneficial during summer. The root is the economic part and harvesting can be commenced after 8-9 months. About 500- 700kg roots can be harvested from a hectare of land per year.

Properties and activity: The root contains gangetin, gangetinin, desmodin, N,N-dimethyl tryptamine, hypaphorine, hordenine, candicine, N-methyl tyramine and -phenyl ethyl amine. The total alkaloid fraction showed hypotensive activity. The root is bitter, antiinflammatory, analgesic, aphrodisiac, constipating, diuretic, cardiotonic, expectorant, astringent, antidiarrhoeal, carminative, antiemetic, febrifuge and anti-catarrhal (Thakur et al, 1989).... desmodium

Desmodium Gangeticum

DC.

Synonym: Hedysarum gangeticum Linn.

Family: Papilionaceae; Fabaceae.

Habitat: Ascending to 1,500 m on the Himalaya; common on lower hills and plains throughout India.

Ayurvedic: Shaaliparni, Shaalaparni, Sthiraa, Somyaa, Guhaa, Triparni, Vidaarigandha, Anshumati. Also used as Prshniparni. (Urariapicta Desv., Prshniparni, is used as a substitute for Shaalaparni.)

Siddha/Tamil: Pulladi, Sirupulladi Moovilai (root).

Folk: Sarivan.

Action: Root—antipyretic, diuretic, astringent (used in irritable bowel syndrome, diarrhoea and dysentery), anticatarrhal (used in post-natal care, chronic fever, cough, biliousness, vomiting), diuretic, anthelmintic, laxative and nervine tonic. Desmodium spp.: Roots—carminative, mildly purgative, stomachic, emmenagogue, diuretic. Leaves—galactagogue; a poultice of leaves is used for lumbago. Bark—used in diarrhoea and haemorrhages.

Roots afforded pterocarpanoids— gangetin, gangetinin, desmodin and several alkaloids. The aerial portion gave indole-3-alkylamines and their derivatives.

Gangetin showed significant anti- inflammatory activity in 50 and 100 mg/kg p.o. in rats.

Dosage: Root—5-10 g powder; 1020 g for decoction. (API Vol. III.)... desmodium gangeticum

Detoxication

Also called detoxi?cation, this is a process whereby toxic agents are removed from the body and toxic effects neutralised. (See POISONS and TOXINS.)... detoxication

Detta

(Latin) Form of Benedetta, meaning “one who is blessed” Dette, Dete, Deta, Dett... detta

Deva

(Hindi) A divine being Devi, Daeva... deva

Devamatar

(Indian) Mother of the gods... devamatar

Devana

(Hindi) One who is in love Devanah, Devanna, Devannah... devana

Devany

(Irish) A dark-haired beauty Devaney, Devanie, Devinee, Devony, Devenny, Devani, Devanee, Devanea, Devaneah... devany

Devera

(Latin) In mythology, goddess of brooms Deverah... devera

Deverell

(Welsh) Woman from the riverbank

Deverelle, Deverele, Deverel, Deverella, Deverela... deverell

Deverra

(Latin) In mythology, goddess of midwives Deverrah... deverra

Devika

(Indian) The little goddess Devicka, Devica, Devyka, Devycka, Devyca... devika

Desmodium Triflorum

(Linn.) DC.

Synonym: Hedysarum triflorum Linn.

Family: Fabaceae.

Habitat: Throughout India, in the plains ascending to 1,200 m in Kumaon and 1,800 m in Kashmir.

Ayurvedic: Tripaadi, Hamsapaadi (Kerala).

Siddha/Tamil: Seruppadi.

Folk: Jangali Methi, Ran-methi.

Action: Fresh leaves—used internally as galactagogue and for diarrhoea; applied externally to wounds and abscesses. Root— diuretic. Also used for cough, asthma.

The leaf contains alkaloids (0.010.15%), major being beta-phenylethyl- amine; also contains tyramine and hy- paphorine. Hypaphorine is present in roots as well. Root contains 0.010.02% alkaloids.... desmodium triflorum

Desmostachya Bipinnata

Stapf.

Synonym: Eragrostis cynosuroides Beauv.

Family: Gramineae; Poaceae.

Habitat: Throughout the plains of India in dry and hot areas and in sandy deserts.

English: Sacrificial Grass (smaller var.)

Ayurvedic: Kusha, Suuchyagra, Yagyabhuushana, Kshurapatra.

Siddha/Tamil: Tharubai.

Action: Root—cooling, diuretic, galactagogue, astringent. Used for urinary calculi, and other diseases of the bladder. Clums—used in menorrhagia, dysentery, diarrhoea and in skin diseases. The Ayurvedic Pharmacopoeia of India recommended the use of the rootstock in dysuria, vaginal discharges and erysipelas.

Dosage: Rootstock—50-100 g for decoction. (API Vol. III.)... desmostachya bipinnata

Detergents

Substances which clean the skin surface. This means that, strictly speaking, any soap, or soap-like substance used in washing, is a detergent. At the present day, however, the term is largely used for the synthetic detergents which are now used on such a large scale. These are prepared by the cracking and oxidation of high-petroleum waxes with sulphuric acid. The commoner ones in commercial preparations are aryl alkyl sulphate or sulphonate and secondary alkyl sulphate.

In view of their widespread use, such detergents appear to cause relatively little trouble with the skin, but more trouble has been reported with the so-called ‘biological’ detergents – named because they contain an ENZYME which destroys protein. As a result they are claimed to remove proteins (stains such as blood, chocolate, milk or gravy) which are relatively di?cult for ordinary detergents to remove. Unfortunately these ‘biological’ detergents may cause dermatitis. In addition, they have been reported to cause asthma in those using them, and even more so in workers manufacturing them.... detergents

Developmental Disability

A severe, chronic disability which is attributable to a mental or physical impairment or combination of mental and physical impairments; is manifested before the person attains the age of 22; is likely to continue indefinitely; results in substantial functional limitations in three or more of the following areas of major life activity: self care, receptive and expressive language, learning, mobility, self direction, capacity of independent living, economic self-sufficiency; and reflects the person’s need for a combination and sequence of special, interdisciplinary or generic care treatments or services which are of lifelong or extended duration and are individually planned and coordinated.... developmental disability

Devils Shoestring

Protection, Gambling, Luck, Power, Employment... devils shoestring

Devon

(English) From the beautiful farmland; of the divine

Devan, Deven, Devenne, Devin, Devona, Devondra, Devonna, Devonne, Devvon, Devyn, Devynn, Deheune, Devina, Devyna... devon

Devota

(Latin) A faithful woman... devota

Dexamphetamine

A drug that stimulates the central nervous system. It can be used to treat NARCOLEPSY and hyperactive children but should not be used to combat obesity or treat depression. It is also a drug of abuse.... dexamphetamine

Dextra

(Latin) Feminine form of Dexter; one who is skillful Dex... dextra

Dextromethophan

An over-the-counter drug used to relieve dry, irritating, persistent coughs, this opioid acts as a cough suppressant. It is available either alone or in combination with other drugs in linctus, lozenges and syrups prepared to provide symptomatic relief for coughs and colds.... dextromethophan

Deyanira

(Spanish) One who is capable of great destruction

Daianira, Dayanira, Dellanira, Diyanira... deyanira

Dioscorea Deltoidea

Wall ex Griseb.

Synonym: D. nepalensis Sweet ex Bernardi.

Family: Dioscoreaceae.

Habitat: The Himalaya from Kashmir to Arunachal Pradesh and in Assam at 450-3,100 m.

Ayurvedic: Vaaraahikanda (var.), Grishti.

Folk: Gun, Kris (Punjab).

Action: Tuber—antipthiriac. Leaf— febrifuge. The rhizomes are a rich source of diogenin and its glycoside. Steroidal saponins have also been isolated. Diogenin is used in the preparation of various steroidal drugs.

Synonym: D. hispada Dennst. D. hirsuta Dennst.

Family: Dioscoreaceae.

Habitat: Sikkim, the Himalayas, Khasi Hills.... dioscorea deltoidea

Drink Tea For Detox

There are various medications which can help with the detoxifying process, though many varieties of tea promote this process, as well. Find out more about teas for detox! About the detoxification process Many people relate detoxification with consumption of drugs and alcohol. While this is true, detoxification isn’t strictly related to this. Detoxification is a process which our body undergoes when it gets rid of various toxic substances. One of the organs responsible for the detoxification process is the liver. While in some cases it might be necessary, you need to be careful when taking the decision to undergo a detoxifying process. Doctors recommend that people with various health conditions - anemia, diabetes, or kidney disease, for example, should not undergo a detoxification process. The same applies to pregnant and nursing women. Tea can prove to be useful during the detoxifying process. As it is a natural beverage, it is also good for your health, bringing along many health benefits, too. This applies with teas for detox, as well. Types of tea for detox Ginger tea and chamomile tea are often recommended when undergoing a detoxifying process. Also, they both have calming effects, which will help you go through with this process. Milk thistle tea is also good when you’re going through a detoxifying process. It is good for the liver, which helps promote detoxification. Other teas for detox include burdock tea, dandelion tea, nettle tea, rosehip tea, lemongrass tea and lemon balm tea. Many of these also promote a proper digestion, help you treat colds or the flu, and can help with various health problems. Side effects of tea for detox While these teas help with the detoxifying process, you have to be careful with their side effects. Milk thistle tea and nettle tea, for example, can act as a laxative if they are drunk for long periods of time. Meanwhile, dandelion tea should not be consumed by persons suffering from diabetes, or those who have low blood sugar levels. Side effects vary from one tea to another. Make sure you discuss with your doctor about the tea for detox you decide on. When undergoing a detoxification process, choose to drink tea that can help you. As a natural beverage, it will promote detoxification, as well as help you stay healthy. Make sure you try some teas for detox!... drink tea for detox

Dryopteris Dentata

(Forsk.) C. Chr.

Synonym: Cyclosorus dentatus.

Family: Polypodiaceae.

Habitat: Throughout India in the plains, also on the hills.

Action: Aqueous extracts— antibacterial against Staphylococcus aureus.... dryopteris dentata

Ductus Deferens

Ductus deferens, or VAS DEFERENS, is the tube which carries spermatozoa from the epidydimis to the seminal vesicles. (See TESTICLE.)... ductus deferens

Electronic Monitoring Devices

Electronically driven equipment that will constantly monitor the physiological status of patients and the effects of medical intervention on that status. Such devices should relieve hospital sta? of time-consuming ‘human monitoring’ procedures and in some instances will enable patients to carry monitoring devices during their daily living activities. An example would be the regular assessment of blood-sugar concentration in subjects with DIABETES MELLITUS or the routine checking on the blood or tissue concentrations of administered drugs.... electronic monitoring devices

Evidence-based Decision-making

In a policy context, evidence-based decision-making is the application of the best available scientific evidence to policy decisions about specific treatments or care, as well as changes in the delivery system.... evidence-based decision-making

Glucose-6-phosphate Dehydrogenase

An ENZYME that performs an essential function in the metabolism of CARBOHYDRATE. A de?ciency in this enzyme – acronym G6PD – results in the breakdown of ERYTHROCYTES (HAEMOLYSIS), usually in the presence of oxidants (see OXIDANT) such as infections or drugs. The de?ciency disorder is a hereditary condition in which the enzyme is absent. The condition, characterised by pallor, rigors and pain in the loin, is divided into African, European (including FAVISM) and Oriental types. Sufferers should avoid substances that trigger haemolysis. Acute episodes are best treated symptomatically.... glucose-6-phosphate dehydrogenase

Glucose-6-phosphate-dehydrogenase (g6pd) Deficiency

A deficiency in the enzyme G6PD resulting in a haemolytic anaemia. This haemoglobinopathy contraindicates the use of the 4-aminoquinolines such as primaquine for the radical treatment of benign tertian and ovale tertian malaria.... glucose-6-phosphate-dehydrogenase (g6pd) deficiency

Gymnema Tea - The Destroyer Of Sugar

Gymnema tea is known for its sugar killing properties. Gymnema (gymnema sylvestre) is a woody plant that grows mainly in the forests of central and southern India. The plant climbs on bushes and trees, has elliptical leaves and small flowers with a yellow corolla. Gymnema is also known as the “destroyer of sugar”. In ancient times, some physicians noticed that chewing gymnema leaves can suppress the taste of sugar. Currently, gymnena is being administrated in India to those who suffer from diabetes, for increasing insulin levels and controlling the blood sugar levels. The constituents of gymnema tea are gymnemic acid, parabin, glucose and carbohydrates. How To Make Gymnema Tea Brewing gymnema tea is a very simple process. You can make it by combining dried gymnema leaves with green tea loose leaf and placing them into boiled water. Let the mix steep for about 5-7 minutes. The more you let it steep, the more intensified the flavor will be. Gymnema Tea Benefits
  • Helps reducing blood sugar levels.
  • Is a strong allied in the process of weight loss.
  • May help treat swollen glands.
  • Has anti-inflammatory properties.
  • Helps treating snakebites.
  • Reduces the craving for sugar.
Gymnema Tea Side Effects
  • Pregnant and breastfeeding women should not drink gymnema tea. Not enough is known about consuming gymnema tea during pregnancy so, it is better to avoid it.
  • Gymnema tea may interfere with blood sugar control during and after surgical procedures.
Ass you can see, gymnema tea has a lot of health benefits. Just make sure you stay away from its side effects and, also, avoid over-consumption! No more than 1-2 cups of gymnema tea per day!... gymnema tea - the destroyer of sugar

Health Care Delivery System

See “health system”.... health care delivery system

Health Development

The process of continuous, progressive improvement of the health status of individuals and groups in a population.... health development

Health Development Agency (hda)

Appointed by the UK government to help improve the NHS in England (Scotland, Wales and Northern Ireland have similar bodies), HDA replaced the long-established Health Education Authority in April 2000. The agency supports government priorities to improve public health and to tackle health inequalities. Among its key functions are:

Maintaining an up-to-date evidence base of ‘what works’ in public health and health improvements.

Providing useful information to health practitioners.

Commissioning research to remedy the gaps in the evidence base for medical practice.

Improving health promotion and advising on the standards for (and implementation of) public-health activities.

(See APPENDIX 7: STATUTORY ORGANISATIONS.)... health development agency (hda)

Hepatolenticular Degeneration

See WILSON’S DISEASE.... hepatolenticular degeneration

Hepolenticular Degeneration

See WILSON’S DISEASE.... hepolenticular degeneration

High Dependency Care Facility

An establishment primarily engaged in providing inpatient nursing and rehabilitative services to individuals requiring nursing care.... high dependency care facility

Human Development Index (hdi)

A composite index that measures the overall achievements in a country in three basic dimensions of human development— longevity, knowledge and a decent standard of living. It is measured by life expectancy, educational attainment and adjusted income per capita in purchasing power parity (PPP) US dollars. The HDI is a summary, not a comprehensive measure of human development.... human development index (hdi)

Integrated Delivery System / Integrated Services Network (isn)

A network of organizations, usually including hospitals and medical practitioner groups, that provides or arranges to provide a coordinated continuum of services to a defined population and is held both clinically and financially accountable for the outcomes in the populations served.... integrated delivery system / integrated services network (isn)

Insulin-dependent Diabetes

Also called Juvenile-onset Diabetes, IDDM (Insulin-Dependent Diabetes) and Type I, it is a deficiency condition wherein the pancreas does not manufacture enough insulin or what it makes is formed improperly. It is usually inherited, although it may not surface until pregnancy, recovering from a life-threatening illness, boot camp or some other profound metabolic stress. It can have a not-hereditary source, since it seems to enigmatically follow after a viral disorder, and can occur spontaneously as an auto-immune condition. The percentage of folks with non-hereditary Type I diabetes is constantly increasing (or the other group is stable, but total numbers are increasing). Radical environmentalists and tree-hugging Gaiaist Pagans (I’m using the dialectic current to the pro-business backlash of the 1990s, when Green is out, and White-With-Green i$ in) claim this is another aspect of massive though subtle pollution from organochemical soup, which even some Real Doctors admit can cause increased auto-immune disease. (SOMETHING is causing it, at any rate, not simply cola drinks.)... insulin-dependent diabetes

Intrauterine Contraceptive Device (iucd)

A mechanical device, commonly a coil, inserted into the UTERUS to prevent CONCEPTION, probably by interfering with the implantation of the EMBRYO. For many women, IUCDs are an e?ective and acceptable form of contraception, although only about 10 per cent of women in the UK use them. The devices are of various shapes and made of plastic or copper; most have a string that passes through the cervix and rests in the vagina.

