A condition characterised by the eruption of circumscribed discrete and confluent reddish, silvery scaled lesions... psoriasis

An unpleasant sensory or emotional experience that is derived from sensory stimuli and modified by individual memory, expectations and emotions.... pain

Forcible and/or irregular beating of the HEART such that the person becomes conscious of its action.

Causes As a rule, a person is not conscious of the beating of the heart except when the nervous system is unduly excited. A disorder of the rhythm of the heart (ARRHYTHMIA) may cause palpitations. Sudden emotions, such as fright, or overuse of tobacco, tea, co?ee or alcohol may bring it on. Sometimes it may appear in people with organic heart disease.

Symptoms There may simply be a ?uttering of the heart and a feeling of faintness, or the heart may be felt pounding and the arteries throbbing, causing great distress. The subject may be conscious of the heart missing beats.

Treatment Although these symptoms can be unpleasant, they do not necessarily signify serious disease. Moderate exercise is a good thing. If the person is a smoker, he or she should stop. Tea, co?ee, alcohol or other stimulants should be taken sparingly. If symptoms persist or are severe, the individual should see a doctor and any underlying disorder should be investigated – including by exercise ECG – and treated. The BETA-ADRENOCEPTOR-BLOCKING DRUGS are the most useful drugs in controlling the palpitations of anxiety and those due to some cardiac arrhythmias.... palpitation

Inflammation of the pancreas... pancreatitis

Benign epithelial neoplasm in which neoplastic cells cover finger-like processes of dermis. Also anybenign epithelial neoplasm growing outward from an epithelial surface.... papilloma

Stroke affecting one side... paraplegia

Disease, particularly one with clear and obvious changes in structure or function; the study of same.... pathology

Inflammation of the mucous membrane and underlying part of the pharynx... pharyngitis

Any dummy medical treatment or intervention. Originally, a medicinal preparation having no specific pharmacological activity against the person’s illness or complaint and given solely for the psychophysiological effects of the treatment. More recently, a dummy treatment administered to the control group in a controlled clinical trial in order that the specific and non-specific effects of the experimental treatment can be distinguished.... placebo

Inflammation of lung tissue... pneumonia

The number of events, such as instances of a given disease, condition or other attribute, present at a particular time. Sometimes used to mean prevalence rate. When used without qualification, the term usually refers to the situation at a specified point in time (point prevalence). annual prevalence: The total number of persons with a given disease or attribute at any time during a year. lifetime prevalence: The total number of persons known to have had a given disease or attribute for at least part of their lives. period prevalence: The total number of persons known to have had a given disease or attribute at any time during a specified period. point prevalence: The total number of persons with a given disease or attribute at a specified point in time. See also “incidence”.... prevalence

An eruption of the skin causing severe itching... prurigo

Itching... pruritus

An inflammation of the kidney pelvis, the interface between the urine-secreting inner surface of the kidney and the muscular ureter that drains into the bladder. It can be caused by kidney stones or an infection that has progressed up from the lower urinary tract. It alone is a serious condition...the next stage, pyelonephritis, since it involves the whole kidney, is still worse.... pyelitis

A condition characterised by the presence of pus... pyrexia

A painful chronic heart condition, characterized by an oppressive sensation, difficulty breathing, and pain in the chest or arms. Attacks are often triggered by exertion or a sudden adrenergic discharge, and the underlying cause is insufficient blood supply to the heart muscles... angina pectoris

A severe illness caused by the Gram negative rod, Yersinia pestis. The reservoirs for the infection are various species of rodent and the bacteria are transmitted through the bite of the rat flea, Xenopsylla cheopis. Patients present with enlarged lymph glands (‘buboes’) often in the groin or armpit. Can become septicaemic or develop into a pneumo nia (‘Pneumonic Plague’) and spread by droplet. Also known in the past as “The Black Death”.... bubonic plague

Blood pressure is that pressure which must be applied to an artery in order to stop the pulse beyond the point of pressure. It may be roughly estimated by feeling the pulse at the wrist, or accurately measured using a SPHYGMOMANOMETER. It is dependent on the pumping force of the heart, together with the volume of blood, and on the elasticity of the blood vessels.

The blood pressure is biphasic, being greatest (systolic pressure) at each heartbeat and falling (diastolic pressure) between beats. The average systolic pressure is around 100 mm Hg in children and 120 mm Hg in young adults, generally rising with age as the arteries get thicker and harder. Diastolic pressure in a healthy young adult is about 80 mm Hg, and a rise in diastolic pressure is often a surer indicator of HYPERTENSION than is a rise in systolic pressure; the latter is more sensitive to changes of body position and emotional mood. Hypertension has various causes, the most important of which are kidney disease (see KIDNEYS, DISEASES OF), genetic predisposition and, to some extent, mental stress. Systolic pressure may well be over 200 mm Hg. Abnormal hypertension is often accompanied by arterial disease (see ARTERIES, DISEASES OF) with an increased risk of STROKE, heart attack and heart failure (see HEART, DISEASES OF). Various ANTIHYPERTENSIVE DRUGS are available; these should be carefully evaluated, considering the patient’s full clinical history, before use.

HYPOTENSION may result from super?cial vasodilation (for example, after a bath, in fevers or as a side-e?ect of medication, particularly that prescribed for high blood pressure) and occur in weakening diseases or heart failure. The blood pressure generally falls on standing, leading to temporary postural hypotension – a particular danger in elderly people.... blood pressure

This illness is characterised by vomiting, diarrhoea and abdominal pain, and results from eating food contaminated with metallic or chemical poisons, certain micro-organisms or microbial products. Alternatively, the foods – such as undercooked red kidney beans or ?sh of the scombroid family (mackerel and tuna) – may contain natural posions. Food poisoning caused by chemical or metallic substances usually occurs rapidly, within minutes or a few hours of eating. Among micro-organisms, bacteria are the leading cause of food poisoning, particularly Staphylococcus aureus, Clostridium perfringens (formerly Cl. welchii), Salmonella spp., Campylobacter jejuni, and Escherichia coli O157.

Staphylococcal food poisoning occurs after food such as meat products, cold meats, milk, custard and egg products becomes contaminated before or after cooking, usually through incorrect handling by humans who carry S. aureus. The bacteria produce an ENTEROTOXIN which causes the symptoms of food poisoning 1–8 hours after ingestion. The toxin can withstand heat; thus, subsequent cooking of contaminated food will not prevent illness.

Heat-resistant strains of Cl. perfringens cause food poisoning associated with meat dishes, soups or gravy when dishes cooked in bulk are left unrefrigerated for long periods before consumption. The bacteria are anaerobes (see ANAEROBE) and form spores; the anaerobic conditions in these cooked foods allow the germinated spores to multiply rapidly during cooling, resulting in heavy contamination. Once ingested the bacteria produce enterotoxin in the intestine, causing symptoms within 8–24 hours.

Many di?erent types of Salmonella (about 2,000) cause food poisoning or ENTERITIS, from eight hours to three days after ingestion of food in which they have multiplied. S. brendeny, S. enteritidis, S. heidelberg, S. newport and S. thompson are among those commonly causing enteritis. Salmonella infections are common in domesticated animals such as cows, pigs and poultry whose meat and milk may be infected, although the animals may show no symptoms. Duck eggs may harbour Salmonella (usually S. typhimurium), arising from surface contamination with the bird’s faeces, and foods containing uncooked or lightly cooked hen’s eggs, such as mayonnaise, have been associated with enteritis. The incidence of human S. enteritidis infection has been increasing, by more than 15-fold in England and Wales annually, from around 1,100 a year in the early 1980s to more than 32,000 at the end of the 1990s, but has since fallen to about 10,000. A serious source of infection seems to be poultry meat and hen’s eggs.

Although Salmonella are mostly killed by heating at 60 °C for 15 minutes, contaminated food requires considerably longer cooking and, if frozen, must be completely thawed beforehand, to allow even cooking at a su?cient temperature.

Enteritis caused by Campylobacter jejuni is usually self-limiting, lasting 1–3 days. Since reporting of the disease began in 1977, in England and Wales its incidence has increased from around 1,400 cases initially to nearly 13,000 in 1982 and to over 42,000 in 2004. Outbreaks have been associated with unpasteurised milk: the main source seems to be infected poultry.

ESCHERICHIA COLI O157 was ?rst identi?ed as a cause of food poisoning in the early 1980s, but its incidence has increased sharply since, with more than 1,000 cases annually in the United Kingdom in the late 1990s. The illness can be severe, with bloody diarrhoea and life-threatening renal complications. The reservoir for this pathogen is thought to be cattle, and transmission results from consumption of raw or undercooked meat products and raw dairy products. Cross-infection of cooked meat by raw meat is a common cause of outbreaks of Escherichia coli O157 food poisoning. Water and other foods can be contaminated by manure from cattle, and person-to-person spread can occur, especially in children.

Food poisoning associated with fried or boiled rice is caused by Bacillus cereus, whose heat-resistant spores survive cooking. An enterotoxin is responsible for the symptoms, which occur 2–8 hours after ingestion and resolve after 8–24 hours.

Viruses are emerging as an increasing cause of some outbreaks of food poisoning from shell?sh (cockles, mussels and oysters).

The incidence of food poisoning in the UK rose from under 60,000 cases in 1991 to nearly 79,000 in 2004. Public health measures to control this rise include agricultural aspects of food production, implementing standards of hygiene in abattoirs, and regulating the environment and process of industrial food production, handling, transportation and storage.... food poisoning

Panacea is a term applied to a remedy for all diseases, or more usually to a remedy which bene?ts many di?erent diseases.... panacea

This is a gland situated above the navel in the abdominal cavity that extends from the left side to the center, with its head tucked into the curve of the duodenum. It is 6-8 inches long, weighs 3 or 4 ounces, secretes pancreatic enzymes and alkali into the duodenum in concert with the gallbladder and liver, and secretes the hormones insulin and glucagon into the blood. Insulin acts to facilitate the absorption of blood glucose into fuel-needing cells, and glucagon stimulates a slow release of glucose from the liver, primarily to supply fuel to the brain. That most cherished organ uses one-quarter of the sugar in the blood and has no fuel storage. Pancreatic enzymes are basically those that digest fats, carbohydrates and proteins into their smaller components of fatty acids+glycerol, maltose, and amino acids...as well as curdling milk (thought you might want to know).... pancreas

A widespread epidemic which may affect large areas of the world.... pandemic

Paralysis, or PALSY, is loss of muscular power due to some disorder of the NERVOUS SYSTEM. Weakness – rather than total movement loss – is sometimes described as paresis. Paralysis may be temporary or permanent and may be accompanied by loss of feeling.

Paralysis due to brain disease The most common form is unilateral palsy, or HEMIPLEGIA, generally arising from cerebral HAEMORRHAGE, THROMBOSIS or EMBOLISM affecting the opposite side of the BRAIN. If all four limbs and trunk are affected, the paralysis is called quadraplegia; if both legs and part of the trunk are affected, it is called paraplegia. Paralysis may also be divided into ?accid (?oppy limbs) or spastic (rigid).

In hemiplegia the cause may be an abscess, haemorrhage, thrombosis or TUMOUR in the brain. CEREBRAL PALSY or ENCEPHALITIS are other possible causes. Sometimes damage occurs in the parts of the nervous system responsible for the ?ne control of muscle movements: the cerebellum and basal ganglion are such areas, and lack of DOPAMINE in the latter causes PARKINSONISM.

Damage or injury Damage to or pressure on the SPINAL CORD may paralyse muscles supplied by nerves below the site of damage. A fractured spine or pressure from a tumour may have this e?ect. Disorders affecting the cord which can cause paralysis include osteoarthritis of the cervical vertebrae (see BONE, DISORDERS OF), MULTIPLE SCLEROSIS (MS), MYELITIS, POLIOMYELITIS and MENINGITIS. Vitamin B12 de?ciency (see APPENDIX 5: VITAMINS) may also cause deterioration in the spinal cord (see also SPINE AND SPINAL CORD, DISEASES AND INJURIES OF).

Neuropathies are a group of disorders, some inherited, that damage the peripheral nerves, thus affecting their ability to conduct electrical impulses. This, in turn, causes muscle weakness or paralysis. Among the causes of neuropathies are cancers, DIABETES MELLITUS, liver disease, and the toxic consequences of some drugs or metals – lead being one example.

Disorders of the muscles themselves – for example, muscular dystrophy (see MUSCLES, DISORDERS OF – Myopathy) – can disturb their normal working and so cause partial or complete paralysis of the part(s) affected.

Treatment The aim of treatment should be to remedy the underlying cause – for example, surgical removal of a displaced intervertebral

disc or treating diabetes mellitus. Sometimes the cause cannot be recti?ed but, whether treatable or not, physiotherapy is essential to prevent joints from seizing up and to try to maintain some tone in muscles that may be only partly affected. With temporary paralysis, such as can occur after a STROKE, physiotherapy can retrain the sufferers to use their muscles and joints to ensure mobility during and after recovery. Patients with permanent hemiplegia, paraplegia or quadraplegia need highly skilled nursing care, rehabilitative support and resources, and expert help to allow them, if possible, to live at home.... paralysis

A condition whose main characteristic is the delusion (see DELUSIONS) that other people are (in an unclear way) connected to the affected individual. A sufferer from paranoia constructs a complex of beliefs based on his or her interpretation of chance remarks or events. Persecution, love, jealousy and self-grandeur are among the emotions evoked. Acute paranoia – a history of less than six months – may be the result of drastic changes in a person’s environment, such as war, imprisonment, famine or even leaving home for the ?rst time. Chronic paranoia may be caused by brain damage, substance abuse (including alcohol and cannbis), SCHIZOPHRENIA or severe DEPRESSION. Those affected may become constantly suspicious and angry and tend to live an isolated existence, exhibiting di?cult and odd behaviour. Often believing themselves to be normal, they do not seek treatment. If treated early with antipsychotic drugs, they often recover; if not, the delusions and accompanying erratic behaviour become entrenched. (See MENTAL ILLNESS.)... paranoia

A plant or animal which lives upon or within or upon another living organism at whose expense it obtains some advantage without compensation. By convention, human parasitology covers the study of the protozoa, helminths and arthropods infecting humans.... parasite

Equality or comparability between two things. Parity legislation, usually applicable to mental health conditions like depression or schizophrenia, requires that health insurers adhere to a principle of equal treatment when making decisions regarding mental health benefits, comparable with medical benefits.... parity

The term applied to in?ammation near the nail (see under SKIN). The infection, usually caused by Staphyloccous aureus (see STAPHYLOCOCCUS), may affect the tissues around the nail, including its root, and sometimes spreads to the pulp of the affected ?nger or toe. The tendons that run along the back of the infected digit may occasionally become infected. Acute paronychia is the most common type, with local pain and tenderness and swelling of the nail fold. Treatment is with ANTIBIOTICS or, if an ABSCESS forms, local surgery to release any pus. Sometimes infection may be caused by a virus, against which antibiotics are ine?ective. If viral infection persists then antiviral drugs may eradicate it.

Chronic paronychia occurs with reinfection of the nail bed. This is usually because the person’s hands are regularly immersed in water, making the skin vulnerable to infection. The ?nger should be kept dry and a dry dressing applied accompanied by a course of antibiotics

– FLUCLOXACILLIN or a cephalosporin.... paronychia

Cyclic manifestation of acute illness in malaria, characterised by a rise in temperature with accompanying symptoms, usually caused by invasion of the blood by a brood of parasites released from RBC’s.... paroxysm

(American) Resembling the garnish Parslee, Parsleigh, Parsly, Parsli, Parslie, Parslea... parsley

Indicative of, or caused by, a disease or condition.... pathological

Effective in diseases of the chest... pectoral

A parasitic infestation of the head, the hairy parts of the body and the clothing by adult lice, larvae and nits (eggs), which often results in severe itching and excoriation of the scalp and body. Secondary infection can occur. Infesting agents include Pediculus capitis, the head louse, P. humanus, the body louse, and Pthirus pubis, the crab louse, which usually infest the pubic region, but may also infest the hair of the face, axillae and the bodysurfaces.... pediculosis

A syndrome resulting from niacin deficiency, associated with photosensitive dermatitis, mucous membrane inflammation, diarrhoea and psychiatric disturbances.... pellagra

An acute or chronic disease of adults, with a singular or constant series of skin eruptions. The causes are not known, although both viruses and auto­immune reactions can be implicated. There are so many distinct types that it is probably not a distinct pathology but a symptom, like nausea, that occurs from many causes. Pemphigus of the mouth, lips and throat is rather common in the aged, particularly in those taking many management medications, and reduced to the spiritual poverty of “rest homes”. These need constant treatment (herbs work as well as medications), else the difficulty of eating, what with dry mouth, sore gums, gas and chronic constipation (from medications and adrenergic stress) coupled with SLBF (Soft Light Brown Food) and NOW the added insult of mouth sores can start the subtle downwards spiral of entropy and asthenia.... pemphigus

A stomach or duodenal ulcer, caused by excess or untimely secretions of gastric acid and pepsin, poor closure of the pyloric sphincter and digestive acid leakage into the duodenum, or poorly mucin-protected membranes resulting from infection or allergen irritation... peptic ulcer

A pre?x meaning around.... peri

Catharanthus roseus

Apocynaceae

San: Nityakalyani;

Hin: Sadabahar, Baramassi;

Mal: Ushamalari, Nityakalyani

Tel: Billaganeru;

Tam: Sudukattu mallikai; Pun: Rattanjot;

Kan: Kasikanigale, Nitya Mallige

Importance: Periwinkle or Vinca is an erect handsome herbaceous perennial plant which is a chief source of patented cancer and hypotensive drugs. It is one of the very few medicinal plants which has a long history of uses as diuretic, antidysenteric, haemorrhagic and antiseptic. It is known for use in the treatment of diabetes in Jamaica and India. The alkaloids vinblastine and vincristine present in the leaves are recognized as anticancerous drugs. Vinblastine in the form of vinblastin sulphate is available in market under the trade name “VELBE” and Vincristine sulphate as “ONCOVIN” (Eli Lilly). Vinblastine is used in combination with other anticancer agents for the treatment of lymphocytic lymphoma, Hodgkin’s disease, testicular carcinoma and choriocarcinoma. Vincristine is used in acute leukemia, lymphosarcoma and Wilm’s tumour. Its roots are a major source of the alkaloids, raubasine (ajmalicine), reserpine and serpentine used in the preparation of antifibrillic and hypertension-relieving drugs. It is useful in the treatment of choriocarcinoma and Hodgkin’s disease-a cancer affecting lymph glands, spleen and liver. Its leaves are used for curing diabetes, menorrhagia and wasp stings. Root is tonic, stomachic, hypotensive, sedative and tranquilliser (Narayana and Dimri,1990).

Distribution: The plant is a native of Madagascar and hence the name Madagascar Periwinkle. It is distributed in West Indies, Mozambique, South Vi etnam, Sri Lanka , Philippines and Australia. It is well adapted to diverse agroclimatic situations prevalent in India and is commercially cultivated in the states of Tamil Nadu, Karnataka, Gujarat, Madhya Pradesh and Assam. USA, Hungary, West Germany, Italy, Netherlands and UK are the major consumers.

Botany: Catharanthus roseus (Linn.) G.Don.

syn. Vinca rosea Linn. belongs to the family Apocynaceae. It is an erect highly branched lactiferous perennial herb growing up to a height of one metre. Leaves are oblong or ovate, opposite, short-petioled, smooth with entire margin. Flowers are borne on axils in pairs. There are three flower colour types , pink, pink-eyed and white. Calyx with 5 sepal, green, linear, subulate. Corolla tube is cylindrical with 5 petals, rose-purple or white with rose-purple spot in the centre; throat of corolla tube hairy, forming a corona-like structure. The anthers are epipetalous borne on short filaments inside the bulging distal end of corolla tube converging conically above the stigma. Two characteristic secretary systems, namely a column like nectarium on both sides of pistil and a secretory cringulam circling the papillate stigma with a presumed role in pollination - fecundation process are present. Ovary bicarpellary, basally distinct with fused common style and stigma. The dehiscent fruit consists of a pair of follicles each measuring about 25 mm in length and 2.3 mm in diameter, containing up to thirty linearly arranged seeds with a thin black tegumen. On maturity, the follicles split along the length dehiscing the seeds.

Agrotechnology: Periwinkle grows well under tropical and subtropical climate. A well distributed rainfall of 1000 mm or more is ideal. In north India the low winter temperatures adversely affect the crop growth. It can grow on any type of soil ,except those which are highly saline, alkaline or waterlogged. Light soils, rich in humus are preferable for large scale cultivation since harvesting of the roots become easy.

Catharanthus is propagated by seeds. Fresh seeds should be used since they are short-viable. Seeds can be either sown directly in the field or in a nursery and then transplanted. Seed rate is 2.5 kg/ha for direct sowing and the seeds are drilled in rows 45 cm apart or broadcasted. For transplanted crop the seed rate is 500gm/ha. Seeds are sown in nursery and transplanted at 45x 30cm spacing after 60 days when the seedlings attain a height of 15-20cm Nursery is prepared two months in advance so that transplanting coincides with the on set of monsoons. Application of FYM at the rate of 15 t/ha is recommended. An alternate approach is to grow leguminous green manure crops and incorporate the same into the soil at flowering stage. Fertilisers are recommended at 80:40:40 kg N:P2O5:K2O/ha for irrigated crop and 60:30:30 kg/ha for rainfed crop. N is applied in three equal splits at planting and at 45 and 90 days after planting. 4 or 5 irrigations will be needed to optimise yield when rainfall is restricted. Fortnightly irrigations support good crop growth when the crop is grown exclusively as an irrigated crop. Weeding is carried out before each topdressing. Alternatively, use of fluchloraline at 0.75 kg a.i. /ha pre-plant or alachlor at 1.0 kg a.i. per ha as pre-emergence to weeds provides effective control of a wide range of weeds in periwinkle crop. Detopping of plants by 2cm at 50% flowering stage improves root yield and alkaloid contents. No major pests, other than Oleander hawk moth, have been reported in this crop. Fungal diseases like twig blight (top rot or dieback) caused by Phytophthora nicotianae., Pythium debaryanum, P. butleri and P. aphanidermatum; leaf spot due to Alternaria tenuissima, A. alternata, Rhizoctonia solani and Ophiobolus catharanthicola and foot-rot and wilt by Sclerotium rolfsii and Fusarium solani have been reported. However, the damage to the crop is not very serious. Three virus diseases causing different types of mosaic symptoms and a phyllody or little leaf disease due to mycoplasma -like organisms have also been reported; the spread of which could be checked by uprooting and destroying the affected plants.

The crop allows 3-4 clippings of foliage beginning from 6 months. The flowering stage is ideal for collection of roots with high alkaloid content. The crop is cut about 7 cm above the ground and dried for stem, leaf and seed. The field is irrigated, ploughed and roots are collected. The average yields of leaf, stem and root are 3.6, 1.5and 1.5 t/ha, respectively under irrigated conditions and 2.0, 1.0 and 0.75t/ha, respectively under rainfed conditions on air dry basis. The harvested stem and roots loose 80% and 70% of their weight, respectively. The crop comes up well as an undercrop in eucalyptus plantation in north India. In north western India a two year crop sequence of periwinkle-senna-mustard or periwinkle-senna- coriander are recommended for higher net returns and productivity (Krishnan,1995).

Properties and activity: More than 100 alkaloids and related compounds have so far been isolated and characterised from the plant. The alkaloid contents in different parts show large variations as roots 0.14-1.34%, stem 0.074-0.48%, leaves 0.32-1.16%, flowers 0.005-0.84%, fruits 0.40%, seeds 0.18% and pericarp 1.14% (Krishnan et al, 1983). These alkaloids includes monomeric indole alkaloids, 2-acyl indoles, oxindole, -methylene indolines, dihydroindoles, bisindole and others. Dry leaves contain vinblastine (vincaleucoblastine or VLB) 0.00013-0.00063%, and vincristine (leurocristine or LC) 0.0000003-0.0000153% which have anticancerous activity (Virmani et al, 1978). Other alkaloids reported are vincoside, isovincoside (strictosidine), catharanthine, vindolinine, lochrovicine, vincolidine, ajmalicine (raubasine), reserpine, serpentine, leurosine, lochnerine, tetrahydroalstonine, vindoline, pericalline, perivine, periformyline, perividine, carosine, leurosivine, leurosidine and rovidine. The different alkaloids possessed anticancerous, antidiabetic, diuretic, antihypertensive, antimicrobial, antidysenteric, haemorrhagic, antifibrillic, tonic, stomachic, sedative and tranquillising activities.... periwinkle

Whooping cough... pertussis

Pin point haemorrhages.... petechiae

An o?cial publication dealing with the recognised drugs and giving their doses, preparations, sources, and tests. Most countries have a pharmacopoeia of their own. That for Great Britain and Ireland is prepared by the British Pharmacopoeia Commission under the direction of the Medicines Commission. Many hospitals and medical schools have a small pharmacopoeia of their own, giving the prescriptions most commonly dispensed in that particular hospital or school. The British National Formulary is a compact authoritative volume for those concerned with the prescribing or dispensing of medicines.... pharmacopoeia

1 The art or practice of preparing and preserving drugs, and of compounding and dispensing medicines according to the prescriptions of medical practitioners. 2 A place where drugs are dispensed.... pharmacy

The branch of science that deals with the discovery and development of drugs. Those working in it (pharmacologists, doctors, scientists and laboratory technicians) determine the chemical structure and composition of drugs and how these act in the body. They assess the use of drugs in the prevention and treatment of diseases, their side-effects and likely toxicity. This work takes place in universities, hospitals and, in particular, the pharmaceutical industry. The latter has expanded tremendously during the 20th century and in Britain it is now one of the largest business sectors, not only providing the NHS with most of its pharmaceutical requirements but also exporting many medicines to other countries.

Pharmacologists not only research for new drugs, but also look for ways of synthesising them on a large scale. Most importantly, they organise with clinicians the thorough testing of drugs to ensure that these are safe to use, additionally helping to monitor the effects of drugs in regular use so as to identify unforeseen side-effects. Doctors and hospital pharmacists have a special reporting system (‘Yellow Cards’) under which they notify the government’s MEDICINES CONTROL AGENCY of any untoward consequences of drug treatments on their patients (see also MEDICINES).... pharmacology

Mucus in the throat or bronchi.... phlegm

An irrational fear of particular objects or situations. A well-known American medical dictionary lists more than 200 ‘examples’ of phobias, ranging, alphabetically, from fear of air to fear of writing. Included in the list are phobophobia (fear of phobias) and triskaidekaphobia (fear of having 13 sitting at table).

Phobia is a form of obsession, and not uncommonly one of the features of anxiety. Treatment is behavioural therapy complemented in some patients with ANTIDEPRESSANT DRUGS. Care is needed, as some sufferers can become psychologically dependent on the drugs used to treat them (see DEPENDENCE). Those who suffer from what can be a most distressing condition can obtain help and advice from the Phobics Society. (See also MENTAL ILLNESS.)... phobia

A plant alkaloid and the primary bioactive substance reducible from Pilocarpus spp. (Jaborandi leaves). It is an almost pure parasympathomimetic (cholinergic), inducing lowered blood pressure and stimulating glandular secretions...EVERYWHERE. It stimulates sweating as well, a sympathetic cholinergic response. Anyway, it is used in eye drops these days to contract the pupil, lower ocular fluid pressure and take some of the stress off glaucoma. The refined alkaloid is better in the eyes, but the dried leaves are the usual complex agents of herb use and have some therapeutic values in low doses. Good Lobelia or Asclepias will work similarly and are both safer, fresher and more predictable as botanicals.... pilocarpine

An inflammation of the serous membranes that both surround the lungs and line the inside of the chest cavity; the two membranes supply fluid lubrication between the expanding and contracting lungs and the body. Most pleurisy (and usually the milder form) follows or accompanies bronchitis or late winter chest colds...sort of pulmonary cabin fever. It may be dry pleurisy (with few secretions and sharp sticking pain that prevents any but moderate inhalation), or acute or effusive pleurisy (with fever, coughing, and built up serous fluids...usually tossed off as bronchitis). Some types are part of serious cardio-pulmonary disorders and/or chronic disease.... pleurisy

Inflammation of the lungs, from whatever cause. It may be concurrent with pneumonia or pleurisy...or the result of a defensive lineman knocking the air out of the quarterback...two days later.... pneumonitis

An acute inflammation of the anterior horn cells of the spinal cord due to an enterovirus infection... poliomyelitis

The immature life-cycle form of a jellyfish (or other cnidarian) which is attached to a substrate. Tumour projecting from mucosal surface.... polyp

1 The administration of many drugs at the same time. 2 The administration of an excessive number of drugs.... polypharmacy

Excess urination. The excreted wastes may stay unchanged but they are dissolved in a far higher volume of water. The causes range from diabetes, kidney disease, elevated thyroid function and the aftermath of diuretic-treated heart failure to booting a half keg of generic beer at a frat blowout... polyuria

A soft mush prepared by various substances with oily or watery fluids... poultice

A broad spectrum anthelmintic very effective against many human trematodiases (including all forms of schistosomiasis) and some cestode infections (e.g. hymenolepiasis; cysticercosis).... praziquantel

The branch of medicine dealing with the prevention of disease and the maintenance of good health practices.... preventive medicine

Basic or general health care focused on the point at which a patient ideally first seeks assistance from the medical care system. It is the basis for referrals to secondary and tertiary level care.... primary care

An estimate of the outcome of a disease. Poor prognosis indicates that outcome is liable to be fatal.... prognosis

Pertaining to the prevention of the development of a disease... prophylactic

Inflammation of the prostate. The causes may be varied, ranging from infection to portal congestion to cancer to increased adipose estradiol release in the middle-aged male...to over-use.... prostatitis

The presence of protein in the urine, sometimes a symptom of kidney compromise. See ALBUMINURIA... proteinuria

The lowest division of the animal kingdom, including unicellular or acellular organisms with a eukaryotic structure.... protozoa

The area of the body that is closest to the heart.... proximal

The mind or soul of an individual and his or her mental – in contrast to the physical – functioning.... psyche

The branch of medicine that deals with the diagnosis, treatment and prevention of mental and emotional disorders. Those who specialize in care of older adults are called geriatric psychiatrists, old-age psychiatrists, psychogeriatricians or geropsychiatrists.... psychiatry

Profession dealing with peoples’ behaviour and cognition and their effects.... psychology

Psychological (as opposed to physical) methods of treatment for mental disorders and psychological problems.... psychotherapy

See EYE, DISORDERS OF.... ptosis

Relating to the LUNGS.... pulmonary

Strong laxative... purgative

A discharge of pus... pyorrhoea

Measures that identify and treat asymptomatic persons who have already developed risk factors or preclinical disease, but in whom the condition is not clinically apparent. These activities are focused on early case-finding of asymptomatic disease that occurs commonly and has significant risk for negative outcome without treatment.... secondary prevention

The atria (see ATRIUM) of the heart contain peptides with potent diuretic and vasodilating properties. It has been known since 1980 that extracts of human atria have potent diuretic and natriuretic effects in animals (see DIURETICS). In 1984 three polypeptide species were isolated from human atria and were called alpha, beta and gamma human atrial natriuretic peptides. Plasma concentration of immunoreactive atrial natriuretic peptide can now be measured: the levels are low in healthy subjects and are increased in patients with congestive heart failure. Infusion of the peptides reduces blood pressure and causes a natriuresis and diuresis.... atrial natriuretic peptide

See SEPTICAEMIA.... blood-poisoning

An extensive web of blood vessels occurring in the ventricles of the BRAIN and producing the CEREBROSPINAL FLUID.... choroid plexus

Another name for pulmonary heart disease, which is characterised by hypertrophy and failure of the right VENTRICLE of the heart as a result of disease of the LUNGS or disorder of the pulmonary circulation.... cor pulmonale

The pressure exerted by the blood against the arterial wall during DIASTOLE. This is the lowest blood pressure in the cardiac cycle. A normal reading of diastolic pressure in a healthy adult at rest is 70 mm Hg. (See HEART.)... diastolic pressure

The term used to describe a group of conditions characterised by varying degrees of paralysis and originating in infancy or early childhood. In some 80 per cent of cases this takes the form of spastic paralysis (muscle sti?ness), hence the now obsolete lay description of sufferers as ‘spastics’. The incidence is believed to be around 2 or 2·5 per 1,000 of the childhood community. In the majority of cases the abnormality dates from well before birth: among the factors are some genetic malformation of the brain, a congenital defect of the brain, or some adverse e?ect on the fetal brain as by infection during pregnancy. Among the factors during birth that may be responsible is prolonged lack of oxygen such as can occur during a di?cult labour; this may be the cause in up to 15 per cent of cases. In some 10–15 per cent of cases the condition is acquired after birth, when it may be due to KERNICTERUS, infection of the brain, cerebral thrombosis or embolism, or trauma. Acute illness in infancy, such as meningitis, may result in cerebral palsy.

The disease manifests itself in many ways. It may not be ?nally diagnosed and characterised until the infant is two years old, but may be apparent much earlier – even soon after birth. The child may be spastic or ?accid, or the slow, writhing involuntary movements known as athetosis may be the predominant feature. These involuntary movements often disappear during sleep and may be controlled, or even abolished, in some cases by training the child to relax. The paralysis varies tremendously. It may involve the limbs on one side of the body (hemiplegia), both lower limbs (paraplegia), or all four limbs (DIPLEGIA and QUADRIPLEGIA). Learning disability (with an IQ under 70) is present in around 75 per cent of all children but children with diplegia or athetoid symptoms may have normal or even high intelligence. Associated problems may include hearing or visual disability, behavioural problems and epilepsy.

The outlook for life is good, only the more severely affected cases dying in infancy. Although there is no cure, much can be done to help these disabled children, particularly if the condition is detected at an early stage. Assistance is available from NHS developmental and assessment clinics, supervised by community paediatricians and involving a team approach from experts in education, physiotherapy, occupational therapy and speech training. In this way many of these handicapped children reach adulthood able to lead near-normal lives. Much help in dealing with these children can be obtained from SCOPE (formerly the Spastics Society), and Advice Service Capability Scotland (ASCS).... cerebral palsy

An outdated term for the tertiary stage of SYPHILIS.... general paralysis of the insane

Ill-de?ned discomfort and pains that occur in the limbs of some children. They occur mainly at night between the ages of 6–12 years. The cause is unknown, but the condition is not signi?cant and does not require treatment once other more important conditions have been ruled out.... growing pains

Any combination of health education and related organizational, political and economic interventions designed to facilitate behavioural and environmental adaptations that will improve or protect health.... health promotion

A thick colourless liquid with the formula H2O2 (water is H2O, possessing only one oxygen atom in its molecule). Available in solution with water and as a cream, it is readily reduced to water – giving up oxygen in the process, which causes the characteristic frothing seen when used. H2O2 has antiseptic and deodorising properties; thus it is used as a mouthwash, to clean wounds and ulcers, and occasionally to disinfect body cavities at operation. It is also a bleach.... hydrogen peroxide

The time interval between exposure to an infectious agent (eg, bite) and appearance of the first sign or symptom of the disease in question.... incubation period

An ectopic pregnancy most commonly develops in one of the FALLOPIAN TUBES. Occasionally it may occur in one of the OVARIES, and rarely in the uterine cervix or the abdominal cavity. Around one in 200 pregnant women have an ectopic gestation. As pregnancy proceeds, surrounding tissues may be damaged and, if serious bleeding happens, the woman may present as an ‘abdominal emergency’. A life-threatening condition, this needs urgent surgery. Most women recover satisfactorily and can have further pregnancies despite the removal of one Fallopian tube as a result of the ectopic gestation. Death is unusual. This disorder of pregnancy may occur because infection or a previous abdominal injury or operation may have damaged the normal descent of an ovum from the ovary to the womb. The ?rst symptoms usually appear during the ?rst two months of pregnancy, perhaps before the woman realises she is pregnant. Severe lower abdominal pain and vaginal bleeding are common presenting symptoms. Ultrasound can be used to diagnose the condition and laparoscopy can be used to remove the products of conception. (See PREGNANCY AND LABOUR.)... ectopic pregnancy

See FUNGUS POISONING.... mushroom poisoning

Lead and lead compounds are used in a variety of products including petrol additives (in the UK, lead-free petrol is now mandatory), piping (lead water pipes were once a common source of poisoning), weights, professional paints, dyes, ceramics, ammunition, homeopathic remedies, and ethnic cosmetic preparations. Lead compounds are toxic by ingestion, by inhalation and, rarely, by skin exposures. Metallic lead, if ingested, is absorbed if it remains in the gut. The absorption is greater in children, who may ingest lead from the paint on old cots

– although lead-containing paints are no longer used for items that children may be in contact with.

Acute poisonings are rare. Clinical features include metallic taste, abdominal pain, vomiting, diarrhoea, ANOREXIA, fatigue, muscle weakness and SHOCK. Neurological effects may include headache, drowsiness, CONVULSIONS and COMA. Inhalation results in severe respiratory-tract irritation and systemic symptoms as above.

Chronic poisonings cause gastrointestinal disturbances and constipation. Other effects are ANAEMIA, weakness, pallor, anorexia, insomnia, renal HYPERTENSION and mental fatigue. There may be a bluish ‘lead line’ on the gums, although this is rarely seen. Neuromuscular dysfunction may result in motor weakness and paralysis of the extensor muscles of the wrist and ankles. ENCEPHALOPATHY and nephropathy are severe effects. Chronic low-level exposures in children are linked with reduced intelligence and behavioural and learning disorders.

Treatment Management of patients who have been poisoned is supportive, with removal from source, gastric decontamination if required, and X-RAYS to monitor the passage of metallic lead through the gut if ingested. It is essential to ensure adequate hydration and renal function. Concentrations of lead in the blood should be monitored; where these are found to be toxic, chelation therapy should be started. Several CHELATING AGENTS are now available, such as DMSA (Meso-2,3dimercaptosuccinic acid), sodium calcium edetate (see EDTA) and PENICILLAMINE. (See also POISONS.)... lead poisoning

Paediatrics means the branch of medicine dealing with diseases of children (see also NEONATOLOGY).... paediatrics

A procedure for removing CEREBROSPINAL FLUID (CSF) from the spinal canal in the LUMBAR region in order: (1) to diagnose disease of the nervous system; (2) to introduce medicaments – spinal anaesthetics or drugs. A hollow needle is inserted into the lower section of the space around the SPINAL CORD (see diagram) and the cerebrospinal ?uid withdrawn. The procedure should not be done too rapidly or the subject may develop a severe headache. Examination of the cerebrospinal ?uid helps in the diagnosis and investigation of disorders of the brain and spinal cord – for example, MENINGITIS and SUBARACHNOID HAEMORRHAGE. When using the procedure to inject drugs into the CSF, the operator must take care to inject only those agents speci?cally produced for CSF injection. Deaths have occurred because the wrong drug has been injected, and there have been demands for specialised equipment and strict procedures that will prevent such tragedies.... lumbar puncture

Unusual paleness of the SKIN caused by a reduced ?ow of blood or a de?ciency in normal pigments. Pallor may be a sign of fright, SHOCK, ANAEMIA, or other diseases.... pallor

Examination of the surface of the body and the size, shape, and movements of the internal organs, by laying the ?at of the hand upon the skin.... palpation

Another name for PARALYSIS. CEREBRAL PALSY involves total or partial paralysis of a limb or limbs due to a perinatal or early infancy brain lesion.... palsy

A CYTOTOXIC drug of the taxane group (see TAXANES). Given by intravenous transfusion, it is used under specialist supervision for the treatment of ovarian cancer (usually following surgery – see OVARIES, DISEASES OF) with or without CISPLATIN. NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE (NICE) guidance in 2001 also recommended that the drug could be used to treat advanced breast cancer (see BREASTS, DISEASES OF) where initial cytotoxic therapy had failed or could not be used. Its use as ?rst-line treatment is limited to clinical trials.

