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By A. Temmy. Grinnell College.

The percent inhihition of blood glucose levels of ethanol extract and glibenclamide were 38 buy 10 mg crestor mastercard. Using adrenaline-induced diabetic rabbits 10mg crestor amex, both aqueous and ethanolic extracts of the whole plant of Scoparia dulcis Linn generic crestor 10 mg fast delivery. Dried crude powder sample and aqueous extract contained glycosides, steroids, polyphenol, tannin, carbohydrates and reducing sugar whereas glycosides, steroids, polyphenol and tannin were present in ethanolic extract. Extracts of the following Myanmar medicinal plants were tested for their hypoglycemic effects on glucose-loaded and diabetic rabbit models. Fresh leaves juices of Cassia glauca and Aegle marmelos and fresh fruit juice of Morinda angustifolia were also investigated. The ethanolic extract had more hypoglycemic effect than watery extract of Orthosiphon aristatus. Extracts of other selected plants produced no hypoglycaemic effects on the glucose loaded hyperglycaemia rabbit model. Probable, structural features of the compounds are being speculated on the light of the present data. A clinical trial to determine the hypoglycemic potential of locally grown Momordica charantia Linn. Fruit powder was carried out on 26 non-insulin dependent diabetes mellitus patients for a period of 28 days during which their diet, exercise, smoking and all medications except anti-hypertensives were restricted. It was found that the fruit powder had highly significant effect on the glucose tolerance patterns in 92. Clinically evident side effects were not detected and it had no effect on liver function test, blood urea and cholesterol levels. The reputed hypolipidiemic effect of locally grown saffron Carthamus tinctorius L. The 80% ethanolic extract of saffron leaves and stem (2g/Kg) and Standard drug lovastatin (500mg/Kg) intraperitoneally. The mean blood total cholesterol levels of the saffron leaves and stem treated group were82. Both saffron leaves and stem treated rat showed not significant lowering the total cholesterol but the standard lovastatin treated rat showed significant lowering the total cholesterol (p<0. Hypolipidiemic effect of (ovJoD;) seed on triton induced hyperlipidiemic rat model. The 70% ethanolic extract of (ovJoD;) seed (2g/Kg) and Standard drug Lovastatin (500mg/Kg) intraperitoneally. The 70% ethanolic extract of (ovJoD;) seed treated rat showed not significant lowering the total cholesterol but the standard lovastatin treated rat showed significant lowering the total cholesterol(p<0. Khin Kyi Kyi; Mya Bwin; Sein Gwan; Chit Maung; Aye Than; Mya Tu, M; Tha, Saw Johnson. Early trials with the water-alcohol soluble extract in a dose of 125mg/kg given intravenously were found to produce a fall in arterial blood pressure of 20-40mmHg. Further fractionation of the extract was carried out and screened for hypotensive activity. The fraction designated F-7 produced a fall in the arterial blood pressure which was sustained up to 1 hour. An indigenous medicinal plant growing in Myeik, Tanintharyi Division whose bitter fruit commonly known as Yardan-zeet is very similar to the vernacular name of the Chinese drug "Yardan-zeet" the ripe bitter fruit of Brucea javanica (L. Due to the similarity in the common names, the specific name of Yardan-zeet plant obtained from Myeik was identified taxonomically. Yardan-zeet fruit available in Yangon market as antidysenteric drug was also identified by comparing the macroscopic features and microscopic characters with that of the identified Yardan- zeet from Myeik. The macroscopic features and microscopic characters of Myeik and market Yardan-zeet fruits were identical. The findings from this study reveals that Yardan-zeet fruits are of the same species as the Chinese drug "Yadanzi" the bitter fruit of Brucea javanica (L. Identification of cultivated chounggyah plant and comparative pharmacognostic studies with market sample. Comparative pharmacognostical, physicochemical and phytochemical studies revealed that cultivated and market Chounggyah are not identical. Identification of omega-3 fatty acid and evaluation of antioxidant activity on seed of Perilla frutescens (L. The primary aim of this study was to identify alpha linolenic acid (omega-3 fatty acid) in Perilla seed oil and the secondary aim was to evaluate the antioxidant activity of Perilla seed. Perilla seed oils yields were studied by driect pressing method, extracted with petroleum ether by refluxing method and Soxhlet extraction method, and were found that the yield percents were 29-44%, 26-35% and 36-45% respectively. Each sharp peak with the relevant molecular weight was identified as 9, 12, 15-Octadecatrienoic acid methyl ester (omega-3 or δ-linolenic acid methyl ester), 9, 12-Octadecatrienoic acid methyl ester (omega-6 or linolenic acid methyl ester), 9 Octadecatrienoic acid methyl ester (omega-9 or linolenic acid methyl ester) respectively. Among these fatty acids, the propotion of of δ- linolenic acid known as omega-3 fatty acids was found to be greatest (81%). In-vitro and in-vivo antimicrobial activity of essential oil and thymol obtained from Carum copticum Benth and Hook. The aim of study is to determine the in-vitro and in-vivo antimicrobial activity of essential oils and isolated thymol from Carum copticum and to evaluate the acute toxicity of isolated thymol. The essential oils of air-dried fruit samples were obtained by hydrodistillation method. It was observed that essential oil, standard and isolated thymol was effective against S. In-vivo study, open wounds were induced by Staphylococcus aureus strain in albino rats and treated with essential oil, isolated thymol, and standard th thymol.