About one-third of women have adverse effects as the result of IUCD use: common ones are backache and heavy menstrual bleeding (see MENSTRUATION). The frequency of unwanted pregnancies is about 2 per 100 women-years of use. (See CONTRACEPTION.)... intrauterine contraceptive device (iucd)

Jakarta Declaration

In July 1997, participants at the Fourth International Conference on Health Promotion presented the Jakarta Declaration on Leading Health Promotion into the 21st Century. The Declaration identifies five priorities: promote social responsibility for health; increase investments for health development; consolidate and expand partnerships for health promotion; increase community capacity and empower the individual; and secure an infrastructure for health promotion.... jakarta declaration

Medical Defence Organisations

These are UK bodies that provide doctors with advice and, where appropriate, ?nancial support in defending claims for medical negligence in their clinical practice. They also advise doctors on all legal aspects of their work, including patients’ complaints, and provide representation for members called to account by the GENERAL MEDICAL COUNCIL (GMC) or other regulatory body. The sharp rise in claims for medical negligence in the NHS in the 1980s persuaded the UK Health Departments to introduce a risk-pooling system called the Clinical Negligence Scheme for Trusts, and the defence societies liaise with this scheme when advising their doctor members on responding to claims of negligence (see MEDICAL LITIGATION; MEDICAL NEGLIGENCE).... medical defence organisations

Medical Devices Agency

An executive agency of the Department of Health in the UK. Set up in 1994, it is responsible for regulating and advising on the sale or use of any product, other than a medicine, used in the health-care environment for the diagnosis, prevention, monitoring or treatment of illness or disease. Equipment ranges from pacemakers (see CARDIAC PACEMAKER) to prostheses (see PROSTHESIS), and from syringes to magnetic resonance imaging (see (MRI).... medical devices agency

Organized Delivery System

See “integrated delivery system”.... organized delivery system

Oxygen Deficit

In a resting individual the potential OXYGEN supply to the tissues is greater than its consumption. During heavy exercise, the energy required by the tissues is greater than can be supplied by aerobic cellular metabolism and the additional energy is supplied by a biochemical reaction called anaerobic metabolism. There is a build-up of lactate – a product of LACTIC ACID

– from anaerobic metabolism which is ultimately oxidised after conversion to citrate and metabolism via the citric acid cycle. The increased amount of oxygen above resting concentrations which needs to be consumed to perform this metabolism is known as the oxygen debt or de?cit.... oxygen deficit

Parasite Density

The number of malaria parasites in a specified volume of blood.... parasite density

Plantar Dermatosis

A common form of eczema (see DERMATITIS) of the soles of the feet typically seen in boys with an atopic (see ATOPY) background who constantly wear trainers.... plantar dermatosis

Puerperal Depression

Also called postnatal DEPRESSION, this is the state of depression that may affect women soon after they have given birth. The condition often occurs suddenly a day or so after the birth. Many women suffer from it and usually they can be managed with sympathetic support. If, however, the depression – sometimes called ‘maternal blues’ – persists for ten days or more, mild ANTIDEPRESSANT DRUGS are usually e?ective. If not, psychiatric advice is recommended. (See PREGNANCY AND LABOUR.)... puerperal depression

Purified Protein Derivative (ppd)

Reagent used by intradermal administration in the Mantoux (tuberculin) test for TB.... purified protein derivative (ppd)

Research Design

The procedures and methods, including ethical considerations, predetermined by an investigator, to be adhered to in conducting a research project.... research design

Rumex Dentatus

Linn.

Family: Polygonaceae.

Habitat: The Himalayas up to 300 m, and in the plains from Assam to Western and Southern India.

Folk: Jangali Paalak.

Action: Plant—astringent; used in cutaneous disorders.

The leaves contain vitamin C 115 mg and vitamin A value 11,700 IU/100 g and are a rich source of calcium and beta-carotene. The dried leaves contained 7.8% of flavonoids and 0.04% of anthraquinone derivatives. Flavonoids include rutin, avicularin, quercitrin, quercetin. Roots contain chrysophan- ic acid and emodin, the total an- thraquinone content being 0.13%.

Rumex hastatus D. Don.

Folk: Amlora, Chumlora (Kumaon); Khattimal, Katambal (Punjab).

Action: Astringent.

The root and bark yield 21-23% tannin.... rumex dentatus

Sopubia Delphinifolia

G. Don.

Habitat: Western India, as a root parasite.

Folk: Dudhaali (Maharashtra).

Action: Root—juice applied to sores on feet, caused by constant exposure to water and moisture.

Alcoholic extract of air-dried powdered stems yielded isoflavonoids, which were found to be estrogenically active in albino rats.... sopubia delphinifolia

Sustainable Development

A process of development that meets the needs of the present generation without compromising the ability of future generations to meet their own needs.... sustainable development

Swertia Densifolia

(Griseb.) Kashyapa.

Synonym: S. decussata Nimmo ex Grah.... swertia densifolia

Vector Density

The number of a given vector species present. It may be expressed in relative terms (e.g., the biting density in relation to the human host) or in absolute numbers (e.g., the number present in a room, cattle-shed or artificial shelter).... vector density

Sudden Infant Death Syndrome (sids)

Sudden infant death syndrome, or cot death, refers to the unexpected death – usually during sleep – of an apparently healthy baby. Well over 1,500 such cases are thought to have occurred in the United Kingdom each year until 1992, when government advice was issued about laying babies on their backs. The ?gure was 192 in 2002 and continues to fall. Boys are affected more than girls, and over half of these deaths occur at the age of 2–6 months. More common in lower social classes, the incidence is highest in the winter; most of the infants have been bottle-fed (see also INFANT FEEDING).

Causes These are unknown, with possible multiple aetiology. Prematurity and low birth-weight may play a role. The sleeping position of a baby and an over-warm environment may be major factors, since deaths have fallen sharply since mothers were o?cially advised to place babies on their backs and not to overheat them. Some deaths are probably the result of respiratory infections, usually viral, which may stop breathing in at-risk infants, while others may result from the infant becoming smothered in a soft pillow. Faults in the baby’s central breathing control system (central APNOEA) may be a factor. Other possible factors include poor socioeconomic environment; vitamin E de?ciency; or smoking, drug addiction or anaemia in the mother. Help and advice may be obtained from the Foundation for the Study of Infant Deaths and the Cot Death Society.... sudden infant death syndrome (sids)

Tea For Depression

Depression is a mental disorder. Patients suffering from this medical condition have a general low mood, they lack self-esteem and may also feel guilty, hopeless and worthless. There are some obvious symptoms displayed by people suffering from depression, such as: agitation, mental disturbance causing hallucinations and morbid thoughts and loss of sexual appetite. One of the main causes of this mental disorder is genetic history. There are also several external issues leading to depression: tormented childhood, relationship difficulties, loss of someone dear, money or  health problems. Anti-depressant medications are usually prescribed to patients suffering from depression. Studies showed that people between the age of 20 and 30 but also those from 30 to 40 years could suffer from depression, if there are right circumstances to cause this disease. Women are more likely to get depressed than men. They also attempt to commit suicide more often than the other sex. How Tea for Depression works Tea for depression usually calms down the person affected. Efficient Teas for Depression Ginseng tea and Gentian tea are said to be efficient as teas for depression. General benefits attributed to Ginseng tea are the following: it has cancer-preventive effects and may reduce the risk of several types of cancer, it controls blood-sugar levels and it has the ability to increase resistance to the effects of stress, by improving the circulation and mental functioning. To prepare Ginseng tea, add 2 tablespoons of the dried plant in a cup of boiling water. Steep it for 5-6 minutes, strain it and you may enjoy this beverage. Gentian plant has a long healing history, especially in Ayurvedic medicine, where it is used to treat anorexia and sluggish digestion. The Gentian tea is successful as a tea for depression, as it improves the circulation of blood to all parts of the body. To prepare Gentian tea, simmer one teaspoon of shredded Gentian root in two cups of water for 20 minutes. Allow it to cool to room temperature and then strain it. It is recommended that Gentian Tea should be drunk 15 to 30 minutes before eating. The tea is bitter and may be sweetened by adding sugar or honey. Tea for Depression: Side effects Rarely, teas for depression may cause diarrhea or vomiting. If these side effects occur, ask for your doctor’s advice. Teas for depression are good to be purchased, especially by patients suffering from this modern medical condition. A cup of the abovementioned beverage may keep away the traditional anti-depressant pills.... tea for depression

Unona Desmos

Raeusch.

Synonym: Desmos cochinchinensis Lour.

Family: Annonaceae.

Habitat: Assam.

Action: Root—febrifuge.

The roots contain a desmoflavone. A cycloartane triterpenoid desmosinol has been isolated from stem. The root of U. discolor Vahl, synonym Desmos chinensis Lour. (forests of north-east, south and west India) is given for vertigo.

The root contains a flavonoid des- mal. Desmal inhibited tyrosine kinase in situ in epidermal growth factor (EGF) receptor overexpressing NIH3T3 (ERIZ) cells. It also inhibited EGF-induced inositol phosphate formation and morphological changes.... unona desmos

Dead Nettle

Lamium album L. Part used: herb.

Constituents: flavone glycosides, mucilage, tannin.

Action: anti-catarrhal.

Uses: Nasal catarrh, leucorrhoea. Anaemia.

Preparations: Tea. As a medicament or daily ‘health’ tea. 1-2 teaspoons to each cup boiling water; infuse 10-15 minutes. 1 cup as desired.

Vaginal douche: 2oz dried (or handful fresh herb) to 2 pints boiling water; infuse, and inject warm. May also be used as a lotion for skin disorders. ... dead nettle

Death Cap

Death Cap or other poisoning by fungi. Fungus contains toxic amanitines.

Symptoms: vomiting, nausea, abdominal pain. Leads to rapid liver degeneration.

Tinctures. Formula. Echinacea 3; Goldenseal 1; Myrrh 1. Dose: 30-60 drops every 2 hours. Practitioner. Stomach irrigation. 50mg ampoules of Silymarin (Madaus) injected by a physician. ... death cap

Ventilago Denticulata

Willd.

Synonym: V. calyculata Tul. V. madraspatana var. calyculata (Tul.) King.

Family: Rhamnaceae.

Habitat: Throughout India in hotter parts, usually climbing on trees.

Siddha/Tamil: Pappili.

Folk: Pitti, Raamadhaani, Kevati (var.).

Action: Stem bark—powdered and mixed with sesame oil, externally applied to skin diseases and sprains. Root bark—used for atonic dyspepsia, mild fever and debility. Sap—used for the treatment of deafness.

The stem bark gave friedelin and several anthraquinones. The root contains anthraquinones, ventinones A and B. Major constituents of the root bark are emodin, its glucoside and corresponding analogues, ventiloquino- nes. The fruit, leaves and stem gave lupeol, beta-sitosterol and its gluco- side.... ventilago denticulata

Wild Desert Gourd Or Colocynth

Citrullus colocynthis

Description: The wild desert gourd, a member of the watermelon family, produces an 2.4- to 3-meter-long ground-trailing vine. The perfectly round gourds are as large as an orange. They are yellow when ripe.

Habitat and Distribution: This creeping plant can be found in any climatic zone, generally in desert scrub and waste areas. It grows abundantly in the Sahara, in many Arab countries, on the southeastern coast of India, and on some of the islands of the Aegean Sea. The wild desert gourd will grow in the hottest localities.

Edible Parts: The seeds inside the ripe gourd are edible after they are completely separated from the very bitter pulp. Roast or boil the seeds--their kernels are rich in oil. The flowers are edible. The succulent stem tips can be chewed to obtain water.... wild desert gourd or colocynth

Anaemia: Iron Deficiency

An estimated 15 per cent of the female population suffers from this form of anaemia. A deficiency of nutritional iron is responsible for oxygen starvation of the blood due to insufficient haemoglobin. Number of red cells is reduced.

Aetiology: heavy menstrual loss, feeble constitution from hereditary weakness, poor diet, hidden or known blood loss from gastric ulcer, pregnancy, bleeding piles or insufficient food minerals: iron, copper, calcium, etc, chronic liver or kidney disease, worms, anorexia nervosa, rheumatoid arthritis, tuberculosis. Symptoms. Tiredness, dizziness, breathlessness, palpitations, pale face and mucous membranes. White of eyes may be blue. Enlarged flabby tongue often bears impression of teeth marks. Hair lifeless, fingernails brittle and ridged. There may be angina, tinnitus and general reduced efficiency.

Treatment. The object is to achieve absorption of iron to raise normal haemoglobin levels and increase red cells. Echinacea has a reputation for regeneration of red cells. Herbs used with success: Echinacea, Gentian, Motherwort, Mugwort, Barberry, Hops, Nettles, Saw Palmetto, Chaparral, Red Clover, Dandelion.

Bitter herbs stimulate absorption of vital nutrients from the stomach, toning liver and pancreas, increasing the appetite; usually given half hour before meals. See: BITTERS.

Gentian. 1 teaspoon fine-cut chips to 2 cups cold water steeped 8 hours (overnight). Dose: Half-1 cup thrice daily before meals.

Tea. Formula. Combine: Agrimony 1; Barberry bark 1; Nettles 2; White Poplar bark half. Place 1oz (30g) in 1 pint (500ml) cold water and bring to boil. Simmer 10 minutes. Drink cold: Half-1 cup thrice daily, before meals.

Powders. Formula. Echinacea 2; Gentian 1; Kelp 1; pinch Red Pepper. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily, before meals.

Liquid extracts. Formula: Echinacea 1; Queen’s Delight 1; Ginseng 1; Ginger quarter. Dose: 30-60 drops in water, thrice daily, before meals.

Infusion Gentian Co Conc BP (1949). Dose: 30-60 drops.

Diet. Dandelion coffee, as desired. Molasses. Desiccated liver.

Floradix. A pre-digested iron preparation. Readily assimilable by the body. Compounded by Dr Otto Greither (Salus Haus). Iron is fed onto yeast which breaks down the metal and absorbs its cells. Other tonic ingredients include extracts of nettles, carrots, spinach, fennel, Vitamin C plus supplements;

Angelica root, Mallow, Horsetail, Yarrow, Juniper and Rosehips. Not chemically preserved.

Avoid chocolate, egg yolk, tea, coffee, wheat bran.

Supplements. Daily. Vitamin C (1g morning and evening). Vitamin B12, Folic acid 400mcg. Vitamin C is the most potent enhancer of iron absorption. Multivitamin containing iron.

Note: Iron absorption is decreased by antacids, tetracyclines, phosphates, phytates (phytic acid from excessive intake of wholewheat bread), and excessive calcium supplements. Lack of stomach hydrochloric acid impairs iron absorption, especially in the elderly. ... anaemia: iron deficiency

Dental Problems

See: TEETH DECAY, TEETH EXTRACTION, ALOE VERA. DEOBSTRUENT. That which clears obstruction by dilating natural passages of the body. Usually of the intestines (Ispaghula seeds) or colon (Buckbean). ... dental problems

Dermatitis, Pseudomonas

 Itchy rash contracted in swimming pools, sports clubs or public baths caused by pseudomonas aeruginosa. Runs a self-limiting course from 7-14 days. Garlic and Echinacea specific. ... dermatitis, pseudomonas

Dermatitis, Seborrhoeic

 See: SEBORRHOEA.