Side-effects of paclitaxel include hypersensitivity, MYELOSUPPRESSION, cardiac ARRHYTHMIA and peripheral NEUROPATHY. Only a minority of patients respond to the drug, but when it works the results are often long-lasting.... paclitaxel

The partition between the cavity of the mouth, below, and that of the nose, above. It consists of the hard palate towards the front, which is composed of a bony plate covered below by the mucous membrane of the mouth, above by that of the nose; and of the soft palate further back, in which a muscular layer, composed of nine small muscles, is similarly covered. The hard palate extends a little further back than the wisdom teeth, and is formed by the maxillary and palate bones. The soft palate is concave towards the mouth and convex towards the nose, and it ends behind in a free border, at the centre of which is the prolongation known as the uvula. When food or air is passing through the mouth, as in the acts of swallowing, coughing, or vomiting, the soft palate is drawn upwards so as to touch the back wall of the throat and shut o? the cavity of the nose. Movements of the soft palate, by changing the shape of the mouth and nose cavities, are important in the production of speech.... palate

Pancreatin preparations (often in the form of a powder) contain the four powerful enzymes (see ENZYME), trypsin, chymotrypsin, lipase, and amylase, which continue the digestion of foods started in the stomach (see PANCREAS – Functions; DIGESTION). They are given by mouth for the relief of pancreatic de?ciency in conditions such as pancreatitis (see PANCREAS, DISORDERS OF) and CYSTIC FIBROSIS. Pancreatin is also used for the preparation of pre-digested, or so-called peptonised, foods, such as milk and some starchy foods.... pancreatin

This plays an important part in the transfer of acetyl groups in the body’s METABOLISM and is one of the essential constituents of the diet. The daily requirement is probably around 10 milligrams. It is widely distributed in food stu?s, both animal and vegetable; yeast, liver and egg-yolk are particularly rich sources. (See APPENDIX

5: VITAMINS.)... pantothenic acid

See Lechosa.... papaya

A small projection, such as those with which the corium of the skin is covered, and which project into the epidermis and make its union with the corium more intimate; or those covering the tongue and projecting from its surface.... papilla

Swelling of the OPTIC DISC of the EYE, speci?cally due to raised intracranial pressure. It can be seen by examining the back of the eye using an OPHTHALMOSCOPE and is an important sign in managing the care of patients with intracerebral disease such as tumours or MENINGITIS.... papilloedema

Small (less than 5 mm) solid elevation of the skin or mucous membranes. A larger lesion is called a nodule.... papule

A pre?x meaning near, aside from, or beyond.... para

The puncture by hollow needle or TROCAR and CANNULA of any body cavity (e.g. abdominal, pleural, pericardial), for tapping or aspirating ?uid. (See ASPIRATION.)... paracentesis

(US, acetaminophen.) A non-opioid analgesic (see ANALGESICS) similar in e?cacy to aspirin, but without any demonstrable antiin?ammatory activity. It also has the advantage over aspirin of causing less gastric irritation. It is indicated for mild to moderate pain and pyrexia in a dose of 0.5–1g by mouth (maximum 4 doses every 24 hours).... paracetamol

A term applied to unusual feelings, apart from mere increase, or loss, of sensation, experienced by a patient without any external cause: for example, hot ?ushes, numbness, tingling, itching. Various paraesthesiae form a common symptom in some nervous diseases.... paraesthesia

A disorder or injury of the NERVOUS SYSTEM in which the affected individual suffers from weakness in both legs and sometimes of the muscles in the lower trunk.... paraparesis

The constriction of the PENIS behind the glans by an abnormally tight foreskin that has been retracted. The condition causes swelling and severe pain. Sometimes the foreskin can be returned by manual manipulation after an ice pack has been applied to the glans or a topical local anaesthetic applied. Sometimes an operation to cut the foreskin is required.... paraphimosis

The branch of PSYCHOLOGY that studies extrasensory perception. This includes precognition (seeing into the future); psychokinesis (a supposed ability of some people to move or change the state of objects by thinking); telepathy (communicating thoughts from one person to another); and clairvoyance (the ability to visualise events at a distance). These phenomena have no scienti?c explanation and some of these ‘abilities’ may be manifestations of mental illness such as SCHIZOPHRENIA.... parapsychology

A contact herbicide widely used in agriculture and horticulture. People using paraquat should be careful to protect their eyes and skin so as not to come into contact with it: a mouthful is enough to kill, and the substance is involved in around 40 suicides annually in the UK. Its major misuse has resulted from its being decanted from the professional pack into soft-drink bottles and kept in the kitchen. Medical assistance should be obtained as soon as possible, as some victims of poisoning may require hospital inpatient care, including renal DIALYSIS. Several medical centres have been set up throughout the country to provide treatment in cases of paraquat poisoning. Details of these can be obtained from the National Poisons Information Service.... paraquat

A general term applied to agents or substances destructive to parasites (see PARASITE).... parasiticide

Mimicking major aspects of parasympathetic function. EXAMPLES: Amanita muscaria mushrooms, Pilocarpine, Lobelia.... parasympathomimetic

One of the ORGANOPHOSPHORUS insecticides. It is highly toxic to humans and must therefore be handled with the utmost care.... parathion

A state of partial PARALYSIS.... paresis

The term applied to anything pertaining to the wall of a cavity: for example, parietal pleura, the part of the pleural membrane which lines the wall of the chest.... parietal

Parkinson’s disease characterised by rigidity of muscles and tremor of the hands... parkinsonism

In?ammation of the PAROTID GLAND caused by infection or by many AUTOIMMUNE DISORDERS. Epidemic parotitis is another name for MUMPS.... parotitis

One of the ANTIDEPRESSANT DRUGS in the SELECTIVE SEROTONIN-REUPTAKE INHIBITORS (SSRIS) group. (See also MENTAL ILLNESS.)... paroxetine

Labour – see PREGNANCY AND LABOUR.... parturition

This is used to identify possible substances that may be causing a patient’s ALLERGY. Small amounts of di?erent substances are placed on the skin – usually of the back or arm. If the patient is allergic then a red ?are and swelling will appear, usually within about 15 minutes. Sometimes the reaction may take longer – up to three days – to develop.... patch test

Also known as the knee-cap, this is a ?at bone shaped somewhat like an oyster-shell, lying in the tendon of the extensor muscle of the thigh, and protecting the knee-joint in front. (See also KNEE.)... patella

See DUCTUS ARTERIOSUS.... patent ductus arteriosus

An organism or substance which caused diseases.... pathogen

This term means disease-producing, and is a term applied, for example, to bacteria capable of causing disease.... pathogenic

A term applied to signs or symptoms which are especially characteristic of certain diseases, and on the presence or absence of which the diagnosis depends. Thus the discovery of the Mycobacterium tuberculosis in the sputum is said to be pathognomonic of pulmonary tuberculosis.... pathognomonic

The stem or stalk of a single flower or a whole floral cluster.... peduncle

Review by individuals from the same discipline and with essentially equal qualifications (peers).... peer review

Measurement of the internal dimensions of the PELVIS. The four diameters measured are: transverse, anterioposterior, and left and right oblique. These measurements help to establish whether a fetus can be delivered normally. If the outlet is abnormally small, the mother will have to be delivered by CAESAREAN SECTION.... pelvimetry

See PEMPHIGUS.... pemphigoid

(PID) Also called salpingitis, the term is applied to infections of the fallopian tubes that follow or are concurrent with uterine and cervical infections. Gonorrhea and Chlamydia are the most common organisms, and the infection is usually begun through sexual contact, although metabolic imbalances, subtler systemic infections like a slow virus, the local insult of herpes or candidiasis, the sequela of medication or recreational drugs, birth control pills, even an IUD...all can alter the vaginal flora and induce inflammation sufficient to allow an endogenous organism to start the infection. PID after birth, on the other hand, is usually the result of staph or strep infections infecting injured membranes.... pelvic inflammatory disease

The bony pelvis consists of the two hip bones, one on each side, with the sacrum and coccyx behind. It connects the lower limbs with the spine. In the female it is shallower than in the male and the ilia are more widely separated, giving great breadth to the hips of the woman; the inlet is more circular and the outlet larger; whilst the angle beneath the pubic bones (subpubic angle), which is an acute angle in the male, is obtuse in the female. All these points are of importance in connection with childbearing.

The contents of the pelvis are the urinary bladder and rectum in both sexes; in addition the male has the seminal vesicles and the prostate gland surrounding the neck of the bladder, whilst the female has the womb, ovaries, and their appendages.

A second meaning is as in renal pelvis – that part of the collecting system proximal to the URETER which collects urine from the renal pyramids (see KIDNEYS).... pelvis

A metabolite of PENICILLIN which is one of the CHELATING AGENTS. It is sometimes used in RHEUMATOID ARTHRITIS that has not responded to the ?rst-line remedies and it is particularly useful when the disease is complicated by VASCULITIS. Penicillamine is also used as an antidote to poisoning by heavy metals, particularly copper and lead, as it is able to bind these metals and so remove their toxic effects. Because of its ability to bind copper it is also used in WILSON’S DISEASE where there is a de?ciency in the copper-binding protein so that copper is able to become deposited in the brain and liver, damaging these tissues.... penicillamine

A drug that is used in the prevention and treatment of African trypanosomiasis (see SLEEPING SICKNESS), and in the treatment of LEISHMANIASIS.... pentamidine

The male organ through which the tubular URETHRA runs from the neck of the URINARY BLADDER to the exterior at the meatus or opening. URINE and SEMEN are discharged along the urethra, which is surrounded by three cylindrical bodies of erectile tissue, two of which (corpora cavernosa) lie adjacent to each other along the upper length of the penis and one (corpus spongiosum) lies beneath them. Normally the penis hangs down in a ?accid state in front of the SCROTUM. When a man is sexually aroused the erectile tissue, which is of spongy constituency and well supplied with small blood vessels, becomes engorged with blood.

This makes the penis erect and ready for insertion into the woman’s vagina in sexual intercourse. The end of the penis, the glans, is covered by a loose fold of skin – the foreskin or PREPUCE – which retracts when the organ is erect. The foreskin is sometimes removed for cultural or medical reasons.

A common congenital disorder of the penis is HYPOSPADIAS, in which the urethra opens somewhere along the under side; it can be repaired surgically. BALANITIS is in?ammation of the glans and foreskin. (See also REPRODUCTIVE SYSTEM; EJACULATION; IMPOTENCE; PRIAPISM.)... penis

Mentha pulegium. N.O. Labiateae.

Synonym: European Pennyroyal.

Habitat: Not common as a wild plant, except on damp heaths and commons. Frequently seen in cottage gardens. Indigenous to Britain and Europe.

Features ? This member of the mint family grows up to twelve inches high, the stem

being bluntly quadrangular. The one to one and a half inch long, egg-shaped leaves are opposite, on short stalks ; they are slightly serrate and nearly smooth. Purple flowers appear in August. The odour is rather pungent, mint-like but characteristic.

Part used ? The whole herb.

Action: Carminative, emmenagogue, diaphoretic and stimulant.

An infusion of 1 ounce to 1 pint of boiling water, taken warm in teacupful doses frequently repeated, is helpful in hysteria, flatulence and sickness. For children's ailments such as feverish colds, disordered stomach and measles, Pennyroyal infusion may be given in appropriate doses with confidence. Its diaphoretic and stimulant action recommends it for chills and incipient fevers, and the infusion works as an emmenagogue when such ailments retard and obstruct menstruation. The oil of Pennyroyal is a first-rate protection against the bites of mosquitoes, gnats, and similar winged pests. The herb is used to some extent as a flavouring. Although not so popular as other herbs for this purpose, the mint-like flavour and carminative virtues of Pennyroyal should recommend it to cooks as adding to both palatability and digestibility of various dishes.

American or Mock Pennyroyal are the names given to the dried leaves and flowering tops of Hedeoma pulegioides. This plant, although quite different in appearance from the European Pennyroyal, has similar medicinal values.... pennyroyal

Paeonia officinalis. N.O. Ranunculaceae.

Synonym: Common Peony, Piney.

Habitat: Cultivated in gardens.

Features ? Stem two feet high, thick, smooth, branched leaves, pinnate or lobed. Flowers (May) large, red, single, terminal. Transverse section of root is starchy, medullary rays tinged purple. Taste sweet, becoming bitter.

Part used ? Root.

Action: Tonic, antispasmodic.

Convulsive and spasmodic nervous troubles as chorea and epilepsy. Infusion of 1 ounce powdered root to 1 pint boiling water in wineglass

doses three or four times daily.... peony

A compound formed by the union of two or more AMINO ACIDS.... peptide

An aid to diagnosis practised by striking the patient’s body with the ?ngers, in such a way as to make it give out a note. It was introduced in 1761 by Leopold Auenbrugger (1722–1809) of Vienna, the son of an innkeeper, who derived the idea from the habit of his father tapping casks of wine to ascertain how much wine they contained. According to the degree of dullness or resonance of the note, an opinion can be formed as to the state of CONSOLIDATION of air-containing organs, the presence of abnormal cavities in organs, and the dimensions of solid and air-containing organs, which happen to lie next to one another. Still more valuable evidence is given by AUSCULTATION.... percussion

Any method of administering remedies by passing them through the SKIN, as by rubbing in an ointment or applying a patch containing a drug.... percutaneous

The perforation of one of the hollow organs of the abdomen or major blood vessels may occur spontaneously in the case of an ulcer or an advanced tumour, or may be secondary to trauma such as a knife wound or penetrating injury from a tra?c or industrial accident. Whatever the cause, perforation is a surgical emergency. The intestinal contents, which contain large numbers of bacteria, pass freely out into the abdominal cavity and cause a severe chemical or bacterial PERITONITIS. This is usually accompanied by severe abdominal pain, collapse or even death. There may also be evidence of free ?uid or gas within the abdominal cavity. Surgical intervention, to repair the leak and wash out the contamination, is often necessary. Perforation or rupture of major blood vessels, whether from disease or injury, is an acute emergency for which urgent surgical repair is usually necessary. Perforation of hollow structures elsewhere than in the abdomen – for example, the heart or oesophagus – may be caused by congenital weaknesses, disease or injury. Treatment is usually surgical but depends on the cause.... perforation

Acute or chronic in?ammation of the PERICARDIUM, the membranous sac that surrounds the HEART. It may occur on its own or as part of PANCARDITIS, when in?ammation also affects the MYOCARDIUM and ENDOCARDIUM (membranous lining of the inside of the heart). Various causes include virus infection, cancer and URAEMIA. (See also HEART, DISEASES OF.)... pericarditis

The smooth membrane that surrounds the HEART.... pericardium

A term applied to the period starting a few weeks before birth, the birth itself and the week or two following it.... perinatal

Popularly called the crotch, or crutch, this is the region situated between the opening of the bowel behind and of the genital organs in front. In women it becomes stretched in childbirth, and the vaginal opening may tear or need to be cut (see EPISIOTOMY) to facilitate delivery of the baby.... perineum

The membrane surrounding a BONE. The periosteum carries blood vessels and nerves for the nutrition and development of the bone. When it is irritated, an increased deposit of bone takes place beneath it; if it is destroyed, the bone may cease to grow and a portion may die and separate as a sequestrum.... periosteum

Periostitis means in?ammation on the surface of a BONE, affecting the PERIOSTEUM. (See BONE, DISORDERS OF.)... periostitis

See NERVOUS SYSTEM.... peripheral nervous system

The worm-like movement by which the stomach and bowels propel their contents. It consists of alternate waves of relaxation and contraction in successive parts of the intestinal tube. Any obstruction to the movement of the contents causes these contractions to become more forcible and are often accompanied by the severe form of pain known as COLIC.... peristalsis

The serous membrane of the abdominal cavity. The parietal peritoneum lines the walls of the abdomen and the visceral peritoneum covers the abdominal organs. The two are continuous with one another at the back of the abdomen and form a complicated closed sac (see MESENTERY; OMENTUM). A small amount of ?uid is always present to lubricate the membrane, while a large amount collects in conditions associated with OEDEMA or in PERITONITIS.... peritoneum

The term applied to a collection of pus or an ABSCESS which occurs complicating an attack of TONSILLITIS. The collection of pus forms between the tonsil and the superior constrictor muscle of the pharynx. This condition is also known as quinsy; treatment drainage of the abscess and the administration of appropriate antibiotics.... peritonsillar abscess

In?ammation of the PERITONEUM. It may be acute or chronic, localised or generally di?used, and its severity and danger may vary according to the cause.

Acute peritonitis generally arises because bacteria enter the peritoneal cavity, from penetrating wounds, e.g. stabs, from the exterior or from the abdominal organs. Hence conditions leading to perforation of the STOMACH, INTESTINE, BILE DUCT, URINARY BLADDER, and other hollow organs such as gastric ulcer (see STOMACH, DISEASES OF), typhoid fever (see ENTERIC FEVER), gall-stones (see under GALLBLADDER, DISEASES OF), rupture of the bladder, strangulated HERNIA, and obstructions of the bowels, may lead to peritonitis. Numerous bacteria may cause the in?ammation, most common being E. coli, streptococci and the gonococcus.

The symptoms usually begin with a RIGOR together with fever, vomiting, severe abdominal pain and tenderness. Shock develops and the abdominal wall becomes rigid. If untreated the patient usually dies. Urgent hospital admission is required. X-ray examination may show gas in the peritoneal cavity. Treatment consists of intravenous ?uids, antibiotics and surgical repair of the causative condition. Such treatment, together with strong analgesics is usually successful if started soon enough.... peritonitis

Along with phenothrin, this is a largely nontoxic pyrethroid insecticide, e?ective in SCABIES and lice infestations. Resistance may develop to these insecticides and also to MALATHION and CARBARYL, in which case topical treatment should be alternated among the di?erent varieties.... permethrin

An autoimmune disease in which sensitised lymphocytes (see LYMPHOCYTE) destroy the parietal cells of the STOMACH. These cells normally produce intrinsic factor, which is the carrier protein for vitamin B12 that permits its absorption in the terminal ileum. Without intrinsic factor, vitamin B12 cannot be absorbed and this gives rise to a macrocytic ANAEMIA. The skin and mucosa become pale and the tongue smooth and atrophic. A peripheral NEUROPATHY is often present, causing paraesthesiae (see under TOUCH), numbness and even ATAXIA. The more severe neurological complication of sub-acute combined degeneration of the cord is fortunately more rare. The anaemia gets its name from the fact that before the discovery of vitamin B12 it was uniformly fatal. Now a monthly injection of vitamin B12 is all that is required to keep the patient healthy.... pernicious anaemia

See PHENOTHIAZINES.... perphenazine

An out-of-date term for less severe type of epileptic seizure (see EPILEPSY) that occurs usually in children or adolescents but less often in adults. The type of seizure is now referred to as an absence attack.... petit mal

Commonly called sweat, it is an excretion from the SKIN, produced by microscopic sweat-glands, of which there are around 2·5 million, scattered over the surface. There are two di?erent types of sweat-glands, known as eccrine and apocrine. Insensible (that is unnoticed) perspiration takes place constantly by evaporation from the openings of the sweat-glands, well over a litre a day being produced. Sensible perspiration (that is, obvious) – to which the term ‘sweat’ is usually con?ned – occurs with physical exertion and raised body temperature: up to 3 litres an hour may be produced for short periods. Normal sweating maintains the body within its customary temperature range and ensures that the skin is kept adequately hydrated – for example, properly hydrated skin of the palm helps the e?ectiveness of a person’s normal grip.

The chief object of perspiration is to maintain an even body temperature by regulating the heat lost from the body surface. Sweating is therefore increased by internally produced heat, such as muscular activity, or external heat. It is controlled by two types of nerves: vasomotor, which regulate the local blood ?ow, and secretory (part of the sympathetic nervous system) which directly in?uence secretion.

Eccrine sweat is a faintly acid, watery ?uid containing less than 2 per cent of solids. The eccrine sweat-glands in humans are situated in greatest numbers on the soles of the feet and palms of the hands, and with a magnifying glass their minute openings or pores can be seen in rows occupying the summit of each ridge in the skin. Perspiration is most abundant in these regions, although it also occurs all over the body.

Apocrine sweat-glands These start functioning at puberty and are found in the armpits, the eyelids, around the anus in association with the external genitalia, and in the areola and nipple of the breast. (The glands that produce wax in the ear are modi?ed apocrine glands.) The ?ow of apocrine sweat is evoked by emotional stimuli such as fear, anger, or sexual excitement.

Abnormalities of perspiration Decreased sweating may occur in the early stages of fever, in diabetes, and in some forms of glomerulonephritis (see KIDNEYS, DISEASES OF). Some people are unable to sweat copiously, and are prone to HEAT STROKE. EXCESSIVE SWEATING, OR HYPERIDROSIS, may be caused by fever, hyperthyroidism (see THYROID GLAND, DISEASES OF), obesity, diabetes mellitus, or an anxiety state. O?ensive perspiration, or bromidrosis, commonly occurs on the hands and feet or in the armpits, and is due to bacterial decomposition of skin secretions. A few people, however, sweat over their whole body surface. For most of those affected, it is the palmar and/or axillary hyperhidrosis that is the major problem.

Conventional treatment is with an ANTICHOLINERGIC drug. This blocks the action of ACETYLCHOLINE (a neurotransmitter secreted by nerve-cell endings) which relaxes some involuntary muscles and tightens others, controlling the action of sweat-glands. But patients often stop treatment because they get an uncomfortably dry mouth. Aluminium chloride hexahydrate is a topical treatment, but this can cause skin irritation and soreness. Such antiperspirants may help patients with moderate hyperhidrosis, but those severely affected may need either surgery or injections of BOTULINUM TOXIN to destroy the relevant sympathetic nerves to the zones of excessive sweating.... perspiration

A disorder in which a vascular tumour of the adrenal medulla (see ADRENAL GLANDS) develops. The tumour may also affect the structurally similar tissues associated with the chain of sympathetic nerves. There is uncontrolled and irregular secretion of ADRENALINE and NORADRENALINE with the result that the patient suffers from episodes of high blood pressure (HYPERTENSION), raised heart rate, and headache. Surgery to remove the tumour may be possible; if not, drug treatment may help.... phaeochromocytoma

Cells – including monocytes (a variety of LEUCOCYTES) in the blood and macrophages (see MACROPHAGE) in the tissues – that envelop and digest BACTERIA cells, cell debris and other small particles. Phagocytes are an essential part of the body’s defence mechanisms.... phagocyte

The act of absorbing and digesting fragments, detritus, or whole organisms, as an amoeba does. Granulocytes do this in the body.... phagocytosis

(Plural: phalanges.) The name given to any one of the small bones of the ?ngers and toes. The phalanges are 14 in number in each hand and foot – the thumb and great toe possessing only two each, whilst each of the other ?ngers and toes has three.... phalanx

An alternative name for the PENIS, this word may also be used to describe a penis-like object. In embryology the phallus is the rudimentary penis before the urethral duct has completely developed.... phallus

Following the AMPUTATION of a limb, it is usual for the patient to experience sensations as if the limb were still present. This condition is referred to as a phantom limb. In most patients the sensation passes o? in time.... phantom limb

The way in which the body deals with a drug. This includes the drug’s absorption, distribution in the tissues, METABOLISM, and excretion.... pharmacokinetics

Another name for the throat. The term throat is popularly applied to the region about the front of the neck generally, but in its strict sense it means the irregular cavity into which the nose and mouth open above, from which the larynx and gullet open below, and in which the channel for the air and that for the food cross one another. In its upper part, the EUSTACHIAN TUBES open one on either side, and between them on the back wall grows a mass of glandular tissue – adenoids (see NOSE, DISORDERS OF).... pharynx

An example of the widely used ANTIDEPRESSANT DRUGS which are classi?ed as MONOAMINE OXIDASE INHIBITORS (MAOIS). The drug is particularly useful because its stimulant e?ect is less than that of most other MAOIs.... phenelzine

See under PENICILLIN.... phenoxymethylpenicillin

Commonly referred to as PKU, this is one of the less common, but very severe, forms of mental de?ciency. The incidence in populations of European origin is around 1 in 15,000 births. The condition is due to the inability of the baby to metabolise the amino acid, phenylalanine (see AMINO ACIDS). In the UK, every newborn baby is screened for PKU by testing a spot of their blood collected by the midwife. A positive diagnosis leads to lifelong treatment with a diet low in phenylalanine, with a good chance that the infant will grow up mentally normal. Parents of children with phenylketonuria can obtain help and information from the National Society for Phenylketonuria (UK) Ltd. (See also METABOLIC DISORDERS; GENETIC DISORDERS – Recessive genes.)... phenylketonuria

Tightness of the foreskin (PREPUCE) which prevents it from being pulled back over the underlying head (glans) of the PENIS. Some phimosis is normal in uncircumcised males until they are six months old. The condition may, however, persist, eventually causing problems with urination. BALANITIS may occur because the inside of the foreskin cannot be properly washed. There may be an increased risk of cancer of the penis. In adolescents and adults with phimosis, erection of the penis is painful. CIRCUMCISION is the treatment.... phimosis

In?ammation of a vein. (See VEINS; VEINS, DISEASES OF.)... phlebitis

The study of the VEINS, particularly by means of X-rays after the veins have been injected with a radio-opaque substance.... phlebography

A traditional name for the operation of bloodletting by opening a vein. (See VEINS; VENESECTION.)... phlebotomy

This is a great reduction in the size of the proximal parts of the limbs. In extreme cases the hands and feet may spring directly from the trunk. A rare condition, it occurred most commonly in children whose mothers took THALIDOMIDE in early pregnancy.... phocomelia

An OPIOID cough suppressant similar to CODEINE; it is not, however, potent enough to suppress severe coughs and is also constipating.... pholcodine

The presence of excess phosphates in the urine. This occurs in...and can even cause, alkaline urine (it’s normally acidic), resulting in cloudy urine, small particle sedimentation, and the more common kinds of kidney stones.... phosphaturia

A non-metallic element whose compounds are widely found in plant and animal tissues. In humans, this element is largely concentrated in BONE. Some phosphorus-containing compounds such as ADENOSINE TRIPHOSPHATE (ATP) and creatine phosphate are essential participants in the conversion and storage of energy that are part of the body’s METABOLISM. Pure phosphorus is toxic.... phosphorus

Coagulation of the tissues of the retina (see EYE) by laser, for treatment of diseases of the retina such as diabetic retinopathy (see under EYE, DISORDERS OF – Retina, disorders of).... photocoagulation

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

Abnormal reaction to sunlight. The condition usually occurs as a skin rash appearing in response to light falling on the skin, and it may be caused by substances that have been eaten or applied to the skin. These are called photosensitisers and may be dyes, chemicals in soaps, or drugs. Sometimes plants act as photosensitisers – for example, buttercups and mustard. The condition may occur in some illnesses such as lupus erythematosus (see under LUPUS).... photosensitivity

Physiology is the branch of medical science that deals with the healthy functions of di?erent organs, and the changes that the whole body undergoes in the course of its activities. The teaching of physiology is a basic part of the medical student’s initial education.... physiology

An important treatment involving the use of physical measures, such as exercise, heat, manipulation and remedial exercises in the treatment of disease. An alternative name is PHYSICAL MEDICINE. It is an essential part of the rehabilitation of convalescent or disabled patients. Those who practise physiotherapy – physiotherapists – have a recognised training and, on successful completion of this, are placed on the profession’s o?cial register (see APPENDIX 8: PROFESSIONAL ORGANISATIONS.)... physiotherapy

The British Pharmacopoeia name for vitamin K. (See APPENDIX 5: VITAMINS.)... phytomenadione

Botanical or herbal medicine, often with a heavy emphasis on studies and monographs and their medical implications (with virtually none from North America), and with a philosophy of “little drug” medical uses and the reliance on the European phytopharmaceutical industry (where the studies came from). No judgment here; this approach is of great value to physicians, since it offers clear implications for medical use. This approach is, however, medical and mechanistic, not vitalist and wholistic... phytotherapy

See HAEMORRHOIDS.... piles

The part of the EAR, formed of cartilage and skin, that is external to the head. In animals it is an important element in detecting the direction of sound.... pinna

A form of PARAESTHESIA, or disturbed sensation, such as may occur, for example, in NEURITIS or POLYNEURITIS.... pins and needles

A nonvenereal tropical treponemal disease similar to yaws and caused by Treponema pertenue.... pinta

An intermediate risk, oral non-steroidal antiin?ammatory drug (see NON-STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS)) with prolonged action. Used to treat pain and in?ammation in RHEUMATOID ARTHRITIS, other musculoskeletal disorders, and acute GOUT.... piroxicam

This English common name can refer to more than one species. For the banana-like plantain fruit, see Plátano; for the low-lying herb whose leaves are primarily used medicinally, see Llantén.... plantain

Also known as the pituitary body and the hypophysis, this is an ovoid structure, weighing around 0·5 gram in the adult. It is attached to the base of the BRAIN, and lies in the depression in the base of the skull known as the sella turcica. The anterior part is called the adenohypophysis and the posterior part the neurohy-P pophysis. The gland is connected to the HYPOTHALAMUS of the brain by a stalk known as the hypophyseal or pituitary stalk.

The pituitary gland is the most important ductless, or endocrine, gland in the body. (See

ENDOCRINE GLANDS.) It exerts overall control of the endocrine system through the media of a series of hormones which it produces. The adenohypophysis produces trophic hormones (that is, they work by stimulating or inhibiting other endocrine glands) and have therefore been given names ending with ‘trophic’ or ‘trophin’. The thyrotrophic hormone, or thyroid-stimulating hormone (TSH), exerts a powerful in?uence over the activity of the THYROID GLAND. The ADRENOCORTICOTROPHIC HORMONE (ACTH) stimulates the cortex of the adrenal glands. GROWTH HORMONE, also known as somatotrophin (SMH), controls the growth of the body. There are also two gonadotrophic hormones which play a vital part in the control of the gonads: these are the follicle-stimulating hormone (FSH), and the luteinising hormone (LH) which is also known as the interstitial-cell-stimulating hormone (ICSH) – see GONADOTROPHINS. The lactogenic hormone, also known as prolactin, mammotrophin and luteotrophin, induces lactation.

The neurohypophysis produces two hormones. One is oxytocin, which is widely used because of its stimulating e?ect on contraction of the UTERUS. The other is VASOPRESSIN, or the antidiuretic hormone (ADH), which acts on the renal tubules and the collecting tubules (see KIDNEYS) to increase the amount of water that they normally absorb.... pituitary gland

See FASCIITIS.... plantar fasciitis

(1) A coating of the TEETH which forms as a result of poor mouth and dental hygiene. It consists of food debris and bacteria; later, calcium salts will be deposited in it to form calculus. It is therefore associated with both caries and periodontal disease (see TEETH, DISORDERS OF – Caries of the teeth).

(2) Raised patch on the skin resulting from the merging or enlargement of papules (see PAPULE; PIMPLES).... plaque

The name applied to the straw-coloured ?uid portion of the BLOOD composed of a solution of various inorganic salts of sodium, potassium, calcium, etc., as well as SERUM and ?brinogen, the material which produces clotting (see COAGULATION). When the plasma is clotted, the thinner ?uid separating from the clot is the serum.... plasma

The thick, spongy, disc-like mass of tissue which connects the EMBRYO with the inner surface of the UTERUS, the embryo otherwise lying free in the amniotic ?uid (see AMNION). The placenta is mainly a new structure growing with the embryo, but, when it separates, a portion of the inner surface of the womb – called the maternal placenta – comes away with it. It is mainly composed of loops of veins belonging to the embryo, lying in blood-sinuses, in which circulates maternal blood. Thus, although no mixing of the blood of embryo and mother takes place, there is ample opportunity for the exchange of ?uids, gases, and the nutrients brought by the mother’s blood. The width of the full-sized placenta is about 20 cm (8 inches), its thickness 2·5 cm (1 inch). One surface is rough and studded with villi, which consist of the loops of fetal veins; the other is smooth, and has implanted in its centre the umbilical cord, or navel string, which is about as thick as a ?nger and 50 cm (20 inches) long. It contains two arteries and a vein, enters the fetus at the navel, and forms the sole connection between the bodies of mother and fetus. The name ‘afterbirth’ is given to the structure because it is expelled from the womb in the third stage of labour (see PREGNANCY AND LABOUR).... placenta

This infection – also known as bubonic plague

– is caused by the bacterium Yersinis pestis. Plague remains a major infection in many tropical countries.

The reservoir for the bacillus in urban infection lies in the black rat (Rattus rattus), and less importantly the brown (sewer) rat (Rattus norvegicus). It is conveyed to humans by the rat ?ea, usually Xenopsylla cheopis: Y. pestis multiplies in the gastrointestinal tract of the ?ea, which may remain infectious for up to six weeks. In the pneumonic form (see below), human-to-human transmission can occur by droplet infection. Many lower mammals (apart from the rat) can also act as a reservoir in sylvatic transmission which remains a major problem in the US (mostly in the south-western States); ground-squirrels, rock-squirrels, prairie dogs, bobcats, chipmunks, etc. can be affected.

Clinically, symptoms usually begin 2–8 days after infection; disease begins with fever, headache, lassitude, and aching limbs. In over two-thirds of patients, enlarged glands (buboes) appear – usually in the groin, but also in the axillae and cervical neck; this constitutes bubonic plague. Haemorrhages may be present beneath the skin causing gangrenous patches and occasionally ulcers; these lesions led to the epithet ‘Black Death’. In a favourable case, fever abates after about a week, and the buboes discharge foul-smelling pus. In a rapidly fatal form (septicaemic plague), haematogenous transmission produces mortality in a high percentage of cases. Pneumonic plague is associated with pneumonic consolidation (person-to-person transmission) and death often ensues on the fourth or ?fth day. (The nursery rhyme ‘Ringo-ring o’ roses, a pocketful o’ posies, atishoo! atishoo!, we all fall down’ is considered to have originated in the 17th century and refers to this form of the disease.) In addition, meningitic and pharyngeal forms of the disease can occur; these are unusual. Diagnosis consists of demonstration of the causative organism.

Treatment is with tetracycline or doxycycline; a range of other antibiotics is also e?ective. Plague remains (together with CHOLERA and YELLOW FEVER) a quarantinable disease. Contacts should be disinfected with insecticide powder; clothes, skins, soft merchandise, etc. which have been in contact with the infection can remain infectious for several months; suspect items should be destroyed or disinfected with an insecticide. Ships must be carefully checked for presence of rats; the rationale of anchoring a distance from the quay prevents access of vermin. (See also EPIDEMIC; PANDEMIC; NOTIFIABLE DISEASES.)... plague

See PLASMA EXCHANGE.... plasmapheresis

A form of calcium sulphate, which, after soaking in water, sets ?rmly. For this reason it is widely used as a form of splinting in the treatment of fractures, for producing casts to immobilise parts of the body, and for dental models. Splints are made with bandages impregnated with plaster and a suitable adhesive. Its great advantage, compared with an ordinary splint, is that it can be moulded to the shape of the limb.... plaster of paris

See RECONSTRUCTIVE (PLASTIC) SURGERY.... plastic surgery

A condition of fullness of the blood vessels in a particular part or in the whole body. This results in a ?orid, red appearance of the affected area, particularly the face. The volume of blood may be increased (POLYCYTHAEMIA) or the blood vessels beneath the skin may be dilated. Plethoric lung ?elds are seen on X-rays of patients with left-to-right shunts through the heart wall (see SEPTAL DEFECT).... plethora

The name of the membrane which, on either side of the chest, forms a covering for one lung. The two pleurae are distinct, though they touch one another for a short distance behind the breast-bone. (See LUNGS.)... pleura

Also known as BORNHOLM DISEASE. A painful condition of the chest wall, it is usually the result of an infection of coxsackie virus B (see COXSACKIE VIRUSES) and may occur in epidemics (see EPIDEMIC). Fever, sore throat, headache and malaise are typical but the condition is self-limiting, subsiding within a few days.... pleurodynia

A network of nerves or vessels: for example, the brachial and sacral plexuses of nerves and the choroid plexus of veins within the brain.... plexus

A pre?x relating to the LUNGS or to air. Examples are PNEUMONIA, PNEUMONECTOMY and PNEUMOPERITONEUM.... pneumo

A type of streptococcal bacterium (see STREPTOCOCCUS) which can cause otitis media (see EAR, DISEASES OF – Diseases of the middle ear), TONSILLITIS, PNEUMONIA, MENINGITIS and SEPTICAEMIA. It is usually sensitive to PENICILLIN.... pneumococcus

The general name applied to a chronic form of in?ammation of the LUNGS which is liable to affect people who constantly inhale irritating particles at work. It has been de?ned by the Industrial Injuries Advisory Council as: ‘Permanent alteration of lung structure due to the inhalation of mineral dust and the tissue reactions of the lung to its presence, but does not include bronchitis and emphysema.’ Some of the tradespeople liable to suffer are stonemasons, potters, steel-grinders, coal-miners, millers, and workers in cotton, ?ax, or wool mills. (See also OCCUPATIONAL HEALTH, MEDICINE AND DISEASES; TUBERCULOSIS.)... pneumoconiosis

The operation of removing an entire lung (see LUNGS) in such diseases as BRONCHIECTASIS, TUBERCULOSIS, and cancer of the lung.... pneumonectomy

A collection of air in the pleural cavity, into which it has gained entrance by a defect in the lung or a wound in the chest wall. When air enters the chest, the lung immediately collapses towards the centre of the chest; but, air being absorbed from the pleural cavity, the lung expands again within a short time. (See LUNGS, DISEASES OF.)

Tension pneumothorax is a life-threatening condition in which the air in the hemithorax is under such pressure that it forces the heart to the other side and compresses the still-in?ated lung on the other side. It must be promptly relieved by inserting a hollow tube into the pleural cavity – a chest drain.

Arti?cial pneumothorax was an operation often performed in the pre-antibiotic days to treat pulmonary tuberculosis. Air was run into the pleural cavity to cause collapse of one lung, which rested it and allowed cavities in it to heal.... pneumothorax

The prevention, diagnosis, treatment and rehabilitation of medical and surgical conditions of the feet and lower limbs.... podiatry

A toxin which introduced to the body via the gastrointestinal tract or the respiratory tract.... poison

Also known as periarteritis nodosa. A rare but potentially serious disease, probably caused by a disturbance of the immune system (see IMMUNITY). Prolonged fever and obscure symptoms referable to any system of the body are associated with local areas of in?ammation along the arteries, giving rise to nodules in their walls. Large doses of CORTICOSTEROIDS, coupled with IMMUNOSUPPRESSANT treatment, usually curtail the disorder. Recovery occurs in about 50 per cent of cases.... polyarteritis nodosa

Inflammation in several joints. Common features of a number of arboviral infections (e.g. Ross River virus and Barmah Forrest virus infections).... polyarthritis

Excessive thirst, which is a symptom of DIABETES MELLITUS and some other diseases.... polydipsia

A rise in the amount of HAEMOGLOBIN in the blood. This may be caused by an excess in the number of ERYTHROCYTES produced in the BONE MARROW or to a fall in the total volume of PLASMA in the circulatory system. It may also be a response to reduced oxygen levels – for example, among people living at high altitudes – or to liver or kidney disease: this type is called secondary polycythaemia.

The disorder may, however, occur for no obvious reason and is then called polycythaemia vera. This type develops mainly in people over 40 and about 400 people develop the disorder every year in the United Kingdom. The blood thickens, the sufferer may develop high blood pressure, ?ushing, headaches, itching and an enlarged spleen. A stroke may occur later in the disease process. Treatment of polycythaemia vera is by regular removal of blood by VENESECTION, sometimes in combination with an anticancer drug. Secondary polycythaemia is treated by remedying the underlying cause.