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In vitro digestion of plant powder underwent gastric phase and intestinal phase of digestion discount 20 mg crestor mastercard. Ethanol and aqueous extract of crude powder cheap 5mg crestor otc, enzyme digested products and digestive enzymes were compared by thin layer chromatography generic 5mg crestor with visa. Compounds of the digested products represent major and prominent substance markers of both extracts and new substance markers were also appeared. Formation of same substance markers in enzyme digested products relative to ethanol or aqueous extract was 100% (n=6/6; n=11/11). Formation of different substance markers in enzyme digested products relative to ethanol of aqueous extract was 66. These simulated digested materials may represent the bioavailable products which can give pharmacological actions in human biological system. The bioavailable products of the particular plant resulting from this digestion tool can be used as more sensible new testable product of in vitro efficacy determination. It is concluded that this technique could serve as a test of bioavailability of traditional medicine which have undergone in vitro digestion: Beyond extraction technique. The effects of two different extracts of three medicinal plants namely Piper betle L. The extracts inhibited the contractions of guinea pig tracheal muscle induced by carbachol and histamine stimulation. The alcoholic extracts also inhibited the spontaneous movement of guinea pig ileum induced by histamine stimulation. These data suggest that the alcoholic extracts have antihistaminic and anti 5- hydroxytryptamine effects and the active principle may probably resides in the saponin glycoside component. C) (watery and 50% ethanolic extract) was studied in laboratory animals; albino rats of Wistar strain. The phytochemical analysis of watery and 50% ethanolic extract was done and results showed that both extract contained glycosides, flavonoids, steroid, polyphenol, tanninoids, saponin and reducing sugar. Acute toxicity study of both watery and ethanolic extract was done by using albino mice. The diuretic effect of watery and ethanolic extract was studied on albino rats of same sex weighing from 160-260gm. They were then put into metabolic cages after giving watery and ethanolic extract orally and urine was collected for 5 hours. Diuretic effect of both watery and ethanolic extract was carried out by using six dosage levels i. Significant diuretic effect was found in both watery and ethanolic extract of Alysicarpus vaginalis (D. The diuretic effect was found to have dose dependant effects for both watery and ethanolic extract. But the diuretic response produced by watery extract was greater than ethanolic extract for same dosage level. Urinary electrolytes content such as Na and + K in the urine of tested animals were determined by using digital flame analyzer. C) on albino rats was studied by giving watery extract 9g/kg body weight for one month period. In conclusion, a definite diuretic effect was seen with both watery and ethanolic extract of Alysicarpus vaginalis (D. The watery extract produced more powerful diuretic response than ethanolic extract of the plant. C) showed no demonstrable toxicity in both live animal and histology after autopsy. The aim of this is to determine the diuretic potential of Centella asiatica (-rif;cGm) on healthy volunteers. The whole plants were purchased from market and were extracted in Pharmacology Research Division. This extract was physicochemically and phytochemically standardized by using standard quality control method. Nine out of 18 healthy volunteers were put under the controlled setting of over night fasting. Fluid intake was restricted up to 250ml and only a standardized meal was allowed immediately preceding the drugs administration. On the next day the subjects were again put under these conditions and text extract (5g) was given orally. After one-week rest the same procedure was repeated with standrd furosemide 40mg orally. Urine volumes were measured and urinary electrolytes (sodium and potassium) were determined by using digital flame analyzer. Urinary sodium excretion of Centalla asiatica and furosemide showed significant increase (p<0. Urinary potassium excretion of Centella asiatica did not showed significant increase but the urinary potassium excretion of furosemides showed significant increase (p<0. May Aye Than; Than Than Lwin; Mu Mu Sein Myint; Mar Mar Myint; San San Myint; Aung Aung Maw; Nu Nu Win; Ei Ei Soe. The aim of this study was to evaluate the diuretic activity of Hydrocotyle umbellata Linn. The plants were collected from Yangon area and were extracted in Pharmacology Research Division. Urine volume was measured and urinary electrolytes (sodium and potassium) were determined by using digital flame analyzer. The watery extract 3gm/kg and 6gm/kg body weight treated groups showed significant increase in mean urine volume (p<0.