DERMATOGRAPHIA. A form of nettle rash (hives). Rubbing a sensitive surface produces raised rough patches. ‘Skin writing.’ Treat as for NETTLE RASH. ... dermatitis, seborrhoeic

Heart – Fibrous Degeneration

Distinct from fatty degeneration. Due to thickening of walls by atheroma. Heart muscle (myocardium) fibres waste away due to lack of nourishment and are replaced by fibrous tissue. The condition usually runs with kidney weakness. Incurable. Partial relief of symptoms – treatment as for arteriosclerosis.

Every cardiac prescription for this condition should include a gentle diuretic to assist kidney function. The kidneys should be borne in mind, the most appropriate diuretic being Dandelion which would also make good any potassium loss. ... heart – fibrous degeneration

Bile Secretion Deficiency

Bile is a greenish-yellow alkaline substance secreted by the liver which emulsifies fat and prevents putrefaction in the intestines. An aid to pancreatic juices.

Alternatives. To stimulate flow, Boldo, Horsetail, Dandelion, Blue Flag root, Milk Thistle, Bogbean, Burdock. Teas, capsules, tablets, Liquid extracts, or Tinctures.

A. Vogel recommends: Barberry, Centuary, St John’s Wort, Sarsaparilla.

Combination tea. Equal parts: Peppermint leaves, Milk Thistle, Dandelion root. 1 teaspoon to each cup boiling water; infuse 15 minutes, 1 cup thrice daily for limited period (1 month).

Bile in the urine. (Bilviria)

Arthur Barker: Liquid Extract Black root 1oz (30ml). Liquid Extract Cornsilk 1oz (30ml). Essential Peppermint 30 drops (2ml). Water to 8oz (240ml). 2 teaspoons in water 3 times daily before meals.

Diet. Dandelion coffee. Artichokes.

See: CHOLAGOGUES. CHOLERETICS. ... bile secretion deficiency

Bust Developer

A small bust may be due to a number of causes – chiefly hormone deficiency involving the pituitary and adrenal glands. Treatment should include stimulants for these glands. Alternatives. Teas. Borage, Dill, Caraway seeds, Fennel, Goat’s Rue, Holy Thistle, Agnus Castus. Decoction. Fenugreek seeds. 2 teaspoons to each cup water gently simmered 10 minutes. Half-1 cup thrice daily. Fenugreek is a Persian remedy of antiquity for this purpose.

Tablets/capsules. Ginseng. Sarsaparilla. Evening Primrose. Agnus Castus, Liquorice.

Powders. Equal parts: Caraway seeds, Saw Palmetto berries. Dose: 750mg (three 00 capsules or half a teaspoon) thrice daily.

Tinctures. Combine Dong Quai 1; Saw Palmetto 2. Dose: one 5ml teaspoon in water thrice daily.

Topical. Cream for use at bedtime: Lanolin 1oz; Cocoa butter half an ounce; Saw Palmetto berries Tincture or Liquid Extract 30 drops (or 10 grams powder); Oil Cajeput 30 drops. Heat in a pan and pour into jar.

Diet. See: DIET – THIN PEOPLE. Improve nutrition with potassium-rich foods. Two or more bananas daily.

Supplements. Vitamins B6, C, E. Zinc. ... bust developer

Dementia, (atherosclerotic)

Arteriosclerotic disease. Due to atheromatic change in blood vessels of the brain. Infarcts.

Symptoms. High cholesterol levels, pathological laughing and crying, depression, delusion. Alternatives. Evening Primrose, Oats, Alfalfa, Garlic. German Chamomile, Gotu Kola, Ginkgo, Ginseng. Hawthorn, Rutin.

Powders. Formula: Hawthorn 3; Ginkgo 2; Lily of the Valley 1. Dose: 500mg (two 00 capsules or one- third teaspoon) thrice daily.

Liquid Extracts. Formula as for powders. Dose: one 5ml teaspoon thrice daily.

Tinctures. Formula as above. Dose: two 5ml teaspoons thrice daily.

Guar gum. Lowers serum fat levels, body weight and blood pressure.

Aromatherapy: massage and inhalation: Rosemary.

Arnica. Lotion: 1 part Tincture Arnica to 20 parts distilled extract Witch Hazel. Wipe over forehead and hair-line 1-3 times daily.

Diet. Egg-yolk, Lecithin, Oatmeal porridge.

Supplements. Vitamins A, B-complex, B12, C and E. Choline, Folic acid, Magnesium, Manganese, Zinc. ... dementia, (atherosclerotic)

Dementia, (senile)

Progressive loss of brain cells, atrophy; caused by stress and a number of diseases: Huntingdon’s Chorea, Alzheimer’s Disease, Pick’s Disease, syphilis, trauma, and by certain sedative, anxiolytic, diuretic and hypotensive drugs.

Symptoms. Disorientation, failure of memory for recent events, failure to comprehend, unable to form elemental judgements, confusion, ataxia (lack of coordination of muscles), emotional instability with outbursts, forgetful.

Alternatives. Remedies known to sustain the brain. Nervines and alteratives believed to leach from the body deposits of toxic minerals: aluminium, sulphur, mercury, etc. Gotu Kola, Ginseng, Ginkgo, Vitamin E conserve oxygen. Pulsatilla – success reported for mental outbursts. Vasodilator of value. Ginkgo favourably reported.

Teas. Basil, Ginseng, Gotu Kola, German Chamomile, Horsetail, Yarrow.

Tea. Formula. Equal parts, Ginkgo, German Chamomile, Yarrow. 1 heaped teaspoon to each cup boiling water; infuse 5-15 minutes; 1 cup thrice daily.

Tablets/capsules. Prickly Ash, Ginseng, Ginkgo, Kelp, Pulsatilla.

Powders, Liquid Extracts, Tinctures. Combine: Gotu Kola 3; Vervain 2; Rosemary 1. Doses.

Powders: 500mg; two 00 capsules or one-third teaspoon. Liquid Extracts: 1 teaspoon. Tinctures: 2 teaspoons. In water, honey or fruit juice thrice daily.

Incontinence. A frequent problem for which American Cranesbill is indicated.

Aromatherapy. Inhalation: Feverfew, Thyme.

Contra-indicated: Black Cohosh.

Diet. Low salt. Low fat. High fibre. Egg yolk. Lecithin.

Supplements. Folic acid, Vitamins B-complex, B12, C and E. Selenium, to conserve oxygen. Magnesium, Manganese, Zinc.

General. Home help. Meals on Wheels. Service from local Psychogeriatric unit. ... dementia, (senile)

Nasal Decongestant

Lobelia, Poke root, Ephedra. ... nasal decongestant

Abrasion, Dental

The wearing away of tooth enamel, often accompanied by the erosion of dentine (the layer beneath the enamel) and cementum (the bonelike tissue that covers the tooth root), usually through too-vigorous brushing. Abraded areas are often sensitive to cold or hot food or drink, and a desensitizing toothpaste and/or protection with a bonding (see bonding, dental) agent or filling may be needed.... abrasion, dental

Alignment, Dental

The movement of teeth by using either fixed or removable orthodontic appliances (braces) to correct malocclusion (incorrect bite).... alignment, dental

Demyelinating Diseases

Disorders that destroy myelin, a fatty substance which forms a sheath round nerve fibres and appears in the central nervous system. A typical example is multiple sclerosis.

Essential fatty acids have an important role in the function of the nervous system, being closely related to the fatty (myelin) sheath and cell membranes. Disturbance in their metabolism may result in nerve disorder. Thus, vegetable oils of Soya, corn, safflower and sunflower should replace animal fats and dairy products.

Symptoms. Numb, prickling, tickling sensation on the skin, paralysis, incoordination, physical weakness and visual complaints.

Treatment. Indeterminate diagnosis.

Tablets/capsules. Prickly Ash, Black Cohosh, Ginseng, Ginkgo.

Powders, Liquid Extracts, Tinctures. Formula. Equal parts: Black Cohosh, Prickly Ash, Ginseng. Doses. Powders: two 00 capsules or one-third teaspoon, (500mg). Liquid Extracts: 1 teaspoon. Tinctures: 2 teaspoons. In water, honey or fruit juice.

Evening Primrose oil capsules or tablets: two 500mg thrice daily.

Aromatherapy. Rosemary spinal rub: 6 drops Oil Rosemary in 2 teaspoons Almond oil.

Diet. High protein, low fat, oily fish or 2 teaspoons Cod Liver oil daily. Gluten-free diet. Cholesterol- free – avoid milk, meat fat and dairy products. Avoid coffee and other caffeine stimulants. Dandelion coffee.

Supplements. B-complex, B3, B6, B12, C, E. Dolomite, Manganese, Zinc. ... demyelinating diseases

Depression – Post-natal

Extreme anguish after birth of a child. Mental illness: “sinking into gloom”. Baby blues. Bursting into tears; every small problem seems magnified; agoraphobic tendency. Etiology. Some mothers have a genetic predisposition to the condition. Death of a close relative, stressful pregnancy, redundancy, moving house, or sheer physical and mental exhaustion.

Treatment. Conventional medicine advises strong anti-depressants. Alternatives, until “hormones settle down”: Agnus Castus, Helonias, Milk Thistle. Raspberry leaf tea (tablets/capsules/liquid extracts/tinctures). Special attention to the thyroid gland.

Diet. See: GENERAL DIET.

Supplements. Vitamins: B group, E. Minerals: Calcium, Iodine, Magnesium, Zinc. Tyrosine. Supportives: Astute GP, helpful health visitor, thoughtful husband. ... depression – post-natal

Dermatitis, Contact

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

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

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

Internal. Burdock tea. Clivers tea.

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

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

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

Dermatitis, Exfoliative

 Erythroderma. Redness and thickening of the skin which later peels off in layers (desquamation). Follows some chronic skin disorders: leukaemia, Hodgkin’s disease or fungoid invasion. May involve the whole of the body.

Alternatives. Teas. Betony, Burdock leaves, Bogbean, Chickweed, Clivers, Dandelion, Gotu Kola, Ground Ivy, Figwort, Red Clover, Violet, Yarrow.

Cold tea. Barberry bark: one heaped teaspoon to each teacup cold water; stand overnight, drink 1 cup morning and evening next day (most effective).

Tablets/capsules. Blue Flag root, Burdock, Devil’s Claw, Echinacea, Garlic, Poke root, Queen’s Delight, Red Clover, Seaweed and Sarsaparilla.

Formula. Equal parts: Dandelion, Echinacea, Yellow Dock root. Dose – Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: one 5ml teaspoon. Tinctures: two 5ml teaspoons. Thrice daily before meals.

Topical. Alternatives to corticosteroids. Tamus tincture or salve – see Black Bryony. Aloe Vera, Witch Hazel, Comfrey, Evening Primrose, Jojoba, Thuja. Bran bath.

Diet. See: DIET – SKIN DISEASES. ... dermatitis, exfoliative

Alveolus, Dental

The bony cavity or socket supporting each tooth in the jaw.... alveolus, dental

Amalgam, Dental

A material, consisting of an alloy of mercury with other metals, that is used as fillings for teeth (see filling, dental).... amalgam, dental

Anaesthesia, Dental

Loss of sensation induced in a patient to prevent pain during dental treatment.

For minor procedures, a local anaesthetic (see anaesthesia, local) is injected either into the gum at the site being treated or into the nerve a short distance away (called a peripheral nerve block).

In addition, topical anaesthetics are often used on the gums.

For more complicated procedures, such as periodontal (gum) surgery and multiple tooth extractions, general anaesthesia is carried out (see anaesthesia, general).... anaesthesia, dental

Bleaching, Dental

A cosmetic procedure for lightening certain types of discoloured teeth, including nonvital ‘dead’ teeth.

The surface of the affected tooth is painted with oxidizing agents and then exposed to ultraviolet light.... bleaching, dental

Dermatitis, Herpetiformis

 Red inflammation of the skin with blisters. Not eczema. Common cause: gluten, as present in cereals barley, oats, rye, wheat.

Alternatives. Teas. Betony, Burdock, Elderflowers, German Chamomile, Hops, Gotu Kola, Mullein, Plantain, Red Clover, Valerian.

Tea formula. Equal parts, Mullein, Red Clover, Valerian. Mix. 1 heaped teaspoon to each cup boiling water; infuse 15 minutes; 1 cup thrice daily.

Tablets/capsules. Blue Flag, Dandelion, Devil’s Claw, Echinacea, Poke root, Red Clover, Seaweed and Sarsaparilla, Valerian.

Powders. Formula. Equal parts: Burdock root, Dandelion root, Valerian root. Two 00 capsules or one- third teaspoon thrice daily, (500mg).

Liquid extracts or tinctures. Formula. Chickweed 10ml; Poke root 5ml; Meadowsweet 10ml; Valerian 10ml. Dose: liquid extracts, one 5ml teaspoon; tinctures, two 5ml teaspoons. Thrice daily in water. Topical. Apply dilute Tea Tree oil 3-4 times daily. Witch Hazel, Aloe Vera, Vitamin E cream, Evening Primrose oil, or Marshmallow and Slippery Elm ointment. Bran bath.

Diet. Gluten-free.

DERMATITIS, LIGHT. Photo dermatitis. Reddening and blistering of the skin on exposure to sunlight.

See: SUNBURN. ... dermatitis, herpetiformis

Detoxifiers

Plant medicines that aid removal of a poison or poisonous effect, reducing toxic properties of certain substances by inducing chemical changes in the offending substance and assisting its excretion from the body. For instance: Sarsaparilla is said to aid the elimination of mercury salts, and the plant Chorella the toxic effects of radiation.

For internal cleansing. Urinary tract – Dandelion, Burdock. Liver – Dandelion, Milk Thistle. Mucous membrane – Goldenseal. Blood – Burdock, Red Clover, Yellow Dock. Intestinal tract – Slippery Elm, Fenugreek, Meadowsweet. Womb – Raspberry leaves. Lymphatic system – Figwort, Poke root. Lungs – Mullein, Angelica root. Skin – Yellow Dock, Chamomile. ... detoxifiers

Devil’s Claw

Harpagophytum procumbens D.C. Rhizome. Native of the Kalahari Desert.

Keynote: rheumatism. A versatile remedy.

Constituents: flavonoids, iridoid glycosides.

Action: anti-inflammatory, antirheumatic, analgesic (mild), liver tonic, cholagogue, diuretic, sedative, detoxicant, stomachic, lymphatic, stimulant, cortisone-like action.

Use s. Inflammatory arthritic stiff joints. Gout. Lumbago, sciatica, polymyalgia, neuralgia, liver congestion. Gall bladder disorders. Itching skin conditions. Piles. Inflammatory conditions of the veins. Avoid in pregnancy. Not given in presence of gastric or duodenal ulcer.

Preparations: Thrice daily.

Tablets: dosage as on bottle.

Alternative: a tea is made by dissolving tablets in a cup of boiling water.

Decoction. Quarter to half a teaspoon in each cup water gently simmered 15 minutes. Dose: half a cup. Liquid Extract, BHC Vol 1. (1:1, 25 per cent ethanol). Dose: 1-2ml.

Powder. 250mg capsules; maintenance dose, 2 capsules thrice daily with meals. Or applied to open wounds for healing. ... devil’s claw

Bonding, Dental

Dental techniques that use plastic resins and acrylic or porcelain veneers to repair, restore, or improve the appearance of damaged or defective teeth.