Polycythaemia rubra vera A disorder in which the red blood cells increase in number along with an increase in the number of white blood cells and platelets. The cause is unknown. Severe cases may require treatment with CYTOTOXIC drugs or RADIOTHERAPY.... polycythaemia

A form of rheumatism characterised by gross early-morning sti?ness, which tends to ease o? during the day, and pain in the shoulders and sometimes around the hips. It affects women more than men, and is rare under the age of 60. The cause is still obscure. It responds well to PREDNISOLONE, but treatment may need to be long continued. On the other hand the condition is not progressive and does not lead to disability.... polymyalgia rheumatica

A connective-tissue disease affecting the muscles throughout the body. This rare disorder, which is associated with DERMATOMYOSITIS, may be acute or chronic but it usually affects the muscles of the shoulders or hip areas. The muscles weaken and are tender to the touch. Di?use in?ammatory changes occur and symptomatic relief may be obtained with CORTICOSTEROIDS.... polymyositis

A molecule in which several AMINO ACIDS are joined together by peptide bonds. PROTEIN molecules are polypeptides.... polypeptide

See DERMATITIS.... pompholyx

Two species are used in medicine: Papaver somniferum, the white opium-poppy (see OPIUM), and Papaver rhoeas, the red corn-poppy. The corn-poppy is chie?y used as a colouring agent, its syrup being a brilliant crimson colour.... poppy

A small opening. The word is usually used to describe an opening in the skin that releases sweat or sebum, a waxy material secreted by the sebaceous glands in the SKIN.... pore

See NAEVUS.... port wine stain

Raised blood pressure in the PORTAL VEIN entering the LIVER. This results in increased pressure in the veins of the oesophagus and upper stomach and these grow in size to form varices – dilated tortuous veins. Sometimes these varices rupture, causing bleeding into the oesophagus. The raised pressure also causes ?uid to collect in the abdomen and form ASCITES. The commonest reason for portal hypertension is cirrhosis (?brosis) of the liver (see LIVER, DISEASES OF). THROMBOSIS in the portal vein may also be a cause. Treatment requires the cause to be tackled, but bleeding from ruptured vessels may be stopped by injecting a sclerosant or hardening solution into and around the veins. Sometimes a surgical shunt may be done to divert blood from the portal vein to another blood vessel.... portal hypertension

A metal which, on account of its great a?nity for other substances, is not found in a pure state in nature. Its salts are widely used in medicine but, as their action depends in general not on their metallic radical but upon the acid with which it is combined, their uses vary greatly and are described elsewhere. All salts of potassium depress the heart’s action as a result of action by the potassium ion.... potassium

A salt of the metallic element POTASSIUM. It is used as a skin antiseptic (see ANTISEPTICS) and for cleaning wounds; its astringent e?ect is useful in the treatment of DERMATITIS. It should not be taken internally because the compound is poisonous.... potassium permanganate

A derivative of CORTISONE, which is ?ve or six times as active as cortisone and has less of the salt- and water-retaining properties of cortisone. It is given by mouth.... prednisolone

A disorder in which EJACULATION of semen occurs before or immediately after the penis penetrates the vagina during sexual intercourse. The most common sexual problem in men, persistent premature ejaculation may have psychological causes, although many adolescents and some adults experience it occasionally. Sexual counselling may help to alleviate the condition.... premature ejaculation

A drug or drugs given to a patient to produce sedation before an operation, whether this is done under a local or general anaesthetic. A narcotic analgesic drug (see NARCOTICS; ANALGESICS) is usually used, as this relieves pain as well as anxiety. An antisecretory drug is often added to reduce the secretions in the airways and thus lessen the risk associated with general anaesthesia. Premedication reduces the amount of anaesthetic needed to make the patient unconscious.... premedication

The two TEETH on each side of the jaw positioned between the canines and the molars in the adult. The teeth are used with the molars for holding and grinding food.... premolar

This has been de?ned as ‘any combination of emotional or physical features which occur cyclically in a woman before MENSTRUATION, and which regress or disappear during menstruation’. It is characterised by mood-changes, discomfort, swelling and tenderness in the breasts, swelling of the legs, a bloated feeling in the abdomen, headache, fatigue and constipation. The mood-changes range from irritability and mild depression to outbursts of violence. It may last for 3–14 days. How common it is is not known, as only the more severe cases are seen by doctors, but it has been estimated that one in ten of all menstruating women suffer from it severely enough to require treatment. The cause is not known, but it is probably due to some upset of the hormonal balance of the body. In view of the multiplicity of causes that have been put forward, it is not surprising that there is an equal multiplicity of treatments. Among these, one of the most widely used is PROGESTERONE. Others include pyridoxine, danazol, and gamma linolenic acid available in the form of oil of evening primrose. Whatever drug may be prescribed, counselling is equally essential and, in many cases, is all that is required.... premenstrual syndrome

Also known as the foreskin, this is the free fold of skin that overlaps the glans PENIS and retracts when the penis becomes erect. It is the part that is removed at CIRCUMCISION.... prepuce

DEAFNESS that comes on with increasing years. It is caused by increasing loss of elasticity in the hearing mechanism, combined with the slow-ing-down of the mental processes that accompanies old age. It is characterised by particular di?culty in hearing high notes such as the telephone and the voices of women and children. Hearing in a background of noise is also affected. Modern, miniaturised, transistor ‘within-the-ear’ hearing aids are now available that are proving helpful in making life more bearable for the elderly in this respect. (See also AGEING; HEARING AIDS.)... presbyacusis

See ACCOMMODATION; EYE, DISORDERS OF.... presbyopia

The written direction for drugs for medicinal use, given by the doctor, dentist and (for some drugs) nurse to the patient, for dispensation by the pharmacist. Drugs should only be prescribed when essential for treatment, and when any possible risks involved to the patient (and fetus in cases of pregnancy) are outweighed by the potential bene?ts of giving the drug. When possible, non-proprietary, or generic, titles should be prescribed; by allowing the pharmacist to dispense any equivalent drug this avoids delay for the patient, as well as reducing the cost to the Health Service. Dosage is generally stated in metric units, and both the amount and frequency should be carefully explained to the patient by the doctor, and clearly written when the drug is dispensed (see also DOSAGE; DRUGS). Strict adherence to the Misuse of Drugs Act 1973 is necessary to restrict the inappropriate prescription and abuse of drugs, particularly CONTROLLED DRUGS. Full details of drugs available on NHS prescription are given in the British National Formulary, which is published by the British Medical Association and the Royal Pharmaceutical Society of Great Britain twice a year and distributed to all NHS doctors by the government. Careful monitoring of prescribing in the UK is carried out by a government-appointed agency.... prescription

An agent, neurologic or hormonal, that increases blood pressure.... pressor

A persisting painful ERECTION of the PENIS occurring without sexual stimulation. It is a rare but acute condition that requires immediate treatment. The cause is the failure of blood to drain from the spongy corpus caversonum tissues of the penis, thus maintaining an erection. This may happen because of infection, damage to the nerves controlling the blood vessels, or a clotting defect in the blood.... priapism

See MILIARIA.... prickly heat

Used for radical cure of malaria and to prevent relapse. It is used to kill the liver stages of the malarial parasite. It also has the potential to be used as a causal prophylactic drug. This 8-aminoquinoline must be used with care or not at all in people who are G6PD deficient.... primaquine

The protection of health by personal and community-wide effects. Primary prevention involves measures provided to individuals to prevent the onset of a targeted condition.... primary prevention

A barbiturate-related drug (see BARBITURATES) used to treat all forms of EPILEPSY, except in sufferers who do not have seizures.... primidone

An aberrant variety of one of the proteins, called PrP, in a brain cell. The result of a gene mutation (see GENES), prions are stable, resistant to radiation and impervious to the normal cellular processes of degradation. They seem to react with normal PrP, turning it into an abnormal type that then accumulates in brain tissue. Prions are believed to be the infectious agents that cause a group of serious neurological disorders called spongiform encephalopathies. CREUTZFELDT-JAKOB DISEASE (CJD), the new variant of CJD linked with BOVINE SPONGIFORM ENCEPHALOPATHY (BSE), and KURU – a neurological disorder found in a cannibal tribe in New Guinea – are all diseases in this group that occur in humans. The prion disorders have a long latent period between infection and manifestation of symptoms; they are hard to diagnose until autopsy and there is no cure as yet.... prion

A benzoic-acid derivative which interferes with the excretion by the KIDNEYS of certain compounds, including PENICILLIN and PARA-AMINO SALICYLIC ACID. Probenecid and was originally introduced into medicine for this reason, as a means of increasing and maintaining the concentration of penicillin in the body; it is also used to treat chronic GOUT.... probenecid

An antineoplastic drug used mainly to treat Hodgkin’s disease (see under LYMPHOMA). It acts by interfering with the process of MITOSIS, the method by which the cells of the body, including tumours, reproduce themselves.... procarbazine

Prochlorperazine is an antipsychotic phenothiazine drug (see NEUROLEPTICS). It is also an e?ective drug for the prevention or treatment of vomiting, and has therefore been used in the treatment of MENIÈRE’S DISEASE.... prochlorperazine

Another term for PROLAPSE.... procidentia

Pain in the rectum... proctalgia

In?ammation situated about the RECTUM or ANUS.... proctitis

A premonitory symptom or precursor; a symptom indicating the onset of a disease.... prodrome

Premature old age (see also AGEING).... progeria

This is the hormone secreted after ovulation by the corpus luteum. It is a steroid (a cholesterol with a funny hat), enters receptive cells to stimulate their growth, and acts as an anabolic agent. Estrogen should be viewed as the primary coat underneath all the cycles during a woman’s reproductive years, with progesterone, its antagonist, surging for ten or twelve days in ovulatory months. Most of the actions of progesterone cannot occur without estrogen having previously induced the growth of progesterone-receptive binding sites. In the estrus cycle, estrogen stimulates the thickening of membranes (the proliferative phase), and progesterone stimulates their sophistication into organized and secreting mucosa (the secretory phase). The new secretions contain anticoagulants, antimicrobials, and rich mucus fluids. If there is pregnancy, the uterine membranes are fully structured for the long haul; if menses occurs, the thickened tissues can erode away without clotting, becoming infected, or flowing poorly. If there is not enough estrogen, the corpus luteum will not mature. If the corpus luteum is weak, menses becomes disorganized, clotty, and painful. It is also the first part of the cycle to become disorganized in early menopause, since the available ovarian proto-follicles have been reduced over the years to only a few. In earlier years, dozens of potential follicles may attempt maturity each month, with only the strongest one able to reach dominance, form a corpus luteum and an ovum...the rest disintegrating. In a manner of speaking, the better the follicle, the better the corpus luteum and (presumably) the sounder the ovum. Since the number of potential follicles is fixed at birth, by early menopause those that still remain contain a high number of hormone-resistant and unsound protofollicles, resulting in more and more cycles having less predictable estrogen and especially progesterone levels.... progesterone

Abnormal protusion of the lower JAW, or sometimes of both jaws. The condition may make biting and chewing di?cult, in which case corrective surgery is necessary.... prognathism

A biguanide antimalarial used alone or in combination for the prevention of malaria.... proguanil

Prolactin is the pituitary hormone (see PITUITARY GLAND) which initiates lactation. The development of the breasts during pregnancy is ascribed to the action of OESTROGENS; prolactin starts them secreting. If lactation does not occur or fails, it may be started by injection of prolactin.

The secretion of prolactin is normally kept under tonic inhibition by the secretion of DOPAMINE which inhibits prolactin. This is formed in the HYPOTHALAMUS and secreted into the portal capillaries of the pituitary stalk to reach the anterior pituitary cells. Drugs that deplete the brain stores of dopamine or antagonise dopamine at receptor level will cause HYPERPROLACTINAEMIA and hence the secretion of milk from the breast and AMENORRHOEA. METHYLDOPA and RESERPINE deplete brain stores of dopamine and the PHENOTHIAZINES act as dopamine antagonists at receptor level. Other causes of excess secretion of prolactin are pituitary tumours, which may be minute and are then called microadenomas, or may actually enlarge the pituitary fossa and are then called macroadenomas. The most common cause of hyperprolactinaemia is a pituitary tumour. The patient may present with infertility – because patients with hyperprolactinaemia do not ovulate – or with amenorrhea and even GALACTORRHOEA.

BROMOCRIPTINE is a dopamine agonist. Treatment with bromocriptine will therefore control hyperprolactinaemia, restoring normal menstruation and ovulation and suppressing galactorrhoea. If the cause of hyperprolactinaemia is an adenomatous growth in the pituitary gland, surgical treatment should be considered.... prolactin

Displacement of an organ or structure from its normal position. The term is applied chie?y to downward displacements of the RECTUM and UTERUS.... prolapse

A phenothiazine drug used to tranquillise disturbed patients (see NEUROLEPTICS).... promazine

The movement whereby the bones of the forearm are crossed and the palm of the hand faces downwards.... pronation

A condition in which the EYE protrudes from the orbit. Some causes include thyroid disorders (see THYROID GLAND, DISEASES OF), tumours within the orbit, in?ammation or infection of the orbit. Proptosis due to endocrine abnormality (e.g. thyroid problems) is known as EXOPHTHALMOS.... proptosis

An oral antithyroid drug given daily to a person with HYPERTHYROIDISM. It interferes with the body’s production of thyroid hormones.... propylthiouracil

See “cohort study”.... prospective study

A group of a dozen or more fatty acid derivatives made by many tissues for paracrine (local) hormone use. Because they are only meant for local use, the same compound may serve opposite purposes in different tissues...inhibiting inflammation in the stomach lining while increasing uterine irritability.... prostaglandin

This is an accessory sex gland in males which is wrapped round the URETHRA as this tube leaves the URINARY BLADDER. Opening into the urethra, the gland secretes an alkaline ?uid during ejaculation and is a constituent of SEMEN. The gland grows during adolescence and is sensitive to the concentrations of sex hormones.... prostate gland

An operation to remove part or all of the PROSTATE GLAND. The most common method is transurethral prostatectomy (TURP) carried out during cytoscopy. A very enlarged prostate may need to be removed by a retropubic prostatectomy. After several weeks, most patients are able to resume normal activity including sexual intercourse.... prostatectomy

Molecular constituent of all cells comprising amino acid building blocks.... protein

The viscid, translucent, glue-like material containing ?ne granules and composed mainly of proteins, which makes up the essential material of plant and animal cells and has the properties of life.... protoplasm

An arti?cial replacement of a missing or malfunctioning body part. Examples include false legs or arms ?tted after AMPUTATION (see below); arti?cial heart valves; arti?cial heart devices; COCHLEAR IMPLANTS to improve hearing; a bio-arti?cial PANCREAS (containing live pancreatic cells from pigs) now under development to treat DIABETES MELLITUS; arti?cial bone; and (under development) arti?cal lungs. Cosmetic prostheses such as arti?cal eyes, teeth, noses and breasts are in widespread use.

Development of such mechanical and biomechanical devices points the way to a much wider use of e?ective prostheses, enabling people who would previously have died or been severely handicapped to lead normal or near normal lives. The technical hazards that have already been overcome provide a sound foundation for future successes. Progress so far in producing prostheses should also ensure that organ replacement is free from the serious ethical problems that surround the use of genetic manipulation to cure or prevent serious diseases (see ETHICS).

Limbs These are best made to meet the individual’s requirements but can be obtained ‘o? the shelf’. Arti?cial joints normally comprise complex mechanisms to stimulate ?exion and rotation movements. Leg prostheses are generally more useful than those for arms, because leg movements are easier to duplicate than those of the arm. Modern electronic circuitry that enables nerve impulses to be picked up and converted into appropriate movements is greatly improving the e?ectiveness of limb prostheses.

Eyes Arti?cial eyes are worn both for appearance and for psychological reasons. They are made of glass or plastic, and are thin shells of a boat-shape, representing the front half of the eye which has been removed. The stump which is left has still the eye-muscles in it, and so the arti?cial eye still has the power of moving with the other. A glass eye has to be replaced by a new one every year. Plastic eyes have the advantage of being more comfortable to wear, being more durable, and being unbreakable. Research is taking place aimed at creating a silicon chip that stimulates the visual cortex and thus helps to restore sight to the blind.

Dental prostheses is any arti?cial replacement of a tooth. There are three main types: a crown, a bridge and a denture. A crown is the replacement of the part of a tooth which sticks through the gum. It is ?xed to the remaining part of the tooth and may be made of metal, porcelain, plastic or a combination of these. A bridge is the replacement of two or three missing teeth and is usually ?xed in place. The replacement teeth are held in position by being joined to one or more crowns on the adjacent teeth. A denture is a removable prosthesis used to replace some or all the teeth. The teeth are made of plastic or porcelain and the base may be of plastic or metal. Removable teeth may be held more ?rmly by means of implants.

Heart The surgical replacement of stenosed or malfunctioning heart-valves with metal or plastic, human or pig valves has been routinely carried out for many years. So too has been the insertion into patients with abnormal heart rhythms of battery-driven arti?cial pacemakers (see CARDIAC PACEMAKER) to restore normal function. The replacement of a faulty heart with an arti?cial one is altogether more challenging. The ?rst working attempt to create an arti?cial heart took place in the early 1980s. Called the Jarvik-7, it had serious drawbacks: patients had to be permanently connected to apparatus the size of an anaesthetic trolley; and it caused deaths from infection and clotting of the blood. As a result, arti?cial hearts have been used primarily as bridging devices to keep patients alive until a suitable donor heart for transplantation can be found. Recent work in North America, however, is developing arti?cial hearts made of titanium and dacron. One type is planted into the chest cavity next to the patient’s own heart to assist it in its vital function of pumping blood around the body. Another replaces the heart completely. Eventually, it is probable that arti?cial hearts will replace heart transplants as the treatment of choice in patients with serious heart disorders.

Liver Arti?cial livers work in a similar way to kidney dialysis machines (see DIALYSIS). Blood is removed from the body and passed through a machine where it is cleaned and treated and then returned to the patient. The core of the device comprises several thousand ?exible membrane tubules on which live liver cells (from pigs or people) have been cultured. There is an exchange of biological molecules and water with the ‘circulating’ blood, and the membrane also screens the ‘foreign’ cells from the patient’s immune system, thus preventing any antagonistic immune reaction in the recipient.

Nose The making of a new nose is the oldest known operation in plastic surgery, Hindu records of such operations dating back to 1,000 BC. Loss of a nose may be due to eroding disease, war wounds, gun-shot wounds or dog bites. In essence the operation is the same as that practised a thousand years before Christ: namely the use of a skin graft, brought down from the forehead. Alternative sources of the skin graft today are skin from the arm, chest or abdomen. As a means of support, the new nose is built round a graft of bone or of cartilage from the ear.... prosthesis

Pseudocyesis means spurious or false pregnancy, a condition characterised by enlargement of the abdomen, and even enlargement of the breasts and early-morning sickness – the woman being quite convinced that she is pregnant.... pseudocyesis

Also called parrot disease. An infectious disease of parrots and other exotic birds which may be transmitted to humans and is caused by the micro-organism Chlamydia psittaci. It presents as PNEUMONIA or a systemic illness in which the patient has an enlarged spleen and liver and PNEUMONITIS. Tetracycline is an e?ective treatment, but relapses may occur.... psittacosis

The term applied to the theories and practice of the school of psychology originating with Freud and developed by Jung and other psychotherapists (see PSYCHOLOGY). It depends upon the theory that states of disordered mental health have been produced by a repression in the subconscious of painful memories or of con?icting instincts, thus absorbing the individual’s mental energy and diverting attention from normal mental activities.

Psychoanalysis aims at discovering these repressed memories, which are responsible for the diversion of mental power and of which the affected person usually is only dimly aware or quite unaware. The fundamental method of psychoanalytical treatment is the free expression of thoughts, ideas and fantasies on the part of the patient. To facilitate this, the analyst uses techniques to relax the patient and maintains a neutral attitude to his or her problems. In the course of analysis the patient will re-explore his or her early emotional attitudes and tensions.

The fundamental conception of psychoanalysis, although hard to prove by orthodox scienti?c methods and therefore challenged by some psychiatrists, has been widely adopted and developed by other schools of psychology. Freud’s work changed the attitudes of the scienti?c community and the public to the problems of the neurotic, the morbidly anxious, the fearful and to the mental and emotional develoment of the child.... psychoanalysis

One of a group of mental disorders in which the affected person loses contact with reality. Thought processes are so disturbed that the person does not always realise that he or she is ill. Symptoms include DELUSIONS, HALLUCINATIONS, loss of emotion, MANIA, DEPRESSION, poverty of thought and seriously abnormal behaviour. Psychoses include SCHIZOPHRENIA, MANIC DEPRESSION and organically based mental disorders. (See also MENTAL ILLNESS.)... psychosis

A degenerative disorder of the conjunctiva (see EYE) which grows over the cornea medially and laterally. The overgrowths look like wings. They are commonly seen in people who live in areas of bright sunlight, particularly when re?ected from deserts or snow?elds. Treatment involves excision of the overgrowth. (See also EYE, DISORDERS OF.)... pterygium

This was introduced in 1936 by Egas Moniz, Professor of Medicine in Lisbon University, for the surgical treatment of certain psychoses (see PSYCHOSIS). For his work in this ?eld he shared the Nobel prize in 1949. The original operation, known as leucotomy, consisted of cutting white ?bres in the frontal lobe of the BRAIN. It was accompanied by certain hazards such as persistent EPILEPSY and undesirable changes in personality; pre-frontal leucotomy is now regarded as obsolete. Modern stereotactic surgery may be indicated in certain intractable psychiatric illnesses in which the patient is chronically incapacitated, especially where there is a high suicide risk. Patients are only considered for psychosurgery when they have failed to respond to routine therapies. One contraindication is marked histrionic or antisocial personality. The conditions in which a favour-able response has been obtained are intractable and chronic obsessional neuroses (see NEUROSIS), anxiety states and severe chronic DEPRESSION.

Psychosurgery is now rare in Britain. The Mental Health Act 1983 requires not only consent by the patient – con?rmed by an independent doctor, and two other representatives of the Mental Health Act Commission – but also that the Commission’s appointed medical representative also advise on the likelihood of the treatment alleviating or preventing a deterioration in the patient’s condition.... psychosurgery

Excessive secretion of saliva... ptyalism

The approach to health that is concerned with the health of the community as a whole. The three core public health functions are: the assessment and monitoring of the health of communities and populations at risk to identify health problems and priorities; the formulation of public policies designed to solve identified local and national health problems and priorities; and ensuring that all populations have access to appropriate and cost-effective care, including health promotion and disease prevention services, and evaluation of the effectiveness of that care. See “community health”.... public health

The change that takes place when childhood passes into manhood or womanhood. This change is generally a very de?nite one, occurring at about the age of 14 years, although it is modi?ed by race, climate, and bodily health so that it may appear a year or two earlier or several years later. At this time, the sexual functions attain their full development; the contour of the body changes from a childish to a more rounded womanly, or sturdy manly, form; and great changes take place in the mode of thought and feeling.

In girls, puberty is marked by the onset of MENSTRUATION and development of the BREASTS. The latter is usually the ?rst sign of puberty to appear, and may occur from nine years onwards; most girls show signs of breast development by the age of 13. The time from the beginning of breast development to the onset of menstruation is usually around two years but may range from six months to ?ve years. The ?rst sign of puberty in boys is an increase in testicular and penile size (see TESTICLE; PENIS) between the age of ten and 14. The LARYNX enlarges in boys, so that the voice – after going through a period of ‘breaking’ – ?nally assumes the deep manly pitch. Hair appears on the pubis and later in the armpits in both boys and girls, whilst in the former it also begins to grow on the upper lip, and skin eruptions are not uncommon on the face (see ACNE).

The period is one of transition from a physical and mental point of view. Puberty is not to be regarded as a physiological ‘coming of age’, for full development is usually achieved in the early 20s.... puberty

In this condition, increased resistance to the blood ?ow through the LUNGS occurs. This is usually the result of lung disease, and the consequence is an increase in pulmonary artery pressure and in the pressure in the right side of the heart and in the veins bringing blood to the heart. Chronic BRONCHITIS or EMPHYSEMA commonly constrict the small arteries in the lungs, thus causing pulmonary HYPERTENSION. (See also EISENMENGER SYNDROME.)... pulmonary hypertension

Fluid in the small air sacs of the lungs, from inefficient pumping by the heart or leakage of fluid from the blood vessels in the lungs (possibly from envenomation). As it prevents air exchange in the lungs it causes hypoxia and may lead to death.... pulmonary oedema

The period which elapses after the birth of a child until the mother is again restored to her ordinary health. It is generally regarded as lasting for a month. One of the main changes to occur is the enormous decrease in size that takes place in the muscular wall of the womb. There are often AFTERPAINS during the ?rst day in women who have borne several children, less often after a ?rst child. The discharge is bloodstained for the ?rst two or three days, then clearer till the end of the ?rst week, before stopping within two or three weeks. The breasts, which have already enlarged before the birth of the child, secrete milk more copiously, and there should be a plentiful supply on the third

day of the puerperium. (See also PREGNANCY AND LABOUR.)

Management The mother should start practising exercises to help ensure that the stretched abdominal muscles regain their normal tone. There is no need for any restriction of diet, but care must be taken to ensure an adequate intake of ?uid, including at least 580 ml (a pint) of milk a day.

Milk, as already stated, appears copiously on the third day, but this is preceded by a secretion from the breast, known as colostrum, which is of value to the newborn child. The child should therefore be put to the breasts within 6–8 hours of being born. This also stimulates both the breasts and the natural changes taking place during this period. Suckling is bene?cial for both child and mother and encourages bonding between the two.... puerperium

The condition in which an embolus (see EMBOLISM), or clot, is lodged in the LUNGS. The source of the clot is usually the veins of the lower abdomen or legs, in which clot formation has occurred as a result of the occurrence of DEEP VEIN THROMBOSIS (DVT) – THROMBOPHLEBITIS (see VEINS, DISEASES OF). Thrombophlebitis, with or without pulmonary embolism, is a not uncommon complication of surgical operations, especially in older patients. This is one reason why nowadays such patients are got up out of bed as quickly as possible, or, alternatively, are encouraged to move and exercise their legs regularly in bed. Long periods of sitting, particularly when travelling, can cause DVT with the risk of pulmonary embolism. The severity of a pulmonary embolism, which is characterised by the sudden onset of pain in the chest, with or without the coughing up of blood, and a varying degree of SHOCK, depends upon the size of the clot. If large enough, it may prove immediately fatal; in other cases, immediate operation may be needed to remove the clot; whilst in less severe cases anticoagulant treatment, in the form of HEPARIN, is given to prevent extension of the clot. For some operations, such as hip-joint replacements, with a high risk of deep-vein thrombosis in the leg, heparin is given for several days postoperatively.... pulmonary embolism

A disorder of the HEART in which obstruction of the out?ow of blood from the right ventricle occurs. Narrowing of the pulmonary valve at the exit of the right ventricle and narrowing of the pulmonary artery may cause obstruction. The condition is usually congenital, although it may be caused by RHEUMATIC FEVER. In the congenital condition, pulmonary stenosis may occur with other heart defects and is then known as Fallot’s tetralogy. Breathlessness and enlargement of the heart and eventual heart failure may be the consequence of pulmonary stenosis. Surgery is usually necessary to remove the obstruction.... pulmonary stenosis

If the tip of one ?nger is laid on the front of the forearm, about 2·5 cm (one inch) above the wrist, and about 1 cm (half an inch) from the outer edge, the pulsations of the radial artery can be felt. This is known as the pulse, but a pulse can be felt wherever an artery of large or medium size lies near the surface.

The cause of the pulsation lies in the fact that, at each heartbeat, 80–90 millilitres of blood are driven into the AORTA, and a ?uid wave, distending the vessels as it passes, is transmitted along the ARTERIES all over the body. This pulsation falls away as the arteries grow smaller, and is ?nally lost in the minute capillaries, where a steady pressure is maintained. For this reason, the blood in the veins ?ows steadily on without any pulsation. Immediately after the wave has passed, the artery, by virtue of its great elasticity, regains its former size. The nature of this wave helps the doctor to assess the state of the artery and the action of the heart.

The pulse rate is usually about 70 per minute, but it may vary in health from 50 to 100, and is quicker in childhood and slower in old age than in middle life; it is low (at rest) in physically ?t athletes or other sports people. Fever causes the rate to rise, sometimes to 120 beats a minute or more.

In childhood and youth the vessel wall is so thin that, when su?cient pressure is made to expel the blood from it, the artery can no longer be felt. In old age, however, and in some degenerative diseases, the vessel wall becomes so thick that it may be felt like a piece of whipcord rolling beneath the ?nger.

Di?erent types of heart disease have special features of the pulse associated with them. In atrial FIBRILLATION the great character is irregularity. In patients with an incompetent AORTIC VALVE the pulse is characterised by a sharp rise and sudden collapse. (See HEART, DISEASES OF.)

An instrument known as the SPHYGMOGRAPH registers the arterial waves and a polygraph (an instrument that obtains simultaneous tracings from several di?erent sources such as radial and jugular pulse, apex beat of the heart and ELECTROCARDIOGRAM (ECG)) enables tracings to be taken from the pulse at the wrist and from the veins in the neck and simultaneous events in the two compared.

The pressure of the blood in various arteries is estimated by a SPHYGMOMANOMETER. (See BLOOD PRESSURE.)... pulse

See EYE.... pupil

A skin rash caused by bleeding into the skin from capillary blood vessels. The discrete purple spots of the rash are called purpuric spots or, if very small, petechiae. The disorder may be caused by capillary defects (nonthrombocytopenic purpura) or be due to a de?ciency of PLATELETS in the blood (thrombocytopenic purpura). Most worryingly, the rash may be due to a fulminant form of meningococcal SEPTICAEMIA called purpura fulminans. (See also HENOCH-SCHÖNLEIN PURPURA; IDIOPATHIC THROMBOCYTOPENIC PURPURA (ITP); THROMBOCYTOPENIA.).... purpura

Containing, comprising or forming PUS.... purulent

A small collection of PUS. Malignant pustule is one of the forms of ANTHRAX.... pustule

See PHOTOCHEMOTHERAPY; PSORIASIS.... puva

The process whereby the KIDNEYS are rendered radio-opaque, and therefore visible on an X- ray ?lm. It constitutes a most important part of the examination of a patient with kidney disease. (See SODIUM DIATRIZOATE.)... pyelography

Surgery to remove a stone from the kidney (see KIDNEYS, DISEASES OF) via an incision in the pelvis of the kidney.... pyelolithotomy

In?ammation of the kidney (see KIDNEYS), usually the result of bacterial infection. The in?ammation may be acute or chronic. Acute pyelonephritis comes on suddenly, is commoner in women, and tends to occur when they are pregnant. Infection usually spreads up the URETER from the URINARY BLADDER which has become infected (CYSTITIS). Fevers, chills and backache are the usual presenting symptoms. ANTIBIOTICS should be given, and in severe cases the intravenous route may be necessary. SEPTICAEMIA is an occasional complication.

Chronic pyelonephritis may start in childhood, and the usual cause is back ?ow of urine from the bladder into one of the ureters – perhaps because of a congenital deformity of the valve where the ureter drains into the bladder. Constant urine re?ux results in recurrent infection of the kidney and damage to its tissue. Full investigation of the urinary tract is essential and, if an abnormality is detected, surgery may well be required to remedy it. HYPERTENSION and renal failure may be serious complications of pyelonephritis (see also KIDNEYS, DISEASES OF).... pyelonephritis

Narrowing of the PYLORUS, the muscular exit from the STOMACH. It is usually the result of a pyloric ulcer or cancer near the exit of the stomach. Food is delayed when passing from the stomach to the duodenum and vomiting occurs. The stomach may become distended and peristalsis (muscular movement) may be seen through the abdominal wall. Unless surgically treated the patient will steadily deteriorate, losing weight, becoming dehydrated and developing ALKALOSIS.

A related condition, congenital hypertrophic pyloric stenosis, occurs in babies (commonly boys) about 3–5 weeks old, and surgery produces a complete cure.... pyloric stenosis

This is a disorder in which large ulcerating lesions appear suddenly and dramatically in the skin. It is the result of underlying VASCULITIS. It is usually the result of in?ammatory bowel disease such as ULCERATIVE COLITIS or CROHN’S DISEASE but can be associated with RHEUMATOID ARTHRITIS.... pyoderma gangrenosum

An antituberculous drug used in combination, usually with RIFAMPICIN and ISONIAZID, as the treatment regime for TUBERCULOSIS. It penetrates the MENINGES so is valuable in treating tuberculous MENINGITIS. The drug is sometimes associated with liver damage and liver function tests should be done before using it.... pyrazinamide

Pyridoxine, or vitamin B, plays an important part in the metabolism of a number of AMINO ACIDS. De?ciency leads to ATROPHY of the EPIDERMIS, the hair follicles, and the SEBACEOUS glands, and peripheral NEURITIS may also occur. Young infants are more susceptible to pyridoxine de?ciency than adults: they begin to lose weight and develop a hypochromic ANAEMIA; irritability and CONVULSIONS may also occur. Liver, yeast and cereals are relatively rich sources of the vitamin; ?sh is a moderately rich source, but vegetables and milk contain little. The minimal daily requirement in the diet is probably about 2 mg. (See APPENDIX 5: VITAMINS.)... pyridoxine

An antimalarial drug used with either sulfadoxine or DAPSONE to treat Plasmodium falciparum malariae (see MALARIA). It should not be used for PROPHYLAXIS because of potentially severe side-effects when used in the long term.... pyrimethamine

The presence of PUS in the URINE, in consequence of in?ammation situated in the KIDNEYS, URINARY BLADDER or other part of the urinary tract.... pyuria

Pain felt in one part of the body which is actually arising from a distant site (e.g. pain from the diaphragm is felt at the shoulder tip). This occurs because both sites develop from similar embryological tissue and therefore have

common pain pathways in the CENTRAL NERVOUS SYSTEM. (See also PAIN.)... referred pain

If an individual is unconscious – whether as a result of accident or illness or when in the postoperative recovery unit – but is breathing and has a pulse, he or she should be placed in the recovery position. The individual is turned on his or her side to allow the tongue to fall forwards and so reduce the likelihood of pharyngeal obstruction (see PHARYNX). Fluid in the mouth can also drain outwards instead of into the TRACHEA and LUNGS. The person can lie on either side with upper or lower leg ?exed. Sometimes the semi-prone position is used; this gives better drainage from the mouth and greater stability during transport, but makes it more di?cult to observe the face, colour or breathing. (See APPENDIX 1: BASIC FIRST AID.)... recovery position

That period during the menstrual cycle (see MENSTRUATION) when fertilisation of the OVUM is unlikely to occur. OVULATION usually occurs about 15 days before the onset of the menstrual period. A woman is commonly believed to be fertile for about 11 days in each menstrual cycle – in other words, on the day of ovulation and for ?ve days before and ?ve days after this; this would be the eighth to the 18th day of the usual 28-day menstrual cycle. Outside this fertile period is the SAFE PERIOD: the ?rst week and the last ten days of the menstrual cycle. On the other hand, there is increasing evidence that the safest period is the last few days before menstruation. In the case of irregular menstruation it is not possible to calculate the safe period. In any event, the safety is not absolute. (See also CONTRACEPTION.)... safe period

A large network of sympathetic nerves and ganglia situated in the abdomen behind the stomach, where it surrounds the coeliac artery. Branches of the VAGUS nerve – the most important part of the PARASYMPATHETIC NERVOUS SYSTEM – lead into the solar plexus, which in turn distributes branches to the stomach, intestines and several other abdominal organs. A severe blow in the solar plexus may cause temporary unconsciousness.... solar plexus

A process aimed at limiting the negative effects of an established disease.... tertiary prevention

Also known as ECTOPIC PREGNANCY. Implantation of the EMBRYO in one of the FALLOPIAN TUBES, rather than in the lining of the UTERUS. The patient usually complains of pain between six and ten weeks’ gestation and, if the Fallopian tube is not removed, there may be rupture with potentially life-threatening haemorrhage.... tubal pregnancy

Paralysis of the 7th (facial) nerve which controls muscles of the face. One-sided stiffness and distortion of the face which lacks expression. Inability to close eyes or whistle. Rarely painful.

Aetiology. Injury, virus infection, cold, stroke. Recovery usually spontaneous. Herpes Simp. Alternatives. Chamomile, Wood Betony, Bryonia, Black Cohosh, Barberry, Asafoetida, Lobelia, Rosemary, Valerian, Sage. Echinacea has been used with convincing results internally and externally.

Tea. Equal parts. Chamomile, Wood Betony. Sage. 1 heaped teaspoon to each cup boiling water; infuse 15 minutes. 1 cup 3 times daily.

Decoctions. Black Cohosh, Rosemary, Valerian, Echinacea.

Tablets/capsules. Black Cohosh. Ginseng. Echinacea. Valerian.

Powders. Formula. Rosemary 1; Echinacea 2; Valerian 1. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily.

Tinctures. Formula. Echinacea 2; Rosemary 1; Black Cohosh 1; Pinch Tincture Capsicum. 1-2 teaspoons 3 times daily.

Evening Primrose oil. 4 × 500mg capsules daily.

Aromatherapy. 10 drops Oil Juniper to eggcup Almond oil; gentle massage affected side of face. Diet. Lacto-vegetarian.

Vitamin E. (400iu daily). ... bell’s palsy

See: PAPAYA. ... papain

Glands that control the level of calcium in the blood. The four glands appear, two on each side, implanted in the thyroid gland in the front of the neck.

Disorders are (1) hypoparathyroidism and (2) hyperparathyroidism. See entries. ... parathyroid glands

An inflammatory skin eruption with small shiny pimples starting from the wrists and spreading towards the trunk. Associated with lesions on mucous surfaces – vulva, penis, mouth. Cause is unknown but sometimes related to tuberculosis or drug poisoning. Usually over front of wrists, trunk and shins.

Symptoms: Severe itching. Thickened skin with shiny red patches which later become brown and scaly. Distinguish from psoriasis. Nails ridged and split.

Alternatives. Relief from itching by use of antihistamines: Garlic, Goldenseal, Ephedra, Lobelia.

Teas. Nettles, Boneset, Chickweed, Heartsease, Yucca.

Decoctions. (1) Combine: equal parts: Burdock, Sarsaparilla, Passion flower. OR (2) Combine: equal parts: Echinacea, Blue Flag root, Sarsaparilla. Half an ounce (14g) to 1 pint (500ml) water gently simmered 20 minutes. Dose: half-1 cup thrice daily.

Cold infusion. One heaped teaspoon Barberry (Berberis Vul) to cup cold water. Steep overnight. Half-1 cup thrice daily.

Powders, Liquid Extracts or Tinctures. Equal parts: Wild Yam, Blue Flag root, Fringe Tree bark. Powders: 500mg. Liquid Extracts: 30-60 drops in water. Tinctures: 1-2 teaspoons in water. Thrice daily before meals.

Mouth ulcers: Rinse mouth with Goldenseal and Myrrh drops, in water.

Topical. Ointment or pulp from any one: Aloe Vera, Comfrey, Chickweed, Houseleek, Marshmallow. Vaginal lesion. Aloe Vera pulp or gel.

Diet. Avoid citrus fruits and milk.

Vitamins. A. B-complex, B12, C. E. F. PABA.

Minerals. Dolomite. Zinc. Cod Liver oil: one dessertspoon daily. ... lichen planus

(Sir James Paget, 1814-99) Osteitis deformans. Chronic inflammation of bone at focal points (Pagetic sites), often widespread. Chronic. Progressive softening followed by thickening with distortion. Renewal of new bone outstrips absorption of old bone. Enlargement of the skull (‘Big head’) and of the long bones. Broadened pelvis, distorted spine (kyphosis) from flattened vertebra. Male predominence. Over 40 years. Spontaneous fractures possible. Paget’s disease and diabetes may be associated in the same family.

Some authorities believe cause is vitamin and mineral deficiency – those which promote bone health being calcium and magnesium (dolomite). Supplementation helps cases but evidence confirms that some pet-owners are at risk – a virus from cats and dogs possibly responsible. The prime candidate is one exposed to canine distemper. Dogs are involved twice as much as cats. The virus is closely related to the measles virus in humans.

Symptoms. Limbs deformed, hot during inflammatory stage. Headaches. Dull aching pain in bones. Deafness from temporal bone involvement. Loss of bone rigidity. Bowing of legs.

Surgical procedures may be necessary. Appears to be a case for immunisation of dogs against distemper.

Alternatives. Black Cohosh, Boneset, Cramp bark, Bladderwrack, German Chamomile, Devil’s Claw, Helonias, Oat husks, Prickly Ash, Sage, Wild Yam.

Tea. Oats (mineral nutrient for wasting diseases) 2; Boneset (anti-inflammatory) 1; Valerian (mild analgesic) 1; Liquorice quarter. Mix. 1 heaped teaspoon to each cup boiling water; infuse 15 minutes. 1 cup thrice daily.

Decoction. Cramp bark 1; White Willow 2. Mix. 4 heaped teaspoons to 1 pint (500ml) water gently simmered 20 minutes. Dose: half-1 cup thrice daily.

Tablets/capsules. Cramp bark, Devil’s Claw, Echinacea, Helonias, Prickly Ash, Wild Yam.

Formula. Devil’s Claw 1; Black Cohosh 1; Valerian 1; Liquorice quarter. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Action enhanced when taken in cup of Fenugreek tea. Thrice daily. Every 2 hours acute cases.

Practitioner’s analgesic. Tincture Gelsemium: 10 drops in 100ml water. Dose: 1 teaspoon every 2 hours (inflammatory stage).

Topical. Comfrey root poultice.

Diet. High protein, low salt, low fat. Oily fish.

Supplements. Daily. Vitamin C (500mg); Vitamin D (1000mg); Calcium citrate (1 gram); Dolomite (1 gram); Beta-Carotene (7500iu). Kelp. ... paget’s disease

A term that describes physical disorders that seem to have been caused, or made worse, by psychological factors. Common examples of conditions that may be psychosomatic are headache, breathlessness, nausea, asthma, irritable bowel syndrome, peptic ulcer, and types of eczema. (See also somatization disorder.)... psychosomatic

A condition (described originally by Dr Argyll Robertson) in which the pupils contract when the eyes converge on a near object, but fail to contract when a bright light falls on the eye. It is found in several diseases, especially in locomotor ataxia and neurosyphilis, an advanced manifestation of SYPHILIS.... argyll robertson pupil

Bell’s palsy, or idiopathic facial nerve palsy, refers to the isolated paralysis of the facial muscles on one or both sides. It is of unclear cause, though damage to the seventh cranial, or FACIAL NERVE, possibly of viral origin, is thought likely. Occurring in both sexes at any age, it presents with a facial pain on the affected side, followed by an inability to close the eye or smile. The mouth appears to be drawn over to the opposite side, and ?uids may escape from the angle of the mouth. Lines of expression are ?attened and the patient is unable to wrinkle the brow. Rare causes include mastoiditis, LYME DISEASE, and hypertension.