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In the past 30 or so years there have been tremendous advances in the understanding of the ways in which many natural therapies and compounds work to promote health or treat disease discount 20 mg crestor otc. Even in mainstream medicine there is a growing trend toward using substances found in nature crestor 5 mg low price, including compounds naturally found in the human body such as interferon discount crestor 5 mg with amex, interleukin, insulin, and human growth hormone, in place of synthetic drugs. Add to this the growing popularity of nutritional supplements and herbal products and it is quite obvious that a trend is emerging toward natural medicine. Suffice it to say that it appears that the concepts and philosophy of naturopathic medicine will persist and be a major part of the medicine of the future. A placebo supposedly does not have a medicinal effect, yet these “sugar pills” and sham treatments often produce tremendous effects. One of the more dramatic examples of the placebo effect reported in medical literature involves a patient of Dr. Bruno Klopfer, a researcher involved in the testing of the drug Krebiozen back in 1950. Wright, had huge tumor masses throughout his body and was in such desperate physical condition that he frequently had to take oxygen by mask, and fluid had to be removed from his chest every two days. Klopfer was involved in research on Krebiozen, he begged to be given Krebiozen treatments. Dr Klopfer gave them, and the patient’s recovery was startling: “The tumor masses had melted like snowballs on a hot stove, and in only a few days, they were half their original size! Wright was discharged from the hospital and had regained a full and normal life, a complete reversal of his disease and its grim prognosis. However, within two months of his recovery, a report that Krebiozen was not effective was leaked to the press. Suspicious of the patient’s relapse, his doctors decided to take advantage of the opportunity to test the dramatic regenerative capabilities of the mind. The patient was told that a new version of Krebiozen had been developed that overcame the difficulties described in the press, and some of the drug was promised to him as soon as it could be procured. With much pomp and ceremony a saline water placebo was injected, increasing the patient’s expectations to a fevered pitch. Recovery from his second near terminal state was even more dramatic than the first. Wright’s tumor masses melted, his chest fluid vanished, and he became a true picture of health. Then a definitive announcement appeared in the press: “Nationwide tests show Krebiozen to be a worthless drug in the treatment of cancer. Recent research demonstrates that the placebo response is a complex phenomenon, initiated by the mind and leading to a cascade of real, measurable effects. In brief, the placebo response is the activation of the healing centers of our being in a way that produces profound physiological changes. The first is the inherent internal healing mechanism, vital force, chi, or primitive life support and repair mechanism that operates even in a person who is asleep, unconscious, or comatose. The second mechanism involves the power of the mind and emotions to intervene and affect the course of health and disease in a way that enhances or supersedes the body’s innate vital force. The placebo response seems to involve activation of the higher control center, but that is not to say that its effects are solely in the mind. He has conducted some very detailed studies trying to discover the underlying features of the placebo response. In roughly 56% of patients in clinical studies, a placebo saline injection is as effective as morphine for severe pain; furthermore, this pain relief can be completely nullified by adding naloxone, a drug that blocks the effects of morphine, to the saline. As a result of these sorts of experiments, a great deal of the credit for the placebo response has been given to endorphins, but Dr. Benedetti’s research has shown that a placebo can produce much more profound changes than simply increasing endorphin levels. For example, he has shown that a saline placebo can reduce tremors and muscle stiffness in people with Parkinson’s disease. That is not surprising, perhaps, but what is very interesting is that researchers found that at the same time that the placebo produced noticeable improvements in symptoms, there was a significant change in the measured activity of neurons in the patients’ brains as shown by a brain scan. In particular, as they administered the saline they found that individual neurons in the subthalamic nucleus (a common target for surgical attempts to relieve Parkinson’s symptoms) began to fire less often and with fewer “bursts”—a characteristic feature associated with Parkinson’s tremors. Somehow the saline placebo resulted in the processing of the information by healing centers in the brain to specifically target an effect that would reduce the dysfunction in the areas of the brain affected by Parkinson’s disease. Other studies have shown that both the placebo response and the experience of particular emotions produce demonstrable