It is sometimes used as an alternative to crowning (see crown, dental) and may also be used as a preventive technique to protect the teeth.... bonding, dental

Bone Density

The compactness of bone tissue in relation to its volume. A decrease in bone density is a normal part of aging. However, in some people, excessive loss of density (see osteoporosis) can lead to fractures. Less commonly, an increase in bone density (see osteosclerosis) occurs in certain disorders (see osteopetrosis; Paget’s disease). Bone density can be measured by a technique known as densitometry, which uses low-dose X-rays.... bone density

Eyes  - Macular Degeneration

Zinc and selenium, supported by doses of Vitamin E and amino acid taurine produced dramatic results in some cases; effect said to be due to antioxidant activity mopping up free radicals associated with degenerative diseases (Journal of Nutritional Medicine)

A preliminary therapeutic trial in patients with ageing macular degeneration or diabetic retinopathy showed that supplementation with Beta-carotene, Vitamin C, Vitamin E and Selenium halted the progression of degenerative changes and in some cases even brought some improvement. (Age and Ageing 1991, 20(1) 60-9). Bilberries.

Referral to a consultant ophthalmologist. ... eyes  - macular degeneration

Eyes – Sight Deterioration

Presbyopia. General deterioration of the eye, usually from long- sightedness. A natural ageing process. Nutritional deficiency is a common cause, promoted by smoking, alcohol and denatured foods. If the eyes are treated nutritionally good sight lasts much longer. Strong emotions such as anger, and infections such as colds may weaken.

Services of a qualified optician should be sought after limits of the Bate’s Method of eyesight training have been reached.

Alternatives. Tablets/capsules. Ginseng. Gotu Kola.

Powders. Mix. Parts: Gentian 2; Dandelion 1; pinch Cayenne. Dose: 500mg, (two 00 capsules or one- third teaspoon) thrice daily. (To build-up good general health)

Cider Vinegar. 2 teaspoons to tumbler water; sips during the day.

Topical. Teas. Any one: Eyebright, Fennel, German Chamomile, Plantain, Rue. 1 teaspoon to each cup boiling water; infuse 15 minutes, strain, half fill eyebath and use as a douche.

Diet. Low salt. High fibre. Bilberries.

Supplements. Daily. Vitamin A, 7500iu. Beta-carotene. B-complex. Vitamin C, 100mg. Vitamin E, 100iu. Zinc.

Supportive. Palming. Bate’s exercises. ... eyes – sight deterioration

Heart – Degeneration, In The Elderly

May take the form of degeneration of healthy cardiac tissue replaced by broken fatty patches. As cardiac muscle wastes fibrous tissue takes its place.

While cure is not possible, atheroma may be arrested by a cup of herbal tea: Hawthorn blossoms, Motherwort, Horsetail: single or in combination. 1-2 teaspoons to each cup boiling water; infuse 5-15 minutes; 1-2 cups daily.

Formula. Hawthorn 2; Ginkgo 2; Horsetail 1; Ginger quarter. Dose. Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Twice daily: morning and evening in water or honey.

Diet. See: DIET – HEART AND CIRCULATION. Few grains of Cayenne pepper as seasoning on food once daily.

Stop smoking. ... heart – degeneration, in the elderly

Heart – Fatty Degeneration

A deposit and infiltration of fat on the heart in the obese and heavy consumers of alcohol. Distinct from true degeneration in which there is no destruction of tissue. Symptoms. Breathlessness and palpitation on slight exertion. Anginal pain: see ANGINA. Mental dullness. May follow enlargement of the heart and acute infections such as influenza.

Alternatives. Teas. Alfalfa, Clivers, Yarrow, Motherwort.

Tablets/capsules. Poke root, Kelp, Motherwort.

Formula. Equal parts: Bladderwrack, Motherwort, Aniseed, Dandelion. Dose. Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons in water thrice daily. Black Cohosh. Introduced into the medical world in 1831 when members of the North American Eclectic School of physicians effectively treated cases of fatty heart.

Diet. Vegetarian protein foods, high-fibre, whole grains, seed sprouts, lecithin, soya products, low-fat yoghurt, plenty of raw fruit and vegetables, unrefined carbohydrates. Oily fish: see entry. Dandelion coffee. Reject: alcohol, coffee, salt, sugar, fried foods, all dairy products except yoghurt.

Supplements. Daily. Broad-spectrum multivitamin including Vitamins A, B-complex, B3, B6, C (with bioflavonoids), E, Selenium. ... heart – fatty degeneration

Nervous Debility

Nerve weakness; loss of strength and power.

To strengthen nerves and generate vitality: Ginseng, Bee pollen, Oats, Ginkgo, Saw Palmetto, Damiana. Tea. Formula. Equal parts: Betony, Balm, Skullcap. One heaped teaspoon to each cup boiling water; infuse 5-15 minutes. 1 cup thrice daily.

Gentian. One teaspoon fine-cut root in cup cold water; infuse overnight. Strain; drink cold following morning.

Tablets/capsules: Damiana, Skullcap, Lady’s Slipper, Ginseng, Ginkgo.

Formula. Equal parts: Gentian, Oats. Gotu Kola. Dose: Liquid Extracts: 2 teaspoons. Tinctures: 3 teaspoons. Powders: 750mg (three 00 capsules or half a teaspoon). Thrice daily.

After surgical operation: St John’s Wort. Hawthorn. ... nervous debility

Brace, Dental

See orthodontic appliances.... brace, dental

Bridge, Dental

False teeth that are attached to natural teeth on either side of a gap left by a missing tooth or teeth. (See also denture.)... bridge, dental

Calcification, Dental

The deposition of calcium salts in developing teeth. Primary teeth begin to calcify in a fetus at between 3 and 6 months gestation; calcification of permanent teeth (other than the wisdom teeth) begins between birth and 4 years. Abnormal calcification occurs in amelogenesis imperfecta, an inherited disorder of the enamel (see hypoplasia, enamel), and can also result from the absorption of high levels of fluoride (see fluorosis).... calcification, dental

Calculus, Dental

A hard, crust-like deposit (also known as tartar) found on the crowns and roots of the teeth. Calculus forms when mineral salts in saliva are deposited in existing plaque. Supragingival calculus is a yellowish or white deposit that forms above the gum margin, on the crowns of teeth near the openings of salivary gland ducts. Subgingival calculus forms below the gum margin and is brown or black. Toxins in calculus cause gum inflammation (see gingivitis), which may progress to destruction of the supporting tissues (see periodontitis). Calculus is removed by professional scaling. Attention to oral hygiene reduces recurrence.... calculus, dental

Abscess, Dental

A pus-filled sac in the tissue around the root of a tooth. An abscess may occur when bacteria invade the pulp (the tissues in the central cavity of a tooth) as a result of dental caries, which destroys the tooth’s enamel and dentine, allowing bacteria to reach the pulp. Bacteria can also gain access to the pulp when a tooth is injured. The infection in the pulp then spreads into the surrounding tissue to form an abscess. Abscesses can also result from periodontal disease, in which bacteria accumulate in pockets that form between the teeth and gums.

The affected tooth aches or throbs, and biting or chewing is usually extremely painful. The gum around the tooth is tender and may be red and swollen. An untreated abscess eventually erodes a sinus (channel) through the jawbone to the gum surface, where it forms a swelling known as a gumboil. As the abscess spreads, the glands in the neck and the side of the face may become swollen, and fever may develop. Treatment may consist of draining the abscess, followed by root-canal treatment of the affected tooth, but in some cases extraction of the tooth is necessary. Antibiotics are prescribed if the infection has spread beyond the tooth.

An abscess in a periodontal pocket can usually be treated by the dentist scraping away infected material.... abscess, dental

Anaemia, Iron-deficiency

The most common form of anaemia caused by a deficiency of iron, an essential constituent of haemoglobin. The main cause of iron-deficiency anaemia is iron loss due to heavy or persistent bleeding; the most common cause in women of childbearing age is menstruation. Other causes include blood loss from the digestive tract due to disorders such as erosive gastritis, peptic ulcer, stomach cancer, inflammatory bowel disease, haemorrhoids, and bowel tumours (see colon, cancer of). Prolonged use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) can cause gastrointestinal bleeding. In some countries, hookworm infestation of the digestive tract is an important cause of anaemia. Rarely, bleeding may also occur as a result of disorders of the urinary tract (such as kidney tumours or bladder tumours).

Iron deficiency may also be caused or worsened by lack of iron in, or its poor absorption from, the diet.

The symptoms are those of the underlying cause, along with a sore mouth or tongue, and those common to all forms of anaemia, such as fatigue and breathlessness. The diagnosis is made from blood tests and tests to look for an underlying cause. Treatment is given for the cause, along with a course of iron tablets or, very rarely, injections.... anaemia, iron-deficiency

Capping, Dental

See crown, dental.... capping, dental

Cavity, Dental

A hole in a tooth, commonly caused by dental caries (see caries, dental).... cavity, dental

Contact Dermatitis

A type of dermatitis caused by an allergic reaction to a substance that is in contact with the skin and which would not cause a reaction in most people exposed to it. Common causes include nickel and rubber. (See also irritant dermatitis.)... contact dermatitis

Cosmetic Dentistry

Procedures to improve the appearance of the teeth or prevent further damage to the teeth and/or gums.

Cosmetic dentistry procedures include: fitting an orthodontic appliance to correct teeth that are out of alignment or where the bite is incorrect (see malocclusion); fitting a crown; bonding to treat chipped or stained teeth; and bleaching of discoloured teeth.... cosmetic dentistry

Crowding, Dental

See overcrowding, dental.... crowding, dental

Crown, Dental

An artificial replacement for the crown of a tooth that has become decayed, discoloured, or broken. A porcelain crown is usually used on front teeth, but back teeth require the greater strength of a crown made from gold or porcelain fused to metal.

A crown may be fitted by filing the natural tooth to form a peg and cementing the crown over the top. If the tooth is... crown, dental

Curettage, Dental

The scraping of the wall of a cavity or other surface with a dental curette.

Dental curettage is one method used to remove the lining of periodontal pockets and diseased tissue from root surfaces in periodontitis.... curettage, dental

Cusp, Dental

A protrusion on the grinding surface of a tooth.... cusp, dental

Caries, Dental

Tooth decay; the gradual erosion of enamel (the covering of the tooth) and dentine (the substance beneath the enamel). Initial decay usually occurs on the grinding surfaces of the back teeth and areas around the gum line. The main cause is plaque, a sticky substance consisting of food deposits, saliva by-products, and bacteria that collects on the teeth. The breakdown of food deposits by bacteria creates an acid that eats into the enamel to form cavities. Unchecked decay spreads to the dentine, and as the cavity enlarges, bacteria may invade and destroy the pulp

at the tooth’s core. Advanced decay causes toothache and bad breath.

Treatment consists of drilling away the area of decay and filling the cavity (see filling, dental). In advanced decay, it may be necessary to remove the infected pulp (see extraction, dental).

Water fluoridation and the use of fluoride toothpaste helps prevent caries.

The risk of caries is also reduced by cutting sugar consumption, practising good oral hygiene, and visiting the dentist regularly.... caries, dental

Child Development

The acquisition of physical, mental, and social skills in children.

Although there is wide variation in individual rates of progress, most children develop certain skills within predictable age ranges.

For example, most infants start to walk at 12–18 months.

Capability for new skills is linked to the maturity of the child’s nervous system.

Individual rates of maturity are determined genetically and modified by environmental factors in the uterus and after birth.

Development is assessed in early childhood by looking at abilities in 4 main areas: locomotion; hearing and speech; vision and fine movement; and social behaviour and play.

(See also developmental delay.)... child development

Colour Vision Deficiency

Any abnormality in colour vision that causes difficulty distinguishing between certain colours. Total absence of colour vision (monochromatism) is rare. The most common types of colour vision deficiency are reduced discrimination of red and green. Most cases of red and green colour vision deficiency are caused by defects in the light-sensitive cells in the retina. These defects are usually inherited, although occasionally defects are caused by retinal or optic nerve diseases or injury. The inherited defects tend to be sex-linked (see genetic disorders), which means that the majority of sufferers are male. A person with a severe green deficiency has difficulty distinguishing oranges, greens, browns, and pale reds. In severe red deficiency, all reds appear dull. A much rarer deficiency in which blue cannot be distinguished may be inherited or may be due to degeneration of the retina or optic nerve.... colour vision deficiency

Death, Sudden Infant

See sudden infant death syndrome (SIDS).... death, sudden infant

Decalcification, Dental

The dissolving of minerals in a tooth. Dental decalcification is the first stage of tooth decay. It is caused by the bacteria in plaque acting on refined carbohydrates (mainly sugar) in food to produce acid, which leads to changes on the surface of the tooth. If the decalcification penetrates the enamel, it spreads into the dentine and permits bacteria to enter the pulp.

(See also caries, dental.)... decalcification, dental

Defence Mechanisms

Techniques used by the mind to cope with unpleasant or unwelcome emotions, impulses, experiences, or events. Repression of emotions surrounding a particular event or refusing to accept an event (denial) are both defence mechanisms.... defence mechanisms

Defoliant Poisoning

The toxic effects of plant poisons that cause leaves to drop off.

Defoliants are poisonous if swallowed.

Widely used defoliants include sodium chlorate, potassium chlorate, phenoxy herbicides, and paraquat.... defoliant poisoning

Decompression, Spinal Canal

Surgery to relieve pressure on the spinal cord or a nerve root emerging from it (see microdiscectomy). Pressure may have various causes, including a disc prolapse, a tumour or abscess of the spinal cord, or a tumour, abscess or fracture of the vertebrae. Any of these conditions can cause weakness or paralysis of the limbs and loss of bladder control.

To treat major disc prolapses and tumours, a laminectomy (removal of the bony arches of 1 or more vertebrae) to expose the affected part of the cord or nerve roots may be performed. Recovery after treatment depends on the severity and duration of the pressure, the success of the surgery in relieving the pressure, and whether any damage is sustained by the nerves during the operation.... decompression, spinal canal

Decongestant Drugs

Drugs that are used to relieve nasal congestion commonly in people with upper respiratory tract infections.

They work by narrowing blood vessels in the membranes lining the nose.

This action reduces swelling, inflammation, and the amount of mucus produced by the lining.

Common drugs include ephedrine, oxymetazoline, and phenylephrine.

Small amounts of these drugs are present in many over-thecounter cold remedies.

Taken by mouth, decongestant drugs may cause tremor and palpitations.

Adverse effects are unlikely with nose drops, but if taken for several days they become ineffective and symptoms may then recur or worsen despite continued treatment.... decongestant drugs

Deformity

Any malformation or distortion of part of the body.

Deformities may be congenital (present from birth), or they may be acquired as a result of injury, disorder, or disuse.

Most congenital deformities are relatively rare.

Among the more common are club-foot (talipes) and cleft lip and palate.

Injuries that can cause deformity include burns, torn muscles, and broken bones.

Disorders that may cause deformity include nerve problems, some deficiencies, such as rickets, and Paget’s disease of the bone.

Disuse of a part of the body can lead to deformity through stiffening and contracture of unused muscles or tendons.

Many deformities can be corrected by orthopaedic techniques, plastic surgery, or exercise.... deformity

Dementia Praecox

An outdated term for severe schizophrenia, especially that affecting adolescents or young adults.... dementia praecox

Densitometry

An imaging technique that uses low-dose X-rays to measure bone density, as determined by the concentration of calcified material. It is used to diagnose and assess the severity of osteoporosis, especially in the spine and femur, and to assess its response to treatment. During the procedure, X-rays are passed through the body. A computer assesses the amount of X-rays absorbed by the body and uses this information to calculate the bone density.... densitometry

Density

The “compactness” of a substance, defined as its mass per unit volume. In radiology, the term relates to the amount of radiation absorbed by the structure being X-rayed. Bone, which absorbs radiation well, appears white on X-ray film. A lung, which contains mostly air, absorbs little radiation and is dark on film. The same holds true in CT scanning and MRI. (See also specific gravity.)... density

Dental Examination

An examination of the mouth, gums, and teeth by a dentist as a routine check or as part of the assessment a person complaining of a symptom. Routine examinations enable tooth decay and gum disease to be detected and treated at an early stage.