Treatment Oral steroids, if started early, increase the rate of recovery, which occurs in over 90 per cent of patients, usually starting after two or three weeks and complete within three months. Permanent loss of function with facial contractures occurs in about 5 per cent of patients. Recurrence of Bell’s palsy is unusual.... bell’s palsy

The pressure of blood within the right atrium of the HEART as measured by a catheter and manometer.... central venous pressure

By the 32nd week of pregnancy most babies are in a head-down position in the womb. Up to 4 per cent of them, however, have their buttocks (breech) presenting at the neck of the womb. If the baby is still a breech presentation at the 34th to 35th week the obstetrician may, by external manipulation, try to turn it to the head-down position. If this is not successful, the fetus is left in the breech position. Breech deliveries are more di?cult for mother and baby because the buttocks are less e?cient than the head at dilating the cervix and vagina. An EPISIOTOMY is usually necessary to assist delivery, and obstetric FORCEPS may also have to be applied to the baby’s head. If the infant and/or the mother become unduly distressed, the obstetrician may decide to deliver the baby by CAESAREAN SECTION; some obstetricians prefer to deliver most breech-presentation babies using this method. (See PREGNANCY AND LABOUR.)... breech presentation

(Lam.) Kurz. 103 stearic, palmitic, myristic, oleic and Bryonopsis laciniosa

(Linn.) Naud.

Synonym: Bryonia laciniosa Linn. Diplocyclos palmatus Jeff.

Family: Cucurbitaceae.

Habitat: Throughout India.

English: Bryony.

Ayurvedic: Lingini, Shivalingi, Chitraphalaa.

Siddha/Tamil: Iyaveli, Iyaviraali.

Folk: Lingadonda (Telugu).

Action: Seeds—anti-inflammatory, spasmolytic. Used for vaginal dysfunctions, as a fertility promoting drug. Powdered seeds, also roots, are given to help conception in women. Plant is also used in venereal diseases.... bryophyllum pinnatum

Cadmium poisoning is a recognised hazard in certain industrial processes, such as the manufacture of alloys, cadmium plating and glass blowing. Sewage sludge, which is used as fertiliser, may be contaminated by cadmium from industrial sources; such cadmium could be taken up into vegetable crops and cadmium levels in sewage are carefully monitored.

A tin-like metal, cadmium accumulates in the body. Long-term exposure can lead to EMPHYSEMA, renal failure (see KIDNEYS, DISEASES OF) and urinary-tract CALCULI. Acute exposure causes GASTROENTERITIS and PNEUMONITIS. Cadmium contamination of food is the most likely source of poisoning. The EU Directive on the Quality of Water for Human Consumption lays down 5 milligrams per litre as the upper safe level.... cadmium poisoning

A ?ssure in the roof of the mouth (palate) and/ or the lip which is present at birth. It is found in varying degrees of severity in about one in 700 children. Modern plastic surgery can greatly improve the functioning of lips and palate and the appearance of the baby. Further cosmetic surgery later may not be necessary. The parent of the child who has cleft lip and/ or palate will be given detailed advice speci?c to his or her case. In general the team of specialists involved are the paediatrician, plastic surgeon, dentist or orthodontic specialist, and speech therapist. (See PALATE, MALFORMATIONS OF.)... cleft palate

Formerly entitled consultant paediatrician (community child health), these are specialists dealing with children with chronic problems not involving acute or hospital care. For example, they have a primary role in dealing with disabled children, children with special educational needs and abused children.... community paediatrician

A method for treating babies who suffer from alveolar collapse in the lung as a result of HYALINE MEMBRANE DISEASE (see also RESPIRATORY DISTRESS SYNDROME).... continuous positive airways pressure

Crutch palsy is weakness or paralysis of muscles in the wrist and hand, due to pressure exerted by the CRUTCH head on the nerves that control the affected muscles. It usually occurs because the crutch is too long for the individual, and/or if he or she attempts too much walking. The nerve damage is temporary and symptoms disappear if the crutch is properly used or left aside for a time.... crutch palsy

A positive test result for a condition that is not, in fact, present.... false positive

See CYSTIC FIBROSIS.... fibrocystic disease of the pancreas

A form of practice in which medical practitioners provide a wide range of primary health care services to people.... general practice

Gram’s Method is a staining procedure that separates bacteria into those that stain (positive) and those that don’t (negative). Gram-positive bugs cause such lovely things as scarlet fever, tetanus, and anthrax, while some of the gram negs can give you cholera, plague, and the clap. This is significant to the microbiologist and the pathologist; otherwise I wouldn’t worry. Still, knowing the specifics (toss in anaerobes and aerobes as well), you can impress real medical professionals with your knowledge of the secret, arcane language of medicine.... gram-positive/negative

A formal association of three or more health practitioners or other health professionals providing health services. Income from the practice is pooled and redistributed to the members of the group according to some prearranged plan.... group practice

A bacterium which colonises the stomach. While it may cause no disease, it has a tendency to produce in?ammation – gastritis. This may progress in some people to peptic ulceration (see PEPTIC ULCER), and even to gastric cancer. The bacterium can be identi?ed on blood testing or, more accurately, by obtaining a biopsy of the stomach wall by ENDOSCOPY. It can be eradicated by treatment with PROTON-PUMP INHIBITORS and antibiotics.... helicobacter pylori

The time between initiation of infection and the first shedding of the agent.... latent period

Around 2,000 mushrooms (toadstools) grow in England, of which 200 are edible and a dozen are classi?ed as poisonous. Not all the poisonous ones are dangerous. It is obviously better to prevent mushroom poisoning by ensuring correct identi?cation of those that are edible; books and charts are available. If in doubt, do not eat a fungus.

Severe poisoning from ingestion of fungi is very rare, since relatively few species are highly toxic and most species do not contain toxic compounds. The most toxic species are those containing amatoxins such as death cap (Amanita phalloides); this species alone is responsible for about 90 per cent of all mushroom-related deaths. There is a latent period of six hours or more between ingestion and the onset of clinical effects with these more toxic species. The small intestine, LIVER and KIDNEYS may be damaged – therefore, any patient with gastrointestinal effects thought to be due to ingestion of a mushroom should be referred immediately to hospital where GASTRIC LAVAGE and treatment with activated charcoal can be carried out, along with parenteral ?uids and haemodialysis if the victim is severely ill. In most cases where effects occur, these are early-onset gastrointestinal effects due to ingestion of mushrooms containing gastrointestinal irritants.

Muscarine is the poisonous constituent of some species. Within two hours of ingestion, the victim starts salivating and sweating, has visual disturbances, vomiting, stomach cramps, diarrhoea, vertigo, confusion, hallucinations and coma, the severity of symptoms depending on the amount eaten and type of mushroom. Most people recover in 24 hours, with treatment.

‘Magic’ mushrooms are a variety that contains psilocybin, a hallucinogenic substance. Children who take such mushrooms may develop a high fever and need medical care. In adults the symptoms usually disappear within six hours.

Treatment If possible, early gastric lavage should be carried out in all cases of suspected poisoning. Identi?cation of the mushroom species is a valuable guide to treatment. For muscarine poisoning, ATROPINE is a speci?c antidote. As stated above, hospital referral is advisable for people who have ingested poisonous fungi.... fungus poisoning

The large process of the temporal bone of the SKULL which can be felt immediately behind the ear. It contains numerous cavities, one of which – the mastoid antrum – communicates with the middle ear, and is liable to suppurate when the middle ear is diseased. (See under EAR, DISEASES OF.)... mastoid process

A condition characterised by pain and PARAESTHESIA on the front and outer aspect of the thigh. It is more common in men than in women, and the victims are usually middle-aged, overweight and out of condition. It is due to compression of the lateral cutaneous nerve of the thigh, and exacerbated by an uncomfortable driving position when motoring long distances. Reduction in weight, improvement in general ?tness and correction of faulty posture usually bring relief. If these fail, surgical decompression of the nerve may help.... meralgia paraesthetica

See CONTRACEPTION.... morning-after pill

Muira puama is one of the most popular and widely consumed herbs. It grows in the northern Amazon river basin. This herb has been used to enhance libido for a long time, making the harvest and sale of the herb a large business throughout Brazil.... muira puama

The individual with this psychiatric disorder has two or more di?erent personalities, often contrasting. The dominant personality at the time determines the behaviour and attitude of the individual, who customarily seems not to know about the other personality – or personalities. The switch from one personality to another is abrupt and the mental condition of the di?ering personalities is usually normal. It is possible that child abuse is a factor in the disorder, which is treated by psychotherapy. The classic multiple personality was the ?ctional form of Dr Jekyll and Mr Hyde.... multiple personality disorder

The large process on the ulnar bone that projects behind the joint of the elbow.... olecranon process

Pacinian corpuscles, or lamellated corpuscles, are minute bulbs at the ends of the nerves scattered through the SKIN and subcutaneous tissue, and forming one of the end-organs for sensation.... pacinian corpuscles

That fraction of the blood’s total volume made up of red cells. The packed cell volume is found by centrifuging blood in a tube and measuring the depth of the column of red cells as a fraction of the whole column of blood. (See also HAEMATOCRIT.)... packed cell volume

See PICTURE ARCHIVING AND COMMUNICATIONS SYSTEM (PACS).... pacs

Also called paliphrasia, this means the involuntary repetition of words or sentences. It is a symptom of GILLES DE LA TOURETTE’S SYNDROME.... palilalia

An adjective describing symptoms or diseases that recur. For example, palindromic rheumatoid arthritis is a condition in which symptoms wax and wane with periods of complete remission.... palindromic

A term applied to treatment that eases the symptoms of a disorder rather than curing the condition. (See also HOSPICE; PALLIATIVE CARE.)... palliative

The active total care offered to a person and that person’s family when it is recognized that the illness is no longer curable, in order to concentrate on the person’s quality of life and the alleviation of distressing symptoms. The focus of palliative care is neither to hasten nor postpone death. It provides relief from pain and other distressing symptoms and integrates the psychological and spiritual aspects of care. It offers a support system to help relatives and friends cope during an individual’s illness and with their bereavement.... palliative care

Also known as pallidectomy, this is a neurosurgical procedure in which the activities of the globus pallidus area of the BRAIN are destroyed or modi?ed. The operation is sometimes used to relieve the symptoms of PARKINSONISM and other neurological conditions in which involuntary movements are a signi?cant and disabling symptom.... pallidotomy

Relating to the eyelid (see EYE).... palpebral

A cardiac or arti?cial pacemaker is a device that helps a faulty HEART to maintain normal rhythm. It consists of a battery that stimulates the heart by an electric current passed through an insulated wire which is attached either to the surface of the ventricle (epicardial pacemaker) or to the heart lining (endocardial pacemaker). In a normal heart, the regular electrical impulses are initiated by a special area of tissue (sinoatrial node). A cardiac pacemaker is used when a person’s sinoatrial node is malfunctioning or when there is interference with the passage of normal impulses. Some devices send out signals at a ?xed rate; others monitor the rate and, when it falters in any way, stimulate regular contractions. Implantation is carried out under a local anaesthetic, and the lithium batteries can last for several years. People with pacemakers should avoid any source of powerful electromagnetic radiation – radio or radar transmitters or airport security screens. (See also CARDIAC PACEMAKER.)... pacemaker

A perverse sexual attraction to children of either sex. Paedophiles are nearly always male and may have heterosexual, homosexual or bisexual orientation.

In England and Wales, the age of consent for heterosexual and homosexual sex is 16 years; in Northern Ireland, 17 years; and in Scotland the age of consent for heterosexual sex is 12 for a girl and 14 for a boy. However, girls are protected by Section 5 of the Criminal Law (Consolidation) Act 1995 which makes it an o?ence to have sexual intercourse with a girl aged under

16. For girls under 13, the maximum sentence is life-imprisonment, and between 13 and 16, two years’ imprisonment. Homosexual consent in Scotland is 16.

Paedophiles suffer from personality problems rather than overt psychoses (see PSYCHOSIS) and the origins of their behaviour may lie in their own early sexual experiences. Their behaviour often has features of an addiction.

It is of note that most underaged sex is between family members such as stepfather and daughter rather than with a stranger or predatory paedophile.

(See CHILD ABUSE.)... paedophilia

In?ammation of the pericardium, myocardium, and endocardium at the same time (see HEART – Structure).... pancarditis

A fall in the number of red ERYTHROCYTES and white LEUCOCYTES, as well as of platelets (see BLOOD – Composition). The condition is found in aplastic ANAEMIA, tumours of the BONE MARROW, enlarged SPLEEN, and other disorders.... pancytopenia

In?ammation of the subcutaneous fat (see FAT – Body fat). It may occur anywhere on the body surface.... panniculitis

1) Blood vessels growing into the cornea (see EYE) beneath its epithelium. Seen in TRACHOMA and to a lesser extent in patients who are long-term soft-contact-lens wearers. 2) In?ammatory tissue which replaces CARTILAGE in RHEUMATOID ARTHRITIS.... pannus

(English) As delicate as a flower; a thoughtful girl

Pansey, Pansi, Pansie, Pansee, Panzi, Panzy, Panzie, Panzee, Pansea, Panzea... pansy

See CERVICAL SMEAR.... papanicolaou test

A smooth-muscle (see MUSCLE) relaxant once used to treat IMPOTENCE (erectile dysfunction). The drug is injected directly into the corpora caverosa (spongy, blood-?lled erectile tissue) of the PENIS. Men with psychogenic or neurological impotence may respond to this treatment. Its use is less common since SILDENAFIL (Viagra®) was introduced for the treatment of erectile dysfunction.... papaverine

In?ammation of any PAPILLA, but especially of the prominence formed by the end of the optic nerve in the retina (see EYE) – also known as OPTIC NEURITIS.... papillitis

(Native American) Resembling ivy Papinah, Papyna, Papena, Papeena, Papiena, Papeina, Papeana... papina

The reverse of the normal movements of breathing (see RESPIRATION). The chest wall moves in instead of out when breathing in (inspiration), and out instead of in when breathing out (expiration). The spaces between the ribs are indrawn on inspiration – a symptom seen in children with respiratory distress, say, as a result of ASTHMA or lung infections. Patients with CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) often suffer from paradoxical breathing; and trauma to the rib cage, with fractured sternum and ribs, also cause the condition. Treatment is of the underlying cause.... paradoxical breathing

One of the small ovoid collections of cells occurring in the walls of the ganglia of the SYMPATHETIC NERVOUS SYSTEM adjacent to the SPINAL CORD. They are CHROMAFFIN cells and sometimes secrete ADRENALINE.... paraganglion

A tropical disease found mainly in the Far East. It is caused by infections of the lungs by a parasitic ?uke called Paragonimus westermani. The infection is acquired by eating insu?ciently cooked shell?sh. The affected person has symptoms similar to those of chronic BRONCHITIS; treatment is with the drugs CHLOROQUINE and bithionol.... paragonimiasis

A clear, colourless liquid with a penetrating ethereal (see ETHER) odour, paraldehyde may be given by mouth, rectally, or occasionally in intramuscular injection. The drug’s prime use is as a hypnotic (see HYPNOTICS) in mentally unstable patients. It is also indicated as an anticonvulsant in STATUS EPILEPTICUS (after initial intravenous DIAZEPAM) and in TETANUS. Its unpleasant taste restricts its use, but this has the advantage that it usually prevents the patient from becoming an addict.

Caution is needed when treating patients with bronchopulmonary disease or liver impairment; and intramuscular injection near the sciatic nerve should be avoided, as it may cause severe CAUSALGIA. Adverse effects include rashes; pain and sterile ABSCESS after intramuscular injection; rectal irritation after ENEMA.... paraldehyde

A generic title for the professions which work closely with or are reponsible to the medical profession in caring for patients. A paramedical worker, coloquially called a ‘paramedic’, has skills, experience and quali?cations in certain spheres of health care. Examples are ambulance crew – primarily those trained to deal with emergencies; physiotherapists (see PHYSIOTHERAPY); radiographers (see RADIOGRAPHER); and dieticians (see DIETETICS).... paramedical

A measurement of a certain factor – for example, pulse rate, blood pressure, or haemoglobin concentration – that is relevant to a disorder under investigation. Often wrongly used to describe the range of test results.... parameter

A derangement of the MEMORY in which words are used without a comprehension of their meaning; it is also applied to illusions of memory in which a person in good faith imagines and describes experiences which never occurred to him or her.... paramnesia

Misplacement of words, or use of wrong words, in speech as a result of a lesion in the speech region of the BRAIN.... paraphasia

A form of PARANOIA. (See also MENTAL ILLNESS.)... paraphrenia

Non-fatal self-poisoning or self-injury, or attempted suicide. It is most common in the 12–15 age group. As a rule, the intention is not to commit suicide but to sound a cry for help to resolve an acute domestic, social or personal upset.... parasuicide

See ENTERIC FEVER.... paratyphoid fever

A term meaning originally all the soft tissues of internal organs except their supporting structures, although now reserved for the secreting cells of the glandular organs.... parenchyma

That part of the AUTONOMIC NERVOUS SYSTEM which is connected with the BRAIN and SPINAL CORD through certain nerve centres in the midbrain, medulla, and lower end of the cord. The nerves from these centres are carried in the third, seventh, ninth and tenth cranial nerves and the second, third and fourth sacral nerves. The action of the parasympathetic system is usually antagonistic to that of the sympathetic system. Thus it inhibits the action of the HEART and augments the action of the INTESTINE; whereas the sympathetic augments the action of the heart and inhibits that of the intestine. (See diagram of sympathetic and parasympathetic nervous systems under NERVOUS SYSTEM.)... parasympathetic nervous system

Administration of drugs by any route other than by the mouth or by the bowel – for example, by intramuscular or intravenous injection or infusion.... parenteral

Either one of a pair of bones that form the top and sides of the cranium of the SKULL.... parietal bone

A major section of each cerebral hemisphere (see BRAIN). The two lobes lie under the parietal bones and contain the sensory cortex.... parietal lobe

A perverted sense of SMELL; everything may smell unpleasant to the affected individual. The most common cause is some septic condition of the nasal passages (see NOSE), but the condition may occasionally be due to a lesion in the BRAIN involving the centre responsible for the sense of smell.... parosmia

One of the SALIVARY GLANDS. It is situated just in front of the ear, and its duct runs forwards across the cheek to open into the interior of the mouth on a little projection opposite the second last tooth of the upper row. The parotid gland is generally the ?rst of the salivary glands to become enlarged in MUMPS.... parotid gland

See PSITTACOSIS.... parrot disease

Non-sexual reproduction. In other words, development of the OVUM into an individual without fertilisation by a SPERMATOZOON. It is common in plants and has been produced in animals experimentally.... parthenogenesis

A method of recording the degree of dilatation, or opening, of the cervix (or neck) of the UTERUS in labour (see PREGNANCY AND LABOUR) to assess how labour is progressing.... partogram

A movement induced by someone other than the patient. Physiotherapists (see PHYSIOTHERAPY) manipulate joints by passive movement in order to retain and encourage function of a nerve or muscle that is not working normally because of injury or disease.... passive movement

A group of bacilli. They are essentially animal parasites (see PARASITE) that under certain conditions are transmitted to humans, and include the micro-organism responsible for PLAGUE and TULARAEMIA.... pasteurella

In the medical context, a term meaning open – for example, patent DUCTUS ARTERIOSUS. The term is also used for proprietary MEDICINES which, because of the research and cost involved in producing many of them, are protected by a patent. This means that without an agreement, no company or organisation other than the patent-holder can produce the substance.... patent

A pre?x indicating relationship to a disease – for example, PATHOLOGY, a study of disease.... patho

The ways in which a disease or disorder starts and develops. The term applies in particular to the physiological and cellular activities that are involved in the mode of origin and development of the condition.... pathogenesis

(Latin) An open-minded woman... patia

A person in contact with the health system seeking attention for a health condition.... patient

A device that measures the rate at which an individual can expel air from the LUNGS. This is an indication of the reserve in the capacity of the lungs. Narrowed airways (bronchospasm) slow the rate at which air can be expelled; the peak ?ow meter can assess the severity of the condition. ASTHMA causes bronchospasm and the device can measure the e?ectiveness of treatment with BRONCHODILATOR drugs; this should be done regularly to monitor the progress of the disease.... peak flow meter

The resonance of the voice, when spoken or whispered words can be clearly heard through the stethoscope placed on the chest wall. It is a sign of consolidation, or of a cavity, in the lung.... pectoriloquy

A narrow tube of tissue formed by folded skin which links a piece of tissue used for surgical grafting to its site of origin. A pedicle graft is used by the surgeon – usually a reconstructive/ plastic surgeon – when the site under repair is unsuitable for an independent graft, usually because the blood supply at the recipient site is inadequate. (See RECONSTRUCTIVE (PLASTIC) SURGERY.)

A pedicle is also found occurring between a tumour and its tissue of origin, and the term is used in anatomy to refer to any slim tubular process.... pedicle

(Greek) In mythology, the personification of poverty

Peniah, Penea, Peniya, Peneah, Peniyah... penia

The name given by Sir Alexander Fleming, in 1929, to an antibacterial substance produced by the mould Penicillium notatum. The story of penicillin is one of the most dramatic in the history of medicine, and its introduction into medicine initiated a new era in therapeutics comparable only to the introduction of ANAESTHESIA by Morton and Simpson and of ANTISEPTICS by Pasteur and Lister. The two great advantages of penicillin are that it is active against a large range of bacteria and that, even in large doses, it is non-toxic. Penicillin di?uses well into body tissues and ?uids and is excreted in the urine, but it penetrates poorly into the cerebrospinal ?uid.

Penicillin is a beta-lactam antibiotic, one of a group of drugs that also includes CEPHALOSPORINS. Drugs of this group have a four-part beta-lactam ring in their molecular structure and they act by interfering with the cell-wall growth of mutliplying bacteria.

Among the organisms to which it has been, and often still is, active are: streptococcus, pneumococcus, meningococcus, gonococcus, and the organisms responsible for syphilis and for gas gangrene (for more information on these organisms and the diseases they cause, refer to the separate dictionary entries). Most bacteria of the genus staphylococcus are now resistant because they produce an enzyme called PENICILLINASE that destroys the antibiotic. A particular problem has been the evolution of strains resistant to methicillin – a derivative originally designed to conquer the resistance problem. These bacteria, known as METHICILLINRESISTANT STAPHYLOCOCCUS AUREUS (MRSA), are an increasing problem, especially after major surgery. Some are also resistant to other antibiotics such as vancomycin.

An important side-e?ect of penicillins is hypersensitivity which causes rashes and sometimes ANAPHYLAXIS, which can be fatal.

Forms of penicillin These include the following broad groups: benzylpenicillin and phenoxymethyl-penicillin; penicillinase-resistant penicillins; broad-spectrum penicillins; antipseudomonal penicillins; and mecillinams. BENZYLPENICILLIN is given intramuscularly, and is the form that is used when a rapid action is required. PHENOXYMETHYLPENICILLIN (also called penicillin V) is given by mouth and used in treating such disorders as TONSILLITIS. AMPICILLIN, a broad-spectrum antibiotic, is another of the penicillins derived by semi-synthesis from the penicillin nucleus. It, too, is active when taken by mouth, but its special feature is that it is active against gram-negative (see GRAM’S STAIN) micro-organisms such as E. coli and the salmonellae. It has been superceded by amoxicillin to the extent that prescriptions for ampicillin written by GPs in the UK to be dispensed to children have fallen by 95 per cent in the last ten years. CARBENICILLIN, a semi-synthetic penicillin, this must be given by injection, which may be painful. Its main use is in dealing with infections due to Pseudomonas pyocanea. It is the only penicillin active against this micro-organism which can be better dealt with by certain non-penicillin antibiotics. PIPERACILLIN AND TICARCILLIN are carboxypenicillins used to treat infections caused by Pseudomonas aeruginosa and Proteus spp. FLUCLOXACILLIN, also a semi-synthetic penicillin, is active against penicillin-resistant staphylococci and has the practical advantage of being active when taken by mouth. TEMOCILLIN is another penicillinase-resistant penicillin, e?ective against most gram-negative bacteria. AMOXICILLIN is an oral semi-synthetic penicillin with the same range of action as ampicillin but less likely to cause side-effects. MECILLINAM is of value in the treatment of infections with salmonellae (see FOOD POISONING), including typhoid fever, and with E. coli (see ESCHERICHIA). It is given by injection. There is a derivative, pivmecillinam, which can be taken by mouth. TICARCILLIN is a carboxypenicillin used mainly for serious infections caused by Pseudomonas aeruginosa, though it is also active against some gram-negative bacilli. Ticarcillin is available only in combination with clarulanic acid.... penicillin

A bacterial ENZYME capable of neutralising the antibacterial properties of PENICILLIN and other beta-lactam antibiotics such as the CEPHALOSPORINS. Most staphylococci are now resistant to benzylpenicillin because they produce this enzyme; cloxacillin, ?ucloxacillin and temocillin are not inactivated.... penicillinase

(American) Resembling the pepper plant; flavorful Peper... pepper

An ENZYME found in the gastric juice which digests proteins, converting them into peptides (see PEPTIDE) and AMINO ACIDS. It is used in the preparation of predigested foods (PEPTONISED FOODS), or, more frequently, taken orally after meals. Available as a white powder or liquid, it is prepared from the mucous membrane of cow, sheep, or pig stomachs.... pepsin

Mentha piperita. N.O. Labiateae.

Synonym: Balm Mint, Brandy Mint.

Habitat: Damp places by water courses. Largely cultivated, especially in the U.S.A., for its oil, which is probably the most used of all the volatile oils. Features ? Stem quadrangular, purplish, reaching three or four feet high. Leaves stalked, serrate, very slightly hairy, about two and a half inches by one inch.

Characteristic taste and smell. Part used ? Herb.

Action: Carminative, stomachic, stimulant.

In flatulence, colic and nausea. Usually combined with other remedies when a complete stomachic is needed. Particularly suitable for children. Dose, wineglassful of ounce to pint infusion.... peppermint

A treatment for a stenosed (restricted) coronary artery (see ARTERIES). A balloon-tipped catheter (see CATHETERS) is passed through an incision in the skin of the chest into the artery of the HEART that has developed stenosis (narrowing). The balloon is aligned with the stenosed section and then in?ated to dilate the coronary artery and allow the blood to ?ow more freely.... percutaneous transluminal coronary angioplasty

The transfer of ?uid through a tissue. For example, when blood passes through the lung tissue, dissolved oxygen perfuses from the moist air in the alveoli to the blood. Fluid may also be deliberately introduced into a tissue by injecting it into the blood vessels supplying the tissue. It is used as a sign of how adequate the circulation is at the time of illness. Poor peripheral perfusion, a sign of circulatory collapse or shock, is recognised by pressing on the skin to force blood from capillaries. The time it takes for them to re?ll and the skin to become pink is noted: more than 5 seconds, and the circulation is likely to be compromised.... perfusion

See POLYARTERITIS NODOSA.... periarteritis nodosa

In?ammation of CARTILAGE and the tissue surrounding it, usually as a result of chronic infection.... perichondritis

A localised in?ammation of the PERITONEUM surrounding the UTERUS.... perimetritis

A test of the visual ?elds of the EYE that assesses the extent of peripheral vision. The procedure does not normally form part of a routine test of vision but can be of value in assessing neurological diseases such as tumour of the brain.... perimetry

Recurrence at regular intervals of symptoms in malaria, characterised clinically by paroxysms and resulting from the invasion of the blood by new generations of parasites. Periodicity may be quotidian, tertian, quartan or double quartan according to the intervals between paroxysms.... periodicity

An adjective that relates to the tissues around the TEETH.... periodontal

See TEETH.... periodontal membrane

see PYORRHEA... periodontitis

The narrowing of the blood vessels in the legs and, less commonly, in the arms. Blood ?ow is restricted, with pain occurring in the affected area. If the blood supply is seriously reduced, GANGRENE of the tissues supplied by the affected vessel(s) may occur and the limb may need to be amputated. The common cause is ATHEROSCLEROSIS which may be brought on by HYPERTENSION, excessively fatty diet, poorly controlled DIABETES MELLITUS or smoking – the latter being the biggest risk factor, with 90 per cent of affected patients having been moderate to heavy smokers. Stopping smoking is essential; adequate exercise and a low-fat diet are important measures. Surgery may be required.... peripheral vascular disease

(Latin) An important woman Perlah... perla

The name given to structures, such as the muscles, and nerves, on the outer or ?bular side of the leg.... peroneal

Perseveration is the senseless repetition of words or deeds by a person with a disordered mind.... perseveration

Diospyros virginiana and other species

Description: These trees have alternate, dark green, elliptic leaves with entire margins. The flowers are inconspicuous. The fruits are orange, have a sticky consistency, and have several seeds.

Habitat and Distribution: The persimmon is a common forest margin tree. It is wide spread in Africa, eastern North America, and the Far East.

Edible Parts: The leaves are a good source of vitamin C. The fruits are edible raw or baked. To make tea, dry the leaves and soak them in hot water. You can eat the roasted seeds.

CAUTION

Some persons are unable to digest persimmon pulp. Unripe persimmons are highly astringent and inedible.... persimmon

Condition in which the individual fails to learn from experience or to adapt to changes. The outcome is impaired social functioning and personal distress. There are three broad overlapping groups. One group is characterised by eccentric behaviour with paranoid or schizoid overtones. The second group shows dramatic and emotional behaviour with self-centredness and antisocial behaviour as typical components of the disorder. In the third group, anxiety and fear are the main characteristics, which are accompanied by dependency and compulsive behaviour. These disorders are not classed as illnesses but psychotherapy and behavioural therapy may help. The individuals affected are notoriously resistant to any help that is o?ered, tending to blame other people, circumstances or bad luck for their persistent diffculties. (See MENTAL ILLNESS; MULTIPLE PERSONALITY DISORDER; MUNCHAUSEN’S SYNDROME.)... personality disorder

A condition of the hip in children, due to death and fragmentation of the epiphysis (or spongy extremity) of the head of the femur. The cause is not known. The disease occurs in the 4–10 year age-group, with a peak between the ages of six and eight; it is ten times more common in boys than girls, and is bilateral in 10 per cent of cases. The initial sign is a lurching gait with a limp, accompanied by pain. Treatment consists of limiting aggressive sporting activity which may cause intact overlying CARTILAGE to loosen. Where there are no mechanical symptoms and MRI scanning shows that the cartilage is intact, only minor activity modi?cation may be necesssary – but for several months or even years. Any breach in the cartilage is dealt with at ARTHROSCOPY by ?xing or trimming any loose ?aps. Eventually the disease burns itself out.... perthes’ disease

The technical name for FLAT-FOOT.... pes planus

Any substance or mixture of substances intended for preventing or controlling unwanted species of plants and animals. This includes any substances intended for use as plant-growth regulators, defoliants or desiccants. The main groups of pesticides are: herbicides to control weeds; insecticides to control insects; and fungicides to control or prevent fungal disease.... pesticides

A leafstalk or stem, or an unexpanded section.... petiole

Group of lymphoid tissue in the small intestine, especially involved in typhoid infections.... peyer’s patches

Also called pharmacogenetics – the use of human genetic variations to optimise the discovery and development of drugs and the treatment of patients. The human race varies much more in its genetic make-up than has previously been realised; these variations in GENES and their PROTEIN products could be utilised to provide safer and more e?ective drugs. Genes affect drug absorption, distribution, METABOLISM and excretion. Drugs are designed and prescribed on the basis of a population’s needs, but patients comprise a diverse range of individuals. For example, nearly one-third of patients fail to respond to the cholesterol-reducing group of drugs, the STATINS. Around half do not respond to the tricyclic ANTIDEPRESSANT DRUGS. Over 80 per cent of patients’ responses to drugs depends on their genetics: this genetic variation needs to be identi?ed so as to make the prescription of drugs more e?ective, and technology for analysing genetic variants is progressing. Assessing drug e?ectiveness, however, is not simple because the health and diets of individuals are di?erent and this can affect the response to a drug. Even so, the genetic identi?cation of people who would or would not respond to a particular drug should bene?t patients by ensuring a more accurately targeted drug and by reducing the risks to a person of side-effects from taking a drug that would not work. There would also be substantial economic savings.... pharmacogenomics

Another name for CARBOLIC ACID.... phenol

An individual’s characteristics as determined by the interaction between his or her genotype – quota of GENES – and the environment.... phenotype

An alpha-adrenoceptor blocking drug (see ADRENERGIC RECEPTORS) used in the treatment of HYPERTENSION caused by PHAEOCHROMOCYTOMA.... phenoxybenzamine

A natural amino acid (see AMINO ACIDS) essential for growth in infants, and for nitrogen metabolism in adults.... phenylalanine

A synthetic anticoagulant (see ANTICOAGULANTS). Given by mouth, it is used to prevent the formation of clots in the blood in rheumatic heart disease and atrial ?brillation (see HEART, DISEASES OF); as prophylaxis after insertion of a prosthetic heart valve; and as prophylaxis and treatment of venous thrombosis and pulmonary embolism. It is slower in action than WARFARIN, not achieving its full anticoagulant e?ect until up to 48 hours after the initial dose. The drug should be avoided in patients with renal or hepatic impairment, and whenever severe hypersensitivity reactions have previously occurred. Adverse effects include rashes, fever, LEUCOPENIA, AGRANULOCYTOSIS, diarrhoea and pink urine; breast feeding should be avoided.... phenindione

A group of major antipsychotic drugs, colloquially called ‘TRANQUILLISERS’, widely used to treat psychoses (see PSYCHOSIS). They can be divided into three main groups. Chlorpromazine, methotrimeprazine and promazine are examples of group 1, usually characterised by their sedative effects and moderate antimuscarinic and extrapyramidal side-effects. Group 2 includes pericyazine, pipothiazine and thioridazine, which have moderate sedative effects but signi?cant antimuscarinic action and modest extrapyramidal side-effects. Fluphenazine, perphenazine, prochlorperazine and tri?uoperazine comprise group 3. Their sedative effects are less than for the other groups and they have little antimuscarinic action; they have marked extrapyramidal side-effects.

Uses Phenothiazines should be prescribed and used with care. The drugs di?er in predominant actions and side-effects; selection depends on the extent of sedation required and the susceptibility of the patient to extrapyramidal side-effects. The di?erences between the drugs, however, are less important than the variabilities in patients’ responses. Patients should not be prescribed more than one antipsychotic drug at a time. In the short term these therapeutically powerful drugs can be used to calm disturbed patients, whatever the underlying condition (which might have a physical or psychiatric basis). They also alleviate acute anxiety and some have antidepressant properties, while others worsen DEPRESSION (see also MENTAL ILLNESS).... phenothiazines

The term applied to a small stone formed in a vein (see VEINS) as a result of calci?cation of a THROMBUS.... phlebolith

The production of vocal sounds – in particular, speech.... phonation

Salts of phosphoric acid. As this substance is contained in many articles of food as well as in bone, the nuclei of cells, and the nervous system, phosphates are constantly excreted in the URINE. The continued use of an excess of food containing alkalis, such as green vegetables, and still more the presence in the urine of bacteria which lead to its decomposition, produce the necessary change from the natural mild acidity to alkalinity, and lead to the deposit of phosphates and to their collection into stones.... phosphates

A LIPID, the molecule of which contains a chemical derivative of PHOSPHORUS called phosphate. This type of lipid, which includes cephalins, lecithins and plasmalogens, is found in all tissues and organs, especially the BRAIN. Phospholipids are produced in the LIVER and and take part in many of the body’s metabolic activities (see METABOLISM).... phospholipid

A form of treatment in which deliberate exposure to a photosensitising drug and ultraviolet light bene?ts certain skin diseases, particularly PSORIASIS and T-cell LYMPHOMA. A psoralen is the photoactive agent which reacts with long-wave ultraviolet light (UVA), giving the acronym, PUVA therapy.... photochemotherapy

This comprises a photosensitising agent (one activated by light), which accumulates in malignant tissue, and a source of light that activates the photosensitiser, triggering it to generate highly reactive oxygen compounds that destroy malignant cells. One such photosensitiser is temopor?n. Photodynamic therapy is used to treat various types of malignancy; a recognised complication is photosensitivity, when a patient may suffer burns after transient exposure to sunlight. Photodynamic therapy is increasingly used and photosensitivity reactions may also become more common.... photodynamic therapy

This is a description of the ?ashing lights which are a not uncommon AURA preceding an attack of MIGRAINE.... photopsia

The method by which green plants and some bacteria produce CARBOHYDRATE from water and carbon dioxide. They use energy absorbed from the sun’s rays by a green pigment in the organism called chlorophyll. Photosynthesis is one of the earth’s fundamental biological processes. As well as converting the carbon dioxide into the essential biological compound carbohydrate, the process removes the gas from the atmosphere where, if it builds to excess, the atmospheric temperature rises, thus contributing to global warming.... photosynthesis

The NERVE which chie?y supplies the DIAPHRAGM. A phrenic nerve arises on each side of the SPINAL CORD from the third, fourth and ?fth cervical spinal nerves; both follow a long course down the neck, and through the chest to the diaphragm. They play a key part in RESPIRATION through control of the diaphragm. Injury to one nerve paralyses one half of the diaphragm. Occasionally the phrenic nerve may be surgically crushed as part of the treatment to repair a HIATUS HERNIA or, rarely, to stop intractable hiccups.... phrenic nerve

A quack method, common in the Victorian era, allegedly to study the mind and character of individuals from the shape of the head. As the shape of the head has been shown to depend chie?y upon accidental characteristics, such as the size of the air spaces in the bones, and not upon development of special areas in the contained brain, there is no scienti?c basis for the practice.... phrenology

A historical term means wasting, and was applied to that progressive enfeeblement and loss of weight that arose from tuberculous disease of all kinds, but especially from the disease as it affected the lungs (see TUBERCULOSIS).... phthisis

That part of a patient’s consultation with a doctor in which the doctor looks, feels (palpates) and listens to (auscultates) various parts of the patient’s body. Along with the history of the patient’s symptoms, this enables the doctor to assess the patient’s condition and decide whether an immediate diagnosis is possible or whether laboratory or imaging investigations are needed to reach a diagnosis. A full physical examination may take 30 minutes or more. Physical examination, along with certain standard investigations, is done when a person attends for a ‘preventive’ check-up of his or her state of health.... physical examination

A medical specialty founded in 1931 and recognised by the Royal College of Physicians of London in 1972. Physical-medicine specialists started by treating rheumatic diseases; subsequently their work developed to include the diagnosis and rehabilitation of people with physical handicaps. The specialty has now been combined with that of RHEUMATOLOGY. (See also PHYSIOTHERAPY.)... physical medicine

Professional person qualified by education and authorised by law to practise medicine. In certain countries refers to a specialist in internal medicine.... physician

Also known as eserine. An alkaloid (see ALKALOIDS) obtained from Calabar bean, the seed of Physostigma venenosum, a climbing plant of West Africa. Its action depends on the presence of two alkaloids, the one known as physostigmine or eserine, the other as calabarine, the former of these being much the more important.

Action Physostigmine produces the same e?ect as stimulation of the PARASYMPATHETIC NERVOUS SYSTEM: i.e. it constricts the pupil of the eye, stimulates the gut, increases the secretion of saliva, stimulates the bladder, and increases the irritability of voluntary muscle. In poisonous doses it brings on a general paralysis.

Uses It is used in medicine in the form of eye drops or ointment to treat GLAUCOMA.... physostigmine

This is the Latin for magpie and is used to describe an abnormal craving for unusual foods. It is not uncommon in pregnancy. Among the unusual substances for which pregnant women have developed a craving are soap, clay pipes, bed linen, charcoal, ashes – and almost every imaginable food stu? taken in excess. In primitive races, the presence of pica is taken as an indication that the growing fetus requires such food. It is also not uncommon in children in whom, previously, it was an important cause of LEAD POISONING due to ingestion of paint ?akes. (See also APPETITE.)... pica

A yellow crystalline solid substance which is used as a ?xative for tissues being prepared for examination under a microscope; it is also used as a dye.... picric acid

The term applied to the colouring matter of various secretions, blood, etc.; also to any medicinal preparation of thick consistency intended for painting on the skin or mucous membranes.... pigment

(Egyptian) The second-born child Pilie, Pily, Piley, Pilee, Pilea, Pileigh... pili

A small reddish structure, 10 mm in length and shaped somewhat like a pine cone (hence its name), situated on the upper part of the midbrain (see BRAIN). Many theories have been expounded as to its function, but there is increasing evidence that, in some animals at least, it is affected by light and plays a part in hibernation and in controlling sexual activity and the colour of the skin. This it seems to do by means of a substance it produces known as MELATONIN. There is also growing evidence that it may play a part in controlling the circadian rhythms of the body – the natural variations in physiological activities throughout the 24-hour day.... pineal gland

See Piña.... pineapple

Pinus species

Description: Pine trees are easily recognized by their needlelike leaves grouped in bundles. Each bundle may contain one to five needles, the number varying among species. The tree’s odor and sticky sap provide a simple way to distinguish pines from similar looking trees with needlelike leaves.