changes in brain activity visible through modern imaging techniques (e. For example, one study showed that expectation or hope is able to stimulate the part of the brain that is activated by pain medications and associated with pain relief. In addition, numerous changes in chemical mediators of pain, inflammation, and mood have also been demonstrated with the placebo response. The bottom line here is that there is tremendous evidence that the placebo response is a highly specific and targeted healing effect that is triggered by both conscious and unconscious activity in the brain. Rather than discounting and trying to avoid a placebo response, modern medicine should be more intent on developing techniques and practices designed to stimulate the same healing centers within patients as noted in these studies with placebos. In order for a drug to be approved it must show a therapeutic effect greater than that of a placebo. Because the outcome of a trial can be affected by both doctors’ and patients’ beliefs about the value of a treatment, most placebo-controlled trials are usually conducted in double-blind fashion: that is, not only are the patients unaware when they are receiving a placebo; the doctors are unaware as well. Beecher published his groundbreaking paper “The Powerful Placebo,” in which he concluded that across the 26 studies he analyzed, an average of 32% of patients responded to a placebo. The reason is that in the real world the placebo response is enhanced by both the doctor’s and the patient’s expectations. Conditions That Respond Significantly to Placebo Angina Anxiety Arthritis Asthma Behavioral problems Claudication, intermittent Common cold Cough, chronic Depression Diabetes (type 2) Drug dependence Dyspepsia Gastric ulcers Hay fever Headaches Hypertension Insomnia Labor and postpartum pain Ménière’s disease Menstrual cramps Nausea of pregnancy Pain Premenstrual syndrome Psychoneuroses Tremor The Holy Trinity of the Placebo Response Noted Harvard psychologist Herbert Benson, M.

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Effects of dehydroepiandrosterone supplement on health-related quality of life in glucocorticoid treated female patients with systemic lupus erythematosus cheap crestor 20 mg. Effects of dehydroepiandrosterone on fatigue and wellbeing in women with quiescent systemic lupus erythematosus: a randomised controlled trial order 5mg crestor with amex. Altered estrogen metabolism and excretion in humans following consumption of indole-3- carbinol generic 5 mg crestor mastercard. Examination of strains of lactobacilli for properties that may influence bacterial interference in the urinary tract. Probiotic Lactobacillus dose required to restore and maintain a normal vaginal flora. Efficacy and safety of vitamin C vaginal tablets in the treatment of non-specific vaginitis. European Journal of Obstetrics & Gynecology & Reproductive Biology 2004; 117(1): 70–75. Monilial and trichomonal vaginitis—topical treatment with povidone iodine treatments. Comparison of povidone-iodine (Betadine) vaginal pessaries and lactic acid pessaries in the treatment of vaginitis. Leg edema protection from buckwheat herb tea in patients with chronic venous insufficiency: a single-center, randomized, double-blind, placebo-controlled clinical trial. Venous ulcers: microcirculatory improvement and faster healing with local use of Pycnogenol. Prevention of venous thrombosis and thrombophlebitis in long-haul flights with pycnogenol. Improvement of signs and symptoms of chronic venous insufficiency and microangiopathy with Pycnogenol: a prospective, controlled study. Rapid relief of signs/symptoms in chronic venous microangiopathy with Pycnogenol: a prospective, controlled study. Control of edema in hypertensive subjects treated with calcium antagonist (nifedipine) or angiotensin-converting enzyme inhibitors with Pycnogenol. Comparison of Pycnogenol and Daflon in treating chronic venous insufficiency: a prospective, controlled study. Micronised purified flavonoid fraction: a review of its use in chronic venous insufficiency, venous ulcers and haemorrhoids. A possible role of lysosomal enzymes in the pathogenesis of varicosis and the reduction in their serum activity by Venostasin. Horse-chestnut seed extract for chronic venous insufficiency: a criteria-based systematic review. Treatment of superficial vein thrombosis: clinical evaluation of Essaven gel —a placebo-controlled, 8-week, randomized study. Comparison of leg compression stocking and oral horse-chestnut seed extract therapy in patients with chronic venous insufficiency. Chemical, pharmacological and clinical profile of the East Asian medical plant Centella asiatica. Comparative efficacy of a single daily dose of two capsules of Cyclo 3 Fort in the morning versus a repeated dose of one capsule morning and noon. An open-label, randomized multicenter study comparing the efficacy and safety of Cyclo 3 Fort® versus hydroxyethyl rutoside in chronic venous lymphatic insufficiency. The relationship between high fibrinolytic activity and daily capsicum ingestion in Thais. Protective effect of garlic oil on the changes produced by 3 weeks of fatty diet on serum cholesterol, serum