During a routine dental examination, the dentist uses a metal instrument to

probe for dental cavities, chipped teeth, or fillings. Dental X-rays are sometimes carried out to check for problems that may not be visible. Dentists also check how well the upper and lower teeth come together. Regular examinations in children enable the monitoring of the replacement of primary teeth by permanent, or secondary, teeth. Referral for orthodontic treatment may be made. dental extraction See tooth extraction. dental X-ray An image of the teeth and jaws that provides information for detecting, diagnosing, and treating conditions that can threaten oral and general health. There are 3 types of dental X-ray: periapical X-ray, bite-wing X-ray, and panoramic X-ray.

Periapical X-rays are taken using X-ray film held behind the teeth. They give detailed images of whole teeth and the surrounding tissues. They show unerupted or impacted teeth, root fractures, abscesses, cysts, and tumours, and can help diagnose some skeletal diseases. Bite-wing X-rays show the crowns of the teeth and can detect areas of decay and changes in bone due to periodontal disease. Panoramic X-rays show all the teeth and surrounding structures on one large film. They can show unerupted or impacted teeth, cysts, jaw fractures, or tumours. The amount of radiation received from dental X-rays is extremely small. However, dental X-rays should be avoided during pregnancy.... dental examination

Descemet’s Membrane

the membrane that forms the deepest layer of the *stroma of the cornea of the eye. The endothelium lies between it and the aqueous humour. [J. Descemet (1732–1810), French anatomist]... descemet’s membrane

Desert

n. the state of deserving something. In medical ethics it is controversial to argue that some patients may be more deserving of treatment than others on the basis of their past or present conduct. See also need.... desert

Designer Drug

a psychoactive drug produced by minor chemical modification of existing illegal substances so as to circumvent prohibitive legislation. These drugs are manufactured in secret laboratories for profit, without regard to any probable medical and social dangers to the consumers.... designer drug

Desmond

(diabetes education and self-management for ongoing and newly diagnosed) a structured one-day education programme for patients with type 2 diabetes, developed in 2003. Outcomes show an increase in participants’ understanding of diabetes and risk factors associated with coronary heart disease.... desmond

Desmoplasia

n. 1. the proliferation of *fibroblasts to produce a fibrous *stroma in response to a malignant tumour. It is a feature of the more aggressive tumours. 2. the formation of fibrous *adhesions. —desmoplastic adj.... desmoplasia

Desmosome

n. an area of contact between two adjacent cells, occurring particularly in epithelia. The cell membranes at a desmosome are thickened and fine fibres (tonofibrils) extend from the desmosome into the cytoplasm.... desmosome

Detoxification

(detoxication) n. 1. the process whereby toxic substances are removed or toxic effects neutralized. It is one of the functions of the liver. 2. the period of withdrawal when a person stops long-term consumption of alcohol or some other drug. Withdrawal symptoms (e.g. *delirium tremens) may occur during detoxification.... detoxification

Detrition

n. the process of wearing away solid bodies (e.g. bones) by friction or use.... detrition

Detrusor

n. the muscle of the urinary bladder wall. The functioning of the detrusor and urethral sphincter is assessed by a urodynamic investigation (see urodynamics). This is used to diagnose dysfunction, absent and exaggerated reflexes, and overactivity of the muscle (detrusor instability, overactive bladder syndrome). Neurogenic detrusor overactivity is due to neurological damage, as occurs in multiple sclerosis or in suprasacral spinal cord injury.... detrusor

Detumescence

n. 1. the reverse of erection, whereby the erect penis or clitoris becomes flaccid after orgasm. 2. subsidence of a swelling.... detumescence

Deut

(deuto-, deuter(o-)) combining form denoting two, second, or secondary.... deut

Deuteranopia

n. a defect in colour vision in which reds, yellows, and greens are confused. It is thought that the mechanisms for perceiving red light and green light are in some way combined in people with this defect. Compare protanopia; tritanopia. See also colour blindness.... deuteranopia

Deutoplasm

n. see yolk.... deutoplasm

Developmental Disorder

any one of a group of conditions in infancy or childhood, that are characterized by delays in biologically determined psychological functions, such as language. They are more common in males than females and tend to follow a course of disability with gradual improvement. They are classified into pervasive conditions, in which many types of development are involved (e.g. *autism), and specific disorders, in which the disability is an isolated problem (such as *dyslexia).... developmental disorder

Developmental Milestones

skills gained by a developing child, which should be achieved by a given age. Examples of such milestones include smiling by six weeks and sitting unsupported by eight months. Failure to achieve a particular milestone by a given age is indicative of *developmental delay. See table.... developmental milestones

Deviation

n. 1. (in ophthalmology) any abnormal position of one or both eyes. For example, if the eyes are both looking to one side when the head is facing forwards, they are said to be deviated to that side. Such deviations of both eyes may occur in brain disease. Deviations of one eye, such as *dissociated vertical deviation, come into the category of squint (see strabismus). 2. see sexual deviation.... deviation

Devic’s Disease

see neuromyelitis optica. [E. Devic (1869–1930), French physician]... devic’s disease

Devitalization

n. (in dentistry) 1. tooth death, normally as a result of disease, trauma, or (less commonly) orthodontic treatment. 2. the removal of a diseased pulp from a tooth. In primary teeth the coronal pulp alone may be removed, while the pulp in the root is kept alive or root canal treatment undertaken. For permanent teeth, see root canal treatment.... devitalization

Developmental Hip Dysplasia

A disorder present at birth in which the head of the femur (thigh-bone) fails to fit properly into the cup-like socket in the pelvis to form a joint. One or both of the hips may be affected.

The cause of developmental hip dysplasia is not known, although it is more common in girls, especially babies born by breech delivery or following pregnancies in which the amount of amniotic fluid was abnormally small.

If dislocation is detected in early infancy, splints are applied to the thigh to manoeuvre the ball of the joint into the socket and keep it in position. These are worn for about 3 months and usually correct the problem. Progress may be monitored by ultrasound scanning and X-rays. Corrective surgery may also be required.

If treatment is delayed, there may be lifelong problems with walking. Without treatment, the dislocation often leads to shortening of the leg, limping, and early osteoarthritis in the joint.... developmental hip dysplasia

Dexa Scan

Dual-energy X-ray absorptiometry, a technique that measures bone density by passing beams of lowdose radiation through bone. scans are used to assess the severity of osteoporosis. (See also densitometry.)... dexa scan

Dextromethorphan

A cough suppressant available over the counter as an ingredient in cough remedies.... dextromethorphan

Dextromoramide

An opioid analgesic drug related to opium that is used to relieve severe pain following injury or surgery and during long-term illnesses.

It relieves pain quickly but has only a short duration of action.

Regular use can produce drug dependence.... dextromoramide

Dextropropoxyphene

A weak opioid analgesic drug included in some compound analgesic preparations.

It works rapidly and relieves mild to moderate pain for about 4 hours.

Adverse effects may include drowsiness, dizziness, nausea, and vomiting.... dextropropoxyphene

Dopa-decarboxylase Inhibitors

Drugs used in the treatment of Parkinson’s disease.

The 2 main dopa-decarboxylase inhibitors, co-beneldopa and co-careldopa, are a combination of levodopa and benserazide and levodopa and carbidopa respectively.

These drugs prevent levodopa from being activated except within the brain, which reduces the incidence of side effects such as nausea and vomiting.... dopa-decarboxylase inhibitors

Emotional Deprivation

Lack of sufficient loving attention and of warm, trusting relationships during a child’s early years, so that normal emotional development is inhibited. Emotional deprivation may result if bonding does not occur in the early months of life. Emotionally deprived children may be impulsive, crave attention, be unable to cope with frustration, and may have impaired intellectual development.... emotional deprivation

Enamel, Dental

The hard outer layer of a tooth that covers and protects the inner structures.... enamel, dental

Erosion, Dental

Loss of enamel from a tooth’s surface due to attack by plaque acids or other chemicals. Erosion of the

outer surfaces of the front teeth is most frequently caused by excessive intake of fruit juices and carbonated drinks. Erosion of the inner surfaces of the molars may be a result of the regurgitation of stomach acid, as occurs in people suffering from acid reflux or bulimia. (See also caries, dental.)... erosion, dental

Exfoliative Dermatitis

A skin disorder characterized by inflammation, redness, and scaling of the skin over most of the body. Exfoliative dermatitis may be the result of an allergic response to a drug or may be due to worsening of a skin condition such as psoriasis or eczema. The condition sometimes occurs in lymphoma and leukaemia.

There is a widespread rash with severe flaking of the skin, which results in increased loss of water and protein from the surface of the body.

Protein loss may cause oedema and muscle wasting.

Further possible complications include heart failure and infection.

The treatment and outlook depend on the cause.... exfoliative dermatitis

Extraction, Dental

Removal of teeth by a dentist. Extraction may be performed when a tooth is severely decayed or too badly broken to be repaired, or when an abscess (see abscess, dental) has formed. Teeth may also be removed if there is crowding or malocclusion, if the teeth are loose due to gum disease, or if they are preventing another tooth from erupting (see eruption of teeth).

For most extractions, local anaesthesia is used (see anaesthesia, dental). Teeth are usually extracted with dental forceps, which grasp the root of the tooth. In difficult extractions, some gum and bone may also need to be removed from around the tooth.... extraction, dental

Filling, Dental

The process of replacing a chipped or decayed area of tooth with an inactive material. Dental filling is also used to describe the restorative material itself. Amalgam, a hard-wearing mixture of silver, mercury, and other metals is generally used for back teeth. If a front tooth is chipped, a bonding technique (see bonding, dental) may be used, in which plastic or porcelain tooth-coloured material is attached to the surface of the tooth.... filling, dental

Flossing, Dental

The removal of plaque (see plaque, dental) and food particles from around the teeth and gums by

using soft nylon or silk thread or tape.

Dental floss may be waxed or unwaxed.

Flossing should be carried out as an adjunct to toothbrushing.... flossing, dental

Forceps Delivery

The use of forceps (see forceps, obstetric) to ease out the baby’s head during a difficult birth (see childbirth). Forceps delivery is used if

the mother is unable to push out her baby unaided, or if the baby is showing signs of fetal distress. Forceps are also used to control the head once the body has been delivered in breech delivery to prevent too rapid a birth.An episiotomy (making of a cut in the perineum) is usually needed for a forceps delivery. Recovery and care for mother and child is usually the same as after a vaginal delivery.... forceps delivery

Fracture, Dental

A break in a tooth (see teeth) most commonly caused by falling onto a hard surface or by being hit in the mouth with a hard object.

Fractures may involve the crown or the root of a tooth, or both.

Fractures of the enamel can usually be repaired by bonding (see bonding, dental); in some cases, a replacement crown may be fitted (see crown, dental).

Pulpotomy may be performed if the pulp of a tooth is damaged.

Fractures of the root may be treated by splinting (see splinting, dental), root-canal treatment, or removing the tooth (see extraction, dental).... fracture, dental

Hip Dysplasia, Developmental

See developmental hip dysplasia.... hip dysplasia, developmental

Impaction, Dental

Failure of a tooth to emerge completely from the gum. It may occur because of overcrowding or when a tooth grows in the wrong direction.

Impacted wisdom teeth are common, and, if symptomless, may not need to be removed.

In some cases, however, symptoms necessitate their removal.... impaction, dental

Implant, Dental

A post, surgically embedded in the jaw for the attachment of a dental prosthesis (an artificial tooth). Titanium or synthetic materials may be used. A dental implant is fitted under local anaesthesia. A hole is drilled in the jaw and a post inserted. Several months later, an attachment that protrudes from the gum is screwed into the post; a few weeks after that, the prosthesis is fitted.... implant, dental

Impression, Dental

A mould taken of the teeth, gums, and palate.

A quick-setting material, such as alginate, is placed in a mould over the teeth.

The mould is removed, and plaster of Paris is poured into it to obtain a model of the area.

This model is then used as a base on which to build a denture, bridge, or dental inlay.

Dental impressions are also used in orthodontics to study the position of the teeth and to make orthodontic appliances to correct irregularities.... impression, dental

Inlay, Dental

A filling of porcelain or gold used to restore a badly decayed tooth.

An inlay may be needed for the back teeth or to protect a weakened tooth.... inlay, dental

Iron-deficiency Anaemia

See anaemia, iron-deficiency.... iron-deficiency anaemia

Lactase Deficiency

A condition in which there is an absence of lactase, an enzyme that breaks down lactose (milk sugar), in the cells of the small intestine.

Lactase deficiency results in a reduced ability to digest lactose, also known as lactose intolerance.

The condition may be permanent, or may occur temporarily after gastroenteritis, particularly in young children.

Symptoms include abdominal cramps, bloating, flatulence, and diarrhoea, all of which are caused by the laxative effect of the undigested sugar in the intestines.

Treatment is with a lactose-free diet.... lactase deficiency

Limb Defects

Incomplete development of one or more limbs at birth.

Limb defects are rare and may be inherited or form part of a syndrome.

In a condition called phocomelia, hands, feet, or tiny finger- or toe-buds are attached to limb stumps or grow directly from the trunk.

The sedative drug thalidomide, when taken by pregnant women, is known to have caused phocomelia in fetuses.... limb defects

Mineralization, Dental

The deposition of calcium crystals and other mineral salts in developing teeth. (See calcification, dental.)... mineralization, dental

Oppositional Defiant Disorder

A type of behavioural disorder that usually appears in childhood or early adolescence.

Typically, a child shows hostile, argumentative behaviour that includes loss of temper, defiance of rules, and swearing.

To some extent such behaviour is common in adolescence, but when law-breaking or violence occur the condition is deemed to be pathological.... oppositional defiant disorder

Manic–depressive Illness

A mental disorder that is characterized by a disturbance of mood. The disturbance may be unipolar (consisting of either depression or mania) or bipolar (swinging between the two). In a severe form that is sometimes referred to as manic– depressive psychosis, there may also be grandiose ideas or negative delusions.

Abnormalities in brain biochemistry, or in the structure and/or function of certain nerve pathways within the brain, could underlie manic–depressive illness. An inherited tendency is also an established causative factor.Severe manic–depressive illness often needs hospital treatment. Antidepressant drugs and/or ECT are used to treat depression, and antipsychotic drugs are given to control manic symptoms. Carbamazepine or lithium may be used to prevent relapse.

Group therapy, family therapy, and individual psychotherapy may be useful in treatment. Cognitive–behavioural therapy may also be helpful. With treatment, more than 80 per cent of patients improve or remain stable. Even those with severe illness may be restored to near normal health with lithium.... manic–depressive illness

Neural Tube Defect

A developmental failure affecting the spinal cord or brain of the embryo. The most serious defect is anencephaly (total lack of a brain), which is fatal. More common is spina bifida, in which the vertebrae do not form a complete ring around the spinal cord. Spina bifida can occur anywhere on the spine, but it is most common in the lower back.

There are different forms of spina bifida. In spina bifida occulta, the only defect is a failure of the fusion of the bony arches behind the spinal cord, which may not cause any problems. When the bone defect is more extensive, there may be a meningocele, a protrusion of the meninges, or a myelomeningocele, a malformation of the spinal cord. Myelomeningocele is likely to cause severe handicap, with paralysis of the legs, loss of sensation in the lower body, hydrocephalus, and paralysis of the anus and bladder, causing incontinence. Associated problems include cerebral palsy, epilepsy, and mental handicap.

Surgery is usually performed a few days after birth. In mild cases, the defect can usually be corrected, but in myelomeningocele, some handicap will remain.

Genetic factors play a part in neural tube defects, which show multifactorial inheritance. Couples who have had an affected child or who have a family history of neural tube defects should seek genetic counselling. The risk of a neural tube defect occurring can be substantially reduced if the mother takes folic acid supplements for a month before conception and during the early part of the pregnancy.

Ultrasound scanning and amniocentesis allow accurate antenatal testing for neural tube defects.... neural tube defect

Overcrowding, Dental

Excessive crowding of the teeth so that they are unable to assume their normal positions in the jaw. Dental overcrowding is commonly inherited and may occur because the teeth are too large for the jaw or the jaw is too small to accommodate the teeth. Premature loss of primary molar (back) teeth can cause the permanent teeth beneath them to move out of position and crowd the teeth further forward.

