The SYNOVITIS usually starts acutely and is frequently asymmetrical, with the knees and ankles most commonly affected. Often there are in?ammatory lesions of tendon sheaths and entheses (bone and muscle functions) such as plantar fasciitis (see FASCIITIS). The severity and duration of the acute episode are extremely variable. Individuals with the histocompatibility antigen HLA B27 are particularly prone to severe attacks.... reactive arthritis

(2) A small, discrete area on the cell membrane or within the cell with which molecules or molecular complexes (e.g. hormones, drugs, and other chemical messengers) interact. When this interaction takes place it initiates a change in the working of the cell.... receptor

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

The term is also applied to the return to the mouth of food already swallowed and present in the gullet or stomach (see also REFLUX).... regurgitation

Louse-borne relapsing fever is an EPIDEMIC disease, usually associated with wars and famines, which has occurred in practically every country in the world. For long confused with TYPHUS FEVER and typhoid fever (see ENTERIC FEVER), it was not until the 1870s that the causal organism was described by Obermeier. It is now known as the Borrelia recurrentis, a motile spiral organism 10–20 micrometres in length. The organism is transmitted from person to person by the louse, Pediculus humanus.

Symptoms The incubation period is up to 12 days (but usually seven). The onset is sudden, with high temperature, generalised aches and pains, and nose-bleeding. In about half of cases, a rash appears at an early stage, beginning in the neck and spreading down over the trunk and arms. JAUNDICE may occur; and both the LIVER and the SPLEEN are enlarged. The temperature subsides after ?ve or six days, to rise again in about a week. There may be up to four such relapses (see the introductory paragraph above).

Treatment Preventive measures are the same as those for typhus. Rest in bed is essential, as are good nursing and a light, nourishing diet. There is usually a quick response to PENICILLIN; the TETRACYCLINES and CHLORAMPHENICOL are also e?ective. Following such treatment the incidence of relapse is about 15 per cent. The mortality rate is low, except in a starved population.

Tick-borne relapsing fever is an ENDEMIC disease which occurs in most tropical and sub-tropical countries. The causative organism is Borrelia duttoni, which is transmitted by a tick, Ornithodorus moubata. David Livingstone suggested that it was a tick-borne disease, but it was not until 1905 that Dutton and Todd produced the de?nitive evidence.

Symptoms The main di?erences from the louse-borne disease are: (a) the incubation period is usually shorter, 3–6 days (but may be as short as two days or as long as 12); (b) the febrile period is usually shorter, and the afebrile periods are more variable in duration, sometimes only lasting for a day or two; (c) relapses are much more numerous.

Treatment Preventive measures are more di?cult to carry out than in the case of the louse-borne infection. Protective clothing should always be worn in ‘tick country’, and old, heavily infected houses should be destroyed. Curative treatment is the same as for the louse-borne infection.... relapsing fever

Mechanism of respiration For the structure of the respiratory apparatus, see AIR PASSAGES; CHEST; LUNGS. The air passes rhythmically into and out of the air passages, and mixes with the air already in the lungs, these two movements being known as inspiration and expiration. INSPIRATION is due to a muscular e?ort which enlarges the chest, so that the lungs have to expand in order to ?ll up the vacuum that would otherwise be left, the air entering these organs by the air passages. The increase of the chest in size from above downwards is mainly due to the diaphragm, the muscular ?bres of which contract and reduce its domed shape and cause it to descend, pushing down the abdominal organs beneath it. EXPIRATION is an elastic recoil, the diaphragm rising and the ribs sinking into the position that they naturally occupy, when muscular contraction is ?nished. Occasionally, forced expiration may occur, involving powerful muscles of the abdomen and thorax; this is typically seen in forcible coughing.

Nervous control Respiration is usually either an automatic or a REFLEX ACTION, each expiration sending up sensory impulses to the CENTRAL NERVOUS SYSTEM, from which impulses are sent down various other nerves to the muscles that produce inspiration. Several centres govern the rate and force of the breathing, although all are presided over by a chief respiratory centre in the medulla oblongata (see under BRAIN – Divisions). This in turn is controlled by the higher centres in the cerebral hemispheres, so that breathing can be voluntarily stopped or quickened.

Quantity of air The lungs do not completely empty themselves at each expiration and re?ll at each inspiration. With each breath, less than one-tenth of the total air in the lungs passes out and is replaced by the same quantity of fresh air, which mixes with the stale air in the lungs. This renewal, which in quiet breathing amounts to about 500 millilitres, is known as the tidal air. By a special inspiratory e?ort, an individual can draw in about 3,000 millilitres, this amount being known as complemental air. By a special expiratory e?ort, too, after an ordinary breath one can expel much more than the tidal air from the lungs – this extra amount being known as the supplemental or reserve air, and amounting to about 1,300 millilitres. If an individual takes as deep an inspiration as possible and then makes a forced expiration, the amount expired is known as the vital capacity, and amounts to around 4,000 millilitres in a healthy adult male of average size. Figures for women are about 25 per cent lower. The vital capacity varies with size, sex, age and ethnic origin.

Over and above the vital capacity, the lungs contain air which cannot be expelled; this is known as residual air, and amounts to another 1,500 millilitres.

Tests of respiratory e?ciency are used to assess lung function in health and disease. Pulmonary-function tests, as they are known, include spirometry (see SPIROMETER), PEAK FLOW METER (which measures the rate at which a person can expel air from the lungs, thus testing vital capacity and the extent of BRONCHOSPASM), and measurements of the concentration of oxygen and carbon dioxide in the blood. (See also LUNG VOLUMES.)

Abnormal forms of respiration Apart from mere changes in rate and force, respiration is modi?ed in several ways, either involuntarily or voluntarily. SNORING, or stertorous breathing, is due to a ?accid state of the soft palate causing it to vibrate as the air passes into the throat, or simply to sleeping with the mouth open, which has a similar e?ect. COUGH is a series of violent expirations, at each of which the larynx is suddenly opened after the pressure of air in the lungs has risen considerably; its object is to expel some irritating substance from the air passages. SNEEZING is a single sudden expiration, which di?ers from coughing in that the sudden rush of air is directed by the soft palate up into the nose in order to expel some source of irritation from this narrow passage. CHEYNE-STOKES BREATHING is a type of breathing found in persons suffering from stroke, heart disease, and some other conditions, in which death is impending; it consists in an alternate dying away and gradual strengthening of the inspirations. Other disorders of breathing are found in CROUP and in ASTHMA.... respiration

A. (See APPENDIX 5: VITAMINS.)... retinol

Retroviruses are also used in the development of gene therapy (see GENETIC ENGINEERING).... retrovirus

Rheumatic fever is now extremely uncommon in developed countries, but remains common in developing areas. Diagnosis is based on the presence of two or more major manifestations – endocarditis (see under HEART, DISEASES OF), POLYARTHRITIS, chorea, ERYTHEMA marginatum, subcutaneous nodules – or one major and two or more minor ones – fever, arthralgia, previous attacks, raised ESR, raised white blood cell count, and ELECTROCARDIOGRAM (ECG) changes. Evidence of previous infection with streptococcus is also a criterion.

Clinical features Fever is high, with attacks of shivering or rigor. Joint pain and swelling (arthralgia) may affect the knee, ankle, wrist or shoulder and may migrate from one joint to another. TACHYCARDIA may indicate cardiac involvement. Subcutaneous nodules may occur, particularly over the back of the wrist or over the elbow or knee. Erythema marginatum is a red rash, looking like the outline of a map, characteristic of the condition.

Cardiac involvement includes PERICARDITIS, ENDOCARDITIS, and MYOCARDITIS. The main long-term complication is damage to the mitral and aortic valves (see HEART).

The chief neurological problem is chorea (St Vitus’s dance) which may develop after the acute symptoms have subsided.

Chronic rheumatic heart disease occurs subsequently in at least half of those who have had rheumatic fever with carditis. The heart valve usually involved is the mitral; less commonly the aortic, tricuspid and pulmonary. The lesions may take 10–20 years to develop in developed countries but sooner elsewhere. The heart valves progressively ?brose and ?brosis may also develop in the myocardium and pericardium. The outcome is either mitral stenosis or mitral regurgitation and the subsequent malfunction of this or other heart valves affected is chronic failure in the functioning of the heart. (see HEART, DISEASES OF).

Treatment Eradication of streptococcal infection is essential. Other features are treated symptomatically. PARACETAMOL may be preferred to ASPIRIN as an antipyretic in young children. One of the NON-STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS) may bene?t the joint symptoms. CORTICOSTEROIDS may be indicated for more serious complications.

Patients who have developed cardiac-valve abnormalities require antibiotic prophylaxis during dental treatment and other procedures where bacteria may enter the bloodstream. Secondary cardiac problems may occur several decades later and require replacement of affected heart valves.... rheumatic fever

Causes There is a major immunogenetic predisposition to rheumatoid arthritis in people carrying the HLA-DR4 antigen (see HLA SYSTEM). Other minor immunogenetic factors have also been implicated. In addition, there is a degree of familial clustering which suggests other unidenti?ed genetic factors. Genetic factors cannot alone explain aetiology, and environmental and chance factors must be important, but these have yet to be identi?ed.

Epidemiology Rheumatoid arthritis more commonly occurs in women from the age of 30 onwards, the sex ratio being approximately 4:1. Typical rheumatoid arthritis may occur in adolescence, but in childhood chronic SYNOVITIS usually takes one of a number of di?erent patterns, classi?ed under juvenile chronic arthritis.

Pathology The primary lesion is an in?ammation of the synovial membrane of joints. The synovial ?uid becomes diluted with in?ammatory exudate: if this persists for months it leads to progressive destruction of articular CARTILAGE and BONE. Cartilage is replaced by in?ammatory tissue known as pannus; a similar tissue invades bone to form erosions. Synovitis also affects tendon sheaths, and may lead to adhesion ?brosis or attrition and rupture of tendons. Subcutaneous and other bursae may be involved. Necrobiotic nodules also occur at sites outside synovium, including the subcutaneous tissues, the lungs, the pericardium and the pleura.

Clinical features Rheumatoid arthritis varies from the very mild to the severely disabling. Many mild cases probably go undiagnosed. At least 50 per cent of patients continue to lead a reasonably normal life; around 25 per cent are signi?cantly disabled in terms of work and leisure activities; and a minority become markedly disabled and are limited in their independence. There is often an early acute phase, followed by substantial remission, but in other patients gradual step-wise deterioration may occur, with progressive involvement of an increasing number of joints.