triglycerides, fibrinolytic activity and platelet adhesiveness in man. Effects of aqueous extracts of onion, garlic and ginger on the platelet aggregation and metabolism of arachidonic acid in the blood vascular system. Sign up for our newsletter and receive special offers, access to bonus content, and info on the latest new releases and other great eBooks from Atria Books and Simon & Schuster. In anaesthesiology, the debate continues about whether a Sell- ick manoeuvre (backward pressure on the cricoid cartilage) is a necessary component of a rapid-sequence intubation. The question for an author assigned the task of writing the airway chapter in a new edition of a standard textbook is different from that of an investi- gator interested in revisiting the question of whether or not the technique is bene¿cial. For one, it is a matter of adjudicating the technique’s inclusion; for the other, it is a question of hypothesis and result. For the student, the standard text becomes the gold standard; for the experienced practitioner, the hypothesis-driven study may become the foundation of a new reality. The tension is clear and the discriminatory responsibility of author–reader relationship is highlighted. Another dif¿culty for the author is the necessity of catering to multiple reader types in a single manuscript or chapter. It is apparent that readers vary in their attention span and the manner in which they obtain and process information. For some, the text itself is the key; for others, the graphics, ¿gures and tables are the most important area and primary focus. Although most authors perceive their articles to be a consistent whole, the most discerning provide each reader a content and style with a unique experience, ensuring that graphs, ¿g- ures, tables and text tell the story independently yet collaboratively. Figures and tables are felt to be the most effective way to present results, but much of the standard textbook relies on a complete, easily understood explanation of technique or process. All graphic material should be presented in a manner that is easy to interpret, and the captions or titles should be understandable independently of the accompanying text. It is dangerous to suppose that the reader will follow the author’s detailed logic to gain an independent interpretation of the data; rather, the author must sell the message in all locations. This is a dif¿cult task and one that becomes increasingly complex as the subject matter broadens and the available information is more expert opinion than objective data.

A summary review of two placebo-controlled studies cheap 5mg crestor, two comparative trials (both lasting 12 to 24 weeks) effective crestor 5 mg, and three double-blind studies of 444 men showed that although Cernilton did not improve urinary flow rates purchase crestor 20mg amex, residual volume, or prostate size, it did improve self-rated urinary symptom scores and reduced nighttime urinary frequency compared with a placebo and an amino acid mixture. Pygeum The bark of Pygeum africanum, an evergreen tree native to Africa, has historically been used in the treatment of urinary tract disorders. Virtually all of the research on pygeum has featured an extract standardized to contain 14% triterpenes, including beta-sitosterol and 0. This extract has been extensively studied in both experimental animal studies and clinical trials with humans. A study on rat prostatic cells suggests that the therapeutic effect of pygeum may be due in part to the inhibition of growth factors (e. However, there may be circumstances where pygeum is more effective than saw palmetto. For example, saw palmetto has not been shown to produce some of the effects on prostate secretion that pygeum has. Of course, as the two extracts have somewhat overlapping mechanisms of actions, they can be used in combination. Fewer studies have been done with stinging nettle root extract than with the other botanical medicines discussed. A randomized, multicenter, double-blind study of 431 patients using both the extracts of saw palmetto and stinging nettle found clinical benefit equal to that of finasteride. It is important to limit the consumption of meat and other animal products; alcohol and coffee; drug-, pesticide-, and hormone-contaminated foods; and cholesterol-rich foods. It affects few blacks in tropical zones but is more common among blacks in temperate zones. It appears commonly among Japanese but is rare in American Indians and is entirely absent in natives of the Andean region of South America. The nails take on a characteristic thimble-like appearance referred to as “oil drop” stippling. Causes Psoriasis is caused by a pileup of skin cells that have replicated too rapidly. The rate at which skin cells divide in psoriasis is roughly one thousand times greater than in normal skin. This high rate of replication is simply too fast for the cells to be shed, so they accumulate, resulting in the characteristic silvery scale of psoriasis. The frequency of psoriasis is increased in people with certain genetic markers, reflecting a possible genetic error in the control over how skin cells divide. The genetic link is also confirmed by the observation that 36% of