Overcrowded teeth may lead to malocclusion or may prevent certain teeth from erupting through the gum (see impaction, dental). They can be difficult to clean, increasing the risk of dental decay (see caries, dental) and periodontal disease.

Teeth may need to be extracted to allow room for others. Usually an orthodontic appliance is fitted to the remaining teeth to position them correctly.... overcrowding, dental

Plaque, Dental

A rough, sticky coating on the teeth consisting of saliva, bacteria, and food debris.

It is the chief cause of tooth decay (see caries, dental) and gingivitis, and forms the basis of a hard deposit (see calculus, dental).

Some of the microorganisms in plaque, particularly STREPTOCOCCUS MUTANS, break down sugar in the remains of carbohydrate food that sticks to the mucus, creating an acid that can erode tooth enamel.... plaque, dental

Postpartum Depression

See postnatal depression.... postpartum depression

Prosthetics, Dental

The branch of dentistry concerned with the replacement of missing teeth and their supporting structures. It includes dentures, overdentures (semipermanent fittings over existing teeth), crowns (see crown, dental), and bridges (see bridge, dental).

protease inhibitors A type of antiviral drug used to delay the progression of HIV infection (see AIDS).... prosthetics, dental

Pulp, Dental

The soft tissue containing blood vessels and nerves in the middle of each tooth (see teeth).... pulp, dental

Reimplantation, Dental

Replacement of a tooth in its socket after an accident so that it can become reattached to supporting tissues. The front teeth are most commonly involved. The tooth needs to be reimplanted soon after the accident and is maintained with a splint (see splinting, dental) while it heals. Healing may take several weeks.... reimplantation, dental

Resorption, Dental

Loss of substance from teeth. The loss may be external (affecting the surface of the root) or internal (affecting the wall of the pulp cavity). External resorption is part of the processs by which primary teeth are lost. Some degree of external resorption also occurs as part of the aging process, and may also be due to injury, inflammation of surrounding tissues, or pressure, for example from an impacted tooth.

Internal resorption is rare, occurring in about 1 percent of adults.... resorption, dental

Restoration, Dental

The reconstruction of part of a damaged tooth. Restoration also refers to the material or substitute part used to rebuild the tooth. Small repairs are usually made by filling the tooth. For extensive repairs, a dental inlay or a crown may be used. Chipped front teeth may be repaired by bonding (see bonding, dental).... restoration, dental

Scaling, Dental

Removal of dental calculi (see calcuus, dental) from the teeth to prevent or treat periodontal disease.... scaling, dental

Sealants, Dental

Plastic coatings that are applied to the chewing surfaces of the back teeth to help prevent decay.... sealants, dental

Seborrhoeic Dermatitis

See dermatitis.... seborrhoeic dermatitis

Sensorineural Deafness

Deafness due to problems with the inner ear, nerves, or the brain’s auditory area.... sensorineural deafness

Sex Determination

The factors that determine biological sex. The underlying determinants are the sex chromosomes which cause the differential development of the gonads in the embryo. In males, the testes then produce hormones that cause the male reproductive organs to

form. In the absence of these hormones, a female reproductive tract develops. At puberty, another surge of hormones produces secondary sexual characteristics.

Chromosomal abnormalities or hormonal defects can lead to ambiguous sex (see genitalia, ambiguous), although true hermaphroditism is rare.... sex determination

Sexual Desire, Inhibited

Lack of sexual desire or of the ability to become physically aroused during sexual activity.... sexual desire, inhibited

Sleep Deprivation

Insufficient sleep.

Irritability and a shortened attention span may occur after a short night’s sleep.

Longer periods without sleep leave a person increasingly unable to concentrate or perform normal tasks.

Three or more sleepless nights may lead to hallucinations and, in some cases, to paranoia.... sleep deprivation

Splinting, Dental

The mechanical joining of several teeth to hold them firmly in place while an injury heals or while periodontal disease is treated.... splinting, dental

Sudden Death

See death, sudden.... sudden death

Titanium Dental Implants

See implants, dental.... titanium dental implants

Tongue Depressor

A flat wooden or metal instrument used to hold the tongue on the floor of the mouth to allow examination of the throat.... tongue depressor

Walking, Delayed

Most children walk by around 15 months of age. Delayed walking may be suspected if the child is unable to walk unassisted by 18 months (see developmental delay).... walking, delayed

X-rays, Dental

See dental X-rays.... x-rays, dental

Abdominal Dehiscence

see burst abdomen.... abdominal dehiscence

Acquired Immune Deficiency Syndrome

see AIDS.... acquired immune deficiency syndrome

Ada Deficiency

see adenosine deaminase deficiency.... ada deficiency

Adenosine Deaminase Deficiency

(ADA deficiency) a genetic disorder affecting about one baby in 25,000 and characterized by a defect in adenosine deaminase (ADA), an enzyme that is involved in purine metabolism. Deficiency of this enzyme results in selective damage to the antibody-producing lymphocytes; this in turn leads to a condition known as *severe combined immune deficiency (SCID), in which the affected baby has no resistance to infection and must be entirely isolated from birth. Such children have only about a 50% chance of surviving for six months. See also gene therapy.... adenosine deaminase deficiency

Thrombosis, Deep Vein

The formation of a thrombus within deep-lying veins in the leg. The cause is usually a combination of slow blood flow through 1 part of the body (such as when sitting for long periods or when the tissues are compressed, as occurs in long-haul aircraft flights) and an increase in the clotting tendency of the blood, which occurs with dehydration, after surgery or injury, during pregnancy, and in women taking oral contraceptives. Deep vein thrombosis may also be caused by polycythaemia. Deep vein thrombosis is common in people with heart failure and those who have had a stroke or who have been immobile for long periods. Clots in the leg veins may cause pain, tenderness, swelling, discoloration, and ulceration of the skin, but they can be symptomless. A deep vein thrombosis is not necessarily serious in itself, but part of the clot may break off and travel in the bloodstream to the lungs. This is known as a pulmonary embolism.

A diagnosis is made by doppler ultrasound scanning.

Treatment depends on the site and extent of the clots.

Small clots may not need treatment if they are confined to the calf and the patient is mobile.

Otherwise, anticoagulant drugs or thrombolytic drugs are given.

If there is a high risk of a pulmonary embolism, thrombectomy may be performed.... thrombosis, deep vein

Advance Directive, Decision, Or Statement

(in England and Wales under the Mental Capacity Act 2005) a legally recognized decision or statement by an adult with *capacity identifying any specific or general treatment the patient does not want in the event that he or she loses capacity. An advance directive or decision (formerly often called a living will) should be informed, made voluntarily, and must be valid and applicable to the medical situation that arises; at the extreme it can constitute an advance refusal of potentially life-saving treatment. It cannot, however, be used to demand future treatment and does not apply as long as the person retains capacity. An advance statement is a more general and less legally binding expression of the person’s values and views on the sort of treatment he or she may or may not wish to undergo. Directives and statements can raise ethical questions: for example, should life-saving treatment refused in advance nevertheless be given if it could restore the patient to a quality of life with which he or she was content before losing capacity.... advance directive, decision, or statement

Age-related Macular Degeneration

(AMD, ARMD) see macular degeneration.... age-related macular degeneration

Alerting Device

see environmental hearing aid.... alerting device

Assistive Listening Device

a device for helping people with hearing difficulties. An assistive listening device can be a stand-alone device or can work in conjunction with a *hearing aid or *cochlear implant. Assistive listening devices include *induction loop systems, amplifiers for telephones, and radio headphones to wear when listening to the radio or television. Such devices increase the loudness of the desired sound without increasing the level of any background noise; i.e. they improve the signal-to-noise ratio. See also environmental hearing aid.... assistive listening device

Automated External Defibrillator

(AED) a type of external *defibrillator that can analyse the heart rhythm it detects and advise via voice prompts on therapy to be given according to the latest guidelines. In cases of ventricular fibrillation, some defibrillators will make decisions on delivering electric shocks and do so after issuing appropriate warnings to the attending health-care professionals.... automated external defibrillator

Biphasic Defibrillator

see defibrillator.... biphasic defibrillator

Boutonnière Deformity

(buttonhole deformity) a deformity seen in a finger when the central strand of the tendon of the extensor muscle of the digits is ruptured. This results in marked flexion of the middle phalanx across the proximal interphalangeal joint and hyperextension of the distal interphalangeal joint.... boutonnière deformity

Buttonhole Deformity

see boutonniére deformity.... buttonhole deformity

Calcium Pyrophosphate Deposition Disease

a condition in which calcium pyrophosphate is deposited in joints. The most common manifestation is *pseudogout, marked by acute pain, redness, and swelling resembling gout. Alternatively it may be asymptomatic in association with *chondrocalcinosis seen on X-ray, it may occur with osteoarthritis in the affected joint, or there may be chronic inflammation of the joint.... calcium pyrophosphate deposition disease

Choroidal Detachment

the separation of the *choroid from the *sclera of the eye as a result of leakage of fluid from the vessels of the choroid. It occurs when pressure inside the eyeball is very low, usually after trauma or intraocular surgery.... choroidal detachment

Decalcification

n. loss or removal of calcium salts from a bone or tooth.... decalcification

Decapitation

n. removal of the head, usually the head of a dead fetus to enable delivery to take place. This procedure is very rare nowadays, being undertaken only in dire circumstances when the fetal head is too large to pass through the birth canal, the mother’s life is endangered, and Caesarean section impossible.... decapitation

Decapsulation

n. see decortication.... decapsulation

Death Certificate

a legal document, signed by a doctor, stating (in Part 1) the immediate cause of a person’s death followed by diseases underlying the condition. For example, if the immediate cause of death was a myocardial infarction, the underlying disease might have been ischaemic heart disease or hypertension. Other diseases, which were not directly linked with the immediate cause of death but may have contributed to the patient’s overall condition, are mentioned in Part 2 of the certificate. The document usually states the decedent’s gender and date and place of death; other details, such as occupation, may also be included. The death certificate forms a vital record in most countries throughout the world; without a death certificate, there can be no funeral. For England and Wales, this information is held at the General Register Office, which is now in Southport. In Scotland death certificates are kept at the National Records of Scotland, and in Northern Ireland at the General Register Office for Northern Ireland. Following the case of the serial killer Dr Harold Shipman and the subsequent public enquiry, legislation has introduced greater checks on, and scrutiny of, death certification by doctors.... death certificate

Decay

n. (in bacteriology) the decomposition of organic matter due to microbial action.... decay

Deception

n. the act of deliberately misleading, misrepresenting, or withholding information. Respect for patient *autonomy and the importance of trust in therapeutic relationships require that doctors should always strive to be honest with patients. The use of deception in research (see intervention study) is ethically highly controversial. See also therapeutic privilege; truth-telling.... deception

Deci

prefix denoting a tenth.... deci

Declive

n. an area of the upper surface of the *cerebellum, posterior to the culmen and anterior to the folium of the middle lobe.... declive

Declotting

n. the removal of a blood clot from a thrombosed arteriovenous *fistula (which is created to perform dialysis). This can be done either by surgically opening the fistula and removing the clot or by using interventional radiological techniques (see fistuloplasty).... declotting

Decomposition

n. the temperature-dependent gradual disintegration of dead organic matter, usually foodstuffs or tissues, by the chemical action of bacteria and/or fungi.... decomposition

Decompression

n. 1. the reduction of pressure on an organ or part of the body by surgical intervention. Surgical decompression can be effected at many sites: the pressure of tissues on a nerve may be relieved by incision; raised pressure in the fluid of the brain can be lowered by cutting into the *dura mater; and cardiac compression – the abnormal presence of blood or fluid round the heart – can be cured by cutting the sac (pericardium) enclosing the heart. 2. the gradual reduction of atmospheric pressure for deep-sea divers, who work at artificially high pressures. See compressed air illness.... decompression

Decongestive Therapy

an approach that combines many of the different treatments (such as compression and physiotherapy) used to minimize the pain and swelling associated with *lymphoedema following breast surgery and radiotherapy. There are two phases: reduction (which lasts up to 12 weeks) and maintenance (which continues for life).... decongestive therapy

Decontamination

n. 1. a combination of processes used to remove adherent proteins, microorganisms, and infectious agents or other contaminants from surgical instruments and the environment so there is no risk or spread of infection or disease. Instruments are sterilized in an autoclave to finish the decontamination process. 2. the reduction or removal of chemical agents from a site following a terrorist attack or industrial accident; this includes decontaminating people who have come into contact with such agents.... decontamination

Decortication

n. 1. the removal of the outside layer (cortex) from an organ or structure, such as the kidney. 2. an operation for removing the blood clot and scar tissue that forms after bleeding into the chest cavity (haemothorax). 3. (decapsulation) the surgical removal of a *capsule from an organ; for example, the stripping of the membrane that envelops the kidney or of the inflammatory capsule that encloses a chronic abscess, as in the treatment of *empyema.... decortication

Deep Brain Stimulation

(DBS) a surgical treatment involving the implantation of a medical device that sends electrical impulses to specific parts of the brain. DBS in selected brain regions can provide benefits for treatment-resistant movement disorders, such as Parkinson’s disease, tremor, and *dystonia.... deep brain stimulation

Deep Transverse Arrest

mechanical obstruction of labour in which the fetal head is unable to rotate from occipitotransverse to occipitoanterior position (see occiput).... deep transverse arrest

Deer Fly

see Chrysops.... deer fly

Defence Mechanism

the means whereby an undesirable impulse or emotion can be avoided or controlled. Defence mechanisms are regarded as normal forms of self-protection; however, used excessively, they can become pathological. Many defence mechanisms have been described, including *repression, *projection, *reaction formation, *sublimation, and *splitting.... defence mechanism

Defensive Medicine

health care that becomes distorted by real or exaggerated fear of legal action so that medical decisions are taken with a view to protecting the professional against legal liability. See also negligence.... defensive medicine

Deferent

adj. 1. carrying away from or down from. 2. relating to the vas deferens.... deferent

Defervescence

n. the disappearance of a fever, a process that may occur rapidly or take several days, depending upon the cause and treatment given.... defervescence

Defibrillation Gel Pads

see coupling agents.... defibrillation gel pads

Defibrillator

n. the apparatus used for *defibrillation, which may be internal (see implantable cardiovertor defibrillator) or external. External defibrillators may be fully automated (see automated external defibrillator), semiautomated, or manual and usually deliver the electric current via two defibrillation paddles. They are now all manufactured to deliver a biphasic current waveform (until recently they were all monophasic). The efficacy of the first shock during *cardiac arrest is higher with biphasic systems, which also use less battery power per shock.... defibrillator

Defibrination

n. the removal of *fibrin, one of the plasma proteins that causes coagulation, from a sample of blood. It is normally done by whisking the blood with a bundle of fine wires, to which the strands of fibrin that form in the blood adhere.... defibrination

Deficiency

n. (in genetics) see deletion.... deficiency

Deficiency Disease

any disease caused by the lack of an essential nutrient in the diet. Such nutrients include *vitamins, minerals, *essential amino acids, and *essential fatty acids.... deficiency disease

Degarelix

n. a *gonadotrophin-releasing hormone antagonist used in the treatment of advanced prostate cancer that does not cause an initial increase in testosterone levels. Side-effects include hot flushes and pain at the injection site.... degarelix

Dehydroepiandrosterone

(DHEA) n. a weak androgen produced and secreted by the adrenal glands after the stage of adrenal maturation known as *adrenarche. It is produced from 17-hydroxypregnenolone and itself is largely converted to dehydroepiandrosterone sulphate and androstenedione. All three of these molecules can cause a degree of mild *androgenization but can also be converted in the circulation to the more potent androgens *testosterone and *dihydrotestosterone.... dehydroepiandrosterone