The diagnosis of rheumatoid arthritis is largely based on clinical symptoms and signs. Approximately 70 per cent of patients have rheumatoid factor ANTIBODIES in the SERUM but, because of the large number of false positives and false negatives, this test has very little value in clinical practice. It may be a useful pointer to a worse prognosis in early cases if the level is high. X-RAYS may help in diagnosing early cases and are particularly helpful when considering surgery or possible complications such as pathological fracture. Patients commonly develop ANAEMIA, which may be partly due to gastrointestinal blood loss from antiin?ammatory drug treatment (see below).

Treatment involves physical, pharmacological, and surgical measures, together with psychological and social support tailored to the individual patient’s needs. Regular activity should be maintained. Resting of certain joints such as the wrist with splints may be helpful at night or to assist prolonged manual activities. Sound footwear is important. Early use of antirheumatic drugs reduces long-term disability. Drug treatment includes simple ANALGESICS, NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS), and slow-acting drugs including GOLD SALTS (in the form of SODIUM AUROTHIOMALATE), PENICILLAMINE, SULFASALAZINE, METHOTREXATE and AZATHIOPRINE.

The non-steroidal agents are largely e?ective in reducing pain and early-morning sti?ness, and have no e?ect on the chronic in?ammatory process. It is important, especially in the elderly, to explain to patients the adverse effects of NSAIDs, the dosage of which can be cut by prescribing paracetamol at the same time. Combinations of anti-rheumatic drugs seem better than single agents. The slow-acting drugs take approximately three months to act but have a more global e?ect on chronic in?ammation, with a greater reduction in swelling and an associated fall in erythrocyte sedimentation rate (ESR) and rise in the level of HAEMOGLOBIN. Local CORTICOSTEROIDS are useful, given into individual joints. Systemic corticosteroids carry serious problems if continued long term, but may be useful under special circumstances. Much research is currently going on into the use of tumour necrosis factor antagonists such as INFLIXIMAB and etanercept, but their precise role remains uncertain.... rheumatoid arthritis

Ribavarin, along with INTERFERON alpha-2b, is given orally to treat patients with chronic HEPATITIS C infection. It is also used to treat LASSA FEVER.... ribavirin

Treatment Long-term, low-dose, oral tetracycline (see ANTIBIOTICS; TETRACYCLINES) is the treatment of choice. In mild cases, METRONIDAZOLE gel can be helpful. Potent topical CORTICOSTEROIDS are contraindicated and make rosacea worse.... rosacea

Cause A virus spread by close contact with infected individuals. Rubella is infectious for a week before the rash appears and at least four days afterwards. It occurs in epidemics (see EPIDEMIC) every three years or so, predominantly in the winter and spring. Children are more likely to be affected than infants. One attack gives permanent IMMUNITY. The incubation period is usually 14–21 days.

Symptoms are very mild, and the disease is not at all serious. On the day of onset there may be shivering, headache, slight CATARRH with sneezing, coughing and sore throat, with very slight fever – not above 37·8 °C (100 °F). At the same time the glands of the neck become enlarged. Within 24 hours of the onset a pink, slightly raised eruption appears, ?rst on the face or neck, then on the chest, and the second day spreads all over the body. The clinical signs and symptoms of many other viral infections are indistinguishable from rubella so a precise diagnosis cannot be made without taking samples (such as saliva) for antibody testing, but this is rarely done in practice.

An attack of German measles during the early months of pregnancy may be responsible for CONGENITAL defects in the FETUS (for information on fetal abnormalities, see under PREGNANCY AND LABOUR). The incidence of such defects is not precisely known, but probably around 20 per cent of children whose mothers have had German measles in the ?rst three months of the pregnancy are born with congenital defects. These defects take a variety of forms, but the most important ones are: low birth weight with retarded physical development; malformations of the HEART; cataract (see under EYE, DISORDERS OF); and DEAFNESS.

Treatment There is no speci?c treatment. Children who develop the disease should not return to school until they have recovered, and in any case not before four days have passed from the onset of the rash.

In view of the possible dangerous e?ect of the disease upon the fetus, particular care should be taken to isolate pregnant mothers from contact with infected subjects. As the risk is particularly high during the ?rst 16 weeks of pregnancy, any pregnant mother exposed to infection during this period should be given an intramuscular injection of GAMMA-GLOBULIN. A vaccine is available to protect an individual against rubella (see IMMUNISATION).

In the United Kingdom it is NHS policy for all children to have the combined measles, mumps and rubella vaccine (see MMR VACCINE), subject to parental consent. All women of childbearing age, who have been shown by a simple laboratory test not to have had the disease, should be vaccinated, provided that the woman is not pregnant at the time and has not been exposed to the risk of pregnancy during the previous eight weeks.... rubella

The rays are part of the electro-magnetic spectrum; their wavelengths are between 10?9 and 10? 13 metres; in behaviour and energy they are identical to the gamma rays emitted by radioactive isotopes. Diagnostic X-rays are generated in an evacuated tube containing an anode and cathode. Electrons striking the anode cause emission of X-rays of varying energy; the energy is largely dependent on the potential di?erence (kilovoltage) between anode and cathode. The altered tissue penetration at di?erent kilovoltages is used in radiographing di?erent regions, for example in breast radiography (25–40 kV) or chest radiography (120–150 kV). Most diagnostic examinations use kilovoltages between 60 and 120. The energy of X-rays enables them to pass through body tissues unless they make contact with the constituent atoms. Tissue attenuation varies with atomic structure, so that air-containing organs such as the lung o?er little attenuation, while material such as bone, with abundant calcium, will absorb the majority of incident X-rays. This results in an emerging X-ray pattern which corresponds to the structures in the region examined.

Radiography The recording of the resulting images is achieved in several ways, mostly depending on the use of materials which ?uoresce in response to X-rays. CONTRAST X-RAYS Many body organs are not shown by simple X-ray studies. This led to the development of contrast materials which make particular organs or structures wholly or partly opaque to X-rays. Thus, barium-sulphate preparations are largely used for examining the gastrointestinal tract: for example, barium swallow, barium meal, barium follow-through (or enteroclysis) and barium enema. Water-soluble iodine-containing contrast agents that ionise in solution have been developed for a range of other studies.

More recently a series of improved contrast molecules, chie?y non-ionising, has been developed, with fewer side-effects. They can, for example, safely be introduced into the spinal theca for myeloradiculography – contrast X-rays of the spinal cord. Using these agents, it is possible to show many organs and structures mostly by direct introduction, for example via a catheter (see CATHETERS). In urography, however, contrast medium injected intravenously is excreted by the kidneys which are outlined, together with ureters and bladder. A number of other more specialised contrast agents exist: for example, for cholecystography – radiological assessment of the gall-bladder. The use of contrast and the attendant techniques has greatly widened the range of radiology. IMAGE INTENSIFICATION The relative insensitivity of ?uorescent materials when used for observation of moving organs – for example, the oesophagus – has been overcome by the use of image intensi?cation. A faint ?uorographic image produced by X-rays leads to electron emission from a photo-cathode. By applying a high potential di?erence, the electrons are accelerated across an evacuated tube and are focused on to a small ?uorescent screen, giving a bright image. This is viewed by a TV camera and the image shown on a monitor and sometimes recorded on videotape or cine. TOMOGRAPHY X-ray images are two-dimensional representations of three-dimensional objects. Tomography (Greek tomos

– a slice) began with X-ray imaging produced by the linked movement of the X-ray tube and the cassette pivoting about a selected plane in the body: over- and underlying structures are blurred out, giving a more detailed image of a particular plane.

In 1975 Godfrey Houns?eld introduced COMPUTED TOMOGRAPHY (CT). This involves

(i) movement of an X-ray tube around the patient, with a narrow fan beam of X-rays; (ii) the corresponding use of sensitive detectors on the opposite side of the patient; (iii) computer analysis of the detector readings at each point on the rotation, with calculation of relative tissue attenuation at each point in the cross-sectional plant. This invention has enormously increased the ability to discriminate tissue composition, even without the use of contrast.

The tomographic e?ect – imaging of a particular plane – is achieved in many of the newer forms of imaging: ULTRASOUND, magnetic resonance imaging (see MRI) and some forms of nuclear medicine, in particular positron emission tomography (PET SCANNING). An alternative term for the production of images of a given plane is cross-sectional imaging.

While the production of X-ray and other images has been largely the responsibility of radiographers, the interpretation has been principally carried out by specialist doctors called radiologists. In addition they, and interested clinicians, have developed a number of procedures, such as arteriography (see ANGIOGRAPHY), which involve manipulative access for imaging – for example, selective coronary or renal arteriography.

The use of X-rays, ultrasound or computerised tomography to control the direction and position of needles has made possible guided biopsies (see BIOPSY) – for example, of pancreatic, pulmonary or bony lesions – and therapeutic procedures such as drainage of obstructed kidneys (percutaneous nephrostomy), or of abscesses. From these has grown a whole series of therapeutic procedures such as ANGIOPLASTY, STENT insertion and renal-stone track formation. This ?eld of interventional radiology has close a?nities with MINIMALLY INVASIVE SURGERY (MIS).

Radiotherapy, or treatment by X-rays The two chief sources of the ionising radiations used in radiotherapy are the gamma rays of RADIUM and the penetrating X-rays generated by apparatus working at various voltages. For super?cial lesions, energies of around 40 kilovolts are used; but for deep-seated conditions, such as cancer of the internal organs, much higher voltages are required. X-ray machines are now in use which work at two million volts. Even higher voltages are now available through the development of the linear accelerator, which makes use of the frequency magnetron which is the basis of radar. The linear accelerator receives its name from the fact that it accelerates a beam of electrons down a straight tube, 3 metres in length, and in this process a voltage of eight million is attained. The use of these very high voltages has led to the development of a highly specialised technique which has been devised for the treatment of cancer and like diseases.

Protective measures are routinely taken to ensure that the patient’s normal tissue is not damaged during radiotherapy. The operators too have to take special precautions, including limits on the time they can work with the equipment in any one period of time.

The greatest value of radiotherapy is in the treatment of malignant disease. In many patients it can be used for the treatment of malignant growths which are not accessible to surgery, whilst in others it is used in conjunction with surgery and chemotherapy.... x-rays

A lack of oestrogen induces hot flushes, night sweats, thinning of the bones (osteoporosis) with possible fractures, and a wide range of physical and emotional disorders.