psoriasis patients have one or more family members with psoriasis. There are also multiple defects noted in the skin and immune cells of psoriatic patients, indicating a complex interplay of genetic factors. It appears that rather than being a disorder of the skin cells, psoriasis is primarily a condition that affects the immune system. There is a clear relationship between psoriasis and conditions associated with altered gastrointestinal permeability, such as celiac disease10 and Crohn’s disease, 11 and in conditions associated with impaired liver function. Therapeutic Considerations Although psoriasis has a significant genetic component, addressing the factors that can activate the immune system or skin cells can result in significant clinical improvement. Incomplete Protein Digestion Incomplete protein digestion or poor intestinal absorption of protein breakdown products can result in elevations of amino acids and polypeptides in the bowel. In particular, toxic metabolites of the amino acids arginine and ornithine, known as polyamines (e. These polyamines have been shown to contribute to the excessive rate of cell proliferation in psoriasis. For example, vitamin A and the alkaloids of goldenseal (Hydrastis canadensis) such as berberine inhibit bacterial decarboxylase, the enzyme that converts amino acids into polyamines. See the chapter “Digestion and Elimination” for more information, as ensuring proper digestion is a key step in dealing with psoriasis. Bowel Toxemia A number of gut-derived toxins are also implicated in the development of psoriasis, including endotoxins (cell-wall components of gram-negative bacteria), Candida albicans, and yeast compounds. A diet low in dietary fiber is associated with increased levels of gut-derived toxins. It is therefore essential that the diet of an individual with psoriasis be rich in beans, fruits, and vegetables. Natural compounds that bind endotoxins and promote their excretion may also be used. For example, an aqueous extract of the herb sarsaparilla (Smilax sarsaparilla) was found in a 1942 study to be effective in psoriasis, particularly the more chronic, large-plaque-forming variety. This benefit is apparently due to the components of sarsaparilla binding to bacterial endotoxins and promoting their excretion. Because the severity of psoriasis as well as therapeutic response have been shown to correlate well with the level of circulating endotoxins, control of gut-derived toxins is important in the treatment of psoriasis. Liver Function The correction of abnormal liver function may be of benefit in the treatment of psoriasis. If hepatic function is compromised by excessive levels of these toxins from the bowel or if there is a decrease in the liver’s detoxification ability, the systemic toxin level rises and the psoriasis worsens. Silymarin, the flavonoid component of milk thistle (Silybum marianum), has been reported to be of value in the treatment of psoriasis. In the absence of sufficient amounts of bile acids, endotoxins can move into the bloodstream and produce a variety of problems, including the release of inflammatory cytokines known to play a role in psoriasis. A study of 800 psoriatic patients was conducted in which 551 were treated with oral bile acid (dehydrocholic acid) supplementation for one to six weeks for acute cases and three to eight weeks for chronic cases. Both groups were encouraged to eat a diet high in vegetables and fruits and were instructed to avoid hot spices, alcohol, raw onion, garlic, and carbonated soft drinks.

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The difficulty in distinguishing between clinical signs originating from the upper versus the 22 lower respiratory system makes the diagnosis and treatment of these problems challenging order crestor 10mg overnight delivery. Respira- tory health is best maintained by frequent exposure to fresh air and sunlight generic crestor 20mg with mastercard, a proper plane of nutrition and flighted exercise crestor 5mg free shipping. Harrison ate subtle changes in posture, wing position, respira- tory rate and respiratory pattern that may indicate an abnormality. A bird uses its intercostal muscula- ture to expand and depress its chest, creating a “bel- lows” action that moves air into and out of the respi- ratory system. An increase in abdominal effort or head movement may be recognized in association with increased respira- tion following exercise, but should return to normal within minutes of ceasing exertional activity. Lung and lower respiratory tract problems are usually associated with a rhyth- mic jerking of the tail (tail-bob). A bird in severe respiratory distress may also move its head forward in an effort to increase air intake. If the respiratory problem is associated with excessive fluid produc- tion, bubbling and gurgling sounds are common on both inspiration and expiration (Table 22. Overt signs of respiratory disease are easy to identify and include oculonasal discharge, stained or matted feathers around the nares, sneezing, coughing, dysp- nea or audible inspirations or expirations (Figure 22. Changes in pitch or vocalization of the patient may indicate problems in the glottis, trachea or