Dehydrogenase

n. see oxidoreductase.... dehydrogenase

Delayed Suture

(delayed primary closure) a technique used in the closure of contaminated wounds and wounds associated with tissue necrosis, such as those produced by missile injuries. The wound is partially closed after it has been cleaned sufficiently to allow adequate healing.... delayed suture

Deletion

(deficiency) n. (in genetics) a type of mutation involving the loss of DNA. The deletion may be small, affecting only a portion of a single gene, or large, resulting in loss of a part of a chromosome and affecting many genes.... deletion

Dellen

pl. n. localized areas of corneal thinning, usually at the limbus (the junction of the cornea with the sclera), due to local dehydration. They may occur after surgery to correct a squint, due to elevated conjunctiva at the limbus causing poor wetting of the adjacent cornea.... dellen

Delusional Intensity

the intensity with which a delusional belief is held. This can vary over time and sometimes shifts quite rapidly. Some factors, such as treatment, may temporarily or permanently reduce the intensity of a delusion, while others may work to reinforce it.... delusional intensity

Delusional Jealousy

a *delusional belief that one’s partner is unfaithful when there is no reasonable evidence for this. It often occurs in the context of *alcoholism.... delusional jealousy

Delusional Parasitosis

see delusional infestation.... delusional parasitosis

Delusional Perception

a *Schneiderian first-rank symptom in which a person believes that a normal percept (product of perception) has a special meaning for him or her. For example, a cloud in the sky may be misinterpreted as meaning that someone has sent that person a message to save the world. While the symptom is particularly indicative of *schizophrenia, it also occurs in other psychoses, including *mania (in which it often has grandiose undertones).... delusional perception

Delusion Of Reference

a *delusion in which the patient believes that unsuspicious occurrences refer to him or her in person. Patients may, for example, believe that certain news bulletins have a direct reference to them, that music played on the radio is played for them, or that car licence plates have a meaning relevant to them. Ideas of reference differ from delusions of reference in that insight is retained.... delusion of reference

Deliberate Self-harm

any attempt at self-injury or self-poisoning, as often occurs in the context of acute stress, personality disorder, depression, and alcoholism. It may or may not involve suicidal intent. Treatment begins with a psychosocial assessment, on the basis of which the patient may be offered various forms of *psychotherapy and occasionally *antipsychotic medication, *lithium, or *SSRIs. If the attempt is serious, immediate treatment may be necessary in a medical ward or (more rarely), if suicidal intent persists, in a psychiatric ward. Patients who do not have a mental disorder should be assessed using the criteria set out in the Mental Capacity Act 2005 and, if found to have *capacity, are entitled to consent to or refuse treatment like any other capacitous adult. See also suicide.... deliberate self-harm

Delusional Infestation

a *monodelusional disorder in which patients believe they or their environment are infested by living or non-living pathogens. These can range from rats in the patient’s house to microspores in the air. Most commonly, patients claim they are infested with insects, worms, parasites, mites, or inanimate threads or fibres, often underneath their skin. Many present the alleged parasite as a specimen for examination. If compliance can be established, most patients respond well to *antipsychotic medication. The term delusional infestation was first introduced by Roland W. Freudenmann and Peter Lepping in 2009, and has gradually superseded the terms delusional parasitosis and Ekbom’s syndrome.... delusional infestation

Delusion By Proxy

a delusion in which the patient believes that another person or an animal (usually the patient’s pet) has certain physical symptoms, even though these cannot be objectively verified. The patient with the delusional belief is called the inducer; the person or pet that is allegedly affected is the proxy. Some *monodelusional disorders, such as *delusional infestation, have a prevalence of delusion by proxy of up to 5%. Treatment is usually with *antipsychotics. In some situations it may be necessary to remove the proxy to provide safety from the behaviour associated with the delusion. See also double delusion; folie à deux.... delusion by proxy

Demeclocycline

n. a *tetracycline antibiotic that is used to treat infections caused by Chlamydia, rickettsiae, and mycoplasmas. It is also used to treat *syndrome of inappropriate secretion of antidiuretic hormone. Common side-effects are nausea, diarrhoea, and symptoms resulting from the growth of organisms not sensitive to the drug.... demeclocycline

Demodex

n. a genus of harmless parasitic mites, the follicle mites, found in the hair follicles and associated sebaceous glands of the face. They resemble tiny worms, about 0.4 mm in length, and their presence may give rise to dermatitis.... demodex

Denaturation

n. the changes in the physical and physiological properties of a protein that are brought about by heat, X-rays, or chemicals. These changes include loss of activity (in the case of enzymes) and loss (or alteration) of antigenicity (in the case of *antigens).... denaturation

Dendrite

n. one of the shorter branching processes of the cell body of a *neuron, which makes contact with other neurons at synapses and carries nerve impulses from them into the cell body.... dendrite

Dendritic Cell

a type of haemopoietic cell with specialized antigen-presenting functions. The head and neck are common sites for dendritic cell pathology. See antigen-presenting cell.... dendritic cell

Denosumab

n. a *monoclonal antibody most commonly used in the treatment of postmenopausal osteoporosis to prevent fractures but also indicated at a higher dose to prevent bone damage in patients with bone metastases. Side-effects include a risk of low calcium, infections, joint pains, fatigue, and headache, all more common with the higher doses.... denosumab

Dens

n. a tooth or tooth-shaped structure.... dens

Dense Deposit Disease

see mesangiocapillary glomerulonephritis.... dense deposit disease

Dens Invaginatus

literally, an infolded tooth: a specific type of tooth malformation that mainly affects upper lateral incisors to varying degrees. Also known as a dens in dente (‘tooth within a tooth’), it involves an infolding of enamel into dentine.... dens invaginatus

Dent

(denti-, dento-) combining form denoting the teeth. Example: dentoalveolar (relating to the teeth and associated jaw).... dent

Dental Chair

a reclinable chair on which a patient lies for dental treatment. Electric switches change the position of the patient, and the chair is frequently attached to the *dental unit.... dental chair

Dental Floss

a fine thread, usually of nylon, used to clean the surfaces between teeth. A thicker version is known as dental tape. It may be waxed to help the user slide it past the tooth contacts.... dental floss

Dental Handpiece

a piece of dental equipment (high-speed or low-speed) for holding a dental *bur or *file. It is made of corrosion-resistant materials to allow sterilization. See drill.... dental handpiece

Dental Care Professional

any of several professionals supporting a dentist, formerly referred to as dental auxiliaries and professionals complementary to dentistry. A dental hygienist performs scaling and instruction in oral hygiene. A dental nurse helps the dentist at the chairside by preparing materials, passing instruments, and aspirating fluids from the patient’s mouth. A dental technician constructs dentures, crowns, and orthodontic appliances in the laboratory for the dentist. A clinical dental technician provides dentures directly to patients. A dental therapist performs non-complex treatment under the prescription of a dentist. In the UK dental care professionals are required to be statutorily registered with the General Dental Council (GDC).... dental care professional

Dental Implant

see implant.... dental implant

Dental Nerve

either of two nerves that supply the teeth; they are branches of the trigeminal nerve. The inferior dental nerve supplies the lower teeth and for most of its length exists as a single large bundle; thus anaesthesia of it has a widespread effect (see inferior dental block). The superior dental nerve, which supplies the upper teeth, breaks into separate branches at some distance from the teeth and it is possible to anaesthetize these individually with less widespread effect for the patient.... dental nerve

Dental Nurse

see dental care professional.... dental nurse

Dental Pantomogram

(DPT) a special form of tomogram (see tomography) that provides a picture of all the teeth of both jaws on one film. Newer equipment can produce three-dimensional images of part of the jaw.... dental pantomogram

Dental Unit

a major fixed piece of dental equipment to which are attached the dental drills, aspirator, compressed air syringe, and ultrasonic scaler. It is frequently integral with the *dental chair.... dental unit

Dentate

adj. 1. having teeth. 2. serrated; having toothlike projections.... dentate

Dentinogenesis

n. the formation of *dentine by *odontoblasts. Although dentinogenesis continues throughout life, very little dentine is formed later than a few years after tooth eruption unless it is stimulated by caries, abrasion, or trauma. Dentinogenesis imperfecta is a hereditary condition in which dentine formation is disturbed; this may result in loss of overlying enamel and excessive wear of the dentine.... dentinogenesis

Dent’s Disease

a rare X-linked (see sex-linked) recessive inherited condition usually presenting in childhood or early adult life with polyuria, microscopic haematuria, renal stone disease, or rickets. The majority of patients have a mutation of the gene encoding chloride channel 5 (CLCN5); others have a defect of the OCRL1 gene, normally associated with Lowe’s syndrome, but do not present with the cataracts, learning disability, and tubular acidosis associated with this condition. In still others the genetic defect has yet to be defined but is not associated with either CLCN5 or OCRL1. Patients with Dent’s disease have evidence of proximal tubular dysfunction. [C. E. Dent (1911–76), British physician]... dent’s disease

Denys–drash Syndrome

a rare disorder consisting of the triad of *nephroblastoma (Wilms’ tumour), congenital nephropathy, and intersex disorders, resulting from mutations in the Wilm’s tumour suppressor gene (WT1). Incomplete forms exist; congenital nephropathy, with diffuse mesangial sclerosis, is the constant feature with either Wilms’ tumour or intersex disorders, usually in the form of male *pseudohermaphroditism. [P. Denys (20th century), French physician; A. Drash (20th century), British physician]... denys–drash syndrome

Deoxycholic Acid

see bile acids.... deoxycholic acid

Deoxycorticosterone

n. a hormone, synthesized and released by the adrenal cortex, that regulates salt and water balance. See also corticosteroid.... deoxycorticosterone

Deoxyribonuclease

n. an enzyme, located in the *lysosomes of cells, that splits DNA at specific places in the molecule.... deoxyribonuclease

Department Of Health And Human Services

(HHS) the major US government agency providing health care. The department was created in 1953 and assumed its current name in 1980. HHS administers more than 300 health and health-related programmes and services, including *Medicare and *Medicaid. Other activities include research, immunization services, and providing financial assistance for low-income families. Almost a quarter of federal spending occurs through HHS.... department of health and human services

Dependent Practitioner

in the USA, a paraprofessional or subprofessional health-care worker who is allowed to provide a limited amount of treatment to patients, usually under the supervision of a licensed practitioner, such as a physician. Examples include a nurse practitioner or occupational therapist.... dependent practitioner

Depolarization

n. the sudden surge of charged particles across the membrane of a nerve cell or a muscle cell that accompanies a physicochemical change in the membrane and cancels out, or reverses, its resting potential to produce an *action potential. The passage of a *nerve impulse is a rapid wave of depolarization along the membrane of a nerve fibre.... depolarization

Deontology

n. an approach to ethics that is concerned with what makes an action inherently right or wrong. Deontology’s emphasis on the primacy of observing duties and respecting rights is at odds with the approach that judges actions by their outcomes (see consequentialism). This tension is central to many issues in medical ethics; for example, in relation to *euthanasia, the wrong of killing versus the good outcome of ending suffering, and is further complicated when rights or duties are in conflict with one another, e.g. in relation to *abortion, the rights of the mother versus the rights of the fetus. See also Kantian ethics. —deontological adj.... deontology

Department Of Health And Social Care

(DHSC) (in Britain) a department of central government that supports the Secretary of State for Health and Social Care in meeting his or her obligations, which include the *National Health Service, the promotion and protection of the health of the nation, and social care, including some oversight of personal social services provided by local authorities. The department is staffed by civil servants, including some health professionals. Following the reforms of the Health and Social Care Act 2012, the Department no longer has direct control of the NHS, which has passed to *NHS England. The name of the department was expanded from ‘Department of Health’ in 2018. Equivalent departments support the ministers responsible for health services in Scotland, Wales, and Northern Ireland.

DHSC section of the website: provides information on a wide range of public health issues... department of health and social care

Depressant

n. an agent that reduces the normal activity of any body system or function. Drugs such as general *anaesthetics, *barbiturates, and opioids are depressants of the central nervous system and respiration. *Cytotoxic drugs, such as azathioprine, are depressants of the levels of white blood cells.... depressant

Dermacentor

n. a genus of hard *ticks, worldwide in distribution, the adults of which are parasites of humans and other mammals. The wood tick, D. andersoni, transmits Rocky Mountain spotted fever to humans in the western USA and the dog tick, D. variabilis, is the vector of this disease in the east.... dermacentor

Dermanyssus

n. a genus of widespread parasitic mites. The red poultry mite, D. gallinae, is a common parasite of wild birds in temperate regions but can also infest poultry. It occasionally attacks and takes a blood meal from humans, causing itching and mild dermatitis.... dermanyssus

Dermatobia

n. a genus of nonbloodsucking flies inhabiting lowland woods and forests of South and Central America. The parasitic maggots of D. hominis can cause a serious disease of the skin in humans (see myiasis). The maggots burrow into the skin, after emerging from eggs transported by bloodsucking insects (e.g. mosquitoes), and produce painful boil-like swellings. Treatment involves surgical removal of the maggots.... dermatobia

Dermatochalasis

n. redundant eyelid skin, which may cause drooping of the upper lid. It usually occurs as a result of ageing. Compare blepharochalasis.... dermatochalasis

Dermatofibrosarcoma Protuberans

a tumour probably derived from *histiocytes that may occur in any part of the body. It is locally invasive but tends not to metastasize. It often recurs locally despite excision.... dermatofibrosarcoma protuberans

Dermatology Life Quality Index

(DLQI) a validated questionnaire designed by Finlay in 1994 to assess the impact of skin diseases on psychological and social wellbeing. It is the most common *quality of life tool used as an endpoint in dermatology clinical trials. DLQI scores of more than 10 (indicating a severe impact on life) are required before biological treatments for psoriasis may be administered in the UK.... dermatology life quality index

Dermatophagoides

n. a genus of *mites that have been detected in samples of dust taken from houses in various parts of Europe. House-dust mites feed on human skin and scales and cause dermatitis of the scalp. Waste products from the mites produce an allergic response in susceptible people that is an important trigger for some forms of *rhinitis and *asthma.... dermatophagoides

Dermatosis

n. any disease of skin, particularly one without inflammation. In juvenile plantar dermatosis, which affects children up to the age of 14, the skin on the front of the sole becomes red, glazed, and symmetrically cracked. This condition, which settles spontaneously after a number of years, is believed to be related to the wearing of trainers.... dermatosis

Dermoscopy

(dermatoscopy) n. the process whereby skin lesions are examined by a dermatoscope (an instrument with a magnifier and a nonpolarized light source). The dermatoscope is pressed firmly on the skin with a liquid medium (e.g. oil) between the instrument and the skin. The technique allows closer examination of pigment networks, vascular structures, etc., and may help to distinguish benign from malignant lesions.... dermoscopy

Descemetocele

n. thinning of the *stroma of the cornea to such an extent that *Descemet’s membrane is all that is maintaining the integrity of the eyeball. It occurs in severe ulceration of the cornea.... descemetocele

Dexa

(dual-energy X-ray absorptiometry) a method of measuring bone density based on the proportion of a beam of photons that passes through the bone. The results of a DEXA scan are expressed as a *T score. See also osteoporosis.... dexa

Dexamethasone Suppression Tests

(DSTs) tests based on the principle that appropriate doses of *dexamethasone can suppress the output of cortisol from the adrenal glands in the normal state and that this ability is reduced or lost in *Cushing’s syndrome. In the overnight DST 1 mg of dexamethasone is administered at midnight and the serum cortisol level is measured at 9.00 am the next morning. Failure to suppress cortisol output may indicate Cushing’s syndrome but also occurs in patients with obesity and depressive illness. In the low-dose DST (0.5 mg dexamethasone every 6 hours for 48 hours), cortisol suppression occurs in patients with obesity and depression but not in those with Cushing’s syndrome. In the high-dose DST (2 mg dexamethasone every 6 hours for 48 hours), cortisol is suppressed in patients with Cushing’s disease (in which excess amounts of ACTH are secreted by the pituitary gland) but not in those with Cushing’s syndrome due to other causes. Although the low- and high-dose tests are unreliable, all three tests should be performed to aid the diagnosis of Cushing’s syndrome.... dexamethasone suppression tests