HRT also prevents the increased frequency of coronary disease which may follow the menopause. With oestrogen only, HRT appears to increase the incidence of cancer of the uterine body. Use of oestrogen and progestogen avoids this.

HRT is available as a tablet, transdermal patch, implant or topical cream. Most women notice temporary improvement in their appearance and hot flushes as long as treatment is continued. HRT is not prescribed by the herbal practitioner. Soya and Hops are a mild alternative.

Side-effects of such treatment include blood pressure rise, weight gain and periods probably continue with a monthly bleed. Elderly women taking HRT for osteoporosis may develop bleeding problems, the risk of blood clot and gall bladder diseases.

Helonias has proved a useful alternative, effective in eliminating excess fluids, reducing hot flushes, and relieving that bloated feeling, thus helping the older woman to live a normal life.

Damiana. 1 heaped teaspoon leaves to each cup boiling water; infuse 5-10 minutes; strain. 1 cup 2-3 times daily for 3-6 weeks.

Sarsaparilla. 1oz (30g) root in 1 pint (500ml) water; simmer gently 20 minutes; strain. 1 cup 2-3 times daily for 3-6 weeks.

Supplementation. Daily. Vitamin E, 400iu. Vitamin B-complex (high potency). Evening Primrose oil capsules, 500mg morning and evening. Dolomite, for Calcium and Magnesium, 2 tablets morning and evening.

Note: An extensive study of breast cancer risks with HRT revealed a positive link between the risk of cancer and length of use. Risk of the disease increased with all types of women using HRT with every year of use. Pre-menstrual women were more than twice at risk. It would appear that oestrogens cannot be taken without risk. (Centre for Disease Control, Atlanta, USA) See: OESTROGENS. ... hormone replacement therapy (hrt)

Habitat: Indigenous to North America.

Action: Cathartic, diuretic, detergent, emetic, tonic.

Habitat: Widely distributed throughout North America.

Action: Stimulant, tonic, expectorant.

Habitat: Gravel Root is a native of the United States, and must not be confused with the English Queen of the Meadow or Meadowsweet (Spiraea ulmaria).

Action: Diuretic and stimulant.

Ionising radiation comprises X-RAYS, GAMMA RAYS and particle radiation. X-rays are part of the continuous electromagnetic-wave spectrum: this also includes gamma rays, infra-red radiation, ultraviolet light and visible light. They have a very short wavelength and very high frequency, and their ability to penetrate matter depends upon the electrical energy generating them. X-rays that are generated by 100,000 volts can pass through body tissue and are used to produce images – popularly known as X-rays. X-rays, generated at several million volts can destroy tissue and are used in RADIOTHERAPY for killing cancer cells. Gamma rays are similar to X-rays but are produced by the decay of radioactive materials. Particle radiation, which can be produced electrically or by radioactive decay, comprises parts of atoms which have mass as well as (usually) an electrical charge.

Non-ionising radiation includes ultraviolet light, radio waves, magnetic ?elds and ULTRASOUND. Magnetic ?elds are used in magnetic resonance imaging (MRI) and ultrasound, which is inaudible high-frequency sound waves, and is used for both diagnoses and treatment in medicine.... radiation

Habitat: Pastures and waysides, especially near the sea-coast.

Action: Diaphoretic, detergent, antiseptic.

Anxiety, DEPRESSION and POST-TRAUMATIC STRESS DISORDER (PTSD) are common after rape: many victims are now given help by rape crisis counselling. A recent report suggests that in at least 50 per cent of reported rapes, the attacker was known to, or had been a friend of, the victim. The deliberate misuse of alcohol or drugs to reduce a potential victim’s resistance seems to be increasing (see DRUG ASSISTED RAPE; FLUNITRAZEPAM.)... rape

Habitat: Woods and heaths ; dry, gravelly or stony ground. Also cultivated in gardens. Features ? Stem erect, freely branched, three or four feet high, covered with small,

Action: Astringent, stimulant.

(2) A public o?cial responsible for registering births, deaths, and marriages.... registrar

Respiratory distress syndrome is a complication of SHOCK, systemic SEPSIS and viral respiratory infections. It was ?rst described in 1967, and – despite advances with assisted ventilation

– remains a serious disease with a mortality of more than 50 per cent. The maintenance of adequate circulating blood volume, peripheral PERFUSION, acid-base balance and arterial oxygenation is important, and assisted ventilation should be instituted early.

In newborns the mechanism is diferent, being provoked by an inability of the lungs to manufacture SURFACTANT.... respiratory distress syndrome

– see CELLS). Consisting of approximately 65 per cent RNA and 35 per cent PROTEIN, they are the sites where protein is made.... ribosome

Visceral rickettsia is a disease transmitted by mites from an infected house mouse, which occurs in the USA, South Africa, Korea and the former Soviet Union. The causal organism is Rickettsia akari. The incubation period is 7–14 days and the characteristic features are fever, headache, and a non-irritating rash on the face, trunk and extremities. The disease is non-fatal and responds rapidly to TETRACYCLINES.... rickettsia

Rifampicin is given by mouth; during the ?rst two months it often causes transient disturbance of LIVER function, with raised concentrations of serum transaminases, but usually treatment need not be interrupted. In patients with pre-existing liver disease more severe toxicity may occur, and liver function should be carefully monitored both before starting and during rifampicin treatment. It induces hepatic enzymes which accelerate the metabolism of various drugs including ANTICOAGULANTS, SULPHONYLUREAS, PHENYTOIN SODIUM, CORTICOSTEROIDS and OESTROGENS. The e?ectiveness of oral contraceptives is reduced and alternative family-planning advice should be o?ered.

Rifampicin should be avoided during pregnancy and breast feeding, and extra caution should be applied if there is renal impairment, JAUNDICE or PORPHYRIAS. Adverse effects include gastrointestinal symptoms, in?uenza-like symptoms, collapse and SHOCK, haemolytic ANAEMIA, acute ?ushing and URTICARIA; body secretions may be coloured red.... rifampicin

Rimah, Reema, Reemah, Ryma, Rymah, Rim, Reem, Reama, Reamah... rima

Secondly – and more commonly termed the ‘At-risk register’ – this is a list held by social-service departments, and accessible to doctors in A&E departments, of children whom a local-authority social-services case conference has deemed to have been harmed or to be at risk of harm from mental, physical or sexual abuse (see also CHILD ABUSE).... risk register

Action: Hips—applied to wounds, injuries, sprains and foul ulcers.

Rasia, Rasine, Rasja, Rasya, Rosa, Rosella, Roselle, Rosena, Rosenah, Rosene, Rosetta, Rosette, Rosey, Rosheen, Rosie, Rosina, Rosine, Rosio, Rosita, Rosy, Roza, Roze, Rozele, Rozella, Rozene, Rozina, Rozsa, Rozsi, Rozsika, Rozy, Ruza, Ruzena, Ruzenka, Ruzha, Ruzsa, Rosai, Rosay, Rosee, Rosae, Roesia, Rohais, Rhosyn, Rois, Roisin, Ros, Russu, Ruusu, Rozeena, Rozyuka, Rhodia... rose

Habitat: Throughout India, in moist places.

Action: Plant—used as a supporting drug in pulmonary tuberculosis, nervous diseases and rheumatism. Leaves—applied to swelling as paste. Stem-mucilage—demulcent and emollient. Used internally in skin diseases and as a diuretic and febrifuge.

Teething. Teas: Spearmint, Roman Chamomile, Peppermint. 1 heaped teaspoon to cup boiling water; infuse 15 minutes; frequent teaspoon doses. Alternative: place one Chamomile flower in feeding bottle. Essential oils: rub gums with diluted oils: Spearmint, German Chamomile, Peppermint or Mullein. Urinary Tract Infection, Cystitis or urethritis.

Teas: Horsetail, Couch Grass, Golden Rod, Rosehip. Dandelion coffee. For pus in the urine: 1-5 drops Tincture Myrrh in cup of warm water: Dose: 1-2 teaspoons thrice daily. Fullness under the eyes may indicate Bright’s Disease for which specialist opinion should be obtained without delay.

Diet. Wholegrain cereals, wholemeal bread, pasta, two servings fresh fruit and vegetables daily. Little lean meat, poultry, fish. Dairy products: yoghurt, cheese, milk in moderation. Fresh orange juice, raw fresh vegetable salads. Oatmeal (porridge oats) is sustaining to the nervous system.

Avoid: crisps, fizzy drinks, hamburgers, biscuits, chocolate, sugar-filled snacks, alcohol, strong tea and coffee.

Supplement. Most children may benefit from one zinc tablet weekly.

Medicine doses. See: DOSAGE.

Fish oils. As well as to help children guard against winter illnesses, Cod Liver oil supplements may help them later in life against arthritis, heart disease, psoriasis, eczema and other inflammatory disorders.

Aspirin. It is clear that a link exists between Reye’s syndrome and aspirin. Aspirin is not advised for minor viral illness in children. ... roseola

the hand, are applied to the lower breastbone until trained help arrives.

Both these measures are used to restore blood circulation to the brain.

Brain damage is likely if the brain is starved of oxygen for more than 3–4 minutes.... cardiopulmonary resuscitation

A radical is a group of atoms which can combine in the same way as single atoms to make a molecule. Free means uncombined. A free radical is a state in which a radical can exist before it combines – an incomplete molecule containing oxygen which has an uneven electrical charge. High energy oxygen atoms are known to form atheroma.

As well as being substances that take part in a process of metabolism, free radicals can be found in industrial fumes and cigarette smoke. They are oxidants and have an anti-bacterial effect. But their activity is not confined to bacteria alone. When produced in large amounts as in inflammation and infection, they may have a damaging effect upon the lining of blood vessels and other tissues. An excess is produced in ischaemic heart disease. They have been shown to be involved in jet lag, Alzheimer’s disease, rheumatoid arthritis, thrombosis, heart failure, cancer, irradiation sickness and a weak immune system. Damaging to the DNA, they are probably the greatest single cause of ill health. They hasten the ageing process. Vitamins A, C, E, being antioxidants and the mineral Selenium stimulate certain enzyme systems to limit damage done by these destructive elements.

Losing weight is believed to generate free radicals – a metabolic side-effect of dieting. See: ANTIOXIDANTS. ... free radicals

The response consists of the production of cells called lymphocytes, substances called antibodies, or immunoglobulins, and other substances and cells that act to destroy the antigenic material.