Habitat and Distribution: Pines prefer open, sunny areas. They are found throughout North America, Central America, much of the Caribbean region, North Africa, the Middle East, Europe, and some places in Asia.

Edible Parts: The seeds of all species are edible. You can collect the young male cones, which grow only in the spring, as a survival food. Boil or bake the young cones. The bark of young twigs is edible. Peel off the bark of thin twigs. You can chew the juicy inner bark; it is rich in sugar and vitamins. Eat the seeds raw or cooked. Green pine needle tea is high in vitamin C. Other Uses : Use the resin to waterproof articles. Also use it as glue. Collect the resin from the tree. If there is not enough resin on the tree, cut a notch in the bark so more sap will seep out. Put the resin in a container and heat it. The hot resin is your glue. Use it as is or add a small amount of ash dust to strengthen it. Use it immediately. You can use hardened pine resin as an emergency dental filling.... pine

A compound leaf, having the leaflets arranged on each side of the stem.... pinnate

See ENTEROBIASIS.... pinworm

A drug used for the treatment of threadworms (see ENTEROBIASIS) and ASCARIASIS.... piperazine

Implantation of the PLACENTA in the bottom part of the UTERUS adjacent to or over the CERVIX. The condition may cause few problems during pregnancy or labour; it may, however, cause vaginal bleeding late in pregnancy or hinder vaginal delivery of the baby and this may necessitate obstetric intervention.... placenta praevia

The procedure of rendering the PLACENTA visible by means of X-rays. This can be done either by using what is known as soft-tissue radiography, or by injecting a radio-opaque substance into the bloodstream or into the amniotic cavity (see AMNION). The procedure has some risk to both mother and fetus, and is carried out under expert supervision. It can help to assess the cause of antepartum haemorrhage. The placenta and fetus can now be visualised by the non-invasive and safe method of ULTRASOUND.... placentography

Describing anything related to the sole of the foot.... plantar

These are cells that produce ANTIBODIES and occur in bone-forming tissue as well as the lining of the gastrointestinal tract and the lungs. The cells develop in LYMPH NODES, SPLEEN and BONE MARROW when T-lymphocytes (see IMMUNITY) are stimulated by antigens (see ANTIGEN) to produce the precursor cells from which plasma cells originate.... plasma cells

A skin disorder typi?ed by a bran-like desquamation (?aking). There are several varieties including P. alba, rosea, versicolor (fungal caused) and rubra (exfoliative dermatitis).

Pityriasis alba is a mild form of chronic eczema (see DERMATITIS) occurring mainly in children on the face and in young adults on the upper arms. It is characterised by round or oval ?aky patches which are paler than the surrounding skin due to partial loss of MELANIN pigment. The appearance is more dramatic in dark-skinned or suntanned subjects. Moisturising cream often su?ces, but 1 per cent HYDROCORTISONE cream is more e?ective.

Pityriasis rosea is a common self-limiting eruption seen mainly in young adults. It usually begins as a solitary red ?aky patch (often misdiagnosed as ringworm). Within a week this ‘herald patch’ is followed by a profuse symmetrical eruption of smaller rose-pink, ?aky, oval lesions on the trunk and neck but largely sparing the limbs and face. Itching is variable. The eruption usually peaks within 3 weeks and fades away leaving collarettes of scale, disappearing within 6–7 weeks. It rarely recurs and a viral cause is suspected but not proved. It is not contagious and there is no speci?c treatment, but crotamiton cream (Eurax) may relieve discomfort.... pityriasis

Also called ?brinolysin, this is an ENZYME that digests the protein FIBRIN. It dissolves blood clots (see COAGULATION) and so is present in the blood in the form of PLASMINOGEN, an inactive precursor.... plasmin

A precursor of PLASMIN, an ENZYME that digests the protein FIBRIN – the main constituent of blood clots (see COAGULATION). When tissue is damaged, activators are released which provoke the conversion of plasminogen into plasmin.... plasminogen

The general term applied to minute protoplasmic cells, and particularly to those which cause MALARIA and allied diseases.... plasmodium

The third stage larva of pseudophyllidean tapeworms, which has a solid body.... plerocercoid

The normally restricted space between the parietal and the visceral PLEURA, which slide over one another as the individual breathes in and out. If gas or ?uid are introduced as a result of injury or infection, the pleural surfaces are separated and the pleural space increases in volume. This usually causes breathing diffculties.... pleural cavity

(American) Resembling the fruit ... plum

Another name for LEAD POISONING.... plumbism

Hypochromic ANAEMIA and di?culty in swallowing due to an oesophageal web.... plummer-vinson syndrome

PNEUMONIA caused by a species of the genus of PROTOZOA, a parasitic micro-organism. Pneumocystis carinii causes an opportunistic infection in the lung which is dangerous to people whose immune system is impaired (see IMMUNITY), thus reducing their resistance to infections. People with AIDS/HIV or LEUKAEMIA have impaired immune systems and P. carinii is a major cause of death in the former. Fever, dry cough and breathlessness are among the symptoms; treatment is with high doses of antibiotic drugs such as CO-TRIMOXAZOLE or PENTAMIDINE.... pneumocystis pneumonia

A collection of air in the peritoneal cavity (see PERITONEUM). Air introduced into the peritoneal cavity collects under the diaphragm which is thus raised and collapses the lungs. This procedure was sometimes carried out in the treatment of pulmonary tuberculosis in the pre-antibiotic days as an alternative to arti?cial PNEUMOTHORAX.... pneumoperitoneum

Another name for GOUT affecting the foot.... podagra

A resin derived from podophyllum plants, its active agent, podophyllotoxin, in alcoholic solution is used to treat genital WARTS. Paints, creams and impregnated plasters are used for calluses and warts elsewhere.... podophyllin

This is a term used to describe the variation seen in the shape of red blood cells in some disorders of the BONE MARROW.... poikilocytosis

A Latin term for thumb.... pollex

Also polychromatophilia; terms applied to an abnormal reaction of the red blood cells in severe ANAEMIA. They have a bluish tinge instead of the normal red colour in a blood ?lm stained by the usual method. It is a sign that the cell is not fully developed.... polychromasia

The presence of extra, or supernumerary, ?ngers or toes.... polydactyly

One of several GENES that between them control a single characteristic in an individual. With each polygene exerting a slight e?ect, the genetic outcome is the consequence of ‘group action’. The hereditary characteristics produced in this way are usually those of a quantitative type – for instance, an individual’s height.... polygene

Characterised by scanty (or absent) MENSTRUATION, INFERTILITY, hirsutism (excessive hairiness) and OBESITY and the sufferers often have multiple cysts in their OVARIES.

The condition is caused by an imbalance between LUTEINISING HORMONE (LH) and FOLLICLE-STIMULATING HORMONE (FSH); this imbalance stops OVULATION and varies the TESTOSTERONE output of the ovaries. The treatment may be with CLOMIPHENE; with a PROGESTOGEN drug; with LUTEINISING HORMONE-RELEASING HORMONE (LHRH); or with oral contraceptives (see under CONTRACEPTION – Non-barrier methods). The treatment chosen depends on the severity of the disease and whether the woman wants to conceive. Rarely a section of ovarian tissue is surgically removed.... polycystic ovary syndrome

(Diminutive of polymorphonuclear leucocyte.) A name applied to certain white corpuscles of the blood which have a nucleus of irregular and varied shape. These form between 70 and 75 per cent of all the white corpuscles. (See BLOOD.)... polymorph

Wide varieties of form of a species.... polymorphism

An in?ammatory condition of nerves in various parts of the body. (See NEURITIS.)... polyneuritis

The presence of a crop, or large number, of polypi (see POLYPUS). The most important form of polyposis is that known as familial polyposis coli. This is a hereditary disease characterised by the presence of large numbers of polypoid tumours in the large bowel. Every child born to an affected parent stands a ?fty-?fty chance of developing the disease. Its importance is that sooner or later one or more of these tumours undergoes cancerous change. If the affected gut is removed surgically before this occurs, and preferably before the age of 20, the results are excellent.... polyposis

A CARBOHYDRATE comprising several monosaccharides linked in long chains. Polysaccharides store energy – as starch in plants and glycogen in animals – and they also form the structural parts of plants (as cellulose) and animals (as mucopolysaccharides).... polysaccharide

or polyp (plural: polypi). A general name applied to tumours which are attached by a stalk to the surface from which they spring. The term refers only to the shape of the growth and has nothing to do with its structure or nature. Most polypi are of a simple nature, although malignant polypi are also found. The usual structure of a polypus is that of a ?ne ?brous core covered with epithelium resembling that of the surrounding surface. The sites in which polypi are most usually found are the interior of the nose, the outer meatus of the ear, and the interior of the womb, bladder, or bowels (see POLYPOSIS).

Their removal is generally easy, as they are simply twisted o?, or cut o?, by some form of snare or ligature. (The tissue removed should be checked for malignant cells.) Those which are situated in the interior of the bladder or bowels, and whose presence is usually recognised because blood appears in the urine or stools, require a more serious operation – usually an endoscopic examination (see ENDOSCOPE).... polypus

Punica granatum

Punicaceae

San: Dadimah;

Hin: Anar, Dhalim;

Ben: Dalim;

Tam: Madalai, Madalam;

Mal: Urumampazham, Matalam, Talimatala m, Matalanarakam; Kan :Dalimbe;

Tel: Dadima; Mar: Dalimba;

Guj: Dadam; Ass: Dalin

Importance: Pomegranate has long been esteemed as food and medicine and as a diet in convalescence after diarrhoea. The rind of the fruit is highly effective in chronic diarrhoea and dysentery, dyspepsia, colitis, piles and uterine disorders. The powdered drug boiled with buttermilk is an efficacious reme dy for infantile diarrohoea. The root and stem bark are good for tapeworm and for strengthening the gums. The flowers are useful in vomiting, vitiated conditions of pitta, ophthalmodynia, ulcers, pharyngodynia and hydrocele. An extract of the flowers is very specific for epistaxis. The fruits are useful in anaemia, hyperdipsia, pharyngodynia, ophthalmodynia, pectoral diseases, splenopathy, bronchitis and otalgia. The fruit rind is good for dysentery, diarrhoea and gastralgia. Seeds are good for scabies, hepatopathy and splenopathy. The important preparations using the drug are Dadimadighrtam, Dadimastaka churnam, Hinguvacadi churnam, Hingvadi gulika, etc (Sivarajan et al, 1994, Warrier et al, 1995).

Distribution: Pomegranate is a native of Iran, Afghanistan and Baluchistan. It is found growing wild in the warm valleys and outer hills of the Himalaya between 900m and 1800m altitude. It is cultivated throughout India, the largest area being in Maharastra.

Botany: Punica granatum Linn. belongs to the family Punicaceace. It is a large deciduous shrub up to 10m in height with smooth dark grey bark and often spinescent branchlets. Leaves are opposite, glabrous, minutely pellucid-punctuate, shining above and bright green beneath. Flowers are scarlet red or sometime yellow, mostly solitary, sometimes 2-4 held together. Stamens are numerous and inserted on the calyx below the petals at various levels. Fruits are globose, crowned by the persistent calyx. Rind is coriaceous and woody, interior septate with membraneous walls containing numerous seeds. Seeds are angular with red, pink or whitish, fleshy testa (Warrier et al, 1995).

Agrotechnology: Pomegranate is of deciduous nature in areas where winters are cold, but on the plains it is evergreen. A hot dry summer aids in the production of best fruits. Plants are grown from seeds as well as cuttings. Mature wood pieces cut into lengths of about 30cm are planted for rooting. The rooted plants are planted 4.5-6m apart. When planted close, they form a hedge which also yields fruits. Normal cultivation and irrigation practices are satisfactory for the pomegranate. An application of 30-45kg of FYM annually to each tree helps to produce superior quality fruits. The pomegranate may be trained as a tree with a single stem for 30-45cm or as a bush with 3 or 4 main stems. In either case suckers arising from the roots and similar growths from the trunk and main branches are removed once a year. Shortening of long slender branches and occasional thinning of branches should be done. The fruit has a tough rind and hence transportation loss is minimum (ICAR, 1966).

Properties and activity: Pomegranate fruit rind gives an ellagitannin named granatin B, punicalagin, punicalin and ellagic acid. Bark contains the alkaloids such as iso-pelletierine, pseudopelletierine, methyl isopelletierine, methyl pelletierine, pelletierine as well as iso-quercetin, friedelin, D- mannitol and estrone. Flowers give pelargonidin-3, 5-diglucoside apart from sitosterol, ursolic acid, maslinic acid, asiatic acid, sitosterol- -D-glucoside and gallic acid. Seeds give malvidin pentose glycoside. Rind gives pentose glycosides of malvidin and pentunidin. Fluoride, calcium, magnesium, vitamin C and phosphate are also reported from fruits. Leaves give elligatannins-granatins A and B and punicafolin.

Rind of fruit is astringent, fruit is laxative. Bark of stem and root is anthelmintic, and febrifuge. Rind of fruit and bark of stem and root is antidiarrhoeal. Pericarp possesses antifertility effect. Fixed oil from seeds are antibacterial. Bark, fruit pulp, flower and leaf are antifungal. Aerial part is CNS depressant, diuretic and hypothermic. The flower buds of pomegranate in combination with other plants showed excellent response to the patients of Giardiasis (Mayer et al, 1977; Singhal et al, 1983).... pomegranate

A vein or collection of veins which ?nish at both ends in a bed of capillary blood vessels. An important example is the hepatic portal system, comprising the portal vein and its tributaries. Blood from the stomach, pancreas, spleen and intestines drains into the veins that join up to comprise the portal vein into the liver, where it branches into sinusoids.... portal system

The vein which carries to the LIVER, blood that has been circulating in many of the abdominal organs. It is peculiar among the veins of the body in that it ends by breaking up into a capillary network instead of carrying the blood directly to the heart – a peculiarity which it shares only with certain small vessels in the kidneys. The PORTAL SYSTEM begins below in the haemorrhoidal plexus of veins around the lower end of the rectum; from this point, along the whole length of the intestines, the blood is collected into an inferior mesenteric vein upon the left, and a superior mesenteric vein upon the right side. The inferior mesenteric vein empties into the splenic vein, and the latter, uniting with the superior mesenteric vein immediately above the pancreas, forms the portal vein. The portal vein is joined by veins from the stomach and gallbladder, and ?nally divides into two branches which sink into the right and left lobes of the liver. (For their further course, see LIVER).

The organs from which the portal vein collects the blood are the large and small intestines, the stomach, spleen, pancreas, and gall-bladder.... portal vein

A pre?x signifying after or behind.... post

See MYALGIC ENCEPHALOMYELITIS (ME).... post-viral fatigue syndrome

After birthing.... postpartum

Facilitation of the drainage of secretions from dilated bronchi of the LUNGS. The patient lies on an inclined plane, head downwards, and is encouraged to cough up as much secretion from the lungs as possible. The precise position depends on which part of the lungs is affected. It may need to be carried out for up to three hours daily in divided periods. It is of particular value in BRONCHIECTASIS and lung abscess (see LUNGS, DISEASES OF).... postural drainage

(American) A lighthearted woman Powdar, Powdir, Powdur, Powdor, Powdi, Powdie, Powdy, Powdey, Powdee, Powdea... powder

See “durable power of attorney”.... power of attorney

An antibody (see ANTIBODIES) that combines with an ANTIGEN and forms the immune complex as a precipitate. The reaction is used in some diagnostic serological tests to identify antigens in the serum.... precipitin

This corticosteroid drug has a similar level of glucocorticoid activity as PREDNISOLONE and is converted to prednisolone in the liver. Though prednisone is still in use, prednisolone is the most commonly used oral corticosteroid for long-term anti-in?ammatory treatment. (See CORTICOSTEROIDS; GLUCOCORTICOIDS.)... prednisone

See ECTOPIC BEAT.... premature beat

See ABORTION; FETUS; PREGNANCY AND LABOUR.... premature birth

There are several tests for pregnancy (see PREGNANCY AND LABOUR) in its early stages, and these can be done on blood or urine; some of the urine tests may be carried out at home. Most tests are based on the detection of HUMAN CHORIONIC GONADOTROPHIN (HCG) in the woman’s urine. They are nearly 100 per cent accurate and may show positive as early as 30 days after the ?rst day of the last normal period.

The haemagglutination inhibition test This, and the subsequent tests to be mentioned, are known as immunological tests. They are based upon the e?ect of the urine from a pregnant woman upon the interaction of red blood cells, which have been sensitised to human gonadotrophin, and anti-gonadotrophin serum. They have the great practical advantage of being performed in a test-tube or even on a slide. Because of their ease and speed of performance, a result can be obtained in two hours.

Enzyme-linked immunosorbent assay (ELISA) This is the basis of many of the pregnancy-testing kits obtainable from pharmacies. It is a highly sensitive antibody test and can detect very low concentrations of human chorionic gonadotrophin. Positive results show up as early as ten days after fertilisation – namely, four days before the ?rst missed period.

Ultrasound The fetal sac can be detected by ULTRASOUND from ?ve weeks, and a fetal echo at around six or seven weeks (see also PRENATAL SCREENING OR DIAGNOSIS).... pregnancy tests

A collection of industrial diseases which provide those with a disease legal entitlement to welfare bene?ts. Examples are DEAFNESS from excessive noise in the workplace; ANTHRAX from farming; PNEUMOCONIOSIS from industrially generated dust (coal mining); and LEAD POISONING from the handling of chemicals. (See also OCCUPATIONAL HEALTH, MEDICINE AND DISEASES.)... prescribed diseases

The appearance in labour of some particular part of the child’s body at the mouth of the uterus (see PREGNANCY AND LABOUR). This is a head presentation in 96 per cent of cases, but in a certain number the breech (or buttocks) may present, or the face, or foot, or even a part of the trunk in cases of cross-birth.

The term is also used for the symptoms or signs with which a patient ?rst brings to a doctor.... presentation

See ULCER – Decubitus ulcer.... pressure sores

Xanthoxylum americanum. N.O. Rutaceae.

Synonym: Toothache Bush or Suterberry.

Habitat: Flourishes in moist places throughout the United States, from which country the medicinal berries and bark are imported.

Features ? A shrub varying between ten and fifteen feet in height with alternate branches covered with strong, sharp prickles, the leaves are pinnate, with lanceolate leaflets, the flowers green and white. Small, blue-black berries enclosed in a grey shell grow in clusters on the top of the branches. The bark is about one- twelfth of an inch thick, and has corky, conical spines nearly one inch in height. Fractures show green in the outer part and yellow in the inner. The taste is very pungent, causing salivation, and there is little odour.

Part used ? Berries and bark, the berries being considered the more effective.

Action: Stimulant, alterative, nervine and diaphoretic.

An infusion of the berries, or the crushed or powdered bark, is made in the proportion of 1/2 ounce to 1 pint of boiling water, the dose being one tablespoonful four times daily. The infusion should be allowed to stand in a covered vessel for two hours before use.

In the treatment of chronic rheumatic trouble this medicine is given a prominent place, and it is also widely used wherever a general stimulant is needed. The powdered bark is applied directly to indolent ulcers. As an external application for rheumatism. Coffin recommends 1 ounce of the pulverised bark to 4 ounces of Olive oil, heated, the part to be well rubbed with this liniment night and morning.... prickly ash

See GENERAL PRACTITIONER (GP)... primary care trust

Opuntia species

Description: This cactus has flat, padlike stems that are green. Many round, furry dots that contain sharp-pointed hairs cover these stems.

Habitat and Distribution: This cactus is found in arid and semiarid regions and in dry, sandy areas of wetter regions throughout most of the United States and Central and South America. Some species are planted in arid and semiarid regions of other parts of the world.

Edible Parts: All parts of the plant are edible. Peel the fruits and eat them fresh or crush them to prepare a refreshing drink. Avoid the tiny, pointed hairs. Roast the seeds and grind them to a flour.

CAUTION

Avoid any prickly pear cactus like plant with milky sap.

Other Uses: The pad is a good source of water. Peel it carefully to remove all sharp hairs before putting it in your mouth. You can also use the pads to promote healing. Split them and apply the pulp to wounds.... prickly pear cactus

A woman who is undergoing her ?rst pregnancy (see PREGNANCY AND LABOUR).... primigravida

The term applied to a woman who has given birth, or is giving birth, to her ?rst child (see PREGNANCY AND LABOUR).... primipara

(Latin) The first rose; resembling the flower

Prymrose, Primula, Primulia, Primrosa, Prymrosa... primrose

The state of being free from unsanctioned intrusion. For example, personal privacy in daily living activities (e.g. for clients in residential facilities) or confidential health records.... privacy

A slender, ?exible instrument, usually made of metal, designed for introduction into a wound or cavity – to explore its depth and direction, to discover the presence of foreign bodies, or to introduce medicinal substances.... probe

Viable BACTERIA that colonise the intestine and alter the micro?ora and their metabolic activities, with a presumed bene?cial e?ect for the host. Many probiotics are LACTIC ACID bacteria

– for example, LACTOBACILLUS or bi?dobacterium. Not all probiotics have the same properties or e?ectiveness. To be e?ective, a probiotic must survive passage through the stomach – an acid environment – and successfully colonise in the intestines, even when antibiotics are present. Research suggests that probiotics ameliorate the symptoms of childhood and travellers’ DIARRHOEA, reducing the period of acute symptoms – particularly if the infection is caused by one of the ROTAVIRUSES.... probiotics

Once used widely as a local anaesthetic, but rarely so now.... procaine

A continuous and regular action or succession of actions taking place or being carried out in a definite manner and leading to the accomplishment of some results.... process

One of a naturally occurring or synthetically produced group of steroid HORMONES, including PROGESTERONE, that help to maintain normal pregnancy. Progestogens are used in contraceptives (see CONTRACEPTION) and are useful in treating AMENORRHOEA, premenstrual tension, and abnormal uterine bleeding.... progestogen

The SPINAL COLUMN is built up of a series of bones, known as vertebrae, placed one upon the other. Between these vertebrae lies a series of thick discs of ?bro-cartilage known as intervertebral discs. Each disc consists of an outer portion known as the anulus ?brosus, and an inner core known as the nucleus pulposus. The function of these discs is to give ?exibility and resiliency to the spinal column and to act as bu?ers against undue jarring. In other words, they are most e?cient shock-absorbers. They may, however, PROLAPSE, or protrude, between the two adjacent vertebrae. If this should happen they press on the neighbouring spinal nerve and cause pain. As the most common sites of protrusion are between the last two lumbar vertebrae and between the last lumbar vertebra and the sacrum, this means that the pain occurs in the back, causing LUMBAGO, or down the course of the sciatic nerve causing SCIATICA. The prolapse is most likely to occur in middle age, which suggests that it may be associated with degeneration of the disc involved, but it can occur in early adult life as well. It usually occurs when the individual is performing some form of exercise which involves bending or twisting, as in gardening. The onset of pain may be acute and sudden, or gradual and more chronic in intensity. (See also INTERVERTEBRAL DISC.)

Treatment varies, depending (amongst other things) on the severity of the condition. In the acute phase, rest in bed is advisable, along with ANALGESICS. Later, exercise and physiotherapy are helpful, and in some cases manipulation of the spine brings relief by allowing the herniated, or prolapsed, disc to slip back into position. The injection of a local anaesthetic into the spine (epidural ANAESTHESIA) is yet another measure that often helps the more chronic cases. If those measures fail, surgery to remove the prolapsed disc may be necessary, but the patient’s condition should be carefully reviewed before surgery is considered since success is not certain. An alternative form of treatment is the injection into the disc of chymopapain, an ENZYME obtained from the paw-paw, which dissolves the disc.... prolapsed intervertebral disc

Lying with the face down, or positioning the arm and hand so that the palm faces downwards.... prone

Treatment or action adopted with the view of warding o? disease.... prophylaxis

A drug used intravenously to induce general ANAESTHESIA. Propofol may be used by intravenous infusion to maintain anaesthesia; it is also useful for sedating patients in intensive care.... propofol

The trade name of a drug registered by the pharmaceutical company which has developed and patented it. This protects the name, ingredients and manufacturing technique for a set period of time, and helps the company to recoup the often costly research and development needed to produce and test the drug. Doctors may prescribe a drug by its trade name or by its o?cial, approved name, although the NHS encourages the latter. (See GENERIC DRUG; PATENT.)... proprietary name

See EXOPHTHALMOMETER.... proptometer

A prostaglandin (see PROSTAGLANDINS) produced by the endothelial lining of the blood vessels. It inhibits the aggregation of PLATELETS, and thereby reduces the likelihood of the blood clotting. It is also a strong vasodilator (see VASODILATORS).... prostacyclin

The condition induced by benign enlargement of the PROSTATE GLAND.... prostatism

A digestive ENZYME – also known as a proteolytic enzyme – that breaks down PROTEIN in food as part of the digestive process. The complex protein molecules are reduced to their constituent AMINO ACIDS.... protease

A key enzyme system in the parietal cells of the mucosal lining of the stomach: hydrogen ions are produced which acidify the stomach’s secretions and convert pepsinogen to PEPSIN, an active participant in the digestion of food.... proton pump

These are drugs that inhibit the production of acid in the stomach by blocking a key enzyme system, known as the PROTON PUMP, of the parietal cells of the stomach. The drugs include omeprazole, lansoprazole and pantoprazole, and they are the treatment of choice for oesophagitis (erosion and stricture – see under OESOPHAGUS, DISEASES OF); for the short-term treatment for gastric ulcer (see under STOMACH, DISEASES OF) and DUODENAL ULCER; and, in combination with ANTIBIOTICS, for the eradication of Helicobacter pylori.... proton-pump inhibitors

One of the tricyclic ANTIDEPRESSANT DRUGS. (See MENTAL ILLNESS.)... protriptyline

See FLUOXETINE.... prozac

The mechanism by which complex PROTEIN molecules are broken down by digestive enzymes (see PROTEASE) in the stomach and small intestine. The constituent AMINO ACIDS are then absorbed into the bloodstream.... proteolysis

An inactive substance in the blood PLASMA that is the precursor of the ENZYME, thrombin, which clots the blood. The conversion occurs when a blood vessel is damaged and the process of blood COAGULATION occurs.... prothrombin

A gene in a cell that regulates cell growth and development in an orderly fashion. If a protooncogene mutates, it can give rise to cancer by causing growth without the normal controls. The proto-oncogene is then called an oncogene.... proto-oncogene

A space within an organ without a de?ned lining and which contains ?uid. Patients with chronic pancreatitis (see PANCREAS, DISORDERS OF) sometimes develop these pseudocysts which ?ll with pancreatic juice containing enzymes produced by the gland. Abdominal pain usually results; treatment is by surgical draining.... pseudocyst

This is a hereditary disorder of elastic tissue. Degenerating elastic tissue in the skin produces lesions which look like soft yellow papules. Elastic tissue in the eye and blood vessels is also involved, giving rise to visual impairment, raised blood pressure and haemorrhages.... pseudoxanthoma elasticum

A powerful muscle which arises from the front of the vertebral column in the lumbar region, and passes down, round the pelvis and through the groin, to be attached to the inner side of the thigh-bone not far from its upper end. The act of sitting up from a recumbent posture, or that of bending the thigh on the abdomen, is mainly accomplished by the contraction of this muscle. Disease of the spine in the lumbar region may produce an ABSCESS which lies within the sheath of this muscle and makes its way down to the front of the thigh. Such an abscess is known as a psoas abscess.... psoas

The branch of PSYCHIATRY that investigates, diagnoses and treats the mental-health problems of old people. Psychogeriatricians work in close co-operation with physicians for the care of the elderly, and with other health professionals and social workers in this branch of medicine.... psychogeriatrics

Psychologists have a graduate degree in PSYCHOLOGY, followed by an accredited postgraduate training leading to chartered status. There are a number of di?erent branches related to the various applications psychology has to di?erent ?elds of work.... psychologist

The use of standardised psychological tests to measure di?erences in functions – for example, intelligence and personality – in individuals.... psychometrics

A general term applied to various functional disorders of the nervous system. (See NEUROSIS.)... psychoneurosis

Any disease of the mind... psychopathy

A?ecting the mind. Psychotropic drugs include HALLUCINOGENS, HYPNOTICS or sleeping drugs, sedatives, TRANQUILLISERS and NEUROLEPTICS (antipsychotic drugs).... psychotropic

The name of the ENZYME contained in the SALIVA, by which starchy materials are changed into sugar, and so prepared for absorption. It is identical to the AMYLASE of pancreatic juice. (See DIGESTION; PANCREAS.)... ptyalin

Pubis is the bone that forms the front part of the pelvis. The pubic bones of opposite sides meet in the symphysis and protect the bladder from the front.... pubis

The nerve that operates the lowest muscles of the ?oor of the PELVIS and also the anal SPHINCTER muscle. It may be damaged in childbirth, resulting in INCONTINENCE.... pudendal nerve

The external genital organs. The term is usually used to describe those of the female (see VULVA).... pudendum

A condition which may develop in both LUNGS (interstitial pulmonary ?brosis) or part of one lung. Scarring and thickening of lung tissues occur as a consequence of previous lung in?ammation, which may have been caused by PNEUMONIA or TUBERCULOSIS. Symptoms include cough and breathlessness and diagnosis is con?rmed with a chest X-ray. The patient’s underlying condition should be treated, but the damage already done to lung tissue is usually irreversible. (See also ALVEOLITIS.)... pulmonary fibrosis

An infection, once called puerperal fever, that starts in the genital tract within ten days after childbirth, miscarriage or abortion (see PREGNANCY AND LABOUR). Once a scourge of childbirth, with many women dying from the infection, the past 50 years have seen a dramatic decline in its incidence in developed countries, with only 1–3 per cent of women having babies now being affected. This decline is due to much better maternity care and the advent of ANTIBIOTICS. Infection usually starts in the VAGINA and is caused by the bacteria that normally live in it: they can cause harm because of the mother’s lowered resistance, or when part of the PLACENTA has been retained in the genital tract. The infection usually spreads to the UTERUS and sometimes to the FALLOPIAN TUBES. Sometimes bacteria may enter the vagina from other parts of the body.

Fever, an o?ensive-smelling post-partum vaginal discharge (lochia) and pain in the lower abdomen are the main features. Untreated, the women may develop SALPINGITIS, PERITONITIS and septicaemia. Antibiotics are used to treat the infection and any retained placental tissue must be removed.... puerperal sepsis

Tests to assess how the LUNGS are functioning. They range from simple spirometry (measuring breathing capacity) to sophisticated physiological assessments.

Static lung volumes and capacities can be measured: these include vital capacity – the maximum volume of air that can be exhaled slowly and completely after a maximum deep breath; forced vital capacity is a similar manoeuvre using maximal forceful exhalation and can be measured along with expiratory ?ow rates using simple spirometry; total lung capacity is the total volume of air in the chest after a deep breath in; functional residual capacity is the volume of air in the lungs at the end of a normal expiration, with all respiratory muscles relaxed.

Dynamic lung volumes and ?ow rates re?ect the state of the airways. The forced expiratory volume (FEV) is the amount of air forcefully exhaled during the ?rst second after a full breath – it normally accounts for over 75 per cent of the vital capacity. Maximal voluntary ventilation is calculated by asking the patient to breathe as deeply and quickly as possible for 12 seconds; this test can be used to check the internal consistency of other tests and the extent of co-operation by the patient, important when assessing possible neuromuscular weakness affecting respiration. There are several other more sophisticated tests which may not be necessary when assessing most patients. Measurement of arterial blood gases is also an important part of any assessment of lung function.... pulmonary function tests

See under TEETH.... pulp

Inflammation, usually infectious, of the pulp of a tooth.... pulpitis

A big fall in a person’s systolic BLOOD PRESSURE when he or she breathes in. It may occur in conditions such as constrictive PERICARDITIS and pericardial e?usion, when the normal pumping action of the heart is hindered. ASTHMA may also cause pulsus paradoxus, as can CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD).... pulsus paradoxus

See EYE – Eyelids.... punctum

Description of a wound made by a sharp object, such as a knife, or by a surgical instrument. Puncture wounds, whether accidental (e.g. from a car accident) or deliberate (e.g. from a ?ght), are potentially dangerous. Despite an often small entry hole, serious damage may have been done to underlying tissues – for example, HEART, LUNGS, LIVER, or large blood vessel – and surgical exploration may be required to assess the extent of the injury. Punctures through the skin are also done deliberately in medicine to extract ?uid or tissue through a hollow needle so that it can be examined in the laboratory. LUMBAR PUNCTURE, where cerebrospinal ?uid is withdrawn, is one example.... puncture

Large specialised nerve cells occurring in great numbers in the cortex (super?cial layer of grey matter) of the cerebellum of the BRAIN. They have a ?ask-shaped body, an AXON and branching tree-like extensions called dendrites, which extend towards the surface of the brain (see NEURON(E)).... purkinje cells

Portulaca oleracea

Description: This plant grows close to the ground. It is seldom more than a few centimeters tall. Its stems and leaves are fleshy and often tinged with red. It has paddleshaped leaves, 2.5 centimeter or less long, clustered at the tips of the stems. Its flowers are yellow or pink. Its seeds are tiny and black.

Habitat and Distribution: It grows in full sun in cultivated fields, field margins, and other weedy areas throughout the world.

Edible Parts: All parts are edible. Wash and boil the plants for a tasty vegetable or eat them raw. Use the seeds as a flour substitute or eat them raw.... purslane

The change that takes place in the bodies of plants and animals after death, whereby they are ultimately reduced to carbonic acid gas, ammonia, and other simple substances. The change is almost entirely due to the action of bacteria, and, in the course of the process, various o?ensive and poisonous intermediate substances are formed. In the case of the human body, putrescine, cadaverine, and other alkaloids are among these intermediate products.... putrefaction

Croton tiglium

Euphorbiaceae

San: Jepalah, Dantibijah

Hin: Jamalgota

Ben: Jaypal Mal: Nirvalam

Tam: Nervalam, Sevalamkottai

Tel: Nepala

Importance: Purging croton or croton oil plant, a small evergreen tree with separate male and female flowers, is one among the seven poisons described in Ayurveda. The drug is well known for its drastic purgative property. The drug is found to be useful in ascites, anasarca, cold, cough, asthma, constipation, calculus, dropsy, fever and enlargement of the abdominal viscera. The seed paste is a good application for skin diseases, painful swellings and alopacia. The seed-oil is useful in chronic bronchitis, laryngeal affections, arthritis and lock jaw. Misraka-sneham is an important preparation using the drug (Nadkarni, 1954; Dey, 1980; Sharma, 1983).

Distribution: It is distributed throughout North India. It is cultivated in Assam, West Bengal and South India.

Botany: Croton tiglium Linn. belongs to the family Euphorbiaceae. It is a small evergreen tree, 4.5-6.0m in height with ash coloured smooth bark and young shoots sprinkled with stellate hairs. Leaves are oblong to ovate-lanceolate, obtuse or rounded at the 2-glanded box, acuminate, membraneous, yellowish green and minutely toothed. Flowers are small, unisexual, males on slender pedicels, females larger and on short thick pedicels. Fruits are ovoid or oblong trigonous capsules. Seeds are smooth, testa black and enclosing reddish brown oily endosperm (Warrier et al,1994). Other species belonging to the genus Croton are as follows:

C. aromaticus Linn. C. caudatus Geisel C. jouera Roxb.

C. malabaricus Bedd.

C. oblongifolius Roxb.

C. polyandrus Roxb. syn. Baliospermum montanum Muell-Arg.

C. reticulatus(Chopra et al, 1980)

Agrotechnology: The plant is propagated by seeds. Seeds are to be sown on seedbeds and about 2 months old seedlings are used for transplanting. Pits of size 50cm cube are to be taken at 3m spacing and filled with dried cowdung, sand and topsoil and formed into a mound. The seedlings are to be planted on these mounds. Irrigation during summer months is beneficial. Application of organic manure after every 6 months is desirable. Weeding is to be carried out one month after transplanting. The plant is not attacked by any serious pests or diseases. Fruits are formed at the end of first year. Fruits when ripen and start to crack are to be collected, dried in sun, then the outer shell is removed and again dried for one day before marketing (Prasad et al,1997).

Properties and activity: Oil contains phorbol myristate acetate (Husain et al, 1992). Seeds contain upto 20% protein and 30-50% lipids. Iso-guanine-D-ribose (crotoniside) and saccharose were isolated from the seeds. In fractionation of croton oil, liquid-liquid distribution procedures proved to be the separation tools of choice. The per hydrogenated parent hydrocarbon of phorbol is a perhydrocyclopropabenzulene called tigliane and phorbol is 1, 1a , 1b , 4, 4a, 7a , 7b, 8, 9, 9a-decahydro-4a , 7 , 9 , 9a - tetrahydroxy-3-(hydroxymethyl)-1, 1, 6, 8 tetramethyl-5-H-cyclopropa[3,4] benz [1.2-e]azulen-5- one. Phorbol, a tetracylic diterpene with a 5, 7, 6 and 3- membered ring has 6 oxygen functions. Phorbol accounts for 3.4% and 4- deoxy- 4 - phorbol for 0.29% of the weight of croton oil. Twenty- five phorbol-12, 13-diesters have been detected (Hecker et al, 1974). A toxin croton 1, mol. wt 72,000 has been isolated from the seeds (Lin et al, 1978).

Phorbol myristate acetate activates nitroblue tetrazolium reduction in human polymorphs. Seed and oil is purgative, rubefacient and anti-dote for snakebite. The seeds and oil are acrid, bitter, thermogenic, emollient, drastic purgative, digestive, carminative, anthelmintic, antiinflammatory, vermifuge, deterent, diaphoretic, expectorant, vesicant, irritant and rubefacient.... purging croton

A form of blood-poisoning in which abscesses (see ABSCESS) appear in various parts of the body. (See also SEPTICAEMIA.)... pyaemia

See INTRAVENOUS PYELOGRAM (UROGRAM).... pyelogram

In?ammation of the PORTAL VEIN. A rare but serious disorder, it usually results from the spread of infection within the abdomen – for example, appendicitis. The patient may develop liver abscesses and ASCITES. Treatment is by ANTIBIOTICS and surgery.... pylephlebitis

Also called Ramstedt’s operation, this is a surgical procedure to divide the muscle around the outlet of the stomach (PYLORUS). It is done – usually on babies – to relieve the obstruction caused at the outlet by congenital PYLORIC STENOSIS.... pyloromyotomy

Spasm of the pyloric portion of the STOMACH. This interferes with the passage of food in a normal, gentle fashion into the intestine, causing the pain that comes on from half an hour to three hours after meals; it is associated with severe disorders of digestion. It is often produced by an ulcer of the stomach or duodenum.... pylorospasm

The lower opening of the STOMACH, through which the softened and partially digested food passes into the small INTESTINE.... pylorus

Pus forming... pyogenic

A powerful urge in a person to set things on ?re. A?ected individuals, more commonly males, are called pyromaniacs. They usually have a history of fascination with ?re since childhood and obtain pleasure or relief of tension from causing ?res. Treatment is di?cult and pyromaniacs commonly end up in the courts.... pyromania

See WATERBRASH.... pyrosis

Disposable sanitary towels or tampons (see TAMPON) used to protect clothing from bloodstains during MENSTRUATION. They are available in different absorbencies to meet women’s individual needs.... sanitary protection

A population in which the age and sex composition is known precisely, as a result of a census. A standard population is used as a comparison group in the procedure for standardizing mortality rates.... standard population

A rare complication of MEASLES due to infection of the brain with the measles virus. It develops 2–18 years after the onset of the measles, and is characterised by mental deterioration leading on to CONVULSIONS, COMA and death. The annual incidence in Britain is about one per million of the childhood population. The risk of its developing is 5–25 times greater after measles than after measles vaccination (see MMR VACCINE; IMMUNISATION).... subacute sclerosing panencephalitis

See BLOOD PRESSURE.... systolic pressure

The group of persons for whom an intervention is planned. For example, the targeting of services to particular user groups.... targeting / target population / target group

Infection of the lung tissue by a VIRUS. Causes of this type of pneumonia include ADENOVIRUSES, COXSACKIE VIRUSES and in?uenza virus. Viral infections do not respond to ANTIBIOTICS and treatment is symptomatic, with antibiotics used only if the patient develops secondary bacterial infection. In a previously healthy individual the viral infection is usually self-limiting, but in vulnerable patients – the elderly or those with pre-existing disease – it can be fatal.... viral pneumonia

A rare disease in which DNA repair mechanisms fail, rendering the skin especially vulnerable to damage from ultraviolet light (see ULTRAVIOLET RAYS (UVR)). Extreme photosensitivity begins in infancy; later, marked freckling occurs and premature CARCINOGENESIS in the skin usually leads to early death. There may also be neurological complications.... xeroderma pigmentosum

Also known as the xiphisternum or xiphoid cartilage, this is the small oval-shaped projection forming the lowest of the three parts of the STERNUM or breastbone.... xiphoid process

Tropical countries are a treasure house of a wide variety of medicinal plants. Some species are found wild, while a number of species have been domesticated by the farmers. Many species have been grown in homesteads and become part of traditional home remedies. A limited number of species are commercially cultivated though a few more have potential for large-scale production. The important tropical and subtropical medicinal plants are discussed here highlighting the importance, medicinal and other uses, distribution, botany, agrotechnology, chemical constituents and activity. For practical convenience of the discussion in this book, they are classified under the following four broad groups.

a) Medicinal herbs

b) Medicinal shrubs

c) Medicinal climbers

d)Medicinal trees... tropical medicinal plants

Many causes, including neuralgia, frontal sinusitis, eye troubles (pain of glaucoma being referred to the temples), dental problems, shingles, psychogenic, migraine; pain referred from lungs or heart. See appropriate entries for each of these complaints.