Dextr

(dextro-) combining form denoting 1. the right side. Example: dextroposition (displacement to the right). 2. (in chemistry) dextrorotation.... dextr

Dextrin

n. a carbohydrate formed as an intermediate product in the digestion of starch by the enzyme amylase. Dextrin is used in the preparation of pharmaceutical products (as an *excipient) and surgical dressings.... dextrin

Differences Of Sexual Development

(DSDs) see intersex.... differences of sexual development

Disorders Of Sexual Development

(DSDs) see intersex.... disorders of sexual development

Dissociated Vertical Deviation

(DVD) a condition in which one eye looks upwards when the amount of light entering it is reduced, e.g. when it is covered. The eye returns to its original position when the cover is removed. DVD is an acquired condition chiefly associated with infantile esotropia (convergent *strabismus). The deviation is dissociated since there is no movement of the focusing (i.e. uncovered) eye during the deviation or return phase.... dissociated vertical deviation

Double Delusion

the situation in which a patient (the inducer) presents with delusional symptoms that he or she believes to be shared by someone else who is incapable of expressing them (typically a child or a pet). This is different from a *delusion by proxy, in which the inducer does not claim to be experiencing the symptoms himself or herself. The term was introduced in 2015 by Peter Lepping, Mark Rishniw, and Roland Wolfgang Freudenmann. Compare folie à deux.... double delusion

Early Neonatal Death

see perinatal mortality rate.... early neonatal death

Eye Movement Desensitization And Reprocessing Therapy

(EMDR) a type of psychotherapy used for the treatment of significant anxiety or distress caused by traumatic events or in the context of *post-traumatic stress disorder. The aim is to separate the emotional from the actual memory of the event in order to reduce the anxiety related to the memory.... eye movement desensitization and reprocessing therapy

Flat-panel Detector

a piece of equipment used instead of a conventional X-ray film to acquire the image in *digital radiography.... flat-panel detector

Frontotemporal Dementia

(FTD) a relatively rare neurodegenerative disease characterized by progressive loss of neurons predominantly involving the frontal and/or temporal lobes. First described by Arnold Pick in 1892, it was originally called Pick’s disease. Common symptoms include significant changes in social and personal behaviour, *abulia, blunting of emotions, and language deficits. Compared with *Alzheimer’s disease, a younger population is affected (age 55–65) and more cases have a genetic cause.... frontotemporal dementia

Glutamate Dehydrogenase

(glutamic acid dehydrogenase) an important enzyme involved in the *deamination of amino acids.... glutamate dehydrogenase

Glutamic Acid Decarboxylase

(GAD) a common enzyme that, because of similarities to certain bacterial proteins, can provoke an autoimmune reaction against the beta cells of the pancreas (see islet cell antibodies) progressing to type 1 *diabetes mellitus.... glutamic acid decarboxylase

Home Delivery

see community midwife.... home delivery

Hunchback Deformity

see kyphos.... hunchback deformity

Immuno- Combining Form Denoting Immunity Or Immunological Response.

... immuno- combining form denoting immunity or immunological response.

Implantable Cardiovertor Defibrillator

(ICD) a self-contained device, similar to a *pacemaker, that monitors heart rhythm and delivers an electric shock to correct life-threatening arrhythmia. See also defibrillator.... implantable cardiovertor defibrillator

Glucose-6-phosphate Dehydrogenase Deficiency

a hereditary disorder – an X-linked condition (see sex-linked) – in which the absence of the enzyme glucose-6-phosphate dehydrogenase (G6PD), which functions in carbohydrate metabolism, results in the breakdown of the red blood cells (*haemolysis), usually after exposure to *oxidants, such as drugs, or infections. The breakdown causes acute attacks that are characterized by pallor, loin pain, and rigors. There are several varieties of G6PD deficiency, which is most common in people of African, Middle Eastern, and Mediterranean descent. Treatment involves identifying and avoiding agents that trigger the haemolysis and treating acute attacks symptomatically. See also favism.... glucose-6-phosphate dehydrogenase deficiency

Inferior Dental Block

(inferior alveolar nerve block) a type of injection to anaesthetize the inferior *dental nerve. Inferior dental block is routinely performed to allow dental procedures to be carried out on the lower teeth on one side of the mouth.... inferior dental block

Inferior Dental Canal

a bony canal in the *mandible on each side. It carries the inferior *dental nerve and vessels and for part of its length its outline is visible on a radiograph.... inferior dental canal

Intrauterine Fetal Death

death of a fetus in the uterus after 24 weeks of gestation. See stillbirth.... intrauterine fetal death

Iron Dextran

a drug containing *iron and *dextran, administered to treat iron-deficiency anaemia. Side-effects can include pain at the site of injection, rapid beating of the heart, and allergic reactions.... iron dextran

Juvenile Plantar Dermatosis

see dermatosis.... juvenile plantar dermatosis

Late Neonatal Death

death of a baby between 7 and 27 completed days of life.... late neonatal death

Lip Licker’s Dermatitis

an irritant contact *dermatitis caused by saliva produced during habitual licking of the lips and the surrounding skin in an attempt to moisten dry chapped lips. The mainstay of treatment is regular frequent application of a moisturizing agent.... lip licker’s dermatitis

Mal De Debarquement Syndrome

(MdDS, disembarkment syndrome) a form of *vertigo in which sufferers experience a sensation of bobbing, rocking, or swaying after getting off a boat or other form of transport. The condition remains little understood.... mal de debarquement syndrome

Maternal Death

deaths of women while pregnant or within 42 days of the end of the pregnancy from any cause related to, or aggravated by, the pregnancy or its management, but not from accidental or incidental causes. These deaths can be subdivided into four main categories: (1) direct deaths: directly related to pregnancy; (2) indirect deaths: due to pre-existing maternal disease aggravated by pregnancy; (3) coincidental: unrelated to pregnancy; (4) late deaths: occurring between six weeks and one year following delivery. See also maternal mortality rate.... maternal death

Miller–deiker Syndrome

a chromosomal abnormality resulting in a characteristic facial appearance and the absence of the grooves on the surface of the brain (see lissencephaly). Affected individuals have severe learning disabilities.... miller–deiker syndrome

Monophasic Defibrillator

see defibrillator.... monophasic defibrillator

Nhs Trust Development Authority

formerly, a *special health authority of the NHS established under the Health and Social Care Act 2012 to oversee NHS trusts without *foundation trust status and to support their transition to such status. The Authority closed in 2016, when its functions were transferred to the newly established *NHS Improvement.... nhs trust development authority

Oxygen Deficit

a physiological condition that exists in cells during periods of temporary oxygen shortage. During periods of violent exertion the body requires extra energy, which is obtained by the breakdown of glucose in the absence of oxygen, after the available oxygen has been used up. The breakdown products are acidic and cause muscle pain. The oxygen required to get rid of the breakdown products (called the oxygen deficit) must be made available after the exertion stops.... oxygen deficit

Paediatric Dentistry

the branch of dentistry concerned with the oral health care of children and adolescents.

Paediatric reference values... paediatric dentistry

Perineal Descent

abnormal bulging down of the *perineum as a result of weakness of the pelvic floor muscles. It often accompanies problems with defecation and micturition.... perineal descent

Plastibell Device

a plastic device that facilitates *circumcision while protecting the glans penis. It is widely used for circumcisions in newborn boys.... plastibell device

Platelet-derived Growth Factor

(PDGF) see growth factor.... platelet-derived growth factor

Practice Development

a policy of actively and continuously improving patient care, with an emphasis on interprofessional collaboration and the integration of evidence-based practice with *person-centred care.... practice development

Probing Depth

a measurement of the depth of a periodontal pocket (see periodontal disease).... probing depth

Proxy Decision

(surrogate decision) a decision made with or on behalf of a person who lacks full legal capacity to *consent to or refuse medical treatment. See best interests; Gillick competence; parental responsibility; power of attorney; substituted judgment.... proxy decision

Psychosexual Development

the process by which an individual becomes more mature in his or her sexual feelings and behaviour. Gender identity, sex-role behaviour, and choice of sexual partner are the three major areas of development. In Freudian psychoanalysis the phrase is sometimes used specifically for a sequence of stages, supposed by psychoanalytic psychologists to be universal, in which oral, anal, phallic, latency, and genital stages successively occur. These stages reflect the parts of the body on which sexual interest is concentrated during childhood development.... psychosexual development

Public Access Defibrillation Programmes

programmes of lay education in the UK that aim to provide training in cardiac resuscitation up to and including *defibrillation. Together with programmes to increase the availability of *automated external defibrillators in public places (e.g. shops and railway stations), they recognize that the best outcomes from cardiac resuscitation are obtained with early defibrillation and good bystander basic life support.... public access defibrillation programmes

Relative Density

see specific gravity.... relative density

Salt Depletion

excessive loss of sodium chloride (common salt) from the body. This may result from sweating, persistent vomiting or diarrhoea, or loss of fluid in wounds. The main symptoms are muscular weakness and cramps. Miners and workers in hot climates are particularly at risk, and salt tablets are often taken as a preventive measure.... salt depletion

Salzmann’s Degeneration

a noninflammatory condition of the cornea resulting in yellow-white nodules under the epithelium in the central area. These may cause symptoms if the epithelium over them breaks down or if they are located along the visual axis. [M. Salzmann (1862–1954), German ophthalmologist]... salzmann’s degeneration

Severe Combined Immune Deficiency

(SCID) a rare disorder that usually manifests itself within the first three months of life by severe bacterial, fungal, and viral infection and *failure to thrive. It is due to reduced numbers of T and B *lymphocytes – white blood cells necessary for fighting infection. Some cases are caused by *adenosine deaminase deficiency. The only treatment currently available is a bone-marrow transplant, but *gene therapy offers hope for the future.... severe combined immune deficiency

Shared Delusion

see folie à deux.... shared delusion

Skew Deviation

a neurological condition of the eyes in which one eye turns down while the other turns up. It is seen in disorders of the *cerebellum or *brainstem.... skew deviation

Spinocerebellar Degeneration

any of a group of inherited disorders of the cerebellum and corticospinal tracts in the brain. They are characterized by *spasticity of the limbs and cerebellar *ataxia.... spinocerebellar degeneration

Sprengel’s Deformity

a congenital abnormality of the scapula (shoulder blade), which is small and positioned high in the shoulder. It is caused by failure of the normal development and descent of this bone. [O. G. K. Sprengel (1852–1915), German surgeon]... sprengel’s deformity

Sudden Unexpected Death In Epilepsy

(SUDEP) the sudden unexpected nontraumatic death of a person with *epilepsy, with or without evidence of a seizure and with no obvious cause found at post mortem.... sudden unexpected death in epilepsy

Superior Canal Dehiscence Syndrome

(SCDS) a rare condition characterized by sound- or pressure-induced vertigo (see Tullio phenomenon), hearing loss, *autophony, and a sense of fullness in the affected ear. It is associated with absence of the bone that normally lies over the superior *semicircular canal. Diagnosis involves computerized tomography and *vestibular evoked myogenic potential testing. Treatment involves surgery to repair the bony defect.... superior canal dehiscence syndrome

Surrogate Decision

see proxy decision.... surrogate decision

Vascular Dementia

see dementia.... vascular dementia

Ventricular Assist Device

(VAD) a mechanical pump implanted in the body for the purpose of taking over some or all of the pumping action of the heart in patients with severe heart damage. Support may be given to the left ventricle (LVAD), right ventricle (RVAD), or both. Most such devices require *thoracotomy, but a percutaneous device is now also available. This is usually regarded as a temporary measure until the heart has recovered or is transplanted.... ventricular assist device

Very Low-density Lipoprotein

(VLDL) a *lipoprotein that is the precursor of *low-density lipoprotein (LDL). Containing triglycerides and cholesterol, it is produced in the liver and circulates in the bloodstream, where its triglycerides are hydrolysed to free fatty acids by *lipoprotein lipase. The remaining lipoprotein becomes progressively denser and richer in cholesterol to form LDL.... very low-density lipoprotein

Vitelliform Degeneration

(Best’s disease) degeneration of the *macula of the eye that is inherited as a dominant characteristic and usually starts in childhood. There is widespread abnormality of retinal pigment epithelium (see retina) with the accumulation of a yellowish material, especially in the macular area.... vitelliform degeneration

Vitreous Detachment

the separation of the *vitreous humour from the underlying retina. This is a normal ageing process, but it is also more common in such conditions as diabetes and severe myopia. It can sometimes cause a tear in the retina and lead to *retinal detachment.... vitreous detachment

Waiter’s-tip Deformity

see Erb’s palsy.... waiter’s-tip deformity

Wallerian Degeneration

degeneration of a ruptured nerve fibre that occurs within the nerve sheath distal to the point of severance. [A. V. Waller (1816–70), British physician]... wallerian degeneration

Water-deprivation Test

a test for *diabetes insipidus in which fluid and food intake is withheld completely for up to 24 hours, with regular measurement of plasma and urinary *osmolality and body weight. Normally (and in a person with psychogenic *polydipsia) the output of *vasopressin will be increased in order to concentrate the urine as the plasma osmolality rises; correspondingly, the urine osmolality also rises and its volume diminishes. In a patient with diabetes insipidus, however, the urine osmolality will remain low and of high volume while the patient steadily dehydrates. The test must be abandoned if the patient loses 3% of body weight.... water-deprivation test

Deertongue

Carphephorus odoratissimus

FAMILY: Asteraceae (Compositae)

SYNONYMS: Trilisa odoratissima, Liatris odoratissima, Frasera speciosa, hound’s tongue, deer’s tongue, Carolina vanilla, vanilla leaf, wild vanilla, vanilla trilisa, whart’s tongue, liatrix (oleoresin or absolute).

GENERAL DESCRIPTION: A herbaceous perennial plant distinguished by a naked receptacle and feathery pappus, with large, fleshy, dark green leaves, clasped at the base. When fresh, the leaves have little odour but when dried they acquire a vanilla-like odour, largely due to the coumarin that can be seen in crystals on the upper sides of the leaves.

DISTRIBUTION: Native to eastern USA; gathered on the savannah land between North Carolina and Florida.

OTHER SPECIES: There are several species of deertongue native to America, for example blazing star or prairie pine (Liatris squarrosa), and gayfeather (L. spicata). Not to be confused with the common vanilla (Vanilla planifolia) or with the European hound’s tongue (Cynoglossum officinale), all of which have been used in herbal medicine.

HERBAL/FOLK TRADITION: The roots have been used for their diuretic effects, and applied locally for sore throats and gonorrhoea. It has also been used as a tonic in treating malaria. In folklore the plant is associated with contraception and sterility in women.

ACTIONS: Antiseptic, demulcent, diaphoretic, diuretic, febrifuge, stimulant, tonic.

EXTRACTION: Oleoresin by solvent extraction from the dried leaves.

CHARACTERISTICS: A dark green, heavy, viscous liquid with a rich, herbaceous, new-mown hay scent. It blends well with oakmoss, labdanum, lavandin, frankincense, clove, patchouli and oriental-type fragrances.

PRINCIPAL CONSTITUENTS: Mainly coumarin (1.6 per cent), with dihydrotoumarin and terpenes, aldehydes and ketones.

SAFETY DATA: ‘Coumarin has toxic properties including liver injury and haemorrhages.’. (There is also the possibility of dermal irritation and phototoxicity due to the lactones present.)

AROMATHERAPY/HOME: USE None.

OTHER USES: The oleoresin is used as a fixative and fragrance component in soaps, detergents and perfumery work. Used for flavouring tobacco and; also employed for the isolation of coumarin.... deertongue

Decongestive

an agent for the relief or reduction of congestion, e.g. mucous.... decongestive



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