(See also immune system.)... immune response

As many body tissues are radiolucent, some X-ray imaging procedures require the introduction of radiopaque substances into the body to make organs stand out clearly.... radiopaque

On exposure to cold, the digits turn white due to lack of blood. As sluggish blood flow returns, the digits become blue; when they are warmed and normal blood flow returns, they turn red. During an attack, there is often tingling, numbness, or a burning feeling in the affected fingers or toes. In rare cases, the artery walls gradually thicken, permanently reducing blood flow. Eventually painful ulceration or even gangrene may develop at the tips of the affected digits.

Diagnosis is made from the patient’s history. Treatment involves keeping the hands and feet as warm as possible. Vasodilator drugs or calcium channel blockers may be helpful in severe cases. (See also Raynaud’s phenomenon.)... raynaud’s disease

Side effects include insomnia, sweating, and dizziness on standing.... reboxetine

rectal examination Examination of the anus and rectum, performed as part of a general physical examination, to assess symptoms of pain or changes in bowel habits, and to check for the presence of tumours of the rectum or prostate gland. rectal prolapse Protrusion outsid.

nent in elderly people. If the prolapse is large, leakage of faeces may occur.

Treatment is with a fibre-rich diet.

Surgery may also be performed.... rectal bleeding

A rectocele is usually associated with a cystocele or a prolapsed uterus (see uterus, prolapse of).

There may be no symptoms, or the rectocele may cause constipation.

Pelvic floor exercises may help.

If not, an operation to tighten the tissues at the back of the vagina may be recommended.... rectocele

A common type of reflux is regurgitation of acid fluid from the stomach (see acid reflux).... reflux

In the simplest reflex, a sensory nerve cell reacts to a stimulus, such as heat or pressure, and sends a signal along its nerve fibre to the central nervous system. There, another nerve cell becomes stimulated and causes a muscle to contract or a gland to increase its secretory activity. The passage of the nerve signal.

from original sensation to final action is called a reflex arc.

Reflexes may be inborn or conditioned. Some inborn reflexes occur only in babies (see reflex, primitive). Inborn reflexes include those that control basic body functions, such as contraction of the bladder after it has filled beyond a certain point, and are managed by the autonomic nervous system. Conditioned reflexes are acquired through experience in a process called conditioning.

Several simple reflexes, such as the knee-jerk, are tested in a physical examination. Changes in the reflexes may indicate damage to the nervous system. The examination of vital reflexes controlled by the brainstem is the basis for diagnosing brain death.... reflex

The syndrome is caused by an immune response and usually develops only in people with a genetic predisposition. Most patients have the -B27 tissue type (see histocompatability antigens). The syndrome’s development is induced by infection: usually nongonococcal urethritis, but sometimes bacillary dysentery. Reiter’s syndrome usually starts with a urethral discharge, which is followed by conjunctivitis and then arthritis. The arthritis usually affects 1 or 2 joints (usually the knee and/or ankle) and is often associated with fever and malaise. Attacks can last for several months. Tendons, ligaments, and tissue in the soles of the feet may also become inflamed. Skin rashes are common.

Diagnosis is made from the symptoms.

Analgesic drugs and nonsteroidal antiinflammatory drugs relieve symptoms but may have to be taken for a long period.

Relapses occur in about 1 in 3 cases.... reiter’s syndrome

The blood is more acidic than normal, and the urine less acidic.

Causes include kidney damage due to disease, drugs, or a genetic disorder; but in many cases the cause is unknown.

The acidosis may result in osteomalacia, kidney stones (see calculus, urinary tract), nephrocalcinosis, and hypokalaemia (an abnormally low level of potassium in the blood).... renal tubular acidosis

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

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

It usually results from thrombosis in the affected vein, and is more common in people who have glaucoma.

Retinal vein occlusion may cause visual disturbances, glaucoma, or blindness.... retinal vein occlusion

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 disorder starts as the child recovers from the infection. Symptoms include uncontrollable vomiting, lethargy, memory loss, and disorientation. Swelling of the brain may cause seizures, disturbances in heart rhythm, coma, and cessation of breathing.

Brain swelling may be controlled by corticosteroid drugs and by intravenous infusions of mannitol. Dialysis or blood transfusions may be needed. If breathing stops, a ventilator is used.

The death rate is around 10 per cent, and higher for those who have seizures, lapse into deep coma, and stop breathing.

Permanent brain damage may occur.... reye’s syndrome

It is usually complete after about 12 hours; the stiffness then disappears over the next 48–60 hours.

Physical exertion before death makes rigor mortis begin sooner.

The sooner rigor mortis begins, the quicker it passes.

These facts are used to help assess the time of death.... rigor mortis

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

The pulp is removed through a hole drilled in the crown. An antibiotic paste and a temporary filling are packed in. A few days later, the filling is removed and the canals are checked for infection. When no infection is detected the cavity is filled and the roots are sealed with cement. If the cavity is not filled completely, periodontitis may occur.

Treated teeth may turn grey but their appearance can be restored by bonding (see bonding, dental), fitting an artificial crown (see crown, dental), or by bleaching (see bleaching, dental).... root-canal treatment

The exact trigger is unknown, but it is thought that, whatever the stimulus, chemical mediators produced by cells of the immune system or elsewhere in the body spread and sustain an in?ammatory reaction. Cascade mechanisms with multiple interactions are provoked. CYTOTOXIC substances (which damage or kill cells) such as oxygen-free radicals and PROTEASE damage the alveolar capillary membranes (see ALVEOLUS). Once this happens, protein-rich ?uid leaks into the alveoli and interstitial spaces. SURFACTANT is also lost. This impairs the exchange of oxygen and carbon dioxide in the lungs and gives rise to the clinical and pathological picture of acute respiratory failure.

The typical patient with ARDS has rapidly worsening hypoxaemia (lack of oxygen in the blood), often requiring mechanical ventilation. There are all the signs of respiratory failure (see TACHYPNOEA; TACHYCARDIA; CYANOSIS), although the chest may be clear apart from a few crackles. Radiographs show bilateral, patchy, peripheral shadowing. Blood gases will show a low PaO2 (concentration of oxygen in arterial blood) and usually a high PaCO2 (concentration of carbon dioxide in arterial blood). The lungs are ‘sti?’ – they are less e?ective because of the loss of surfactant and the PULMONARY OEDEMA.

Causes The causes of ARDS may be broadly divided into the following:... acute respiratory distress syndrome (ards)

For long it had been realised that in certain cases of ASTHMA, adrenaline had not the usual bene?cial e?ect of dilating the bronchi during an attack; rather it made the asthma worse. This was due to its acting on both the alpha and beta adrenergic receptors. A derivative, isoprenaline, was therefore produced which acted only on the beta receptors. This had an excellent e?ect in dilating the bronchi, but unfortunately also affected the heart, speeding it up and increasing its output – an undesirable e?ect which meant that isoprenaline had to be used with great care. In due course drugs were produced, such as salbutamol, which act predominantly on the beta2 adrenergic receptors in the bronchi and have relatively little e?ect on the heart.

The converse of this story was the search for what became known as BETA-ADRENOCEPTORBLOCKING DRUGS, or beta-adrenergic-blocking drugs. The theoretical argument was that if such drugs could be synthesised, they could be of value in taking the strain o? the heart – for example: stress ? stimulation of the output of adrenaline ? stimulation of the heart ? increased work for the heart. A drug that could prevent this train of events would be of value, for example in the treatment of ANGINA PECTORIS. Now there is a series of beta-adrenoceptor-blocking drugs of use not only in angina pectoris, but also in various other heart conditions such as disorders of rhythm, as well as high blood pressure. They are also proving valuable in the treatment of anxiety states by preventing disturbing features such as palpitations. Some are useful in the treatment of migraine.... adrenergic receptors

Adverse effects can be divided into types. First, those which are closely related to the concentration of the drug and accord with what is known of its PHARMACOLOGY. These so-called type A (augmented pharmacological) effects are distinguished from type B (bizarre) effects which are unpredictable, usually rare, and often severe. ANAPHYLAXIS is the most obvious of these; other examples include bone-marrow suppression with CO-TRIMOXAZOLE; hepatic failure (see HEPATITIS) with SODIUM VALPROATE; and PULMONARY FIBROSIS with AMIODARONE. A more comprehensive classi?cation includes reactions type C (chronic effects), D (delayed effects – such as teratogenesis or carcinogenesis) and E (end-of-dose effects – withdrawal effects). Examples of adverse reactions include nausea, skin eruptions, jaundice, sleepiness and headaches.

While most reported adverse reactions are minor and require no treatment, patients should remind their doctors of any drug allergy or adverse e?ect they have suffered in the past. Medical warning bracelets are easily obtained. Doctors should report adverse effects to the authorities – in the case of Britain, to the Committee on Safety of Medicines (CSM), using the yellow-card reporting machinery.... adverse reactions to drugs

Habitat: Western Ghats, tropical forests in the hills of Andhra Pradesh, Karnataka, Kerala and Andaman and Nicobar islands.

Action: Fruit—cooling (in febrile complaints), antipyretic, astringent, antidiarrhoeal, antidysenteric, anti-inflammatory (seeds used for painful micturition). Fruits are also used for treating obstinate skin diseases and tumours.

... aglaia roxburghiana

Habitat: The western Himalayas and Kashmir at altitudes between 2,700 and 3,600 m.

Action: Demulcent (used in cystitis, nephritis), aperient, diuretic and urinary antiseptic, anticholesterolaemic.

Habitat: Native to the West Indies. Cultivated in Bengal, Assam, Khasi Hills and southern India.

Action: Leaves—insecticide, an- thelmintic, styptic, externally used as suppurant. Unripe and dried fruit—antidysenteric. Bark— powerful astringent, used as antidysenteric and vermifuge.

Habitat: Native to Europe and West Asia.

Habitat: Found wild in tropical and subtropical parts of India, including the Andamans and ascending in the Himalayas to 1,500 m.

Action: Used as a galactagogue and for disorders of female genitourinary tract; as a styptic and ulcer-healing agent; as an intestinal disinfectant and astringent in diarrhoea; as a nervine tonic, and in sexual debility for spermatogenesis.

Habitat: Kashmir and Himachal Pradesh up to 2,500 m.

Action: Highly poisonous; sedative, narcotic, anodyne, nervine, antispasmodic (used in paralysis); parkinsonism; encephalitis; carcinoma; spastic dysmenorrhoea; whooping cough, spasmodic asthma; colic of intestines, gall bladder or kidney, spasm of bladder and ureters; contraindicated in enlarged prostate.