Maria Treben’s Facial Pack: of any of the following – Thyme, Mullein, Chamomile or Yarrow. Fill small muslin bag and steep in boiling water. Ring out. Apply as hot as possible.

Internal: Chamomile tea. ... facial pain

(Acute). Sudden unexplained colicky pain with distension in a healthy person justifies immediate attention by a doctor or suitably trained practitioner. Persistent tenderness, loss of appetite, weight and bowel action should be investigated. Laxatives: not taken for undiagnosed pain. Establish accurate diagnosis.

Treatment. See entries for specific disorders. Teas, powders, tinctures, liquid extracts, or essential oils – see entry of appropriate remedy.

The following are brief indications for action in the absence of a qualified practitioner. Flatulence (gas in the intestine or colon), (Peppermint). Upper right pain due to duodenal ulcer, (Goldenseal). Inflamed pancreas (Dandelion). Gall bladder, (Black root). Liver disorders (Fringe Tree bark). Lower left – diverticulitis, colitis, (Fenugreek seeds). Female organs, (Agnus Castus). Kidney disorders, (Buchu). Bladder, (Parsley Piert). Hiatus hernia (Papaya, Goldenseal). Peptic ulcer, (Irish Moss). Bilious attack (Wild Yam). Gastro-enteritis, (Meadowsweet). Constipation (Senna). Acute appendicitis, pain central, before settling in low right abdomen (Lobelia). Vomiting of blood, (American Cranesbill). Enlargement of abdominal glands is often associated with tonsillitis or glandular disease elsewhere which responds well to Poke root. As a blanket treatment for abdominal pains in general, old-time physicians used Turkey Rhubarb (with, or without Cardamom seed) to prevent griping.

Diet: No food until inflammation disperses. Slippery Elm drinks. ... abdominal pain

Impulsive, destructive behaviour that often disregards the feelings and rights of others.

People who have an antisocial personality lack a sense of guilt and cannot tolerate frustration.

They may have problems with relationships and are frequently in trouble with the law.

Behaviour therapy, and various forms of psychotherapy, may help to improve integration.

In general, the effects of this disorder decrease with age.... antisocial personality disorder

(BPH) A medical term for enlargement of the prostate gland (see prostate, enlarged).... benign prostatic hyperplasia

An antiseptic agent used in the treatment of acne and fungal skin infections (see fungal infections). In acne, benzoyl peroxide also acts by removing the surface layer of skin, unblocking sebaceous glands.... benzoyl peroxide

See pulmonary disease, chronic obstructive.... chronic obstructive pulmonary disease

The toxic effect of mercury has been known since days of the medieval alchemists. Charles II presented all the symptoms we now recognise as mercurial poisoning, presumably the result of medication received over many years. Its symptoms simulate multiple sclerosis, when chronic. They are: constant fatigue, pins and needles in the limbs, resting tremor, nausea, dizziness, ataxia, pains in the bones and joints, drooling (excessive salivation), blue line along the gums. In children they may include all kinds of vague aches and pains, chorea, hyperthyroidism and facial neuralgia. Weakness, walking difficulties, metallic taste in the mouth, thirst, mental deterioration. It is now known to cause a number of serious nerve dystrophies.

Mercury has an affinity for the central nervous system. Soon it concentrates in the kidney causing tubular damage. A common cause is the mercurial content (50 per cent) in the amalgam fillings in teeth which, under certain conditions, release a vapour. Fortunately, its use in dentistry is being superceded by an alternative composite filling.

A common cause of poisoning was demonstrated in 1972 when 6,000 people became seriously ill (600 died) from eating bread made from grain treated with a fungicide containing methylmercury. For every fungus in grain there is a mercuric compound to destroy it. The seed of all cereal grain is thus treated to protect its power of germination.

Those who are hypersensitive to the metal should as far as possible avoid button cells used in tape recorders, cassette players, watch and camera mechanisms. As the mercury cells corrode, the metal enters the environment and an unknown fraction is converted by micro organisms to alkylmercury compounds which seep into ground waters and eventually are borne to the sea. When cells are incinerated, the mercury volatilises and enters the atmosphere. (Pharmaceutical Journal, July 28/1984)

Mercury poisoning from inhalation of mercury fumes goes directly to the brain and pituitary gland. Autopsies carried out on dentists reveal high concentrations of mercury in the pituitary gland. (The Lancet, 5-27-89,1207 (letter))

Treatment. For years the common antidote was sulphur, and maybe not without reason. When brought into contact sulphur and mercury form an insoluble compound enabling the mercury to be more easily eliminated from the body. Sulphur can be provided by eggs or Garlic.

Old-time backwoods physicians of the North American Medical School used Asafoetida, Guaiacum and Echinacea. German pharmacists once used Bugleweed and Yellow Dock. Dr J. Clarke, USA physician recommends Sarsaparilla to facilitate breakdown and expulsion from the body.

Reconstructed formula. Echinacea 2; Sarsaparilla 1; Guaiacum quarter; Asafoetida quarter; Liquorice quarter. Dose: Liquid Extracts: 1 teaspoon. Tinctures: 2 teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon). Thrice daily.

Chelation therapy.

Formula. Tinctures. Skullcap 2-15 drops; Pleurisy root 20-45 drops; Horehound 5-40 drops. Mercurial salivation. Thrice daily. (Indian Herbology of North America, by Alma Hutchens) Dental fillings: replace amalgam with safe alternative – ceramic, etc. Evidence of a link between tooth fillings containing mercury and ME has caused the use of dental amalgam to be banned in Sweden. ... mercury poisoning

A protein produced in the body in response to inflammation.... c-reactive protein

An oil that is extracted from the seeds of the plant

OENOTHERA BIENNIS, commonly known as the evening primrose. The oil contains an anti-inflammatory substance called gamolenic acid, and is believed by some to be of benefit in treating eczema and premenstrual syndrome.... evening primrose oil

The deliberate limitation or spacing of births. Strategies for family planning include the different methods of contraception. (See also birth control.)... family planning

A type of virus that is responsible for warts and genital warts.

There are over 50 strains of human papillomavirus.

Infection with some of these strains is thought to be a causative factor in cervical cancer and anal cancer.... human papillomavirus

A common condition in which patches of rough skin appear on the upper arms, thighs, and buttocks. The openings of the hair follicles become enlarged by plugs of keratin, and hair growth may be distorted. The condition occurs most commonly in

adolescents and obese people. It is not serious and usually clears up on its own. In severe cases, applying a mixture of salicylic acid and soft paraffin and scrubbing with a loofah may help.... keratosis pilaris

Paralysis of the lower arm, with wasting of the small muscles in the hand, and numbness of the fingers (excluding the thumb) and of the inside of the forearm.

Klumpke’s paralysis is caused by injury to the 1st thoracic nerve (one of the spinal nerves) in the brachial plexus, which is usually the result of dislocation of the shoulder.... klumpke’s paralysis

Position in which a patient lies on his or her back with the hips and knees bent and the legs wide apart.

Once used for lithotomy, the position is still used for pelvic examinations and some types of pelvic surgery.... lithotomy position

A collection of large nerve trunks that are formed from nerve roots of the lower part of the cervical spine (in the neck) and the upper part of the thoracic spine (in the chest). These nerve trunks divide into the musculocutaneous, axillary, median, ulnar, and radial nerves, which control muscles in and receive sensation from the arm and hand. Injuries to this plexus can cause loss of movement and sensation in the arm.

In severe injuries, there may be damage to both the upper and the lower nerve roots of the brachial plexus, producing complete paralysis of the arm.

Paralysis may be temporary if the stretching was not severe enough to tear nerve fibres.

Nerve roots that have been torn can be repaired by nerve grafting, a microsurgery procedure.

If a nerve root has become separated from the spinal cord, surgical repair will not be successful.

Apart from injuries, the brachial plexus may be compressed by the presence of a cervical rib (extra rib).... brachial plexus

Removal of all or part of the pancreas.

Pancreatectomy may be performed to treat pancreatitis or localized cancer of the pancreas (see pancreas, cancer of).

Rarely, it is performed to treat insulinomas.

Pancreatectomy may lead to diabetes mellitus and malabsorption.... pancreatectomy

A type of anxiety disorder, characterized by recurrent panic attacks of intense anxiety and distressing physical symptoms.... panic disorder

The scientific study of parasites. Although viruses and many types of bacteria and fungi are parasites, their study is conducted under the title of microbiology.... parasitology

A viral infection that causes a rash and joint inflammation. Many children have no symptoms, but some have a bright red rash on the cheeks, a mild fever, and sometimes mild joint inflammation. Symptoms are more severe in adults; they include a rash on the palms and soles of the feet and severe inflammation in the knee, wrist, and hand joints. A diagnosis is made from the symptoms and a blood test. The infection usually clears up within 2 weeks without treatment.... parvovirus

The process of heating foods to destroy disease-causing microorganisms, and to reduce the numbers of microorganisms responsible for fermentation and putrefaction.... pasteurization

A suffix that denotes a disease or disorder.... pathy

An oil obtained from the peppermint plant MENTHA PIPERITA. It is prescribed to relieve abdominal colic but may cause heartburn. Peppermint oil is also used as a flavouring in some drug preparations.... peppermint oil

The interpretation of a sensation. Information is received through the 5 senses (taste, smell, hearing, vision, and touch) and organized into a pattern by the brain. Factors such as attitude, mood, and expectations affect the final interpretation. Hallucinations are false perceptions that occur in the absence of sensory stimuli.... perception

A haematoma under the skin around the anus.... perianal haematoma

An inherited condition causing recurrent bouts of fever. (See familial Mediterranean fever.)... periodic fever

Any disorder of the periodontium (the tissues that surround and support the teeth).... periodontal disease

See dialysis.... peritoneal dialysis

An alternative term for chilblain.... pernio

Long-term unconsciousness caused by damage to areas of the brain that control higher mental functions. The eyes may open and close, and there may be random movements of the limbs, but there is no response to stimuli such as pain. Basic functions such as breathing and heartbeat are not affected. There is no treatment to reverse the situation, but, with good nursing care, survival for months or years is possible.... persistent vegetative state

The sum of a person’s traits, habits, and experiences.

Temperament, intelligence, emotion, and motivation are important aspects.

The development of personality seems to depend on the interaction of heredity and environment.... personality

Any of a variety of devices placed in the vagina. Some types are used to correct the position of the uterus (see uterus, prolapse of); others are used as contraceptive devices. The term pessary is also used to refer to a medicated vaginal suppository.... pessary

A disorder of the penis in which part of the sheath of fibrous connective tissue thickens, causing the penis to bend during erection. This commonly makes intercourse difficult and painful. Eventually, some of the penile erectile tissue may also thicken. Men over 40 are most often affected. The cause is unknown. The disease may improve without treatment. Otherwise, local injections of corticosteroid drugs or surgical removal of the thickened area and replacement with normal tissue may be carried out.... peyronie’s disease

The small bones that make up the fingers, thumb, and toes.

The thumb and big toe have 2 phalanges; all the other fingers and toes have 3.... phalanges

Any medicinal drug.

The term is also used in relation to the manufacture and sale of drugs.... pharmaceutical

The study or knowledge of the pharmacologically active ingredients of plants.... pharmacognosy

See oesophageal diverticulum.... pharyngeal pouch

A barbiturate drug used mainly as an anticonvulsant. It is often used with phenytoin to treat epilepsy. Possible side effects include drowsiness, clumsiness, dizziness, excitement, and confusion.... phenobarbital

A decongestant drug used to treat seasonal allergic rhinitis (hay fever) and the common cold. As eye-drops, it is used to dilate the pupils for eye examinations. High doses or prolonged use of nasal preparations may cause headache and blurred vision; stopping taking the drug suddenly may make nasal congestion worse.... phenylephrine

An anticonvulsant drug used to treat epilepsy and trigeminal neuralgia.

Side effects include nausea, dizziness, tremor, and overgrown and tender gums.... phenytoin

A surgical treatment for astigmatism, myopia, and hypermetropia, in which areas of the cornea are shaved away by laser.... photorefractive keratectomy

Treatment with light, including sunlight, ultraviolet light, blue light, or lasers. Moderate exposure to sunlight is the most basic form, and is often helpful in treating psoriasis.

PUVA combines the use of long-wave ultraviolet light with a psoralen drug, which sensitizes the skin to light. This is used to treat psoriasis and other skin diseases such as vitiligo. Psoriasis may also be treated using short-wave ultraviolet light, sometimes combined with the application of coal tar.

Visible blue light is used to treat neonatal jaundice (see jaundice, neonatal), which is due to high levels of the pigment bilirubin in the blood. In phototherapy, bilirubin is converted into a harmless substance that can be excreted. To maximize exposure, the baby is undressed and placed under the lights in an incubator to keep him warm.phrenic nerve One of the pair of main nerves supplying the diaphragm. Each phrenic nerve carries motor impulses to the diaphragm, and plays a part in controlling breathing. Injury to, or surgical cutting of, 1 of the nerves results in paralysis of 1 half of the diaphragm.... phototherapy

A small, noncancerous, yellowish spot on the conjunctiva over the white of the eye.

They are common in elderly people, and may be removed for cosmetic reasons.... pinguecula

See conjunctivitis.... pink-eye

An oral hypoglycaemic drug that is used in combination with other oral hypoglycaemics (either metformin or a sulphonylurea) in the treatment of type 2 diabetes mellitus.

Pioglitazone acts by reducing peripheral insulin resistance.

Side effects may include gastrointestinal disturbances, weight gain, and anaemia.... pioglitazone

See wart, plantar.... plantar wart

Coloration of the skin, hair, and iris of the eyes by melanin. The more melanin present, the darker the coloration. Blood pigments can also colour skin (such as in a bruise).

There are many abnormalities of pigmentation.

Patches of pale skin occur in psoriasis, pityriasis alba, pityriasis versicolor, and vitiligo.

Albinism is caused by generalized melanin deficiency.

Phenylketonuria results in a reduced melanin level, making sufferers pale-skinned and fair-haired.

Areas of dark skin may be caused by disorders such as eczema or psoriasis, pityriasis versicolor, chloasma, or by some perfumes and cosmetics containing chemicals that cause photosensitivity.

Permanent areas of deep pigmentation, such as freckles and moles (see naevus), are usually due to an abnormality of melanocytes.

Acanthosis nigricans is characterized by dark patches of velvet-like, thickened skin.

Blood pigments may lead to abnormal colouring.

Excess of the bile pigment bilirubin in jaundice turns the skin yellow, and haemochromatosis turns the skin bronze.... pigmentation

Separation of all or part of the placenta from the wall of the uterus before the baby is delivered. The exact cause is not known, but placental abruption is more common in women with long-term hypertension and in those who have had the condition in a previous pregnancy or who have had several pregnancies. Smoking and high alcohol intake may also contribute to the risk of placental abruption.

Symptoms usually occur suddenly and depend on how much of the placenta has separated from the wall of the uterus. They include slight to heavy vaginal bleeding, which can be severe haemorrhaging in complete separation; cramps in the abdomen or backache; severe, constant abdominal pain; and reduced fetal movements. If the bleeding does not stop, or if it starts again, it may be necessary to induce labour (see

A small placental abruption is usu-tal. In more severe

ergency caesarean section is often necessary to save the the life of the fetus. A blood transfusion required.

placenta praevia Implantation of the placenta in the lower part of the uterus, near or over the cervix. Placenta praevia occurs in about 1 in 200 pregnancies. It varies in severity from marginal placenta praevia, when the placenta reaches the edge of the cervical opening, to complete placental praevia, when the entire opening of the cervix is covered. Mild placenta praevia may have no adverse effect. More severe cases often cause painless vaginal bleeding in late pregnancy. If the bleeding is slight and the pregnancy still has several weeks to run, bed rest in hospital may be all that is necessary. The baby will probably be delivered by caesarean section at the 38th week. If the bleeding is heavy or if the pregnancy is near term, an immediate delivery is carried out. placenta, tumours of See choriocarcinoma; hydatidiform mole.... placental abruption

The smallest type of blood cell, also called a thrombocyte. Platelets play a major role in blood clotting.... platelet

A flat or ribbon-shaped parasitic worm. (See liver fluke, schistosomiasis, tapeworm)... platyhelminth

A way of estimating the blood flow in vessels by measuring changes in the size of a body part.... plethysmography

A surgical procedure in which tucks are taken in the walls of a hollow organ and then stitched to decrease the size of the organ.... plication

The presence of gas in the urine, usually indicating that a fistula has developed between the bladder and the intestine.... pneumaturia

A prefix meaning many or much.... poly-

See ovary, polycystic.... polycystic ovary

Excess amniotic fluid surrounding the fetus during pregnancy. It occurs in about 1 in 250 pregnancies and often has no known cause. The condition sometimes occurs if the fetus has a malformation that makes normal swallowing impossible, or if the pregnant woman has diabetes mellitus. The excess amniotic fluid usually accumulates in the 2nd half of pregnancy, producing symptoms from about week 32. The main symptom is abdominal discomfort. Other possible symptoms are breathlessness and swelling of the legs. The uterus is larger than would usually be expected. Occasionally, fluid accumulates rapidly, causing abdominal pain, breathlessness, nausea, and vomiting, and leg swelling. Premature labour may result.

The condition is usually evident from a physical examination, but ultrasound scanning may be needed.

In mild cases, only rest is needed.

In more severe cases, amniotic fluid may be withdrawn using a needle.

In late pregnancy, induction of labour may be performed.... polyhydramnios

(PCR) A method of rapidly copying DNA sequences so that they can be analysed.... polymerase chain reaction

The middle part of the brainstem.... pons

See

PET scanning.... positron emission tomography

See contraception, emergency.... postcoital contraception

Relating to the back of the body, or referring to the rear part.... posterior

Any of a group of uncommon and usually inherited disorders caused by the accumulation of substances called porphyrins. Sufferers often have a rash or blistering brought on by sunlight, and certain drugs may cause abdominal pain and nervous system disturbances. Porphyrins are formed in the body during the manufacture of haem (a component of haemoglobin). A block in this manufacture causes a build-up of porphyrins. Such blocks are the result of various enzyme deficiencies, which are genetic disorders. Porphyria may also be due to poisoning.

There are 6 types of porphyria. Acute intermittent porphyria usually appears in early adulthood, causing abdominal pain, and often limb cramps, muscle weakness, and psychiatric disturbances. The patient’s urine turns red when left to stand. Barbiturate drugs, phenytoin, oral contraceptives, and tetracyclines precipitate attacks.

Variegate porphyria has similar effects but also causes blistering of sun-exposedskin. Hereditary coproporphyria also has similar effects and may cause additional skin symptoms.

Protoporphyria usually causes skin symptoms after exposure to sunlight, as does porphyria cutanea tarda. In this type, wounds are slow to heal, and urine is sometimes pink or brown. Many cases are precipitated by liver disease.

The rarest and most serious form, congenital erythropoietic porphyria, causes red discoloration of urine and the teeth, excessive hair growth, severe skin blistering and ulceration, and haemolytic anaemia. Death may occur in childhood. Diagnosis is made from abnormal levels of porphyrins in the urine and faeces. Treatment is difficult. Avoiding sunlight and/or precipitating drugs is the most important measure. Acute intermittent porphyria, variegate porphyria, and hereditary coproporphyria may be helped by administration of glucose or haematin. Cases of porphyria cutanea tarda may be helped by venesection.... porphyria

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

Excessive blood loss after childbirth. It is more common after a long labour or after a multiple birth. The haemorrhage is usually due to excessive bleeding from the site where the placenta was attached to the uterus.... postpartum haemorrhage

A form of anxiety that develops after a stressful or frightening event.

Common causes include natural disasters, violence, rape, torture, serious physical injury, and military combat.

Symptoms, which may develop many months after the event, include recurring memories or dreams of the event, a sense of personal isolation, and disturbed sleep and concentration.

There may be a deadening of feelings, or irritability and feelings of guilt, sometimes building up to depression.

Most people recover, in time, with emotional support and counselling.... post-traumatic stress disorder

See hypotension.... postural hypotension

A lipid-lowering drug.... pravastatin

A vasodilator drug used to treat hypertension, heart failure, and Raynaud’s disease.

Prazosin is also used to treat urinary symptoms resulting from an enlarged prostate gland (see prostate, enlarged).

Side effects include dizziness and fainting, nausea, headache, and dry mouth.... prazosin

A term applied to any condition in which there is a tendency for cancer to develop.

There are 3 types of such conditions.

In the 1st, there are no tumours present but the condition carries an increased risk of cancer.

In the 2nd, there are noncancerous tumours that tend to become cancerous or are associated with the development of cancerous tumours elsewhere.

The 3rd type comprises disorders which have irregular features from the beginning but do not always become fully cancerous.... precancerous

The development of secondary sexual characteristics before age 8 in girls and 9 in boys. It is uncommon and may be caused by various disorders that can result in production of sex hormones at an abnormally early age. Possible underlying causes include a brain tumour or other brain abnormalities; abnormality of the adrenal glands (for example, congenital adrenal hyperplasia); ovarian cysts, and tumours, or a tumour in the testes. In some cases, no underlying cause can be identified.

The hormones may cause a premature growth spurt followed by early fusion of the bones. As a result, affected children may initially be tall but, if untreated, final height is often greatly reduced.

The child’s pattern of pubertal development is assessed by a doctor. Blood tests are performed to measure hormone levels. Ultrasound scanning of the ovaries and testes, and CT scanning of the adrenal glands or brain, may also be carried out, depending on the underlying cause suspected.

Treatment is of the underlying cause, and hormone drugs may be given to delay puberty and increase final height.... precocious puberty

The period from conception to birth. Pregnancy begins with the fertilization of an ovum (egg) and its implantation. The egg develops into the placenta and the embryo, which grows to form the fetus. Most eggs implant into the uterus. Very occasionally, an egg implants into an abnormal site, such as a fallopian tube, resulting in an ectopic pregnancy.

A normal pregnancy lasts around 40 weeks from the first day of the woman’s last menstrual period. It is divided into 3 stages (trimesters) of 3 months each. For the first 8 weeks of pregnancy, the developing baby is called an embryo; thereafter it is called a fetus.

In the 1st trimester the breasts start to swell and may become tender. Morning sickness is common. The baby’s major organs have developed by the end of this stage. During the 2nd trimester, the mother’s nipples enlarge and darken and weight rises rapidly. The baby is usually felt moving by 22 weeks. During the 3rd trimester, stretch marks and colostrum may appear, and Braxton Hick’s contractions may be felt. The baby’s head engages at about 36 weeks.

Common, minor health problems during pregnancy include constipation, haemorrhoids, heartburn, pica, swollen ankles, and varicose veins. Other common disorders include urinary tract infections, stress incontinence (see incontinence, urinary), and candidiasis.Complications of pregnancy and disorders that affect it include antepartum haemorrhage; diabetic pregnancy; miscarriage; polyhydramnios; pre-eclampsia; prematurity; and Rhesus incompatibility. (See also childbirth; fetal heart monitoring; pregnancy, multiple.)... pregnancy

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

The 1st teeth (also known as milk teeth), which usually start to appear at age 6 months and are replaced by the permanent teeth from about age 6 years. There are 20 primary teeth, 10 in each jaw. (See also teeth; eruption of teeth; teething.)... primary teeth

An anticholinergic drug used to treat Parkinson’s disease and minimize the side effects of some antipsychotic drugs. Possible adverse effects include dry mouth and blurred vision.... procyclidine

A noncancerous tumour of the pituitary gland that causes overproduction of prolactin. In women, this may result in galactorrhoea, amenorrhoea, or infertility. In men, it may cause impotence and gynaecomastia. In either sex, it may cause headaches, diabetes insipidus, and, if the tumour presses on the optic nerves, loss of the outer visual field. Diagnosis is made from blood tests and CT scanning or MRI of the brain. Treatment may involve removal of the tumour, radiotherapy, or giving the drug bromocriptine.... prolactinoma

An antihistamine drug used to relieve itching in a variety of skin conditions, such as eczema.

It is also used as an antiemetic drug, and sometimes as a premedication.

Possible adverse effects include dry mouth, blurred vision, and drowsiness.... promethazine

An antispasmodic drug used to treat irritable bowel syndrome and forms of urinary incontinence.

Possible adverse effects include dry mouth, blurred vision, and retention of urine.... propantheline

A beta-blocker drug used to treat hypertension, angina pectoris, and cardiac arrhythmias.

It may also be used to reduce the risk of further heart damage after myocardial infarction.

It relieves symptoms of hyperthyroidism and anxiety, and can prevent migraine attacks.

Possible adverse effects are typical of other beta-blocker drugs.... propranolol

A term meaning false joint, used to describe an operation in which the ends of the 2 opposing bones in a joint are removed and a piece of tissue is fixed in the gap as a cushion.

The term also describes a rare childhood condition in which congenital abnormality of the lower half of the tibia leads to spontaneous fracture.... pseudarthrosis

Severe depression in elderly people that mimics dementia. Symptoms include intellectual impairment and loss of memory.... pseudodementia

A form of arthritis that results from the deposition of calcium pyrophosphate crystals in a joint.

The underlying cause is unknown; in rare cases, it is a complication of diabetes mellitus, hyperparathyroidism, and haemochromatosis.

Symptoms are similar to gout.

Diagnosis is from a sample of joint fluid.

Treatment is with nonsteroidal anti-inflammatory drugs (NSAIDs).... pseudogout

A congenital abnormality in which the external genitalia resemble those of the opposite sex, but ovarian or testicular tissue is present as normal. A female pseudohermaphrodite may have an enlarged clitoris resembling a penis and enlarged labia resembling a scrotum. A male may have a very small penis and a divided

scrotum resembling labia. (See also hermaphroditism, sex determination.)... pseudohermaphroditism

Species of rod-like bacteria that live in soil and decomposing matter. PSEUDOMONA AERUGINOSA is capable of causing disease in humans and is present in pus from wounds.... pseudomonas

An aid to psychotherapy in which the patient acts out certain roles or incidents.

Psychodrama is often carried out with a partner or in a group; music, dance, and mime are often used.... psychodrama

A term for a symptom or disorder that is caused by psychological or emotional problems.... psychogenic

The study of abnormal mental processes. There are 2 main approaches: the descriptive, which aims to record symptoms that make up a diagnosis of mental illness; and the psychoanalytic, which is concerned with the unconscious feelings and motives of the individual.... psychopathology

The study of drugs that affect mental states, such as antipsychotic drugs, antidepressant drugs, and anti-anxiety drugs.... psychopharmacology

The pubic hair or the area of the body covered by this hair.... pubes

The removal of the tooth pulp. It is part of root-canal treatment.... pulpectomy

Removal of the coronal part of the pulp of a tooth after it has become inflamed, usually by infection.

Infection is most often due to extensive tooth decay (see caries, dental) or dental fractures (see fracture, dental).

Pulpotomy prevents further degeneration of the pulp.

If treatment is unsuccessful, rootcanal treatment may be required.... pulpotomy

Any of a group of nitrogencontaining compounds synthesized in the body or produced by the digestion of certain proteins. Increased levels of purine can cause hyperuricaemia, which may lead to gout. Foods that have a high purine content include sardines, liver, kidneys, pulses, and poultry.... purine

An operation in which the pylorus (the outlet from the stomach) is widened to allow free passage of food into the intestine.

Pyloroplasty may be performed as part of the surgery for a peptic ulcer, or to prevent tightening of the pyloric muscles after vagotomy.... pyloroplasty

A common, noncancerous skin tumour that develops on exposed areas after minor injury. It can be removed surgically, by electrocautery, or by cryosurgery.... pyogenic granuloma

A substance that produces fever. The term is usually applied to proteins released by white blood cells in response to infections. The word is also sometimes used to refer to chemicals released by microorganisms.... pyrogen

An inherited condition in which there is degeneration of the rods and cones of the retina at the back of both eyes.

The 1st symptoms appear during or after adolescence and include night blindness.

Tests show a ring-shaped area of blindness which, over some years, extends to destroy an increasing area of the visual field, though central vision is retained, often for many years.

Opthalmoscopy reveals several masses of black pigment corresponding to the areas of visual loss.

Affected individuals and their parents should have genetic counselling.... retinitis pigmentosa

The acting out of a role (the pattern of behaviour expected in a given situation).

The phrase “sick role” describes the type of passive behaviour expected and allowed of a patient; people with social or emotional problems may unconsciously adopt this role to gain sympathy and understanding.... role-playing

See stork mark.... salmon patch

The sensation of being unable to move at the moment of going to sleep or when waking up, usually lasting only a few seconds. It may be accompanied by hallucinations. Sleep paralysis most often occurs in people with narcolepsy. (See also cataplexy.)... sleep paralysis

Inability to move a part of the body, accompanied by rigidity of the muscles. Causes of spastic paralysis include stroke, cerebral palsy, and multiple sclerosis. (See also paralysis.)... spastic paralysis

Weakness in part of the body following some types of epileptic seizure (see epilepsy).

The weakness may last for minutes, hours, or even days, but there is no lasting effect.

The cause is thought to be temporary damage to the motor cortex (the area of the brain that controls movement).... todd’s paralysis

The thick, transparent, noncellular layer that surrounds a developing egg cell in the ovarian follicle. At fertilization, the zona pellucida is penetrated by at least 1 sperm.... zona pellucida

n. an agent that kills lice; examples include *dimeticone, *malathion, and *permethrin.... pediculicide

adj. 1. relating to pepsin. 2. relating to digestion.... peptic

n. a unit of loudness of sound. The intensity of a sound to be measured is compared by the human ear to a reference tone of 2 × 10?5 pascal sound pressure and 1000 hertz frequency. The intensity of the reference tone is increased until it appears to be equal in loudness to the sound being measured; the loudness of this sound in phons is then equal to the number of decibels by which the reference tone has had to be increased.... phon

Royle.

Synonym: A. pindrow Spach. A. webbiana Lindl. var. pindrow Brandis. Pinus pindrow Royle.

Family: Pinaceae.

Habitat: Kashmir, Himachal Pradesh, Tehri-Garhwal and other areas of northern India, at altitudes of 2,100-3,600 m.

English: Pindrow-Fir, Silver-Fir, The West-Himalayan Low-Level Fir.

Ayurvedic: Taalisha (related sp.).

Folk: Badar, Morinda, Raisalla, Ransla.

Action: Uses similar to those of A. webbiana.

Terpenoids, flavonoids, glycosides and steroids of the leaf were found to have mast cell stabilizing action in rats. Terpenoids and flavonoids offered bronchoprotection against his- tamine challenge in guinea pigs. The ulcer protective action of petroleum ether, benzene and chloroform fraction has been attributed to steroidal contents. Terephthalic acid demethyl ester (TADE), isolated from the leaf, exhibited protection against inflammation and bronchospasm in guinea pigs. Ethanolic extract of leaves showed significant anxiolytic effects on all the paradigms of anxiety, barbiturate hypnosis potentiation.

Pindrolactone, a lanostane-based triterpene lactone, isolated from the leaves, showed mild activity against Gram-positive bacteria but exhibited potent antibacterial activity against Gram-negative bacteria E. coli.... abies pindrow

Placental bleeding after the 24th week of pregnancy, which may result in complete or partial detachment of the placenta from the wall of the womb. The woman may go into shock. The condition is sometimes associated with raised blood pressure and PRE-ECLAMPSIA. (See also PREGNANCY AND LABOUR.)... abruptio placenta

Linn.

Family: Papilionaceae; Fabaceae.

Habitat: Throughout the country, ascending to an altitude of about 1,050 m in the outer Himalayas.

English: Indian Wild Liquorice, Jequirity, Crab's Eye, Precatory Bean.

Ayurvedic: Gunjaa, Gunjaka, Chirihintikaa, Raktikaa, Chirmi- ti, Kakanti, Kabjaka, Tiktikaa, Kaakananti, Kaakchinchi. (Not to be used as a substitute for liquorice.)

Unani: Ghunghchi, Ghamchi.

Siddha/Tamil: Kunri.

Folk: Chirmiti, Ratti.

Action: Uterine stimulant, abortifa- cient, toxic. Seeds—teratogenic. A paste of seeds is applied on vitiligo patches.

Along with other therapeutic applications, The Ayurvedic Pharmacopoeia of India has indicated the use of seeds in baldness.

Seeds contain abrin, a toxalbumin, indole derivatives, anthocyanins, ste- rols, terpenes. Abrin causes agglutination of erythrocytes, haemolysis and enlargement of lymph glands. A non- toxic dose of abrin (1.25 mcg/kg body weight), isolated from the seeds of red var., exhibited a noticeable increase in antibody-forming cells, bone marrow cellularity and alpha-esterase-positive bone marrow cells.

Oral administration of agglutinins, isolated from the seeds, is useful in the treatment of hepatitis and AIDS.

The seed extract exhibited antischis- tosomal activity in male hamsters.

The methanolic extract of seeds inhibited the motility of human spermatozoa.

The roots contain precol, abrol, gly- cyrrhizin (1.5%) and alkaloids—abra- sine and precasine. The roots also contain triterpenoids—abruslactone A, methyl abrusgenate and abrusgenic acid.

Alkaloids/bases present in the roots are also present in leaves and stems.

A. fruticulosus Wall. Ex Wight and Arn. synonym A. pulchellus Wall., A. laevigatus E. May. (Shveta Gunjaa) is also used for the same medicinal purposes as A. precatorius.

Dosage: Detoxified seed—1-3 g powder. Root powder—3-6 g. (API Vols. I, II.)... abrus precatorius

(L.) willd.

Family: Mimosaceae.

Habitat: Throughout India; ascending to 1,700 m in the Himalayas.

Ayurvedic: Lataakhadira, Aadaari, Ari.

Siddha/Tamil: Indan, Indu. Iyak Koluntu (tender leaves).

Folk: Aila.

Action: Bark—antibilious, antiasth- matic. Leaf—stomachic, styptic (for bleeding gum), antiseptic (for scalding of urine). A decoction of young leaves is taken for body pain, headache and fever.

The bark contains tannin 9%, lupe-ol and alpha-spinasterol. Stem yields sitosterol.... acacia pennata

The Crown-of-thorns starfish, known for the considerable damage that it may cause to coral reefs. It seems to occur in epidemics. The spines are venom-tipped, but usually the envenomation leads only to a painful spike wound which may sometimes get infected. Multiple spikes, either in one episode, or many individual stings rarely lead to systemic symptoms, but may lead to hypersensitivity.... acanthaster planci

D. Don.

Synonym: A. bisma (Buch.-Ham.) Rapaics.... aconitum palmatum

The authorization given by a health care organization’s governing body to medical practitioners and, in some cases, other professionals who request the privilege of admitting and/or treating patients. Privileges are based on a provider’s licence, training, experience and education.... admitting privileges

A type of foster care in which an older person lives with an approved family.... adult placement

Planning in advance for decisions that may have to be made prior to incapability or at the end of life. People may choose to do this planning formally, by means of advance directives, or informally, through discussions with family members, friends and health care and social service providers, or a combination of both methods.... advance care planning

Linn.

Adansonia digitata Linn.

Family: Bombacaceae.

Habitat: Native to tropical Africa; common along the west coast of India.

English: Baobab, Monkey Bread tree, African calabash.

Ayurvedic: Sheet-phala, Ravanaam- likaa, Gorakshi, Panchparni.

Unani: Gorakh Imli.

Siddha/Tamil: Papparapuli.

Folk: Gorakh Imli; Gorakh Chinchaa.

Action: Cooling, refrigerant (allays burning sensation). Leaves— diaphoretic (used as a prophylactic against fevers). Fruit—antidysen- teric, antiseptic, antihistaminic.

The fruit pulp is a source of vitamin C (175.0-445.4 mg/100 g); dried pulp contains calcium and vitamin B1. Furfural (9.6%) is obtained after distillation of the fruit. In Africa, dried leaves provide much of the dietary calcium. Aqueous extract of the bark is used for treating sickle cell anaemia.

An infusion of the leaves and flowers is given in respiratory disorders. (Powdered leaves prevented crisis in asthma induced by histamine in guinea pigs.) Dried fruit pulp also gives relief in bronchial asthma, allergic dermatitis and urticaria.

Family: Leguminosae; Mimosaceae.

Habitat: The western Ghats, the Andamans and sub-Himalayan tract; also cultivated.

English: Coral Wood, Red Wood.

Ayurvedic: Rakta Kanchana, Rakta Kambala.

Siddha/Tamil: Anai-gundumani.

Folk: Ghumchi (bigger var.).

Action: Astringent and styptic (used in diarrhoea, haemorrhage from the stomach, haematuria), anti-inflammatory (in rheumatic affections, gout). Seeds— anticephalgic; also used for the treatment of paralysis. A decoction is given in pulmonary affections.

The seed contains an anti-inflammatory active principle, O-acetyletha- nolamine. The leaves contain octa- cosanol, dulcitol, glucosides of beta- sitosterol and stigmasterol. The bark contains sitgmasterol glucoside.... adenanthera pavonina

Meeting the desire and ability of people, through the provision of appropriate services and assistance, to remain living relatively independently in the community in his or her current home or an appropriate level of housing. Ageing in place is designed to prevent or delay more traumatic moves to a dependent facility, such as a nursing home.... ageing / aging in place

See “population ageing”.... ageing of the population

These are the nose, pharynx or throat (the large cavity behind the nose and mouth), larynx, trachea or windpipe, and bronchi or bronchial tubes. On entering the nose, the air passes through a high narrow passage on each side, the outer wall of which has three projections (the nasal conchae). It then passes down into the pharynx where the food and air passages meet and cross. The larynx lies in front of the lower part of the pharynx and is the organ where the voice is produced (see VOICE AND SPEECH) by aid of the vocal cords. The opening between the cords is called the glottis, and shortly after passing this the air reaches the trachea or windpipe.

The windpipe leads into the chest and divides above the heart into two bronchi, one of which goes to each lung, in which it splits into ?ner and ?ner tubes (see LUNGS). The larynx is enclosed in two strong cartilages: the thyroid (of which the most projecting part, the Adam’s apple, is a prominent point on the front of the neck), and the cricoid (which can be felt as a hard ring about an inch below the thyroid). Beneath this, the trachea – which is sti?ened by rings of cartilage so that it is never closed, no matter what position the body is in – can be traced down until it disappears behind the breastbone.... air passages

Benth.

Family: Mimosaceae.

Habitat: All over India.

Ayurvedic: Shveta Shirisha (bark- white or greenish-white).

Action: Bark—a decoction is given in rheumatism and haemorrhage.

The bark contains beta-sitosterol and yields 12-17% tannins.

An oleanolic acid saponin, proceric acid saponin mixture from seeds and root saponin exhibit spermicidal activity.... albizia procera

A system in which prices for health services and payment methods are the same, regardless of who is paying. For instance, in an all payer system, federal or state government, a private insurer, a self-insured employer plan, an individual, or any other payer could pay the same rates. The uniform fee bars health care providers from shifting costs from one payer to another. See “cost shifting”.... all payer system

Specially trained and licensed (when necessary) people in occupations that support and supplement the functions of health professionals. For the older population, such health personnel may include home health workers and nursing assistants. See also “auxiliary worker”.... allied health personnel

A protein produced in the gut and liver of the FETUS. Abnormality in the fetus, such as neural tube defect, may result in raised levels of alphafeto protein in the maternal blood. In DOWN’S (DOWN) SYNDROME, levels may be abnormally low. In either case, screening of the pregnancy should be carried out, including AMNIOCENTESIS to check the amount of alpha-feto protein in the amniotic ?uid. The protein may also be produced in some abnormal tissues in the adult – in patients with liver cancer, for example.... alpha-feto protein

Characteristic waxy deposits of amyloid found in primary AMYLOIDOSIS, the cause of which is unknown.... amyloid plaques

(Bieb.) Desv.

