Remedies

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Albendazole, marketed as Albenza, Eskazole, Zentel, Andazol and Alworm, is a member of the benzimidazole compounds used as a drug indicated for the treatment of a variety of worm infestations. Although this use is widespread in the United States, the U.S. Food and Drug Administration (FDA) has not approved albendazole for this indication. It is marketed by Amedra Pharmaceuticals. Albendazole was first discovered at the SmithKline Animal Health Laboratories in 1972. It is a broad spectrum anthelmintic, effective against: roundworms, tapeworms, and flukes of domestic animals and humans.

MAIN USES

It is effective first line of treatment against:

• Flatworms
• Flukes/trematodes Fasciolosis
• Tapeworm/cestodes
• Cysticercosis
• Echinococcosis
• Nematodes
• Enterobiasis (pinworm infection)
• Trichuriasis (whipworm infection)
• Ascariasis
• Hookworm
• Cutaneous larva migrans (caused by Ancylostoma)
• Filariasis

OTHER USES

In Africa, albendazole (donated by GlaxoSmithKline) is being used to treat lymphatic filariasis as part of efforts to stop transmission of the disease. In sub-Saharan Africa, albendazole is used in conjunction with ivermectin, and elsewhere in the world, the medicine is used in combination with diethylcarbamazine. In Brazil and other countries it is used against giardiasis.

MODE OF ACTION

As a vermicidal, albendazole causes degenerative alterations in the tegument and intestinal cells of the worm by binding to the colchicine-sensitive site of tubulin, thus inhibiting its polymerization or assembly into microtubules. The loss of the cytoplasmic microtubules leads to impaired uptake of glucose by the larval and adult stages of the susceptible parasites, and depletes their glycogen stores. Degenerative changes in the endoplasmic reticulum, the mitochondria of the germinal layer, and the subsequent release of lysosomes result in decreased production of adenosine triphosphate (ATP), which is the energy required for the survival of the helminth. Due to diminished energy production, the parasite is immobilized and eventually dies. Albendazole also has been shown to inhibit the enzyme fumarate reductase, which is helminth-specific. This action may be considered secondary to the effect on the microtubules due to the decreased absorption of glucose. This action occurs in the presence of reduced amounts of nicotinamide-adenine dinucleotide in reduced form (NADH), which is a coenzyme involved in many cellular oxidation-reduction reactions. Albendazole has larvicidal effects in necatoriasis and ovicidal effects in ascariasis, ancylostomiasis, and trichinosis.

DOSAGE

Albendazole is only given orally (PO).

HYDATID DISEASE

Patients 60 kg or greater: 400 mg twice daily, with meals. Patients less than 60 kg: 15 mg/kg/day given in divided doses twice daily with meals (maximum total daily dose 800 mg). Treatment interval: 28-day cycle followed by a 14-day albendazole-free interval, for a total of 3 cycles. NOTE: When administering albendazole in the pre- or post-surgical setting, optimal killing of cyst contents is achieved when 3 courses of therapy have been given.

NEUROCYSTICERCOSIS

Patients 60 kg or greater: 400 mg twice daily, with meals. Patients less than 60 kg: 15 mg/kg/day given in divided doses twice daily with meals (maximum total daily dose 800 mg). Treatment interval: 8–30 days. Note: Patients being treated for neurocysticercosis should receive appropriate steroid and anticonvulsant therapy as required. Oral or intravenous corticosteroids should be considered to prevent cerebral hypertensive episodes during the first week of treatment.

FILARIA

Single dose of 400 mg. For Filariasis, note that Albendazole has no effect on the adult worms (Lymphatic filariasis and onchocerciasis Mark J Taylor, Achim Hoerauf, Moses Bockarie, 2010, Lancet). Filariasis, albendazole and/or disintegrating filariae can affect the lymphatic system.

SIDE EFFECTS

Albendazole may cause abdominal pain, dizziness, headache, fever, nausea, vomiting, or temporary hair loss. In rare cases it may cause persistent sore throat, severe headache, seizures, vision problems, yellowing eyes or skin, dark urine, stomach pain, easy bruising, mental/mood changes, very stiff neck, change in amount of urine. Elevation of liver enzymes during treatment is a common side effect, but in rare cases there have also been reports of acute liver failure. Allergic reactions are also possible. Rarely Albendazole has been reported to cause marrow suppression, agranulocytosis or aplastic anemia which may be permanent. The risk of developing this side effect seems to be increased in patients with liver disease, including echinococcal cysts. Because of this dangerous side effect it is important to regularly monitor complete blood counts.

DRUG INTERACTIONS

ANTIEPILEPTICS

The drugs carbamazepine, phenytoin and phenobarbital lower the plasmatic concentration and the half life of albendazole.

ANACIDS / HISTAMINE ANTAGONISTS

The drug cimetidine heightens serum albendazole concentrations, and increases the half life of albendazole. This might be a helpful interaction on more severe cases, because it boosts the potency of albendazole.

CONTRAINDICATIONS

Hypersensitivity to the benzimidazole class of compounds.

PREGNANCY CLASS

D (Australia) - Do not take when pregnant, and do not become pregnant for one month after taking this drug. Pharmacokinetic studies have shown that trace amounts of albendazole appears in semen. Given this potential for teratogenicity, the manufacturers advise that the male sexual partner should also use adequate protection.