Habitat: Sub-Himalayan tracts from Ravi eastwards, ascending to 1,000 m. in the Uttar Pradesh, West Bengal and Central and South India.

Action: Bark—highly astringent, anti-inflammatory (used in glandular inflammations, skin diseases, ulcers), cholagogue. Leaves—anthelmintic; with onion for diarrhoea. Flowers—used in haemorrhages, piles; also in cough. Seed—antibacterial.

Habitat: Northwestern Himalayas up to 1500 m, also in Orissa, Madhya Pradesh and Andhra Pradesh.

Action: Gum—emmenagogue, diuretic. (Gum resembles Gum arabic; used as an external application for sores). Protein isolated from seeds—hypoglycaemic, hypoc- holesterolaemic in young, normal as well as alloxan-induced diabetic albino rats.

Habitat: The tropical Himalayas and Deccan peninsula.

Action: Used as a galactagogue (as a supporting drug in herbal compound formulations). Spasmogenic.... breynia retusa

Habitat: Throughout India up to an altitude of 1,000 m, except in very dry regions.

Action: Bark—astringent, used in the form of a liniment in rheumatism. Paste of the stem bark is applied to wounds.

• Pour boiling water over the desired amount of herbs.
• Cover and let them steep 10 to 20 minutes.
• Strain off the herbs using a tea strainer or coffee filter.

• soothe the skin and gastrointestinal tract
• improve appetite and digestion
• reduce liver damage
• mildly lower blood sugar (hypoglycemic effect)
• purify the blood
• fight the effects of rheumatism
• treat some kidney disorders
• counter bronchial cough and other irritations of the pulmonary tract

Habitat: Central and South India.

Action: Astringent, antidiarrhoeal, anti-inflammatory (used in chronic fevers, piles, abdominal tumours, strangury), antibilious, spasmolytic. Wood—vermifuge.

Habitat: Rajasthan, Gujarat, Deccan and Karnataka.

Action: See C. myxa.

Habitat: Commonly grown in Indian gardens.

Action: The cytotoxic dimeric alkaloids, present in Madagascar Periwinkle, Catharanthus roseus L. Don, Vincea rosea L., and used for the treatment of certain type of cancer, have not been found in V. major.

Habitat: Temperate Himalayas from Kashmir to Bhutan up to at 3,000-4,000 m.

Action: Sedative, anti-inflammatory, antitussive, diuretic, emmenagogue. Used in homoeopathy for rheumatic diseases of nervous, hysterical women, suffering from uterine affections; also for locomotor ataxia.

The new Council for Healthcare Regulatory Excellence will help to promote the interests of patients and to improve co-operation between the existing regulatory bodies – providing, in e?ect, a quality-control mechanism for their activities. The government and relevant professions will nominate individuals for this overarching council. The new council will not have the authority to intervene in the determination by the eight regulatory bodies of individual ?tness-to-practise cases unless these concern complaints about maladministration.... council for healthcare regulatory excellence

Habitat: A parasitic climber common throughout India up to 3,000 m.

Action: See C. epithymum.

Habitat: Throughout India, as a weed upto 2,000 m.

Action: Carminative, astringent, anti-inflammatory, antirheumat- ic, hepatoprotective, diuretic, antipyretic, analgesic, hypoten- sive, emmenagogue and nervine tonic.

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

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

Habitat: The Western Himalayas from Kashmir to Garhwal.

Action: The root is reported to prevent giddiness caused during high attitude ascents.

Synonym: Putranjiva roxburghii Wall.

Habitat: Wild and cultivated throughout tropical India.

Action: Leaves, fruits and stones of fruits are given in colds and fevers, also in rheumatic affections. Rosaries, made ofhard stones of the fruit, are placed around the necks of children to protect them from diseases.

Habitat: Throughout India.

Action: Ascaricidal, anthelmintic, carminative, diuretic, astringent, anti-inflammatory, antibacterial, febrifuge. Used in diseases of chest and skin. Active principles are found to be oestrogenic and weakly progestogenic. Root—bechic, antidiarrhoeal. Seed—spermicidal, oxytocic, diuretic. The plant is also used for its blood purifying properties. It is an ingredient in cough syrups, preparations for anaemia, genitourinary tract infections, diarrhoea and diseases of the liver.

Habitat: Throughout greater part of India.

Action: Fruit—antispasmodic, carminative, anthelmintic, antibacterial. Powdered fruit—used in dysentery. Plant—used in weak pulse rate.

Habitat: Sub-tropical and temperate regions.

Habitat: Assam, Western Ghats and Andaman Islands.

Action: Properties are similar (though inferior) to those of Ipeac (Cephaelis ipecacuanha A. Rich.).... geophila repens

Habitat: Native to Morocco.

Action: A drastic purgative, irritant, vesicant and toxic, proinflammatory. Internal use of the drug has been abandoned.

Habitat: Western Himalaya from Kumaon to Nepal.

Action: Latex—cathartic, anthelmintic.

Habitat: Throughout India. Grows wild in forests and hills. Often found around subterranean water streams.

Action: Astringent and antiseptic; used in threatened abortions, menorrhagia, leucorrhoea, urinary disorders, skin diseases, swellings, boils, haemorrhages. Unripe fruits—astringent, carminative, digestive, stomachic; used in diarrhoea, dyspepsia, dysentery, menorrhagia and haemorrhages. Ripe fruits—antiemetic, also

Habitat: Sub-Himalayan tracts, West Bengal, Central and South India; planted throughout India as an avenue tree.

Action: Bark—astringent, antiseptic, alterative, laxative, haemostatic, vaginal disinfectant (used in diabetes, diarrhoea, leucorrhoea, menorrhagia, nervous disorders; also in skin diseases.) Applied externally on unhealthy ulcers and wounds. Leaves and twigs— laxative.

Habitat: Western temperate Himalaya from Kashmir to Kumaon at 2,700-4,35 m.

Action: Used in the treatment of asthma, bronchitis and tuberculosis. (Withania somnifera is a substitute for Kaakoli and Kshira-Kaakoli.)

Habitat: Central India and Deccan Peninsula.

Action: Gum—antimicrobial, anthelmintic; used in skin diseases. Gum gave flavonoids—gardenins, wagonin derivatives, de-Me- tangeretin, nevadensin, hexacosyl- p-coumarate. See G. gummifera.... gardenia resinifera

Gastro-oesophageal disease should be diagnosed in those patients who are at risk of physical complications from the re?ux. Diagnosis is usually based on the symptoms present or by monitoring the production of acid using a pH probe inserted into the oesophagus through the mouth, since lesions are not usually visible on ENDOSCOPY. Severe heartburn, caused by the lining of the oesophagus being damaged by acid and PEPSIN from the stomach, is commonly confused with DYSPEPSIA. Treatment should start with graded doses of one of the PROTON PUMP INHIBITORS; if this is not e?ective after several months, surgery to remedy the re?ux may be required, but the effects are not easily predictable.... gastro-oesophageal reflux

Habitat: Western Himalayas from Kashmir to Garhwal at 2,0002,700 m.

Action: Haemostatic, astringent, antidiarrhoeic, styptic, antidiabetic.

Habitat: Northeastern parts of India and in Deccan Peninsula.

Action: Blood-purifier in itch and cutaneous eruptions; mixed with lemon juice, applied externally.

Habitat: Drier parts of Northern and Western India and Deccan Peninsula.

Action: Anthelmintic. Fresh herb is used for taenia.

• Helps prevent the formation of kidney and bladder stones.
• Effective in treating gout.
• Relieves fever by encouraging sweating.
• Treats various urinary problems.
• Helps relieve constipation.
• Reduces stomach acidity.
• In some cases, it can act as an anti-inflammatory, reducing swelling.

• Due to the fact that Gravel Root Tea contains chemicals called hepatotoxic pyrrolizidine alkaloids (PAs), it may block blood flow and cause liver damage.
• Pregnant women should avoid drinking Gravel Root Tea since it can produce birth defects. Also, if you are breastfeeding, do not drink gravel root tea, because the chemicals (PAs) can affect the breast-milk and harm the baby.
• Do not apply gravel root on wounds or broken skin. The chemicals can be absorbed quickly through broken skin and can lead to dangerous body-wide toxicity.

Habitat: Gujarat, Madhya Pradesh, Maharashtra, Andhra Pradesh, Karnataka, Tamil Nadu.

Action: Tar extracted from wood— used in skin diseases. Leaf juice— applied externally on toe sores and in chilblain.

Habitat: Native of China; grown in gardens throughout India.

Action: Flower—used in impo- tency, bronchial catarrh. Flower and bark—emmenagogue. Leaf— stimulates expulsion of placenta after childbirth; laxative, anodyne. Flower and root—used in menorrhagia.

Habitat: North-west Himalayas at 2,350-5,000 m.

Action: Fruit—astringent, anti- diarrhoeal, stomachic, antitussive, antihaemorrhagic.

Habitat: Western Peninsula, from Konkan southwards to Kerala.

Action: Leaf—used in eczema.... jasminum rottlerianum

Habitat: Eastern, Central and Peninsular India, up to 700 m.

Action: Root—diuretic, spasmolytic, antilithic. Used for urinary discharges. Leaf and stem— depurative. Leaf and fruit—used in skin diseases.

• Strenghtens the immune system.
• Can speed recovery from the common cold.
• Helps heal wounds and cuts.
• Treats respiratory infections such as pharyngitis and tonsilitis.
• Heals sore thorat.
• Helps reduce fever.
• Helps in the treatment of chronic fatigue syndrome when combined with echinacea.

• Taking in large doses, Indigo Root Tea can cause nausea, diarrhea, voming or asphyxiation.
• Pregnant and breastfeeding women should avoid drinking Indigo Root Tea.
• People with auto-immune disorders should not drink Indigo Root Tea.

The improvement in the infant mortality rate has occurred mainly in the period from the second month of life. There has been much less improvement in the neonatal mortality rate – that is, the number of infants dying during the ?rst four weeks of life, expressed as a proportion of every 1,000 live births. During the ?rst week of life the main causes of death are asphyxia, prematurity, birth injuries and congenital abnormalities. After the ?rst week the main cause of death is infection.

Social conditions also play an important role in infant mortality. In England and Wales the infant mortality rate in 1930–32 was: Social Class I (professional), 32·7; Social Class III (skilled workers), 57·6; Social Class V (unskilled workers), 77·1. Many factors come into play in producing these social variations, but overcrowding is undoubtedly one of the most important.