Synonym: A. camelorum Fisch. ex DC.

A. maurorum Medic.

Family: Papilionaceae; Fabaceae.

Habitat: The drier parts of Rajasthan, Gujarat, Punjab and Uttar Pradesh.

English: Camel Thorn, Persian Manna Plant.

Ayurvedic: Yavaasaka, Yavaasa, Yaasa, Duhsparshaa, Duraalab- haa, Kunaashak. Substitute for Dhanvayaasa. Yaasa-sharkaraa (Alhagi-manna).

Unani: Jawaansaa. Turanjabeen (Alhagi-manna).

Siddha/Tamil: Punaikanjuri, Kan- chori.

Action: Laxative, antibilious, diuretic, diaphoretic, expectorant. Leaves—used for fever, headache, rheumatism. Flowers—blood coagulant, used for piles. Alhagi- manna—expectorant, antiemetic, laxative.

Along with other therapeutic applications, The Ayurvedic Pharmacopoeia of India indicates the use of dried whole plant in gout and haemorrhagic disorders.

The aerial parts contain flavonoids, tannins, sterols, triterpenes, saponins and anthroquinones.

The proanthocyanidins derived from the plant possess hypolipidemic and antiatherosclerotic properties. The compounds prevented an increase in rat serum cholesterol and triglycerides, and they decreased the manifestation of atherosclerosis.

A polymeric proanthocyanidin, extracted from the plant, improved energy metabolism and increased the work capacity in rats.

Ethanolic extract of the aerial parts produced positive inotropic effect on rabbit heart.

Dosage: Whole plant—20-50 g for decoction. (API Vol. II.) Decoction—50-100 ml. (CCRAS.)... alhagi pseudalhagi

Linn.

Synonym: A. ameloprasum Hook. f. non Linn.

Family: Liliaceae, Alliaceae.

Habitat: Native to the Mediterranean region; cultivated in India.

English: Leek.

Folk: Vilaayati Piyaaz. Praan (Kashmir). Seemevangayam (Tamil Nadu).

Action: Expectorant; used as a substitute for garlic.

Leek is poor in volatile oil content in comparison with garlic, but it contains sufficient amounts of non-toxic sapo- nins, which perhaps give it expectorant properties.

The bulbs contain several thiosul- phinates, and also potentially anticar- cinogenic flavonoids, quercetin and kaempferol.... allium porrum

Linn.

Synonym: Prunus persica Batsch.

Family: Rosaceae.

Habitat: Native to China; cultivated in Himalayan regions; grows in tropical and semi-tropical regions and temperate climates.

English: Peach tree.

Ayurvedic: Aaruka.

Unani: Aaaduu, Khokh.

Action: Leaves and bark—expectorant (used in cough, whooping cough, and chronic bronchitis), sedative, stomachic, demulcent, antiscorbutic, diuretic. Fresh leaves—anthelmintic. Powder of leaves—styptic (externally). Fruit— stomachic, antiscorbutic.... amygdalus persica

DC.

Synonym: A. officinarum Hayne

Family: Compositae; Asteraceae.

Habitat: Native to the Mediterranean region; cultivated in Algeria.

English: Spanish, Pellitory, Pyrethrum Root.

Ayurvedic: Aakaarakarabha, Aakallaka, Aakulakrit, Agragraahi.

Unani: Aaqarqarhaa.

Siddha/Tamil: Akkiraakaaram.

Action: Stimulant, cordial, rubefa- cient.A gargle of infusion is prescribed for relaxed vulva. Root— used for toothache, rheumatic and neuralgic affections and rhinitis. Roots, along with the root of Witha- nia somnífera and Vitis vinifera, are used in epilepsy.

Along with other therapeutic applications, Ayurvedic Pharmacopoeia of India indicates the use of the root in sciatica, paralysis, hemiplegia and amenorrhoea.

The root contains anacycline, isobu- tylamide, inulin and a trace ofessential oil.

The local anaesthetic activity of the alcoholic (2%) extract of the root was found to be comparable to that of xy- locaine hydrochloride (2%) in dental patients.

Use of the drug in patients with insulin-dependent diabetes mellitus reduces the dose of insulin. It decreased the plasma glucose and serum cholesterol levels after oral administration for 3-6 weeks. (The plant is mixed with Helleborus nigar in a ratio of 1:3.) The plant extract inhibited tobacco-induced mutagenesis by 47.5% at a concentration of 1 mg/plate.

Dosage: Root—500 mg to 1 g powder. (CCRAS.)... anacyclus pyrethrum

See HENOCH-SCHÖNLEIN PURPURA.... anaphylactoid purpura

See Anís chiquito.... anís pequeño

(Latin) In mythology, a goddess who was the personification of the perennial year... anna perenna

Wall. ex Nees

Family: Acanthaceae.

Habitat: Throughout India, from Himachal Pradesh to Assam and Mizoram, and all over southern India.

English: Creat.

Ayurvedic: Kaalmegha, Bhuunimba, Bhuuminimbaka, Vishwambharaa, Yavtikta, Kalpanaatha, Kiraata-tikta (var.).

Unani: Kiryaat.

Siddha/Tamil: Nilavembu.

Action: Hepatoprotective, cholin- ergic, antispasmodic, stomachic, anthelmintic, alterative, blood purifier, febrifuge. It acts well on the liver, promoting secretion of bile. Used in jaundice and torpid liver, flatulence and diarrhoea of children, colic, strangulation of intestines and splenomegaly; also for cold and upper respiratory tract infections.

Key application: As bitter tonic, febrifuge and hepatoprotective. (Indian Herbal Pharmacopoeia.)

Kaalmegha, officinal in IP, consists of dried leaves and tender shoots, which yield not less than 1% andro- grapholide on dry-weight basis.

Several active constituents have been identified from the leaf and rhizome, including andrographolide, deoxyan- drographolide and other diterpenes.

Andrographolide exhibited strong choleretic action when administered i.p. to rats. It induces increase in bile flow together with change in physical properties of bile secretion. It was found to be more potent than sily- marin.

Andrographolide was found to be almost devoid of antihepatitis-B virus surface antigen-like activity (when compared with picroliv.)

The leaf and stem extracts of Kaal- megha/andrographolide given s.c. or orally did not change blood sugar level of normal or diabetic rats.

Alcoholic extract of the plant exhibited antidiarrhoeal activity against E. coli enterotoxins in animal models.

Clinical evidence of effectiveness of andrographis in humans is limited to the common cold. Preliminary evidence suggests that it might increase antibody activity and phagocytosis by macrophages, and might have mast cell-stabilizing and antiallergy activity. (Natural Medicines Comprehensive Database, 2007.)

The herb is contraindicated inbleed- ing disorders, hypotension, as well as male and female sterility (exhibited infertility in laboratory animals).

Dosage: Whole plant—5-10 ml juice; 50-100 ml decotion; 1-3 g powder. (CCRAS.)... andrographis panicultata

(Wall.) Parker.

Synonym: Amoora rohituka W. and A.

Family: Meliaceae.

Habitat: The sub-Himalayas tracts, Sikkim, Assam, Bengal, western Ghats and the Andamans.

Ayurvedic: Rohitaka, Daadima- chhada, Daadima-pushpaka, Plihaghna. Tecoma undulata G. Don., Bignoniaceae, is also equated with Rohitaka.

Siddha/Tamil: Malampuluvan.

Action: Bark—strongly astringent, used in the diseases of the liver and spleen, and for tumours, enlarged glands. Seed oil—used in muscular pains and rheumatism. All parts of the plant exhibit pesticidal activity. Seed extract—antibacterial, antifungal.

An aqueous extract of the bark, when injected i.p. in normal guinea pigs, showed reduction in absolute lymphocyte count and an increase in spleen weight. The bark appears to be an effective immunosuppressive drug similar to prednisolone.

The stembark contains a limonoid, ammorinin and a saponin, poriferas- terol-3-rhamnoside.... aphanamixis polystachya

See PROSTHESIS.... artificial limbs and other parts

ASPIRIN is a commonly available analgesic (see ANALGESICS) which is frequently taken in overdose. Clinical features of poisoning include nausea, vomiting, TINNITUS, ?ushing, sweating, HYPERVENTILATION, DEHYDRATION, deafness and acid-base and electrolyte disturbances (see ELECTROLYTES). In more severe cases individuals may be confused, drowsy and comatose. Rarely, renal failure (see KIDNEYS, DISEASES OF), PULMONARY OEDEMA or cardiovascular collapse occur. Severe toxicity may be delayed, as absorption of the drug may be prolonged due to the formation of drug concretions in the stomach. Treatment involves the repeated administration of activated CHARCOAL, monitoring of concentration of aspirin in the blood, and correction of acid-base and electrolyte imbalances. In more severely poisoned patients, enhanced excretion of the drug may be necessary by alkalinising the urine (by intravenous administration of sodium bicarbonate – see under SODIUM) or HAEMODIALYSIS.... aspirin poisoning

A process that allows a person who has been assessed to dispute the assessment, and which provides for the assessment to be changed.... assessment appeal process

See ATROPINE; BELLADONNA POISONING.... atropine poisoning

Flacourtia inermis

Description: This shrub or small tree has dark green, alternate, simple leaves. Its fruits are bright red and contain six or more seeds.

Habitat and Distribution: This plant is a native of the Philippines but is widely cultivated for its fruit in other areas. It can be found in clearings and at the edges of the tropical rain forests of Africa and Asia.

Edible Parts: Eat the fruit raw or cooked.... batoko plum

Musa species

Description: These are treelike plants with several large leaves at the top. Their flowers are borne in dense hanging clusters.

Habitat and Distribution: Look for bananas and plantains in open fields or margins of forests where they are grown as a crop. They grow in the humid tropics.

Edible Parts: Their fruits are edible raw or cooked. They may be boiled or baked. You can boil their flowers and eat them like a vegetable. You can cook and eat the rootstocks and leaf sheaths of many species. The center or “heart” or the plant is edible year-round, cooked or raw.

Other Uses: You can use the layers of the lower third of the plants to cover coals to roast food. You can also use their stumps to get water (see Chapter 6). You can use their leaves to wrap other foods for cooking or storage.... banana and plantain

Linn.

Family: Acanthaceae.

Habitat: Throughout the hotter parts of India. Also, commonly grown as a hedge plant in gardens.

English: Common Yellow Nail Dye Plant.

Ayurvedic: Sahachara, Baana, Kurantaka, Kuranta, Koranda, Korandaka, Shairiya, Pita-saireyaka

(yellow-flowered var.). Also equated with Vajradanti.

Unani: Piyaabaansaa.

Siddha/Tamil: Chemmulli.

Folk: Piyaabaasaa, Jhinti, Kat- saraiyaa.

Action: Leaf—juicegiveninstomach disorders, urinary affections; mixed with honey and given to children with fever and catarrh; leaf juice is applied to lacerated soles of feet in the rainy season, mixed with coconut oil for pimples. Leaves and flowering tops—diuretic. Bark—diaphoretic and expectorant. Roots—paste is applied over boils and glandular swellings. Plant (Vajradanti)—antidontalgic, used for bleeding gums in Indian medicine. Ash, obtained from the whole plant, mixed with honey, is given in bronchial asthma.

The Ayurvedic Pharmacopoeia of India recommends oil extract of the plant for arresting greying of hair.

The leaves and flowering tops are diuretic, rich in potassium salts. Leaves and stems showed presence of iridoid glucosides, barlerin and acetylbarlerin. Flowers gave the flavonoid glycoside, scutellarein-7-neohesperidoside. The presence of beta-sitosterol is reported in the plant.

In the south, Nila Sahachara is equated with Ecbolium linneanun Kurz. (known as Nilaambari), and Shveta Sa- hachara with Justica betonica Linn.

Ecbolium linneanun plant is used for gout and dysuria; the root is prescribed for jaundice.

Dosage: Whole plant—50-100 g for decoction. (API Vol. III.)... barleria prionitis

Basil tea is an Ayurvedic natural remedy used to treat a wide variety of diseases such as asthma, diabetes and high cholesterol. Hindus worship the plant for its religious significance as well. Basil Tea description Basil, a plant from the mint family, is original from India and Asia. It is an aromatic herb with a strong fragrance being largely used in spaghetti sauces, stews and tomato recipes. Basil is a source of vitamins and other nutrients.  Studies showed that this herb has anti-bacterial and anti-inflammatory health properties, fighting against intestinal problems, headaches and ulcers, as well. In aromatherapy, basil is used to alleviate mental fatigue. Basil tea is the resulting beverage from brewing the abovementioned plant. Basil Tea brewing To prepare Basil tea:

• bring the water and the basil leaves to boil (in a small tea pan)
• lower the heat and allow it to brew for 3-4 minutes
• add the tea leaves or tea bags and sugar according to taste
• bring to boil
• turn off the heat
• strain it into cups and add milk according to taste

Basil Tea benefits Studies claimed that Basil Tea is successesfully used to:

• treat intestinal colics, gastric ulcers and bloating/swelling of the abdomen
• treat anorexia
• fight urinary tract infections
• help against diarrhea
• help fight insomnia
• help treat lesions and inflammations in the mouth
• enhance the body’s ability to resist stress
• help to relieve pain

Basil Tea side effects Basil tea side effects are generally associated to large intakes. There have been thus noticed:shallow breathing, blood in the urine or sputum, mouth and throat burns, nausea, racing heartbeat, seizures, dizziness and coma. Pregnant or breastfeeding women, as well as women trying to become pregnant should not use Basil tea. Basil tea has anti-inflammatory and anti-microbial properties, proving itself to be an important adjuvant in treating arthritis, fevers and other ailments. It is also constantly used to add savor to several dishes.... basil tea has anti-inflammatory properties

(BPH) The benign buildup in the prostate of “warts” or epithelial neoplasias that can block or interrupt urination, and which are usually concurrent with moderate prostate enlargement. They cause a dull ache on urination, ejaculation, and/or defecation. The diagnosis is medical, since the same subjective conditions can result from cancer of the prostate. BPH is common in men over fifty and can be the result either of diminished production of complete testosterone or poor pelvic circulation. Alcohol, coffee, speed, and antihistamines can all aggravate the problem.... benign prostatic hypertrophy, or hyperplasia

A pool of warm water in which a woman can give birth to her baby. The infant is delivered into the water. The method was introduced during the 1980s and is claimed to make delivery less painful and upsetting.... birth pool

See PHARMACOPOEIA.... british pharmacopoeia

See PNEUMONIA.... broncho-pneumonia

Linn.

Habitat: The Himalayas, and distributed in Northern India, Assam, Khasi Hills. Also cultivated in gardens.

English: Camel's Foot tree, Pink Bauhinia, Butterfly tree, Geramium tree, Orchid tree.

Ayurvedic: Kovidaara, Rakta Kaanchanaara.

Unani/Siddha: Sivappu mandaarai.

Siddha: Mandarai.

Folk: Koilaara, Khairwaal, Kaliaar, Rakta Kanchan.

Action: Bark—astringent, antidiar- rhoeal. Flower buds and flowers, fried in purified butter, are given to patients suffering from dysentery. Extract of stems are used internally and externally for fractured bones. Plant is used in goitre. It exhibited antithyroid-like activity in experimental animals.

The flowers contain astragalin, iso- quercitrin and quercetin, also antho- cyanins. Seeds contain chalcone gly- cosides.... bauhinia purpurea

Atropa belladonna (deadly nightshade) is a relatively rare plant and severe poisoning is not common. The berries, which are black, ripen from August to October and are the most commonly ingested part of the plant. However, all parts of the plant are toxic. The berries contain ATROPINE and other unidenti?ed ALKALOIDS, the leaves HYOSCINE and atropine, and the roots hyoscine. All these alkaloids have an ANTICHOLINERGIC e?ect which may cause a dry mouth, dilated pupils with blurred vision, TACHYCARDIA, HALLUCINATIONS and PYREXIA. There may also be ATAXIA, agitation, disorientation and confusion. In severe cases there may be CONVULSIONS, COMA, respiratory depression and ARRHYTHMIA. Clinical effects may be delayed in onset for up to 12 hours, and prolonged for several days. Treatment is supportive.... belladonna poisoning

Privet tea has been known for its health benefits, especially related to liver and kidney problems. As an herbal tea, it is a good everyday drink which also helps you stay healthy. Find out more about it in this article! About Privet Tea Privet tea is made from privet, an herbal plant which grows all around the world. The privet is a semi-evergreen shrub which includes species of plants used as hedges in gardens. Some species can grow up to 20 meters tall. The plant has glossy, oppositely-arranged, dark green leaves; they can grow as long as 10-12cm. The flowers are small, white, fragrant and blooming in pinnacles. The fruits are purple-black drupes born in clusters; the fruits of some species can be poisonous to humans. How to prepare Privet Tea The fruit of the plant is used to make privet tea. To enjoy this tea, you need to add some dried privet fruit to a cup of freshly-boiled water. Let it steep for 5-7 minutes before you remove the dried fruit. Sweeten it with honey, if you want to. If not, your tea’s ready! You can also use granulated or powdered forms of the fruit in order to make privet tea. Privet Tea Benefits Privet tea has plenty of health benefits thanks to the active constituents which are transferred from the fruit of the herbal plant. Some of them include ligustrum, oleanolic acid, betulinic acid, ursolic acid, saponins and tannins. Drinking privet tea will help strengthen your immune system. Thanks to this, it is often recommended in the treatment for HIV, AIDS, and cancer. It is also often used in treating liver and kidney problems, as well as hepatitis, hypertension, Parkinson’s disease, and respiratory tract infections. Privet tea is also helpful when it comes to treating backaches, insomnia, palpitations, rheumatic pains, and tinnitus. You can use it if you’re feeling dizzy, tired or you’ve got blurred vision caused by stress. It also reduces the chances of getting grey hair, and helps you deal with premature menopause or general menopausal problems. Privet Tea Side Effects If you’re pregnant or breast feeding, you should stop drinking privet tea. Also, children with ages under 12 shouldn’t drink it either. Privet tea can worsen asthma symptoms to those already suffering from this disease. You should also avoid drinking it if you’ve got diarrhea. You should be careful with the amount of privet tea you drink: don’t drink more than 5-6 cups of tea a day. This counts for other types of tea, as well. If you drink too much, you might get some of these symptoms: headaches, dizziness, insomnia, diarrhea, vomiting, and loss of appetite. Privet tea has very few side effects, while it has plenty of important health benefits. It can be consumed every day with no worries.... benefits of privet tea

See PARALYSIS; MOTOR NEURONE DISEASE (MND).... bulbar paralysis

Corypha elata

Description: This tree may reach 18 meters in height. It has large, fan -shaped leaves up to 3 meters long and split into about 100 narrow segments. It bears flowers in huge dusters at the top of the tree. The tree dies after flowering.

Habitat and Distribution: This tree grows in coastal areas of the East Indies.

Edible Parts: The trunk contains starch that is edible raw. The very tip of the trunk is also edible raw or cooked. You can get large quantities of liquid by bruising the flowering stalk. The kernels of the nuts are edible.

CAUTION

The seed covering may cause dermatitis in some individuals.

Other Uses: You can use the leaves as weaving material.... burl palm

For a sweet tea, try the muira puama tea. As an herbal tea, it has many health benefits, especially for men. Read the article and find out more about the muira puama tea! About Muira Puama Tea The main ingredient of the muira puama tea is, of course, the muira puama herbal plant. It is a flowering plant with two species (Benth and Anselmino). Its origin can be found in the Amazonian rainforests, although at present it is grown in Europe, as well. The trees grow up to 4 meters, sometimes even taller. They have short-petioled leaves which are light green on upper surface and dark brown on lower surface. It has small, white flowers that have a similar scent to those of jasmine. How to prepare Muira Puama Tea In order to drink a cup of muira puama tea, pour boiling water in a cup that contains one teabag or a teaspoon of dried herbs. Cover the cup and let it steep for 2-4 minutes. Next, remove the teabag or tea herbs. If you want, you can add milk and honey to your cup of tea, to sweeten the taste. Muira Puama Iced Tea You can also enjoy muira puama tea during summertime, by preparing it as an iced tea. For 1 liter, you mainly need 5 teabags, 2 cups of boiling water, and a similar amount of cold water. Place the teabags into a teapot or a heat resistant pitcher, then pour the boiling water. Let it steep for about 5 minutes, while you fill a serving pitcher with cold water. Remove the tea bags and pour the tea into the serving pitcher. Add ice and more cold water to the serving pitcher. Sweeten it with honey, sugar or anything else that comes to your mind. Components of Muira Puama Tea Muira Puama tea’s components come from the herb with the same name. There are two medically active ones: long-chain fatty acids and alkaloid chemicals. Also, the bark and roots of the plant (which are used to make the tea) contain some of the following constituentsg: alpha-pinene, alpha-terpinene, beta-sitosterol, camphor, eugenol, imonene, linalool, stigmasterols, and various acids and essential oils. Muira Puama Tea Benefits The most important benefit of the muira puama tea is for men. After all, the muira puama herb is also known as the “Viagra of the Amazon”. That is because it helps with sexual impotence, by increasing the blood flow to the genital areas. It also helps in the treatment of male pattern baldness. Muira puama tea can be used as a tonic for nervous conditions and depressions. It is useful when it comes to improving one’s memory, especially among elders. The tea also increases your energy level, and improves mental focus and clarity. It is often used in the treatment for rheumatism and indigestion. It also helps women with treating the discomforts of menopause, as well as lessening the pain that comes with menstrual cramps. Muira Puama Tea side effects It is considered best to avoid drinking muira puama tea during pregnancy or when you are breast feeding. In both cases, it can affect the baby.The teaalsoincludes some enzymes which are harmful if you’re suffering from peptic ulcers. In this case, it is recommended that you not consume this type of tea. Consumption of muira puama tea can also lead to an increase in the blood pressure levels. For most people, it is only temporary, but it can be harmful for people with existing complications of blood pressure levels. If this is your case, it’s best that you consult your doctor first before you start drinking this tea. As muira puama acts as a stimulant, drinking too much muira puama tea may lead to anxiety and insomnia. It is generally advised that you not drink more than six cups of tea a day, no matter the type of tea. Other symptoms that you might get are headaches, loss of appetite, vomiting, diarrhea, dizziness, and irregular heartbeats.   Muira puama tea is clearly full of health benefits, especially for men. It is good for women, as well, as long as it is not consumed during pregnancy or breast feeding periods. Be careful not to get any side effects and you can enjoy this type of tea with no worries.... benefits of muira puama tea

Linn.

Family: Compositae; Asteraceae.

Habitat: Throughout India in gardens, waste places and tea plantations.

Folk: Phutium (Gujarat), Kuri (Garhwal).

Action: Plant—cytotoxic. Leaf— applied to ulcers and swollen glands.

The plant contains a number of poly- acetylenes which are toxic to bacteria, fungi and human fibroblast cells. Phenylheptatriyne is the major constituent of the leaves and stems.

B. pilosa Linn. var. minor (Blume) Sherff, synonym B. pilosa Linn. var. bi- pinnata Hook. f. in part, gave phytos- terin-B, which like insulin, showed hy- poglycaemic activity both in normal and diabetic rats. B. pilosa auct. non Linn., synonym B. chinensis Willd., is used for leprosy, fistulae, pustules, tumours.... bidens pilosa

See HEART, ARTIFICIAL.... cardiac pump

A combination of mouth to mouth resuscitation (E.A.R.) to oxygenate the blood, and external chest compression (E.C.C.) to compress the heart to help pump this artificially oxygenated blood around the body to maintain tissue oxygen concentration and prevent death.... cardio-pulmonary resuscitation

A combination of services designed to meet a person’s assessed needs.... care package

An agreed and explicit route an individual takes through health and social care services. Agreements between the various providers involved will typically cover the type of care and treatment, which professional will be involved and their level of skills, and where treatment or care will take place. See also “care plan”; “care programme”.... care pathway

A dynamic document based on an assessment which outlines the types and frequency of care services that a client receives. It may include strategies, interventions, continued evaluation and actions intended to help an older person to achieve or maintain goals.... care plan

A documented arrangement of integrated care, based on the analysed needs of a specific group of people, from intake to supply of care and services, as well as the intended outcomes, and including a description of the way the arrangement should be applied in order to match the needs of individual persons.... care programme

Try an herbal tea from Africa - pygeum bark tea. Despite its bitter, slightly unpleasant taste, this tea is becoming quite popular. It has plenty of health benefits which will surely help you stay healthy. Find out more about pygeum bark tea and give it a try! About Pygeum Bark Tea Pygeum bark tea is made from the bark of the pygeum tree, an evergreen tree which belongs to the rose family. It grows in central and southern Africa, although it has become endangered due to the large demands for the tree’s bark. A mature tree can be as tall as 25m. The bark is black-brown and scaly, with alternate, simple and long dark green leaves. The flowers bloom from October to May; they are androgynous and greenish-white. The fruit is red-brown, rather wide but not big (about 1cm) and has two lobs, with a seed in each one. The fruit can be used as food both for humans and animals. The wood can be used to make tools, or build homes. How to prepare Pygeum Bark Tea There are two ways in which you can make pygeum bark tea. One involves chopped bark; add it to a cup of freshly-boiled water and let it steep for 10-15 minutes. For the other, you can use the powdered form of the pygeum; you add it to a cup of boiled water, letting it steep for 3-5 minutes. Pygeum bark tea is known to be pretty bitter. If the taste is too much for you, sweeten it with milk, honey or fruit juice. Pygeum Bark Tea Benefits A few important active constituents that are transferred from the pygeum bark to the tea are: beta-sitosterol, ursolic acid, oleanic acid and ferulic acid. Pygeum bark tea can be drunk by men, as it has important health benefits for them. It is often added in the treatment for benign prostatic hyperplasia. It is also recommended in the case of male infertility, as it increases the quantity and quality of the sperm. It can even be used as an aphrodisiac, as it enhances the sexual performance. Pygeum bark tea is used to treat urinary tract infections (cystitis, prostatitis); it also increases the urinary function. You can drink pygeum bark tea if you’ve got symptoms of bronchitis, influenza, or various other respiratory infections. This tea will also help you if you’ve got a fever. An interesting benefit is related to hair: drinking pygeum bark tea is quite useful in the treatment for hair loss. The infusion can be applied on wet hair, after it’s been washed with shampoo. Try it if you’ve got these problems. Pygeum Bark Tea Side Effects If you’re pregnant or breast feeding, it is best not to drink pygeum bark tea; it can affect the baby in both cases. Also, it’s safer not to give it to children, either. It might neutralize the effects of various types of medication. Make sure you talk to your doctor first if you’re taking any kind of medication; he will tell you if it’s safe or not to drink pygeum bark tea. Also, drinking too much pygeum bark tea might not be good for you. It might lead to stomach discomfort, diarrhea, constipation, nausea, dizziness, headaches, or visual disturbances. Don’t let its bitter taste scare you - pygeum bark tea is good for your health. It is especially recommended for men, but it can be useful for women, as well.... benefits of pygeum bark tea

Black Dragon Pearl tea is a type of black tea that provides a full range of benefits to consumers of all ages, worldwide. It distinguishes itself through its chocolate taste and therapeutical benefits. Black Dragon Pearl Tea description Black Dragon Pearl tea, originating from the Chinese province Yunnan, is a type of unsteady black tea, well-known in the area. Each tea pearl contains thirty hand-picked leaves and buds which are immediately rolled to prevent leaves from drying. A morning or afternoon cup of Black Dragon Pearl tea together served with fruits may be a pleasant way to relax oneself. How to prepare Black Dragon Pearl Tea Black Dragon Pearl Black tea can be infused up to three times and still keeps its malty flavor. In case of steeping too long, like any black tea, it can get bitter. When brewed, it has a reddish-brown color, whose aroma makes it identifiable for the senses and, when drunk it has a very delicate and chocolaty taste. Black Dragon Pearl Black tea can be served with or without sugar (or honey) and milk. It contains a relatively low caffeine level. When preparing Black Dragon Pearl tea:

• Use 1 teaspoon of tea for 8 ounces of water ( 2ounces of tea equals 25-30 teaspoons)
• Heat water until it is almost boiling (195 degrees).
• Pour over the pearls.
• Steep them for 3 or 4 minutes.

Black Dragon Pearl Tea benefits Studies revealed the important qualities of Black Dragon Pearl tea. Like any type of black tea, this luxurious beverage contains antioxidants - proven adjuvants in treating cancer and stopping tumors growth. This type of tea has been associated to lowering the risk of stomach, colon and breast cancer, although the connection is not fully scientifically proven. Researchers claim that a compound in Black Dragon Pearl tea caused colorectal cancer cells to disappear, whereas normal cells were not affected by it. Black Dragon Pearl tea is also recommended in dealing with:

• poor arterial functioning that can cause heart attacks and strokes
• inflammation
• viruses
• cholesterol reduction
• teeth decay
• blood toxins removing
• aging effects

Black Dragon Pearl Tea side effects In case of intaking more than 3 cups of tea per day, headaches and dizziness can sometimes appear. Rarely, symptoms of upset stomach may follow Black Dragon Pearl tea consumption. A diet based on Black Dragon Pearl tea plays an important part in one’s life because it renders the sufficient quantity of antioxidants needed by human body to fight against a large array of diseases.... black dragon pearl tea

Fixed cost for a case. See also “fee for service”.... case payment

A group of sensory organs at the posterior end of some male nematodes (excluding “phasmids” which are situated on the lateral aspects of the tip of the tail); the number and arrangement of caudal papillae are used for identification of nematodes such as in Ascarididae and Thelaziidae.... caudal papillae

(Wall.) Gagnep.

Synonym: Vitispedata VahlexWall.

Family: Vitaceae.

Habitat: Bihar, West Bengal and Assam, up to 900 m.

Ayurvedic: Godhaapadi.

Siddha/Tamil: Kattuppirandai.

Action: Leaves—astringent and refrigerant (used for ulcers, diarrhoea, uterine and other fluxes).

Aerial parts—diuretic, spasmolytic.... cayratia pedata

The pomegranate tea is a refreshing, fruity tea whose main ingredient is the pomegranate. The fruit itself is refreshing, sweet and a bit bitter. Not only doespomegranate tea taste lovely, but it is also good for your health! About the Pomegranate Tea The pomegranate tea is a delicious beverage, sweet and fruity-flavored. The main ingredient is, of course, the pomegranate. Pomegranate trees are cultivated all over Asia, as well as in California, Arizona, tropical Africa, and in the Mediterranean region of Southern Europe. In the Northern Hemisphere, they are harvested from September to February, and in the Southern Hemisphere, from March to May. As a fruit, the pomegranate has vitamin C, vitamin B5, potassium, natural phenols, and polyphenols. Also, the edible seeds contain fiber. How to prepare Pomegranate Tea It isn’t difficult to prepare pomegranate tea. First, boil 6-8 ounce of water. Pour the hot water in the cups which contain either tea leaves or teabags. Let it steep for about 10 minutes before you remove the tea leaves or the teabag. For a calming effect, you can try to combine the pomegranate tea with chamomile tea. You can also mix it with black or green teas, based on your taste. Pomegranate Ice Tea If you miss the taste of pomegranate tea, but you don’t feel like drinking it during summer, you can try pomegranate ice tea. It shouldn’t take you more than 10 minutes to prepare it. For 5 serves, you need the following ingredients: 5 cups of boiling water, 5 teabags (of a non-fruity kind of tea), 2 cups of pomegranate juice, and sugar. First, boil the water. Pour it into a heat-resistant pitcher, add the teabags and let it steep for about 10 minutes. Next, remove the teabags and let the temperature cool. Add the pomegranate juice and the sugar, stir well and then put it in the refrigerator. Later, serve it with ice. For a richer flavor, you can add lemon, lime or mint leaves.  Or experiment a little and add anything else you like and think it might make it taste better. Benefits of Pomegranate Tea Pomegranate as a fruit, consumed in all its forms, contains lots of health benefits. The pomegranate tea is no exception. Pomegranate tea is rich in antioxidants. They are helpful when it comes to fighting against aging. They also strengthen the immune system, and lower the risk of getting cancer and diabetes. Pomegranate tea can also help reduce blood pressure and bad cholesterol levels. The chances of getting cardiovascular diseases become lower if you drink pomegranate tea. Pomegranates also have anti-inflammatory properties. Drinking pomegranate tea can slow down joint conditions (osteoarthritis), as well as reduce the pain caused by joint conditions and diseases. It will also help you protect your body’s cartilage. Also, pomegranate tea can help with strengthening your immunity, reducing LDL (bad cholesterol), and treating depression and preserving a good mental balance. Side effects of Pomegranate Tea There aren’t really any bad side effects related to pomegranate as a fruit, as well as pomegranate tea. Although rare, there are cases of allergies to pomegranate. Also, pomegranate juice and, based on how much you drink, possibly pomegranate tea as well, may neutralize the positive effects of some medications; it’s best to check with your doctor. Other side effects are related to drinking too much pomegranate tea; this applies to all types of tea, as well. It is advised that you not drink more than 6 cups of tea a day. Otherwise, you might get the following symptoms: headaches, loss of appetite, vomiting, diarrhea, insomnia, dizziness, and irregular heartbeats. In this case, you need to try and drink less. Whether hot during winter, or cold during summer, pomegranate tea is a great choice for a fruity, refreshing beverage.  It also brings many health benefits with it. Give it a try and you’ll surely enjoy it!... benefits of the pomegranate tea

A group of sensory organs around the mouth opening (excluding amphids which are situated on the lateral aspects of the mouth); the number and arrangement of the cephalic papillae are significant for the classification of nematodes.... cephalic papillae

Fidelity, Hex Breaking, Love ... chili pepper

The opening through which the cirrus is protruded.... cirrus pore

Gingerbush (Pavonia spinifex).

Plant Part Used: Leaf, root.

Dominican Medicinal Uses: The leaf and root are traditionally prepared as a tea by decoction and administered orally for disorders of the kidney, gallbladder or liver, blood in the urine, hepatitis, sexually transmitted infections, uterine fibroids, tumors, cysts and menopausal hot flashes.

Safety: Insufficient information identified.

Contraindications: Unknown; insufficient information identified in the available literature.

Drug Interactions: Unknown; insufficient information identified in the available literature.

Laboratory & Preclinical Data: The chloroform extract of the plant has shown antibacterial activity in vitro.

* See entry for Cadillo de gato in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... cadillo tres pies

Sw.

Family: Caesalpiniaceae.

Habitat: Cultivated in gardens throughout India.

English: Barbados Pride, Peacock Flower.

Ayurvedic: Padangam, Ratnagandhi, Krishnachuudaa.

Siddha/Tamil: Mayirkonrai, Nalal.

Folk: Guleturaa, Sankeshwara.

Action: Leaves—laxative, antipyretic. Used in Eastern India as a substitute for senna. Dried and powdered leaves are used in erysipelas. Flowers—anthelmintic. Also used for cough and catarrh. Root—a decoction is prescribed in intermittent fevers. Bark— emmenagogue, abortifacient.

The plant contains a flavonoid, my- ricitroside. The leaves, flowers and fruits contain tannins, gums, resin, benzoic acid. Presence of cyanidin- 3,5-diglucoside is also reported from the flowers, hydrocyanic acid from the leaves. The root contains caesalpin type diterpenoids along with sitosterol.

The leaves have displayed anticancer activity in laboratory animals. A diter- penoid, isolated from the root, also showed anticancer activity.

In Pakistan, the leaf and flower extract exhibited activity against Grampositive bacteria.... caesalpinia pulcherrima

A hollow organ surrounding the inverted cirrus.... cirrus pouch

A multidisciplinary set of daily prescriptions and outcome targets for managing the overall care of a specific type of patient, e.g. from pre-admission to post-discharge for patients receiving inpatient care. Clinical pathways are often intended to maintain or improve quality of care and decrease costs for patients in particular diagnosis-related groups.... clinical pathway

An instrument that estimates the extent to which a health care provider delivers clinical services that are appropriate for each patient’s condition; provides them safely, competently and in an appropriate time-frame; and achieves desired outcomes in terms of those aspects of patient health and patient satisfaction that can be affected by clinical services.... clinical performance measure

California Poppy tea is a natural remedy against insomnia. It is largely used for its healing properties against anxiety, too. California Poppy Tea description California poppy is an annual or perennial plant, originating from the Pacific coast. Its orange-yellow flowers flourish during spring and midsummer. North Americans used to consume this plant for stress-caused illnesses. Landscape artists appreciate California poppy plant for its beauty. California Poppy tea is the beverage resulting from brewing the abovementioned plant. California Poppy Tea brewing To prepare California Poppy tea, place the flowers, stems and leaves in boiling water for about 10 minutes. California Poppy Tea benefits California Poppy tea has been successfully used to:

• fight insomnia by ushering in restful sleep
• fight anxiety
• fight headaches
• fight toothaches and stomachaches
• fight skin sores and ulcers

California Poppy Tea side effects Pregnant women and children should not consume California Poppy tea. California Poppy tea is a healthy beverage able to deal with a large array of diseases such as stomachaches and ulcers and it also proved to be helpful for skin sores.... california poppy tea against insomnia

(Ait.) R.Br.

Family: Asclepiadaceae.

Habitat: An evergreen shrub distributed in West and Central India.

English: Swallow-Wart, Milk Weed, (purple-flowered), King's Crown.

Ayurvedic: Alarka, Surya, Su- uryaahvya, Vikirna, Vasuka, Tapana, Tuulaphala, Kshirparna, Arkaparna, Aasphota.

Unani: Aakh, Madaar, Ashar.

Siddha/Tamil: Vellerukku, Erukku.

Action: The plant is used against bronchial asthma (especially flowers with black pepper). Leaves—used for treating chronic cases of dyspepsia, flatulence, constipation and mucus in stool. Seed oil— geriatric and tonic. Leaves, flowers and root-bark oil—antimicrobial (maximum activity in leaves). The Ayurvedic Pharmacopoeia of India indicated the use of the root and leaf in asthma and dyspnoea; stem bark in diseases of the spleen.

Root bark contains benzoylline- olone and benzolisolineolone. Root, stem and leaves, also latex contain beta-amyrin. Flowers contain evanidin 3-rhamnoglucoside. The plant contains a cardenolide, proceragenin, an antibacterial principle.

The latex is given for treating epilepsy, also in painful, joints and swellings. The latex exhibited anti-inflammatory activity in carrageenan-and formalin- induced rat paw oedema model.

The herb can alter menstrual cycle and temporarily inhibit ovulation. Cardiac glycosides may be additive when combined with Digoxin. (Sharon M. Herr.)

Dosage: Leaf—250-750 mg powder; root—1-3 g for decoction (API Vol. I); stem bark—0.5-1 g powder (API Vol. III). Milky juice—500 mg to 1 g (CCRAS.)

Action: Anti-inflammatory. Root— hypocholesterolaemic. Poisonous to human beings in mature stages.

The flowers contain flavonoids, 7- rhamnosides, 3-glucosides and 3-glu- co-7-rhamnosides of kaempferol and quercetin. Roots gave triterpenoid glycosides, which decreased serum cholesterol and total protein and increased blood sugar equivalent to bu- tadione in rats.

EtOH (50%) extract of the plant exhibits CNS depressant and hypotensive activity in rat.... calotropis procera

Lam.

Synonym: Plectronia parviflora (Lam.) Bedd.

Family: Rubiaceae.

Habitat: Throughout the Deccan Peninsula, from Gujarat and Maharashtra southwards, and in Bihar and Orissa.

English: Wild Jasmine.

Folk: Kaari.

Siddha/Tamil: Karai, Kadan Karai, Nalla Karai, Kudiram.

Action: Leaves and fruits— astringent, antispasmodic; used against cough. A decoction of the root and leaves is given in flu. Bark—antidysenteric.

The plant contains mannitol (0.5%) and alkaloids. Canthium umbellatum Wight is also known as Kaari.... canthium parviflorum

A systematically developed statement to assist practitioner and patient decisions about appropriate health care for one or more specific clinical circumstances.... clinical practice guideline

The specified portion (cost amount or percentage) that health insurance, or a service programme, may require a person to pay towards his or her medical bills or services.... co-payment

An excellent analgesic treatment for the skin pain of many envenomations, especially those of jellyfish stings. It is usually less effective than heat for the treatment of stonefish, stingray and other venomous-spined fish envenomations.... cold packs

See RECOVERY POSITION and APPENDIX 1: BASIC FIRST AID.... coma position

A doctor who works in the specialty that encompasses PREVENTIVE MEDICINE, EPIDEMIOLOGY and PUBLIC HEALTH.... community physician

The blend of health and social services provided to an individual or family in his/her place of residence for the purpose of promoting, maintaining or restoring health or minimizing the effects of illness and disability. These services are usually designed to help older people remain independent and in their own homes. They can include senior centres, transportation, delivered meals or congregate meals sites, visiting nurses or home health aides, adult day care and homemaker services.... community-based care / community-based services / programmes

(Linn.) Moench.