syr- inx. The area was thoroughly cleaned and severely matted Dyspnea may be caused by chronic lung or air sac feathers were removed. The discharge was found to be associated consolidation or by an acute reduction in the amount with conjunctivitis and not sinusitis. The bird was successfully managed by fre- induced by protracted respiratory disease, it is usu- quently flushing the eyes with sterile saline. Acute dyspnea in an appar- ently healthy bird usually results from exposure to The first areas to examine for respiratory disease are aerosolized toxins, dislocation and movement of the nares and surrounding tissues. Unilateral or plaques in the trachea (from malnutrition or infec- bilateral diseases of the upper respiratory tract are tious agents) or aspiration of foreign bodies (particu- indicated by matted or mildly stained feathers larly seed husks or cage litter material). Dyspnea around the nostrils, occluded nares, nasal discharge may also be caused by rhinoliths, air sac granulomas, or a growth or change in size of the nasal opening. With the efficiency of the air exchange Clinically important components of the avian respi- system in birds, it is unlikely that this procedure is ratory system include the external nares, operculum, of any value. The infraorbital sinus opens caudally into the cranial and cervical portions of the cervicocephalic air sac and dorsally into the middle nasal concha. By contrast, avian sinuses are restricted laterally by the skin and subcutaneous tissues of the face. The sinuses have simple mucous glands and are lined by stratified squamous and ciliated columnar epithelium. Hypovitaminosis A commonly causes squamous metaplasia and hyper- keratosis of the sinuses and nasal passages, leading to granuloma formation. Sinuses The infraorbital sinus is the only paranasal sinus in birds and is located lateral to the nasal cavity and surrounding the eyes ventrally. No other abnormalities were noted by physical examination, radiog- rous Passeriformes), the right and left infraorbital raphy or clinicopathologic evaluation. The presence of a beak defect from the cere to the tip indicates the The interconnection of the nasal cavity, infraorbital chronicity of the problem. Cellular debris can accumulate between the op- the nasal system make sinus infections difficult to erculum and the wall of the nasal cavity, leading to treat. With severe chronic sinusitis, the accumula- substantial necrosis of the rostral nasal passages and tion of caseous necrotic debris can cause destruction its associated bone (see Chapter 41). This degree of destruction is particularly com- A septum divides the nasal cavity into two halves, mon in Amazon parrots and African Grey Parrots each containing a rostral, middle and caudal nasal with aspergillosis sinusitis. Air that enters the mulation of debris in the infraorbital sinus can lead external nares is warmed and moistened by the to periorbital swellings (Color 22. On the ventral surface are just cranial and dorsal to the choanal slit, which of the palate and along the choana are numerous courses longitudinally in the dorsal oral cavity or roof caudally directed choanal papillae, which are most of the mouth. The choanae are separated into right pronounced in gallinaceous species but are also and left openings by the nasal septum or vomer bone. The paired entrances of the nasal cavity can be viewed with a rigid or flexible endoscope by directing Swollen, inflamed choanal tissues, with a sloughing it through the rostral end of the choanal slit (see of the protruding papillae, are common with upper Color 13). The choanal slit represents the incomplete respiratory tract infections (particularly chlamy- diosis),30 and secondarily infected with candidiasis in fusion of the two bony plates of the hard palate (see Color 8). Instead, air immunosuppressed states following prolonged ill- moves from the nasal cavity through the choana via ness, malnutrition or improper antibiotic admini- the choanal slit (oropharynx) and then into the rima stration. The configuration of the cho- diagnostic indicator of current respiratory disease, as anal slit varies with the species, but in all cases the they seldom regrow after sloughing. These carti- also become lodged in the choanal slit and cause laginous rings may calcify as the bird grows older. Some birds, like the Whooping Crane, have a trachea that ex- tends to the cloaca, where it doubles back and re- Trachea turns to the thoracic inlet before connecting to the The opening of the larynx, or rima glottis, is not syrinx. Other species (Helmeted Curassow) have a covered by an epiglottis as it is in mammals. The similar configuration, but the trachea courses subcu- laryngeal cartilages are reduced or absent. When a bird breathes, the mouth is closed and can be classified as tracheal, tracheobronchial or the mobile glottis seals with the choanal slit, allow- bronchial depending on the location of fusion of the cartilages. There are no vocal cords in the bronchial-type syrinx in which the last of the tra- larynx. The shape of the The trachea is loosely found on the right side of the syrinx and the sound it emits are controlled by the neck, ventral to the esophagus.