1838–9 146 1950–52 30 1851–60 154 1960–62 22 1900–02 142 1970–72 18 1910–12 110 1980–82 12 1920–22 82 1990–92 7 1930–32 67 1996 6·2 1940–42 59 1999 5.8 2000 5.6

It is thus evident that for a reduction of the infant mortality rate to the minimum ?gure, the following conditions must be met. Mothers and potential mothers must be housed adequately in healthy surroundings, particularly with regard to safe water supplies and sewage disposal. The pregnant and nursing mother must be ensured an adequate diet. E?ective antenatal supervision must be available to every mother, as well as skilled supervision during labour (see PREGNANCY AND LABOUR). The newborn infant must be adequately nursed and fed and mothers encouraged to breast feed. Environmental and public-health measures must be taken to ensure adequate housing, a clean milk supply and full availability of medical care including such protective measures as IMMUNISATION against diphtheria, measles, poliomyelitis and whooping-cough. (See also PERINATAL MORTALITY.)... infant mortality rate (imr)

Action: Used in age-sustaining and invigorating tonics.... lipasis rostrata

Habitat: Temperate and Alpine Himalayas from Chitral to Nepal at 1,500-4,200 m.

Action: Antispasmodic, stomachic, antihistaminic, expectorant, anticatarrhal. Used for asthma, chronic bronchitis and pulmonary disorders.

Habitat: In damp places in upper Gangetic plains; Bihar, Bengal, Peninsular India.

Action: Deobstruent, diuretic, alterative. Used for rheumatic affections, neuralgia, headache, skin diseases and urinary affections.

Habitat: Native to Iran; now cultivated in Kashmir, Himachal Pradesh., Khasi Hills and the hills of Uttar Pradesh.

Action: Leaves and bark— alterative, laxative, antiseptic, mild hypoglycaemic, anti-inflammatory, antiscrofula, detergent. An infusion of leaves and bark is used for herpes, eczema and other cutaneous affections; externally to skin eruptions and ulcers. Volatile oil— antifungal, antimicrobial.

Habitat: Throughout India in wet or humid shaded areas.

Action: Tuber—antitumour. Used for swellings (removes blood clot), mumps and wounds.

Habitat: Costal forests of eastern and western Peninsulas, the Sunderbans (West Bengal).

Action: Bark—used with ginger or long pepper and rose water for diabetes (aqueous or alcoholic extracts of the bark did not exhibit any effect on the blood sugar of normal or alloxan-diabetic rabbits).

Habitat: All over India; also grown as a hedge plant.

Action: Plant—spasmolytic, hypotensive, antiviral. Fruit— astringent, used in inflammations. Leaves—astringent, antidiarrhoeal, diuretic. Root bark—astringent, attenuant, diuretic.

Habitat: Many parts of India, as a common weed.

Action: Diuretic, slightly aperient. Used as a diuretic in calculous affections, also for chronic obstruction of liver and bowels.

Habitat: Tropical Himalaya, and Assam, Western and Eastern Ghats, up to 1,000 m.

Action: Seed—narcotic. Root— astringent, stimulant, febrifuge. Fruit—used for aphthae of the mouth. Leaves—purgative, diuretic, deobstruent. Bark—an infusion is given in diarrhoea and abdominal pain.

Habitat: Western and Eastern Himalayas, Simla and Kumaon, hills of Assam.

Habitat: Plain and hills of Kumaon and Punjab, extending westwards to Afghanistan. Imported into India from Persia.

Action: Seed—cooling, diuretic, sedative; given internally as a soothing agent during urinary troubles, also for cough. A poultice of seeds is applied to abscesses, boils and inflammations. (Seeds are not to be used as a substitute for Plantago sp.)

Habitat: Sub-Himalayan tracts of Punjab and Uttar Pradesh and Deccan Peninsula up to an altitude of 900 m.

Action: Plant—stimulant and restorative. Improves eyesight. Found useful in the treatment of habitual abortion. Leaves and roots used in skin diseases.

Habitat: Simla, Kumaon and plains of North India.

Action: Leaves—demulcent, emollient; used in glycosuria, stomach disorders and as emmenagogue; used as poultice for maturing abscesses. Seeds—demulcent; prescribed in bronchitis, cough, inflammation of the bladder and haemorrhoids.

Medical Dictionary

[catlist id=11 numberposts=100 pagination=yes instance=2 orderby=title order=asc]

In developed countries ORT is useful in treating gastroenteritis. There are a number of proprietary preparations, often dispensed as ?avoured sachets, including Dioralyte® and Rehydrate®.... oral rehydration therapy (ort)

Habitat: Throughout the warmer parts of India.

Action: Flower—astringent, cardiac tonic; used in palpitation of heart. Rhizomes—used for dysentery and dyspepsia.... nymphaea rubra

Habitat: The Himalayas, Khasi hills and the Western Ghats at altitudes of 1,500-3,000 m.

Action: Fern—antispasmodic, astringent, an aqueous extract is administered for intestinal gripe; used externally in rheumatism; also prescribed in muscular debility Fonds enter into diuretic drinks used for treating body swellings. Root—mucilaginous, styptic, stimulant.

Habitat: Extensively cultivated all over India.

Action: Used as a pulse. Soup is given as a diet to patients of enlarged liver and spleen, and after recovery from acute illness. A poultice of it is used for checking secretion of milk and reducing distention of the mammary glands.... phaseolus radiatus

Habitat: The Western and Eastern Himalayas.

Action: Needle, needle oil— decongestant, expectorant, antiseptic. Oil—used in cough and cold remedies, particularly inhalations and in rubefacients for rheumatism and muscle stiffness. Resin— expectorant, antiseptic, antipruritic.

Habitat: Moist, loamy soil. Indigenous to U.S.A

Action: Diaphoretic, expectorant, antispasmodic.

Habitat: Native to Mexico; grown throughout India.

Action: Root bark—used in blennorrhagia. Flower—bechic (used in pectoral syrups). Bark— a decoction is used in venereal diseases and leprosy.

Habitat: U.S.A. Cultivated on a sm.ill scale in England for medicinal purposes.

Action: Alterative, cathartic.

Wall.

Synonym: Drypetes roxburghii (Wall.) Hurusawa.Family: Euphoriaceae.

Habitat: Throughout tropical India, wild and cultivated as an avenue tree.English: Child-life tree, Indian Amulet Plant, Spurious Wild Olive.Ayurvedic: Putranjiva, Putrajivaka, Putrajiva, Yashtipushpa, Arth- saadhanaSiddha/Tamil: Karupali Garbhadaa and Garbhakaraa are misleading synonyms.Folk: Jiyaapotaa.

Action: Fruit—powered (deseeded) fruits are used against cough, cold and sprue. Rosaries of hard stones are used for protecting children from infections. (Due to misleading nomenclature, the "conception-promoting" property has been attributed to the drug in folk medicine. Its use is possible in vaginal infections and genitourinary diseases, or skin eruptions during pre-conception stage.)The seed kernel on steam distillation yield 0.5% of a sharp-smelling essential oil of the mustard oil type. The oil contains isopropyl and 2-butyl isothio- cyanates as the main constituents and 2-methyl-butyl isothiocyanate as a minor component. The iso-thiocyanates are produced on enzymic hydrolysis of glycosidic progenitors present in the kernels, viz. glucoputranjivin, gluco- cochlearin and glucojiaputin respectively. An additional glucoside, gluco- cleomin has been identified in the seed kernel, it affords a non-volatile mustard oil, cleomin. A glycosidic pattern similar to that in the seed is reported in the shoots and roots.The fruit pulp contains a large proportion of mannitol and small quantities of saponin glucosides and alkaloids.The seed coat gave putranjivoside, putranoside A, B, C and D, beta- sitosterol and tis beta-D-glucoside.The leaves gave amentoflavone and its derivatives, beta-amyrin and its palmite, polyphenols, putranjiva sa- ponin A,B,C, and D and stigmasterol.The bark contains friedelin, friede- lanol, friedelanone, friedelan-3,7-di- one (putranjivadione), 3-alpha-hydro- xy friedelan- 7-one (roxburgholone), carboxylic acid, putric acid, putran- jivic acid.The essential oil from leaves showed mild antifungal activity against Rhizoctonia solani.

Rachael, Racheal, Rachelanne, Rachelce, Rachele, Racheli, Rachell, Rachelle, Rachil, Raechel, Raechell, Raychel, Raychelle, Rashell, Rashelle, Raychel, Rechell, Rakel... rachel

Habitat: North-Western and eastern Himalaya at altitudes of 2,700-3,000 m. and in Khasi and Jaintia hills up to 1,500 m.

Action: Plant—astringent and antilithic. Used for healing wounds. A decoction of the plant is prescribed against profuse menses, bloody stools, haemorrhages and ulcers in urinary passages. The whole herb is used in traditional chinese medicine for the treatment of arthritis.

Habitat: Gujarat, Karnataka, Tamil Nadu.

Action: Plant—antiseptic. Resin— used for the treatment of skin diseases. Rootbark—bitter, astringent; used as substitute for Stereospermumpersonatum (Hassk.) D. Chatterjee and S. suaveolens DC. (Trumpet-Flower, Yellow Snake tree, also known as Padri).

Radeya, Radhiya, Radhiyah, Radhia, Radhiah, Radhea, Radheah... radeyah

Radilla, Radinka, Radmila, Redmilla, Radilu... radmilla

Radwah, Radhwa, Radhwah... radwa

Raekah, Rayka, Raika, Raykah, Raikah... raeka

Rafah, Raafa, Raffa, Raffah... rafa

Rafigah, Rafeega, Rafeegah, Rafyga, Rafygah... rafiga

Ragnal, Ragnalle, Ragnalla, Ragnale, Ragnala, Ragnallia, Ragnallea... ragnall

Ragnarah, Ragnarra, Ragnaria, Ragnarea, Ragnari, Ragnarie, Ragnary, Ragnarey, Ragnaree... ragnara

Ragnfride, Ragnfrida, Ragna, Ragnfryd, Ragnfryde, Ragnfryda, Ragni, Ragnie, Ragny, Ragney, Ragnee, Ragnea... ragnfrid

Ragnild, Ragnhilda, Ragnhilde, Ragnilda, Ranillda, Renild, Renilda, Renilde, Reynilda, Reynilde, Ragnilde... ragnhild

Rahabe, Rahabb, Rahaba, Rahabah... rahab

Raenah, Raene, Rainah, Raine, Rainee, Rainey, Rainelle, Rainy, Reina, Reinella, Reinelle, Reinette, Reyna, Reynalda, Reynelle, Reyney, Reine, Ranee, Reia... raina

Raileigh, Railey, Raley, Rawleigh, Rawley, Raly, Rali, Ralie, Ralee, Rawli, Rawlie, Rawlee, Rawly... raleigh

Ramirah, Rameera, Rameerah, Rameira, Ramiera, Ramyrah, Ramyra, Rameirah, Ramierah, Rameara, Ramearah... ramira

Ramyah, Ramiya, Ramiyah, Ramia, Ramiah... ramya

Ranah, Ra’naa, Rand, Raniyah, Ranarauna, Ranaraunaa, Raunaa... rana

Ranalt, Rathnait, Ranaite, Rathnaite, Ranalta... ranait

Randa, Randee, Randelle, Randene, Randie, Randy, Randey, Randilyn, Randilynn, Randilynne... randi

Habitat: Assam, Naga and Khasi Hills, Travancore and the Andamans.