Family: Cruciferae; Brassicaceae.

Habitat: Throughout India as a weed in cultivated areas and waste places, particularly in the temperate regions up to an altitude of 4,200 m.

English: Shepherd's Purse, St. James's Wort.

Folk: Mumiri.

Action: The herb or its juice extracts are employed to check menorrhagia and haemorrhages from renal and genitourinary tract. Also used in diarrhoea and dysentery and as a diuretic.

Key application: In symptom-based treatment of mild menorrhagia and metrorrhagia. (German Commission E.) The British Herbal Pharmacopoeia reported antihaem- orrhagic action.

Aerial parts contain flavonoids, polypeptides, choline, acetylcholine, histamine and tyramine.

The extract of dried or green plant causes strong contraction of the small intestines and uterus of guinea pigs. A quarternary ammonium salt has been isolated from the herb which is reported to be responsible for its pharmacological activity.

Young leaves contain vitamin A (5,000 IU/100 g) and ascorbic acid (91 mg/100 g); among other constituents are hesperidin and rutin, which reduced permeability of blood vessel walls in white mice. A neoplasm inhibitory substance has been identified as fumaric acid. An inhibitory effect of the extracts of the herb on Ehrlich solid tumour in mice was found to be due to the fumaric acid.

Major constituent of the essential oil is camphor.... capsella bursa-pastoris

The natural pacemaker is the sinuatrial node, found at the base of the heart. The heart normally controls its rate and rhythm; heart block occurs when impulses cannot reach all parts of the heart. This may lead to ARRHYTHMIA, or even cause the heart to stop (see HEART, DISEASES OF). Arti?cial pacemakers may then be used; in the United Kingdom these are required for around one person in every 2,000 of the population. Usually powered by mercury or lithium batteries, and lasting up to 15 years, they are either ?xed to the outside of the chest or implanted in the armpit, and connected by a wire passing through a vein in the neck to the heart. Normally adjusted to deliver 65–75 impulses a minute, they also ensure a regular cardiac rhythm. Patients with pacemakers may be given a driving licence provided that their vehicle is not likely to be a source of danger to the public, and that they are receiving adequate and regular medical supervision from a cardiologist.

Although there are numerous possible sources of electrical interference with pacemakers, the overall risks are slight. Potential sources include anti-theft devices, airport weapon detectors, surgical diathermy, ultrasound, and short-wave heat treatment. Nevertheless, many pacemaker patients lead active and ful?lling lives.... cardiac pacemaker

Linn.

Family: Caricaceae.

Habitat: Native to West Indies and Central America; now cultivated in Uttar Pradesh, Punjab, Rajasthan, Gujarat, Maharashtra and South India.

English: Papaya, Papaw.

Ayurvedic: Erand-karkati, Papitaa.

Unani: Papitaa Desi.

Siddha/Tamil: Pappaali, Pappayi.

Action: Ripe fruit—stomachic, digestive, carminative, diuretic, galactagogue. Useful in bleeding piles, haemoptysis, dysentery and chronic diarrhoea. Seeds— emmengagogue, abortifacient, vermifuge. Juice of seeds is administered in enlarged liver and spleen, and in bleeding piles.

Key application: Papain, the enzyme mixture extracted from raw papain (latex of Carica papaya), has been included among unapproved herbs by German Commission E. Experiment-based as well as clinical research indicate that papain may be effective (in the treatment of inflammations) in high doses (daily dose 1500 mg corresponding to 2520 FIP units).

Unripe fruit—emmengagogue and abortifacient. Latex—applied topically on eczema, ringworm, psoriasis, corns, warts, sloughing wounds, carbuncles and eschar of burns.

Green parts of the plant and seed contain an alkaloid carpaine. Seeds also contain carpasemine.

Latex contain enzymes—papain and chymopapain and alkaloids carpaine and pseudocarpaine. A proteinaceous material from latex showed anticoagulant activity; in higher doses it is heart depressant and as a spasmogen on smooth muscle of guinea pig ileum. An alkaloid solution showed depressant action on heart, blood pressure and intestine.

The anthelmintic action of seeds against Ascaris lumbricoides is due to carpasemine.

Papain, an enzyme mixture prepared from the fruit, seeds and leaf, hydrolyses polypeptides, amides and esters, particularly when used in an alkaline environment, and is used in digestive disorders.

Papain inhibits platelet aggregation, which may further increase the risk of bleeding in patients also taking anticoagulants. Concurrent administration of cyclophosphamide with papain caused sever damage to lung tissues in rats. (Sharon M. Herr.)

Chymopapin C is an immunosup- pressive enzyme from plant extract. Carpaine, extracted from the plant, exhibited anti-tubercular activity, also antitumour in vitro, and hypotensive.

Dosage: Leaf—40-80 ml infusion; latex—3-6 g (CCRAS.)... carica papaya

Delivery of meals and socialization activities to older adults in a designated location.... congregate meals programme

The name applied to the collapsing pulse found with incompetence of the heart’s aortic valve. It is so-called after Sir Dominic John Corrigan (1802–80), the famous Dublin physician, who ?rst described it.... corrigan’s pulse

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

(Linn.) Gaertn.

Synonym: Eriodendron anafractuo- sum DC.

Family: Bombacaceae.

Habitat: West and South India. Often found planted around villages and temples.

English: Kapok, White Silk Cotton.

Ayurvedic: Kuuta-Shaalmali, Shveta Shaalmali.

Siddha/Tamil: Ielavum (Tamil).

Action: Gum—laxative, astringent, demulcent (given in painful micturition). Unripe fruit—astringent. Root—diuretic, antidiabetic, an- tispasmodic (used in dysentery). Flowers—laxative; used in lochi- orrhoea. Unripe pods—used in vertigo and migraine. Seed oil— used in rheumatism.

The plant contains linarin (acacetin 7-rutinoside). Seeds contain fatty acids, diglycerides and phospholipids. Leaves are considered a good source of iron and calcium. Stem-bark extract—antimicrobial.... ceiba pentandra

Attacks of uncontrollable coughing or “whooping”, often relating to whooping cough or bronchiectasis, but they can also be caused by the smoke from burning plastics and (memories of yesteryear) hash oil.... cough, paroxysmal

A managerial process dealing directly with the selection of priority health problems, specification of operational objectives and translation of these into activities, resource needs and organization.... country health programming

A treatment protocol based on a consensus of clinicians that includes only those few vital components or items proved to affect patient outcomes, either by the omission or commission of the treatment or the timing of the intervention.... critical pathway

Roxb.

Family: Dilleniaceae.

Habitat: The Himalayan terai from Punjab to Assam, and South India and the Andamans.

Folk: Dillenia. Agai (Bihar), Agachi (Maharashtra).

Action: See D. indica.

The bark contains 6% tannin.... dillenia pentagyna

Willd.

Family: Celastraceae.

Habitat: Sub-Himalayan tract up to 2,000 m and South Indian hills.

English: Staff tree, Intellect tree.

Ayurvedic: Jyotishmati, Paaraavat- padi. Kangunikaa, Kanguni, Vegaa, Maalkaanguni, Svarnalatikaa, Kaakaandaki, Katuveekaa.

Unani: Maalkangani.

Siddha/Tamil: Vaaluluvai.

Action: Seeds—nervine and brain tonic, diaphoretic, febrifugal, emetic. Seed-oil—used for treating mental depression, hysteria and for improving memory; also used for scabies, eczema, wounds, rheumatic pains, paralysis. A decoction of seeds is given in gout, rheumatism, paralysis and for treating leprosy and other skin diseases. Leaves— antidysenteric, emmenagogue. Root—a paste of root-bark is applied to swollen veins and pneumonic affections.

Key application: As a tranquilizer (Indian Herbal Pharmacopoeia) and brain tonic (The Ayurvedic Pharmacopoeia of India). The Ayurvedic Pharmacopoeia of India indicated the use of ripe seed in leucoderma and vitiligo.

The seeds are reported to contain the alkaloids, celastrine and paniculatine, which are the active principles of the drug.

In experimental animals, the drug showed lowering of leptazol toxicity, motor activity and amphetamine toxi- city, and raising the capacity for learning process. It showed significant CNS depressant effect and a clear synergism with pentobarbital. The seed extract showed hypolipidaemic effect and prevented atherogenesis in rabbits.

The seed oil showed tranquillizing effect and hastened the process of learning in experimental animals. It produced fall in blood pressure in anaesthetized dog, depressed the heart of frog, and was found to be toxic to rats.

In addition to the seed, 70% alcoholic extract of the plant showed sedative, anti-inflammatory and antipyretic, anti-ulcerogenic effect in experimental animals.

Methanolic extract of flowers showed both analgesic and anti- inflammatory activities experimentally.

Dosage: Ripe seed, devoid of capsule wall—1-2 g; oil—5-15 drops. (API Vol. II.)... celastrus paniculatus

Any activities by a health professional involving direct interaction, treatment, administration of medications or other therapy or involvement with a patient.... direct patient care

Measures that can be initiated among those with a disease, usually a chronic disease, to lessen or delay the impact of disability from that disease, e.g. averting renal complications among those with diabetes.... disability postponement

A process by which an admitted inpatient’s needs on discharge are anticipated, planned for or arranged.... discharge planning

See “prevention”.... disease prevention

Linn.

Family: Compositae; Asteraceae.

Habitat: Native to Europe.

Unani: Daarunaj Aqrabi.

Action: Used in nervous depression, melancholia and as a constituent of cardiac tonic preparations.

The plant contains photoactive thio- phenes, in amounts reported to be toxic. Roots and aerial parts yield sesquiterpene alcohol, paralianchol and its aetophenone derivatives.... doronicum pardalianches

A finished dosage form, for eg., a tablet, capsule or solution that contains a drug substance... drug product

Chaga tea is a medicinal beverage with anti-inflammatory and anti-cancer properties. It is also an adjuvant in the liver treatment. Chaga Tea description Chaga is an irregularly-shaped polypore fungus (a mushroom), mainly found on the wounds of birch trees, on elm trees, alder trees and ironwood trees. This mushroom has a brown color, its veins being white or cream. It is acknowledged to hold less water than other types of mushrooms. In North Europe and Russia, the chaga mushroom has been used for a long period of time as a popular medicine remedy. Scientists have demonstrated that chaga has anti-cancer, anti-inflammatory, antiviral and immune-stimulating actions. It could also be used to relieve pain. Changa tea is the resulting beverage from brewing the abovementioned mushroom. Chaga Tea brewing Chaga tea is prepared in the following way:

• shred the Chaga mushrooms
• soften the pieces in cold water for about five hours
• get the softened mushrooms out
• save the liquid
• add heated water to the softened mushrooms
• let the mixture stand for about 2 days
• mix the resultant Chaga tea with the saved liquid from the softening process
• drink it slowly

Chaga tea may be consumed three times a day. Chaga Tea benefits Chaga tea has been successfully used to:

• boost and strengthen the immune system
• help in the treatment of various stomach diseases
• help in expelling intestinal worms
• help in the treatment of liver problems
• help in the treatment of certain heart ailments, including hypertension
• help in fighting tumors and lowering the risk of certain cancers (like breast, liver, uterus and stomach cancers)
• help in the treatment of diabetes
• act against HIV
• treat inflammations

Chaga Tea side effects Before drinking Chaga tea, consult a health care provider. Chaga tea is a natural beverage used as a treatment for diabetes, several heart ailments as well as for inflammations.... chaga tea has anti-cancer properties

Hook. f.

Synonym: C. rottleri Klotzsh.

Family: Euphorbiaceae.

Habitat: Throughout India except Jammu & Kashmir and northeastern India as a weed.

Ayurvedic: Suuryaavart.

Folk: Nilakanthi.

Action: Ash of root—bechic. Leaf— depurative. Seed—cathartic.

Roots contain xanthone glycosides and a chromone glycoside. Seeds gave oil rich in linoleate. The plant contains 9.0% tannin.... chrozophora plicata

Linn.

Family: Menispermaceae.

Habitat: The tropical and subtropical parts of India.

English: Velvet-Leaf Pareira, Pareira Brava.

Ayurvedic: Paathaa, Ambashthaa, Varatiktaaa, Vriki, Aviddhakarni, Piluphalaa, Shreyashi.Bigger var., Raaja Paathaa, is equated with Stephania hernandifolia Walp.)

Unani: Paathaa.

Siddha/Tamil: Paadakkizhangu, Appatta.

Action: Root astringent, an- tispasmodic (used for cramps, painful menstruation), analgesic, antipyretic, diuretic, antilithic and emmenagogue. Prescribed for diarrhoea, dysentery, piles, urogenital affections (cystitis, nephritis, menorrhagia) Root paste is applied topically on scabies and eruptions on the body. Also used for preventing miscarriage.

The Ayurvedic Pharmacopoeia ofIn- dia attributed blood purifying properties to the root and indicated it in lactal disorders.

Hayatine (dl-beberine) is the principal alkaloid of the root. Its derivatives, methiodide and methochloride are reported to be potent neuromus- cular-blocking agents.

Not to be confused with Abuta grandiflora, a South American medicinal plant.

Dosage: Root—3-6 g powder. (API Vol. I.) the plant hastens fracture-healing by reducing the total convalescent period by 33% in experimental rats and dogs; it aids in recovery of the strength of the bones up to 90% in 6 weeks.

Dosage: Stem—10-20 ml juice. (API Vol. III.)... cissampelos pareira

A written legal document in which a person appoints another individual to act as his/her agent for the purposes of health care decision-making in the event that he/she is unable or unwilling to make such decisions. See also “advance directive”.... durable power of attorney (enduring power of attorney)

Jacq.

Synonym: Duranta repens Linn.

Family: Verbenaceae.

Habitat: Cultivated as a hedge plant.

Folk: Durantaa.

Action: Antifungal (topically).

The leaves contain a saponin and fruits an alkaloid analogous to narco- tine. Macerated fruits, which even in dilutions of 1 : 100 parts of water, is lethal to mosquito larvae (the action is less marked on Culicine larvae.... duranta plumieri

See “durable power of attorney”.... enduring power of attorney

Disease common in Australia and caused by the Ross River Virus, an arbovirus transmitted by mosquitoes.... epidemic polyarthritis

Erb’s paralysis is a form of paralysis of the arm due to stretching or tearing of the ?bres of the brachial nerve plexus. Such damage to the brachial plexus may occur during birth, especially when the baby is unusually large, and it is found that the arm lies by the side of the body with elbow extended, forearm pronated, and the ?ngers ?exed. The infant is unable to raise the arm.... erb’s paralysis

This is a term encompassing chronic BRONCHITIS, EMPHYSEMA, and chronic ASTHMA where the air?ow into the lungs is obstructed.

Chronic bronchitis is typi?ed by chronic productive cough for at least three months in two successive years (provided other causes such as TUBERCULOSIS, lung cancer and chronic heart failure have been excluded). The characteristics of emphysema are abnormal and permanent enlargement of the airspaces (alveoli) at the furthermost parts of the lung tissue. Rupture of alveoli occurs, resulting in the creation of air spaces with a gradual breakdown in the lung’s ability to oxygenate the blood and remove carbon dioxide from it (see LUNGS). Asthma results in in?ammation of the airways with the lining of the BRONCHIOLES becoming hypersensitive, causing them to constrict. The obstruction may spontaneously improve or do so in response to bronchodilator drugs. If an asthmatic patient’s airway-obstruction is characterised by incomplete reversibility, he or she is deemed to have a form of COPD called asthmatic bronchitis; sufferers from this disorder cannot always be readily distinguished from those people who have chronic bronchitis and/ or emphysema. Symptoms and signs of emphysema, chronic bronchitis and asthmatic bronchitis overlap, making it di?cult sometimes to make a precise diagnosis. Patients with completely reversible air?ow obstruction without the features of chronic bronchitis or emphysema, however, are considered to be suffering from asthma but not from COPD.

The incidence of COPD has been increasing, as has the death rate. In the UK around 30,000 people with COPD die annually and the disorder makes up 10 per cent of all admissions to hospital medical wards, making it a serious cause of illness and disability. The prevalence, incidence and mortality rates increase with age, and more men than women have the disorder, which is also more common in those who are socially disadvantaged.

Causes The most important cause of COPD is cigarette smoking, though only 15 per cent of smokers are likely to develop clinically signi?cant symptoms of the disorder. Smoking is believed to cause persistent airway in?ammation and upset the normal metabolic activity in the lung. Exposure to chemical impurities and dust in the atmosphere may also cause COPD.

Signs and symptoms Most patients develop in?ammation of the airways, excessive growth of mucus-secreting glands in the airways, and changes to other cells in the airways. The result is that mucus is transported less e?ectively along the airways to eventual evacuation as sputum. Small airways become obstructed and the alveoli lose their elasticity. COPD usually starts with repeated attacks of productive cough, commonly following winter colds; these attacks progressively worsen and eventually the patient develops a permanent cough. Recurrent respiratory infections, breathlessness on exertion, wheezing and tightness of the chest follow. Bloodstained and/or infected sputum are also indicative of established disease. Among the symptoms and signs of patients with advanced obstruction of air?ow in the lungs are:

RHONCHI (abnormal musical sounds heard through a STETHOSCOPE when the patient breathes out).

marked indrawing of the muscles between the ribs and development of a barrel-shaped chest.

loss of weight.

CYANOSIS in which the skin develops a blue tinge because of reduced oxygenation of blood in the blood vessels in the skin.

bounding pulse with changes in heart rhythm.

OEDEMA of the legs and arms.

decreasing mobility.

Some patients with COPD have increased ventilation of the alveoli in their lungs, but the levels of oxygen and carbon dioxide are normal so their skin colour is normal. They are, however, breathless so are dubbed ‘pink pu?ers’. Other patients have reduced alveolar ventilation which lowers their oxygen levels causing cyanosis; they also develop COR PULMONALE, a form of heart failure, and become oedematous, so are called ‘blue bloaters’.

Investigations include various tests of lung function, including the patient’s response to bronchodilator drugs. Exercise tests may help, but radiological assessment is not usually of great diagnostic value in the early stages of the disorder.

Treatment depends on how far COPD has progressed. Smoking must be stopped – also an essential preventive step in healthy individuals. Early stages are treated with bronchodilator drugs to relieve breathing symptoms. The next stage is to introduce steroids (given by inhalation). If symptoms worsen, physiotherapy – breathing exercises and postural drainage – is valuable and annual vaccination against INFLUENZA is strongly advised. If the patient develops breathlessness on mild exertion, has cyanosis, wheezing and permanent cough and tends to HYPERVENTILATION, then oxygen therapy should be considered. Antibiotic treatment is necessary if overt infection of the lungs develops.

Complications Sometimes rupture of the pulmonary bullae (thin-walled airspaces produced by the breakdown of the walls of the alveoli) may cause PNEUMOTHORAX and also exert pressure on functioning lung tissue. Respiratory failure and failure of the right side of the heart (which controls blood supply to the lungs), known as cor pulmonale, are late complications in patients whose primary problem is emphysema.

Prognosis This is related to age and to the extent of the patient’s response to bronchodilator drugs. Patients with COPD who develop raised pressure in the heart/lung circulation and subsequent heart failure (cor pulmonale) have a bad prognosis.... chronic obstructive pulmonary disease (copd)

Ergot poisoning, or ergotism, occasionally results from eating bread made from rye infected with the fungus, Claviceps purpurea. Several terrible epidemics (St Anthony’s Fire), characterised by intense pain and hallucinations, occurred in France and Germany during the Middle Ages (see ERYSIPELAS). Its symptoms are the occurrence of spasmodic muscular contractions, and the gradual production of gangrene in parts like the ?ngers, toes and tips of the ears because of constriction of blood vessels and therefore the blood supply.... ergot poisoning

Roxb.

Family: Convolvulaceae.

Habitat: Throughout India, common in Uttar Pradesh.

Ayurvedic: Ashoka-rohini (non- classical).

Siddha/Tamil: Unamkodi.

Action: Bark—anticholerin. Ripe fruit eaten in constipation. Pounded root prescribed internally in fever. Bark is used in cholera.

EtOH (50%) extract of aerial parts exhibit diuretic and hypotensive activity.... erycibe paniculata

Lindl.

Synonym: E. ramentaceae Lindl. ex Wt.

Family: Orchidaceae.

Habitat: Pasture lands of Deccan from Konkan southwards.

English: Salep (var.).

Folk: Sataavari (Maharashtra).

Action: Tuber—used for scrofulous glands.... eulophia pratensis

Macf.

Family: Rutaceae.

Habitat: Khasi Hills, submountain- ous Himalayan ranges in Garhwal, Kumaon in U.P., Maland areas of South, Pachmarhi (Madhya Pradesh), Sikkim and Western Ghats.

English: Citron.

Ayurvedic: Maatulunga, Lunga, Maatulaka, Mahaalunga, Bijpuura, Bijaahva.

Unani: Turanj.

Siddha/Tamil: Kadaranrathai, Naarthankai, Thurinjippazham.

Folk: Bijoraa.

Action: Fruit—antiscorbutic, refrigerant, astringent, carminative, stomachic, antibacterial. Used for dyspepsia, bilious vomiting, cold, fever, hiccough. Root— anthelmintic. Flowers and buds— astringent.

The peel contains coumarins, limet- tin, scoparone, scopoletin and um- belliferon; besides nobiletin, limonin,

Family: Rutaceae.

Habitat: Native to the West Indies. Commercialized in the USA. Cultivated mainly in Punjab.

English: Grapefruit, 'Marsh' Grapefruit.

Folk: Chakotraa. Chima Bombili- maas (Tamil Nadu).

Action: Young leaves—decoction is used to relieve cold or headache. Fruit—used for developing resistance against colds and influenza.

Grapefruit is rich in vitamins, minerals, potassium and pectin, which balance the acid reaction in the stomach and stimulate appetite. Half grapefruit contains vitamin A 318 IU, vitamin C 46.8 mg, niacin 0.2 mg, potassium 158 mg. The fruit contains beta- carotene and cartenoid lycopene. Ly- copene is especially noted for reducing the risk of prostate cancer. The fruit juice contains furanocoumarins, including bergamottin, also naringin, naringenin, limonin, quercetin, kaem- pferol and obacunone.

For drug interactions with grapefruit juice, see Natural Medicines Comprehensive Database, 2007.

Grapefruit is not to be confused with grape (Vitis vinifera).... citrus paradisi

(Roxb.) DC.

Family: Rutaceae.

Habitat: The sub-Himalayan tract from Garhwal to Sikkim; also in Chakrata range.

Folk: Ratanjot (var.), Rowana. Surasi is a doubtful synonym.

Action: Bark—anti-inflammatory, spasmolytic; used in veterinary medicine for wounds and sprains.

Aerial parts contain coumarins— clausmarins A and B. Coumarins exhibit spasmolytic activity. The root also contains coumarins. Root and stem bark of Clausena excavata Burm. f. Eastern sub-Himalayan tract, Orissa and Bihar) also contain coumarins— clausenin and clausenidin. The root bark exhibits antibacterial activity against both Gram-positive and Gramnegative bacteria.

A related species, C. anisata (Willd.) Oliver, is reported from Uttar Pradesh. Ethanolic extract of the aerial parts exhibited spasmolytic activity. The fu- ranocoumarins, anisolactone, xantho- toxol, indicolactone, imperatorin and 2', 3'-epoxy-anisolactone have been isolated from the extract.

In West African traditional medicine, the decoction of the root is given to control convulsions in children. The anticonvulsant agent has been found to be heliettin, extracted from the stem bark and roots.... clausena pentaphylla

(Fr.) Tul.

Family: Hypocreaceae.

Habitat: A fungous parasite on a number of grasses particularly in rye, cultivated in the Nilgiris and at Chakrohi farm in Jammu.

English: Ergot of Rye. Fungus of Rye.

Ayurvedic: Annamaya, Sraavikaa.

Unani: Argot.

Siddha/Tamil: Ergot.

Action: Uterine stimulant. Oxy- tocic, abortifacient, parturient, vasoconstrictor, haemostatic. Used in obstetrics (difficult childbirth, for exciting uterine contractions in the final stages of parturition). Also used after abortion for removal of the placenta. It is no more employed in internal haemorrhages, as it has been found to raise blood pressure in pulmonary and cerebral haemorrhage. Included among unapproved herbs by German Commission E.

The fungus gave indole alkaloids. The ergometrine or ergonovine group includes ergometrine and ergometri- nine. The ergotamine group includes ergotamine and ergotaminine. The er- gotoxine group includes ergocristine, ergocristinine, ergocryptine, ergo- cryptinine, ergocornine and ergo- corninine. The fungus also contains histamine, tyramine and other amines, sterols and acetylcholine.

The alkaloids of ergot are being used independently (not as a herbal medicine). Ergotamine is used to relieve migrainous headaches as it is a vasoconstrictor and has antisero- tonin activity. Ergometrine is used after childbirth in the third stage of labour and for post-partum haemorrhage, as it is a powerful uterine stimulant, particularly of the puerperal uterus. (Both the constituents are used under medical supervision). Er- gocornine significantly inhibited the development of induced mammary tumours in rats. The derivatives of ergot alkaloids are known to have suppressing effect on human breast cancer in initial stages. This activity is linked to prolactin inhibitory action.

The extract is toxic at 1.0-3.9 g, ergot alkaloids at 1 g in adults, 12 mg in infants. (Francis Brinker).

Dosage: Whole plant—10-30 ml infusion. (CCRAS.)... claviceps purpurea

Linn.

Family: Euphorbiaceae.

Habitat: Western Himalayas from Garhwal, westwards to Kashmir.

Ayurvedic: Saatala, Saptalaa. (Substitute).

Action: Purgative, emetic. Root— used in fistulous sores.

Prostratin, isolated from the roots of var. cornigeria Hook. f., was found to be pro-inflammatory.... euphorbia pilosa

An opening of the excretory system, normally situated on the ventral side at the anterior part of the body (e.g. in trematode miracidia).... excretory pore

Linn.f.

Synonym: C. multiflorum (Burm. f.) O. Kuntze.

Family: Verbenaceae.

Habitat: Throughout India, in the drier parts.

Ayurvedic: Agnimantha, Tarkaari, Vikraantaa, Jayanti, Jai, Jayaa, Ganikaarikaa, Vaijayanti, Bigger var. is equated with Premna integri- folia Linn., Shriparni, Naadeyi.

Siddha/Tamil: Tazhuthaazhai.

Folk: Laghu Arni.

Action: Plant parts used in dyspepsia, stomachache, colic, cholera, dysentery, postnatal fever, during convalscence from measles. Root and bark—bitter tonic, used in debility and nervous disorders.

The Ayurvedic Pharmacopoeia of India indicated the use of root in dysuria and retention of urine.

Flavonoids, scutellarein and pec- tolinarin, have been isolated from the leaves. Stems gave d-mannitol, beta- sitosterol, its glucosides and ceryl alcohol. The roots contain ceryl alcohol, clerodin, clerosterol and clerodendrin A.

The ethanolic extract of leaves exhibited hepatoprotective activity. The aqueous extract of leaves exhibited in vitro anthelmintic activity. The plant also exhibited antidiabetic activity.

Dosage: Root—12-24 g for decoction. (API Vol. III.)... clerodendrum phlomidis

Psychology is the scienti?c study of behaviour. It may be applied in various settings including education, industry and health care. Clinical psychology is concerned with the practical application of research ?ndings in the ?elds of physical and mental health. Training in clinical psychology involves a degree in psychology followed by postgraduate training. Clinical psychologists are speci?cally skilled in applying theoretical models and objective methods of observation and measurement, and in therapeutic interventions aimed at changing patients’ dysfunctional behaviour, including thoughts and feelings as well as actions. Dysfunctional behaviour is explained in terms of normal processes and modi?ed by applying principles of normal learning, adaption and social interaction.

Clinical psychologists are involved in health care in the following ways: (1) Assessment of thoughts, emotions and behaviour using standardised methods. (2) Treatment based on theoretical models and scienti?c evidence about behaviour change. Behaviour change is considered when it contributes to physical, psychological or social functioning. (3) Consultation with other health-care professionals about problems concerning emotions, thinking and behaviour. (4) Research on a wide variety of topics including the relationship between stress, psychological functioning and disease; the aetiology of problem behaviours; methods and theories of behaviour change. (5) Teaching other professionals about normal and dysfunctional behaviour, emotions and functioning.

Clinical psychologists may specialise in work in particular branches of patient care, including surgery, psychiatry, geriatrics, paediatrics, mental handicap, obstetrics and gynaecology, cardiology, neurology, general practice and physical rehabilitation. Whilst the focus of their work is frequently the patient, at times it may encompass the behaviour of the health-care professionals.... clinical psychology

The time or times during which the infectious agent may be transferred directly or indirectlyfrom an infected person to another person, from an infected animal to human, or from an infected human to an animal, including arthropods. In diseases such as diphtheria and scarlet fever, in which mucous membranes are involved from the first entry of the pathogen, the period of communicability is from the date of first exposure to a source of infection until the infective microorganism is no longer disseminated from the involved mucous membranes, ie, from the period before the prodromata until termination of a carrier stage, if this develops. Most diseases are not communicable during the earlyincubation period or after full recovery. In diseases transmitted by arthropods, such as malaria and yellow fever, the periods of communicability are those during which the infectious agent occurs in infective form in the blood or other tissues of the infected person in sufficient numbers to permit vector infections. A period of communicability is also to be distinguished for the arthropod vector - namely, that time during which the agent is present in the tissues of the arthropod in such form and locus (infective stage) as to be transmissible.... communicable period

An alleged way of perceiving current events (clairvoyance), future events (precognition) or the thoughts of other people (telepathy). ESP has never been scienti?cally proven and does not involve the use of any known senses.... extrasensory perception (esp)

See ECTOPIC PREGNANCY.... extrauterine pregnancy

A form of specialty practice in which medical practitioners provide continuing comprehensive primary care within the context of the family unit.... family practice

Organization or company in which profits are distributed to shareholders or private owners.... for profit

An older person in need of a substantial level of care and support.... frail older person

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

The Royal College of General Practitioners has issued guidelines on the use of computer-generated prescriptions for drugs other than controlled drugs. The guidelines include rules on giving the patient’s name, address and date of birth with the responsible prescribing doctor’s name at the bottom, along with his or her surgery address and telephone number. The prescription has to be signed by the doctor. Several other requirements are included to minimise the risk of prescription-tampering, fraud or the inclusion of identi?able con?dential information. Full details of the guidelines appear in the British National Formulary, published every six months.... computer-generated prescriptions

Choisy.

Synonym: C. Microphyllus Sieb. C. Prostratus Forsk

Family: Convolvulaceae.

Habitat: Throughout India, Ascending To 2,000 M In The Himalayas.

Ayurvedic: Shankhapushpi, Shankhaahvaa, Kshirapushpi, Maangalya Kusuma (White- Flowered). Blue-Flowered Var., Vishnukraanti, Vishnukraantaa, Vishnugandhi Is Equated With Evolvulus Alsinoides Linn.

Unani: Sankhaahuli (Blue-Flowered)

Siddha/Tamil: Sivakraandi (White- Flowered), Vishnukraandi (Blue- Flowered).

Action: Plant—Brain Tonic, Tranquilizer Used In Nervine Disorders, Mental Aberration, Anxiety Neurosis, Internal Haemorrhages, Spermatorrhoea. Also Astringent, Antidysenteric, Antispasmodic, Antiphlogistic, Febrifuge, Alterative. Flowers—Styptic, Used For Uterine Bleeding. Leaf—Antiasthmatic, Used In Chronic Bronchitis. Root— Used In Gastric And Duodenal Ulcers, Uterine Affections And For Promoting Fertility.

The Ayurvedic Pharmacopoeia Of India Recommends The Plant For Epilepsy. The Plant Contains Sankhpushpine Alkaloids.

The Alcoholic (50%) Extract Of The Plant, When Administered To Rats (Through Gastric Intubation At Different Intervals), Has Shown Enhanced Neuropeptide Synthesis Of The Brain. It Induces An Increase In Brain Protein Content And Increases Acquisition Efficiency.

Evolvulus Alsinoides Contains Pen- Tatriacontane, Triacontane And Beta- Sitosterol.

Shankhapushpi Syrup (A Compound Containing C. Pluricaulis, Centella Asiatica, Nardostachys Jatamansi, Nepeta Hindostana, Nepeta Elliptica And Onos- Ma Bracteatum), When Administered With Phenytoin, A Modern Antiepilep- Tic Drug, Reduced Not Only Antiepileptic Activity Of Phenytoin But Also Lowered Plasma Phenytoin Levels.

Dosage: Whole Plant—3-6 G Powder. (Api Vol. III.)... convolvulus pluricaulis

Linn.

Synonym: C. myriocarpus Naud.

Family: Cucurbitaceae.

Habitat: Wild on wastelands of Sindh, Baluchistan, Rajasthan; in dry districts of Bellary in the South.

English: Wild Cucumber.

Ayurvedic: Indravarruni (var.).

Folk: Khar-indraayana.

Action: Emetic, purgative. Toxic.

Fruit pulp—a bitter resinous body, myriocarpin, produces nausea and is slightly purgative.

The fruit contain cucurbitacin B,C,D and Q1, and propheterosterol and its acetate. Cucurbitacin Q1 is an anti- tumour agent. Amino acids from the fruits are leucine, iso-leucine, pheny- lalanine, valine, tryptophan, tyrosine, proline, alanine threonine, glycine, arginine, crystine and aspartic acid.... cucumis prophetarum

Linn.

Family: Cucurbitaceae.

Habitat: Native to N. Mexico and eastern U.S.A. Now commonly cultivated in Northern India.

English: Pumpkin, Marrow.

Unani: Safed Kaddu, Kumhraa.

Siddha: Suraikayi (Tamil).

Action: See C. maxima.

Key application: Seeds—in irritated bladder condition, micturition problems of benign prostatic hyperplasia stages 1 and 2. (German Commission E, The British Herbal Pharmacopoeia.) In childhood enuresis noctruna. (Expanded Commission E.)

The roasted and fresh seeds yield 32.2 and 38.0% of fatty oil respectively. The oil filled capsules were administered to patients suffering from hypertrophy of the prostate. Results showed that the frequent urge to urinate decreased and the urine residues were minimized.

The oil consists of the glycerides of linoleic 45, oleic 25, palmitic and stearic acids 30%. Sterols have been isolated.... cucurbita pepo

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

Guidelines for doctors on the provision of good medical care laid down by the GENERAL MEDICAL COUNCIL (GMC).... good medical practice

A period past the due date of an insurance premium, during which coverage may not be cancelled.... grace period

Lust, Luck, Love, Money, Wishes ... grains of paradise

Cyanide inhibits cellular RESPIRATION by binding rapidly and reversibly with the ENZYME, cytochrome oxidase. E?ects of poisoning are due to tissue HYPOXIA. Cyanide is toxic by inhalation, ingestion and prolonged skin contact, and acts extremely quickly once absorbed. Following inhalation of hydrogen cyanide gas, death can occur within minutes. Ingestion of inorganic cyanide salts may produce symptoms within 10 minutes, again proceeding rapidly to death. On a full stomach, effects may be delayed for an hour or more. Signs of cyanide poisoning are headache, dizziness, vomiting, weakness, ATAXIA, HYPERVENTILATION, DYSPNOEA, HYPOTENSION and collapse. Loss of vision and hearing may occur, then COMA and CONVULSIONS. Other features include cardiac ARRHYTHMIA and PULMONARY OEDEMA. Patients may have a lactic ACIDOSIS. Their arterial oxygen tension is likely to be normal, but their venous oxygen tension high and similar to that of arterial blood.

Treatment Administration of oxygen when available is the most important ?rst-aid management. Rescuers should be trained, must not put themselves at risk, and should use protective clothing and breathing apparatus. In unconscious victims, establish a clear airway and give 100 per cent oxygen. If breathing stops and oxygen is unavailable, initiate expired-air resuscitation. If cyanide salts were ingested, mouth-to-mouth contact must be avoided and a mask with a one-way valve employed instead. Some commercially available ?rst-aid kits contain AMYL NITRATE as an antidote which may be employed if oxygen is unavailable.

Once in hospital, or if a trained physician is on the scene, then antidotes may be administered. There are several di?erent intravenous antidotes that may be used either alone or in combination. In mild to moderate cases, sodium thiosulphate is usually given. In more severe cases either dicobalt edetate or sodium nitrite may be used, followed by sodium thio-sulphate. Some of these (e.g. dicobalt edetate) should be given only where diagnosis is certain, otherwise serious adverse reations or toxicity due to the antidotes may occur.... cyanide poisoning

This legislation puts into e?ect the UK European Directive 95/46/EC on the processing of personal data, whether paper or computer records. The Act is based on eight principles, the ?rst of which stipulates that ‘personal data shall be processed fairly and lawfully’. Unfortunately this phrase is open to di?erent interpretations. Clari?cation is required to determine how the common-law duty of con?dentiality affects the health services in the context of using data obtained from patients for research work, especially epidemiological studies (see EPIDEMIOLOGY). Health authorities, trusts and primary care groups in the NHS have appointed ‘Caldicott guardians’ – named after a review of information that identi?es patients. A prime responsibility of the guardians is to agree and review internal protocols for the protection and use of identi?able information obtained from patients. The uncertainties over the interpretation of the legislation require clari?cation, but some experts have suggested a workable solution: to protect patients’ rights, researchers should ensure that data are fully anonymised whenever possible; they should also agree their project design with those responsible for data protection well in advance of its planned starting date. (See ETHICS.)... data protection act 1998

Phoenix dactylifera

Description: The date palm is a tall, unbranched tree with a crown of huge, compound leaves. Its fruit is yellow when ripe.

Habitat and Distribution: This tree grows in arid semitropical regions. It is native to North Africa and the Middle East but has been planted in the arid semitropics in other parts of the world.

Edible Parts: Its fruit is edible fresh but is very bitter if eaten before it is ripe. You can dry the fruits in the sun and preserve them for a long time.

Other Uses: The trunks provide valuable building material in desert regions where few other treelike plants are found. The leaves are durable and you can use them for thatching and as weaving material. The base of the leaves resembles coarse cloth that you can use for scrubbing and cleaning.... date palm

R.Br.

Synonym: D. macrophylla auct. non-Wall. ex D. Don.

Family: Gesneriaceae.

Habitat: Sub-tropical Himalaya from Himachal Pradesh to Aruna- chal Pradesh at 500-2,500 m.

Ayurvedic: Kshudra-Paashaana- bheda, Shilaa-valkaa, Shilaa- pushpa.

Action: Leaf—antilithic. Used for stones in kidney and bladder.

The leaves contain a number of chal- cones, quinochalcones and flavanones. Pediflavone has also been isolated from young leaves.... didymocarpus pedicellata

A general rule that can be used as a guide, for example, to develop and implement policies, to set up a managerial process or to organize primary health care in communities.... guiding principle

All persons employed or contracted to provide health services.... health personnel

Planning for the improvement of the health of a population or community, for a particular population, type of health service, institution or health programme.... health planning

A formal statement or procedure within an institution (notably government) which defines goals, priorities and the parameters for action in response to health needs, within the context of available resources.... health policy

An organized series of activities directed towards the attainment of defined health objectives and targets.... health programme

Linn.

Family: Scrophulariaceae.

Habitat: Native to West Europe. Cultivated in Tangmarg and Kishtawar in Kashmir, Darjeeling and the Nilgiris.

English: Digitalis, Foxglove.

Ayurvedic: Hritpatri, Tilapushpi (non-classical). (Purple var.)

Action: Main source of digoxin for the pharmaceutical industry. Digitalis glycosides increase the force of contraction of heart without increasing the oxygen consumption and slow the heart rate when auricular fibrillation is present. To be used only under strict medical supervision.

Not used as a herbal drug.... digitalis purpurea

Linn.

Synonym: D. triphylla var. doemona Prain & Burkill.

Family: Dioscoreaceae.

Habitat: Native to tropical Asia; distributed throughout India.

Ayurvedic: Vaaraahikanda (var., dry pieces are sold as Vidaarikanda).

Folk: Kaantaalu.

Action: Tubers contain 71.0780.77% carbohydrates, 8.68-15.93% albuminoids. Tubers are used to disperse swellings.... dioscorea pentaphylla

Prain & Burkill.

Synonym: D. Clarkei Prain & Burkill D. deltoidea Wall. var. sikkimensis Prain

Family: Dioscoreaceae.

Habitat: The Himalaya from Nepal to Bhutan, up to 1,500 m, also in Naga Hills.

Ayurvedic: Neelaalu.

Action: Tuber—antiphthiriac.

The rhizomes are used as a hair wash for killing lice. They contain diogenin (on dry basis) 2.5%. Also obtained are steroidal sapogenins, sito- sterol glucoside, prazerigenin-A gluco- side, prazerigenin-A bioside and 9,10- dihydrophenanthrenes.... dioscorea prazeri