It is rarely possible from an inspection of the skin wound alone to com- ment usefully on the width of the blade because the skin retracts and the knife is unlikely to have been introduced and removed perfectly perpendicularly buy crestor 5mg mastercard. Deliberate Self-Harm Deliberate self-harm refers to any attempt by an individual to harm him- self or herself discount 20 mg crestor visa. When assessing injuries generic 20mg crestor otc, it is important to understand which factors may indicate the possibility that an injury was caused by deliberate Injury Assessment 143 Table 4 Indicators of Possible Deliberate Self-Harm Injuries • Must be on an area of body accessible to the person to injure themselves. Individuals injure themselves for numerous reasons, including psy- chiatric illness and others, such as attempting to imply events took place that did not or for motives of gain. Self-inflicted injuries have several characteris- tics, which are not diagnostic but that together may give an indication of self- infliction. Table 4 lists features that may assist in the recognition or suspicion that cuts or other injury, such as scratches, are self-inflicted—all or some may be present—their absence does not preclude self-infliction nor does their pres- ence necessarily imply self-infliction (2). As with all injuries within the forensic setting it is essential in these nonfatal cases that the initial appear- ances of the injuries be accurately described and the wounds photographed. This is particularly important because subsequent surgical treatment may dis- tort or completely obliterate the wound characteristics. Furthermore, any frag- ments, bullets, or pellets found within the wounds must be carefully removed and handed over to the appropriate authorities. Smooth-Bore Weapons Shotguns, which fire a large number of small projectiles, such as lead shot, are the most common type of smooth-bore weapons. They are commonly used in sporting and agricultural activities and may be either single or double- barreled. The ammunition for these weapons consists of a plastic or cardboard cartridge case with a brass base containing a percussion cap. Inside the main part of the cartridge is a layer of propellant, plastic, felt, or cardboard wads and a mass of pellets (lead shot of variable size) (see Fig. In addition to the pellets, the wads and/or cards may contribute to the appearance of the wounds and may be important in estimating range and possible direction. Rifled Weapons Rifled weapons are characterized by having parallel spiral projecting ridges (or lands) extending down the interior of the barrel from the breach to the muzzle. The rifling also leaves characteristic scratches and rifling marks that are unique to that weapon on the bullet surface. There are three common types of rifled weapons: the revolver, the pistol, and the rifle. The Injury Assessment 145 revolver, which tends to have a low muzzle velocity of 150 m/s, is a short- barreled weapon with its ammunition held in a metal drum, which rotates each time the trigger is released. In the self-loading pistol, often called “semi-automatic” or erroneously “automatic,” the ammunition is held in a metal clip-type maga- zine under the breach. Each time the trigger is pulled, the bullet in the breach is fired, the spent cartridge case is ejected from the weapon, and a spring mecha- nism pushes up the next live bullet into the breach ready to be fired. The rifle is a long-barreled shoulder weapon capable of firing bullets with velocities up to 1500 m/s. Most military rifles are “automatic,” allowing the weapon to continue to fire while the trigger is depressed until the magazine is empty; thus, they are capable of discharging multiple rounds within seconds. Shotgun Wounds When a shotgun is discharged, the lead shot emerges from the muzzle as a solid mass and then progressively diverges in a cone shape as the distance from the weapon increases. The pellets are often accompanied by particles of unburned powder, flame, smoke, gases, wads, and cards, which may all affect the appearance of the entrance wound and are dependent on the range of fire. Both the estimated range and the site of the wound are crucial factors in deter- mining whether the wound could have been self-inflicted. If the wound has been sustained through clothing, then important resi- dues may be found on the clothing if it is submitted for forensic examination. It is absolutely essential that the advice of the forensic science team and crime scene investigator is sought when retrieving such evidence. When clothing is being cut off in the hospital, staff should avoid cutting through any apparent holes. The entrance wound is usually a fairly neat circular hole, the margins of which may be bruised or abraded resulting from impact with the muzzle. In the case of a double-barreled weapon, the circular abraded imprint of the nonfiring muzzle may be clearly seen adjacent to the contact wound. The wound margins and the tissues within the base of the wound are usually blackened by smoke and may show signs of burning owing to the effect of flame. Because the gases from the discharge are forced into the wound, there may be subsid- iary lacerations at the wound margin, giving it a stellate-like shape. This is seen particularly where the muzzle contact against the skin is tight and the skin is closely applied to underlying bone, such as in the scalp. Carbon mon- oxide contained within the gases may cause the surrounding skin and soft 146 Payne-James et al. Con- tact wounds to the head are particularly severe, usually with bursting ruptures of the scalp and face, multiple explosive fractures of the skull, and extrusion or partial extrusion of the underlying brain. Most contact wounds of the head are suicidal in nature, with the temple, mouth, and underchin being the sites of election. In these types of wounds, which are usually rapidly fatal, fragments of scalp, skull, and brain tissue may be dispersed over a wide area. At close, noncontact range with the muzzle up to about 15 cm (6 in) from the skin, the entrance wound is still usually a single circular or oval hole with possible burning and blackening of its margins from flame, smoke, and unburned powder. Blackening resulting from smoke is rarely seen beyond approx 20 cm; tattooing from powder usually only extends to approx 1 m. Up to approx 1 m they are still traveling as a compact mass, but between approx 1–3 m, the pellets start to scatter and cause variable numbers of individual satellite punc- ture wounds surrounding a larger central hole.