Action: Fruit—nervine, calmative, antispasmodic, emetic, anthelmintic, abortifacient. Used as a substitute for ipecacuanha.

Habitat: Southern, Central and Eastern India, including Assam and Sikkim.

Action: Unripe fruit—astringent. Root—diuretic; used for biliousness, diarrhoea and dysentery

Rania, Ranice, Ranique, Ranit, Ranica, Ranita, Ranite, Ranith, Ranitta, Raanee, Rane, Ranie... rani

Habitat: The Western Himalayas from Kashmir to Kumaon.

Action: Used in intermittent fevers, asthma and gout.

Habitat: The plains of northern India, and the warm valleys of the Himalayas from Kashmir to Assam.

Action: Fresh Plant—highly acrid, rubefacient, vesicant and toxic; causes inflammation of the digestive tract. Used after drying or as a homoeopathic medicine for skin diseases.

Habitat: Kashmir to Sikkim.

Action: Herb—used in intermittent fevers, rheumatism and asthma.

Raphoo, Raphou... raphu

Racquel, Racquell, Raquela, Raquelle, Roquel, Roquela, Rakel, Rakell... raquel

Habitat: Cultivated in Uttar Pradesh, Punjab, Maharashtra and Gujarat.

Action: Radish—preparations are used in liver, gallbladder and urinary complaints. Green leaves— diuretic and carminative. Seeds— diuretic, purgative, expectorant.

Physiological changes, such as a fall in temperature and blood pressure, take place just before sleep and continue during the early stages of NREM sleep. There is an intrinsic rhythm of sleep which in most subjects has a periodicity of around 25 hours. This can be modi?ed by external factors to bring it into line with the 24-hour day. Two peaks of a tendency to sleep have been identi?ed, and these usually occur between around 14.00–18.00 hours, and 02.00–06.00 hours. There are, however, di?erences according to age, in that, for instance, infants sleep for most of the 24 hours; during adolescence there is also an increase in the duration of sleep. Sleep requirements fall later in life, but there are wide genetic di?erences in the amount of sleep that people require and also the time at which they fall asleep most readily.

The internal clock can be disturbed by a variety of external factors which include irregular sleeping habits due, for instance, to shift work or jet lag. Sleep is also more likely to occur after physical exertion, reading and social activity. The duration and intensity of exposure to light can also modify sleep profoundly. Light promotes wakefulness and is the main factor that adjusts the 25-hour internal rhythm to the 24hour daily cycle. Neural connections from the retina of the EYE act on an area in the brain called the supra-chiasmatic nucleus which stimulates the pineal gland which produces MELATONIN. This is thought to trigger the range of neurological and metabolic processes that characterise sleep.... rapid-eye-movement (rem) sleep

Rasheda, Rasheeda, Rasheedah, Rasheida, Rashidah, Rashyda, Rachida, Raashida, Raashidah... rashida

Ratie, Ratea, Ratee, Raty, Ratey... rati

Habitat: Abundant in moist and warm regions of West Bengal, particularly in 24 Parganas and Howrah, and Kerala (as a weed).

Action: Root—sedative, hypotensive. Plant juice, mixed with castor oil, is applied to skin diseases and to destroy parasites.

Habitat: The Himalayas from Kashmir to Sikkim; commonly grown in gardens.

Action: Plant—used for the treatment of paralysis in Bihar. The crushed leaves and stems are applied to wounds infested with maggots.... rauvolfia tetraphylla

Rawda, Rawdha, Rawdhah... rawdah

Rawiya, Rawiyya, Rawiyyah... rawiyah

Raeann, Raeanna, Raeanne, Rayana, Rayanna, Rayanne, Rayane, Raeane, Raeana, Raiann, Raiane, Raianne, Raianna, Raiana... rayann

Habitat: The sub-Himalayas tract from Punjab to Nepal, Sikkim, Bhutan, Assam, Western Ghats and the Andamans.

Action: Root—decoction is employed to increase uterine contractions and for expulsion of foetus in difficult cases. The total alkaloidal extract of the root induces bradycardia, hypotension, sedation. It finds application in hypochondria, neuropsychi- atric disorders, psychosis and schizophrenia.

Symptoms The condition is most commonly con?ned to the occurrence of ‘dead ?ngers’ – the ?ngers (or the toes, ears, or nose) becoming white, numb, and waxy-looking. This condition may last for some minutes, or may not pass o? for several hours, or even for a day or two.

Treatment People who are subject to these attacks should be careful in winter to protect the feet and hands from cold, and should always use warm water when washing the hands. In addition, the whole body should be kept warm, as spasm of the arterioles in the feet and hands may be induced by chilling of the body. Su?erers should not smoke. VASODILATORS are helpful, especially the calcium antagonists. In all patients who do not respond to such medical treatment, surgery should be considered in the form of sympathectomy: i.e. cutting of the sympathetic nerves to the affected part. This results in dilatation of the arterioles and hence an improved blood supply. This operation is more successful in the case of the feet than in the case of the hands.... raynaud’s disease

Razia, Razi, Raziela, Raziella, Razili, Raziella, Raziel, Raziele, Razie, Razee... raziah

– runs up again into the neck, where it enters the larynx and supplies branches to the muscles which control the vocal cords.... recurrent laryngeal nerve

Imperforate anus, or absence of the anus, may occur in newly born children, and the condition is relieved by operation.

Itching at the anal opening is common and can be troublesome. It may be due to slight abrasions, to piles, to the presence of threadworms (see ENTEROBIASIS), and/or to anal sex. The anal area should be bathed once or twice a day; clothing should be loose and smooth. Local application of soothing preparations containing mild astringents (bismuth subgallate, zinc oxide and hamamelis) and CORTICOSTEROIDS may provide symptomatic relief. Proprietary preparations contain lubricants, VASOCONSTRICTORS and mild ANTISEPTICS.

Pain on defaecation is commonly caused by a small ulcer or ?ssure, or by an engorged haemorrhoid (pile). Haemorrhoids may also cause an aching pain in the rectum. (See also PROCTALGIA.)

Abscess in the cellular tissue at the side of the rectum – known from its position as an ischio-rectal abscess – is fairly common and may produce a ?stula. Treatment is by ANTIBIOTICS and, if necessary, surgery to drain the abscess.

Prolapse or protrusion of the rectum is sometimes found in children, usually between the ages of six months and two years. This is generally a temporary disorder. Straining at defaecation by adults can cause the lining of the rectum to protrude outside the anus, resulting in discomfort, discharge and bleeding. Treatment of the underlying constipation is essential as well as local symptomatic measures (see above). Haemorrhoids sometimes prolapse. If a return to normal bowel habits with the production of soft faeces fails to restore the rectum to normal, surgery to remove the haemorrhoids may be necessary. If prolapse of the rectum recurs, despite a return to normal bowel habits, surgery may be required to rectify it.

Tumours of small size situated on the skin near the opening of the bowel, and consisting of nodules, tags of skin, or cauli?ower-like excrescences, are common, and may give rise to pain, itching and watery discharges. These are easily removed if necessary. Polypi (see POLYPUS) occasionally develop within the rectum, and may give rise to no pain, although they may cause frequent discharges of blood. Like polypi elsewhere, they may often be removed by a minor operation. (See also POLYPOSIS.)

Cancer of the rectum and colon is the commonest malignancy in the gastrointestinal tract: around 17,000 people a year die from these conditions in the United Kingdom. Rectal cancer is more common in men than in women; colonic cancer is more common in women. Rectal cancer is a disease of later life, seldom affecting young people, and its appearance is generally insidious. The tumour begins commonly in the mucous membrane, its structure resembling that of the glands with which the membrane is furnished, and it quickly in?ltrates the other coats of the intestine and then invades neighbouring organs. Secondary growths in most cases occur soon in the lymphatic glands within the abdomen and in the liver. The symptoms appear gradually and consist of diarrhoea, alternating with attacks of constipation, and, later on, discharges of blood or blood-stained ?uid from the bowels, together with weight loss and weakness. A growth can be well advanced before it causes much disturbance. Treatment is surgical and usually this consists of removal of the whole of the rectum and the distal two-thirds of the sigmoid colon, and the establishment of a COLOSTOMY. Depending upon the extent of the tumour, approximately 50 per cent of the patients who have this operation are alive and well after ?ve years. In some cases in which the growth occurs in the upper part of the rectum, it is now possible to remove the growth and preserve the anus so that the patient is saved the discomfort of having a colostomy. RADIOTHERAPY and CHEMOTHERAPY may also be necessary.... rectum, diseases of

Super?cial re?exes comprise the sudden movements which result when the skin is brushed or pricked, such as the movement of the toes that results from stroking the sole of the foot.

Deep re?exes depend upon the state of mild contraction in which muscles are constantly maintained when at rest, and are obtained, as in the case of the knee-jerk (see below), by sharply tapping the tendon of the muscle in question.

Visceral re?exes are those connected with various organs, such as the narrowing of the pupil when a bright light is directed upon the EYE, and the contraction of the URINARY BLADDER when distended by urine.

Faults in these re?exes give valuable evidence as to the presence and site of neurological disorders. Thus, absence of the knee-jerk, when the patellar tendon is tapped, means some interference with the sensory nerve, nerve-cells, or motor nerve upon which the act depends – as, for example, in POLIOMYELITIS, or peripheral NEURITIS; whilst an exaggerated jerk implies that the controlling in?uence exerted by the BRAIN upon this re?ex mechanism has been cut o? – as, for example, by a tumour high up in the SPINAL CORD, or in the disease known as MULTIPLE SCLEROSIS (MS).... reflex action

Rehobothe, Rehobotha, Rehobothia... rehoboth

Habitat: Konkan, and the South Andamans.

Action: Root—used for the treatment of respiratory affections, common cold and influenza.

Habitat: North-eastern India.

Action: Root bark—used for the treatment of respiratory troubles. Stem—febrifuge. Leaves—scorched and given to women during confinement. Powdered leaves and roots are applied to sores and wounds.

Rekhah, Reka, Rekah... rekha

Remphana, Remphane, Remphaine, Remphayn, Remphena, Remphaen, Remphaina, Remphayna, Remphaena... remphan

Habitat: Maharashtra, Karnataka.

Action: Root—use for obstinate skin diseases and pruritus; also for disinfecting genitourinary tract and for promoting conception. Alocasia indica and Eulophia nuda are also known as Maanakanda in Indian medicine. Alocasia indica is used in Siddha medicine as an anti-inflammatory and diuretic herb.... remusatia vivipara

Remi, Remie, Remmy, Remmi, Remmie, Remy, Remmey, Remey, Rhemy, Rhemmy, Remee, Remmee... remy

Reena, Reene, Rina, Rinah, Rinna, Rinnah, Renna, Rennah... rena

Reneeta, Renyta, Reneata, Renieta, Reneita... renita

Renukah, Renooka, Renookah, Renouka, Renoukah... renuka

Rephidima, Rephydim, Rephydima, Rephidem, Rephydem, Rephedem... rephidim

In 1997 the Royal College of Psychiatrists in the UK produced a comprehensive report which was sceptical about the notion that the awareness of recurrent severe sexual abuse in children could be pushed entirely out of consciousness. The authors did not believe that events could remain inaccessible to conscious memory for decades, allegedly provoking vague non-speci?c symptoms to be recovered during psychotherapy with resolution of the symptoms. Supporting evidence pointed to the lack of any empirical proof that unconscious dissociation of unpleasant memories from conscious awareness occurred to protect the individual. Furthermore, experimental and natural events had shown that false memories, created through suggestion or in?uence, could be implanted. Many individuals who had claimed to have recovered memories of abuse subsequently withdrew and, often, non-speci?c symptoms allegedly linked to suppression worsened rather than improved as therapy to unlock memories proceeded. The conclusion is that recovered memory therapy should be viewed with great caution.... repressed memory therapy

Resedah, Reselda, Resedia, Reseldia... reseda

Ethics of research Although Britain has had legislation governing aspects of research on animals since the 19th century, there is no over-arching statute regulating research on humans and human material. Such activity is covered in law by the vaguely de?ned common-law concept of consent, and by piecemeal legislation such as the DATA PROTECTION ACT 1998 and the HUMAN FERTILISATION & EMBRYOLOGY ACT 1990. Nevertheless, extensive and very detailed ethical guidance on aspects of research has been published by a wide range of national and international organisations (see ETHICS COMMITTEES). Several basic principles feature in all statements about research ethics: these include the importance of ensuring that research is independently and rigorously scrutinised by appropriately constituted ethics committees; verifying that any risk to the research subject is reasonable in relation to the anticipated bene?t; and ensuring that all e?orts are made to minimise possible harm. The research subject’s willingness to tolerate some risk does not relieve researchers of the responsibility of making sure that all risks are kept to a minimum. Above all, a key feature of ethical research has involved seeking informed consent from research participants. This rule, initially applied to actual involvement by human subjects in research, has gradually been extended to include seeking informed consent from patients or from their relatives to the use of data and to the use of human organs and tissue in research, including after POST-MORTEM EXAMINATION. (See also EVIDENCE-BASED MEDICINE.)... research

0.1 and 1 per cent. A ?gure of 1 per cent means that, in the United Kingdom at any one time, maybe 30 studies are being conducted, or their results published, which could contain false information. Examples include forged ethics-committee approval, patient signatures and diary cards; fabricated ?gures and results; invention of non-existent patient subjects; or sharing one electrocardiogram or blood sample amongst many subjects.

Research fraud should be ?rst suspected by a clinical-trial monitor who recognises that data are not genuine, or by a quality-assurance auditor who cannot reconcile data in clinical-trial report forms with original patient records. Unfortunately, it often comes to light by chance. There may be suspicious similarities between data ostensibly coming from more than one source, or visits may have been recorded when it was known that the clinic was shut. Statistical analysis of a likely irregularity will frequently con?rm such suspicion. The motivation for fraud is usually greed, but a desire to publish at all costs, to be the original author of a medical breakthrough, to bolster applications for research grants, or to strengthen a bid for more departmental resources are other recognised reasons for committing fraud.

In the USA, those proved to have committed fraud are debarred from receiving federal funds for research purposes or from undertaking government-funded therapeutic research. The four Nordic countries (Denmark, Finland, Norway and Sweden) have committees on research dishonesty that investigate all cases of suspected research misconduct. In the United Kingdom, an informal system operated by the pharmaceutical industry, using the disciplinary mechanism of the General Medical Council (GMC), has led to more than 16 doctors in the past ten years being disciplined for having committed research fraud. Editors of many of the world’s leading medical journals have united to form the Committee on Publishing Ethics, which advises doctors on proper practice and assists them in retracting or refusing to publish articles found or known to be false. (See ETHICS; ETHICS COMMITTEES.) Where an author does not o?er a satisfactory explanation, the matter is passed to his or her institution to investigate; where an editor or the committee is not satis?ed with the result they may pass the complaint to the appropriate regulatory body, such as the GMC in Britain.... research fraud and misconduct

Habitat: Indigenous to western Europe; grown in gardens in India.

Action: Plant—diuretic, diaphoretic, anthelmintic.

Reuelah, Reuella, Reuellah, Reuelia, Reuelea, Reueliah, Reueleah... reuela

The cause is not known, but there is evidence that ASPIRIN may also play a part in its causation. Doctors recommend that children should be given PARACETAMOL in place of aspirin. The initial feature is severe, persistent vomiting and fever. This is followed by outbursts of wild behaviour, DELIRIUM and CONVULSIONS terminating in COMA and death, often from liver failure. The MORTALITY rate is around 23 per cent, and 50 per cent of the survivors may have persistent mental or neurological disturbances. The younger the patient, the higher the death rate and the more common the permanent residual effects. Since aspirin has no longer been licensed for use in children and young people the incidence of the condition has fallen dramatcally. Some cases, previously thought to be Reye’s syndrome, have subsequently turned out to have been due to certain inherited metabolic diseases and to be unconnected with aspirin.... reye’s syndrome

Rezah, Rezia, Reziah, Rezi, Rezie, Rezy, Rezee, Resi, Resee, Resie, Resea, Resy, Resey, Rezea, Resea... reza

Habitat: Western Himalayas from Simla to Kumaon at an altitude of 2,300 to 2,600 m.

Action: Plant—anticonvulsant, anti-inflammatory, anti-ulcer.

Habitat: Native to Europe; introduced in Kashmir, Himachal Pradesh, Bhutan and the Nilgiris.

Action: Bark—stool-softener, non-habit forming stimulant laxative, pancreatic stimulant. Used for dyspepsia and habitual constipation.

Habitat: Throughout Himalayas, Khasi and Jaintia Hills, hills of Orissa, Madhya Pradesh, and the Nilgiris.

Action: Ripe fruit—purgative, emetic. Given in the affections of spleen. (Purgative action not found in the bark.)

Habitat: Deccan Peninsula, Coromandel Coast, Malabar and southwards to Sri Lanka.

Action: Antidote to poisonous inflictions; used against bites of poisonous raptiles.... rhaphidophora laciniata

Rhawne, Rhaun, Rhaune, Rhawna, Rhauna... rhawn

Rhaxmah, Rhaxima, Rhaxmia, Rhaxmana, Rhaxmae, Rhaxmai... rhaxma

Habitat: Hills of Peninsular India, up to an altitude of 2,000 m.

Action: Bark—bitter, astringent and deobstruent.

Habitat: Sub-alpine Himalayas, from Kashmir to Sikkim at altitudes of 3,300-5,200 m.; also cultivated in Assam.

Action: Purgative, astringent, aperient. Used for constipation and atonic dyspepsia. Not advised for patients suffering from gout, rheumatism, epilepsy. (When given internally, the root imparts a deep tinge to the urine.)

Habitat: The Himalayas from Nepal to Bhutan at 3,900-4,800 m.

Action: The roots resemble those of Rheum emodi, but are spongy and inert. Stems are acidic, used as salad. Dried leaves are sometimes used as a substitute for tobacco.... rheum nobile

Habitat: Western Himalayas. Folk: Archa.

Action: Antispasmodic, muscle relaxant, antiseptic.

Rhiamone, Rhiamona, Rhiamonia, Rhiamonea, Rhyamon, Rhyamone, Rhyamona, Rhyamonia, Rhyamonea... rhiamon

Rheanna, Rheanne, Rhiana, Rhiann, Rhianna, Rhiannan, Rhianon, Rhyan, Riannon, Rianon, Rheann, Rhian, Rhiain, Rhyanon, Rhyannon... rhiannon

Habitat: Southeast Tibet, West and Northwest China.

Action: Astringent and cathartic (anthraquinones are laxative and tannins astringent), stomachic, aperient, cholinergic, gastric stimulant, antispasmodic, anti-inflammatory, antiseptic. Used for indigestion, diarrhoea, dysentery and disorders of liver and gallbladder.

Rhodeia, Rhodia, Rhodie, Rhody, Roda, Rodi, Rodie, Rodina, Rodyna, Rodine, Rhodyna, Rhodine, Rhodina, Rhodee, Rhodea... rhoda

Habitat: Throughout the greater part of India.

Action: Leaf, seed and root—used for skin diseases. A paste of the root, with lime juice, is applied externally to eczema, ringworm and Dhobi's itch.

Habitat: The Sunderbans and along the Coromandel Coast and the Andamans.

Action: Bark—astringent. Used in the treatment of haemorrhages, haematuria.

Habitat: The alpine Himalayas from Himachal Pradesh to Bhutan, from 3,000 to 5,000 m.

Action: Leaves—stimulant. The plant yields an incense. The leaves of R. anthopogon get mixed up with those of Abies webbiana (used for respiratory diseases).

Habitat: The temperate Himalayas from Kashmir to Bhutan, the Nilgiris, Khasi Hills and Travancore.

Action: Leaf—anticephalalgic (applied to the forehead). Leaf and stem-bark—spasmolytic. Flowers— used in diarrhoea and dysentery.