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Ampicillin is a beta-lactam antibiotic that is part of the aminopenicillin family and is roughly equivalent to its successor, amoxicillin in terms of spectrum and level of activity. It can sometimes result in reactions that range in severity from a rash (in the case of patients that may unwittingly have mononucleosis) to potentially lethal allergic reactions such as anaphylaxis. However, as with other penicillin drugs, it is relatively non-toxic and adverse effects of a serious nature are encountered only rarely.

MECHANISM OF ACTION

Belonging to the penicillin group of beta-lactam antibiotics, ampicillin is able to penetrate Gram-positive and some Gram-negative bacteria. It differs from penicillin only by the presence of an amino group. That amino group helps the drug penetrate the outer membrane of gram-negative bacteria. Ampicillin acts as a competitive inhibitor of the enzyme transpeptidase, which is needed by bacteria to make their cell walls. It inhibits the third and final stage of bacterial cell wall synthesis in binary fission, which ultimately leads to cell lysis. Ampicillin has received FDA approval for its mechanism of action.

EFFECTS ON CHLOROPLAST DIVISION

Ampicillin, like other B-lactam antibiotics, not only blocks the division of bacteria, but also the division of chloroplasts of the Glaucophytes (called cyanelles) and chloroplasts of the moss Physcomitrella patens, a bryophyte. In contrast, it has no effect on the plastids of the higher developed vascular plant Lycopersicon esculentum L. (tomato).

SPECTRUM OF BACTERIAL SUSCEPTIBILITY AND RESISTANCE

Bacillus subtilis, Enterococcus faecalis, and Haemophilus influenzae (non-ESBL)species are generally susceptible to ampicillin,while Enterobacteriaceae, Escherichia coli (ESBL), and Klebsiella oxytoca are resistant to ampicillin.In the meanwhile, some Aeromonas hydrophila, Staphylococci, Staphylococcus haemolyticus and Shigella flexneri have developed resistance to ampicillin to varying degrees.

APPLICATION

Ampicillin is closely related to amoxicillin, another type of penicillin, and both are used to treat urinary tract infections, otitis media, Haemophilus influenzae, salmonellosis and Listeria meningitis. It is used with flucloxacillin in the combination antibiotic co-fluampicil for empiric treatment of cellulitis; providing cover against Group A streptococcal infection whilst the flucloxacillin acts against the Staphylococcus aureus bacterium. Of concern is the number of bacteria that become resistant to Ampicillin necessitating combination therapy or use of other antibiotics. All Pseudomonas and most strains of Klebsiella and Aerobacter are considered resistant. Additionally, resistance to ampicillin is seen in enterobacter, citrobacter, serratia, indole-positive proteus species, and other hospital-acquired gram negative infections. An ampicillin resistance gene (abbreviated ampR) is commonly used as a selectable marker in routine biotechnology. Due to concerns over horizontal gene transfer to pathogenic organisms in the wild, the European Food Safety Authority restricts use of this gene (among other resistance genes) in commercial genetically modified organisms. The enzyme responsible for degrading ampicillin is called beta-lactamase, in reference to the beta-lactam structure of ampicillin and related drugs.

HISTORY

Ampicillin has been used extensively to treat bacterial infections since 1961. Until the introduction of ampicillin by the British company Beecham, penicillin therapies had only been effective against Gram-positive organisms such as staphylococci and streptococci. Ampicillin (originally branded as 'Penbritin') also demonstrated activity against Gram-negative organisms such as H. influenzae, coliforms and Proteus spp. Ampicillin was the first of a number of so-called broad spectrum penicillins subsequently introduced by Beecham.

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Bacillus is a genus of Gram-positive, rod-shaped bacteria and a member of the division Firmicutes. Bacillus species can be obligate aerobes or facultative anaerobes, and test positive for the enzyme catalase. Ubiquitous in nature, Bacillus includes both free-living and pathogenic species. Under stressful environmental conditions, the cells produce oval endospores that can stay dormant for extended periods. These characteristics originally defined the genus, but not all such species are closely related, and many have been moved to other genera.

INDUSTIAL SIGNIFICANCE

Many Bacillus species are able to secrete large quantities of enzymes. Bacillus amyloliquefaciens is the source of a natural antibiotic protein barnase (a ribonuclease), alpha amylase used in starch hydrolysis, the protease subtilisin used with detergents, and the BamH1 restriction enzyme used in DNA research. A portion of the Bacillus thuringiensis genome was incorporated into corn (and cotton) crops. The resulting GMOs are therefore resistant to some insect pests.

USE AS MODEL ORGANISM

Bacillus subtilis is one of the best understood prokaryotes, in terms of molecular biology and cell biology. Its superb genetic amenability and relatively large size have provided the powerful tools required to investigate a bacterium from all possible aspects. Recent improvements in fluorescence microscopy techniques have provided novel and amazing insight into the dynamic structure of a single cell organism. Research on Bacillus subtilis has been at the forefront of bacterial molecular biology and cytology, and the organism is a model for differentiation, gene/protein regulation, and cell cycle events in bacteria.

CLINICAL SIGNIFICANCE

Two Bacillus species are considered medically significant: B. anthracis, which causes anthrax, and B. cereus, which causes a foodborne illness similar to that of Staphylococcus. A third species, B. thuringiensis, is an important insect pathogen, and is sometimes used to control insect pests. The type species is B. subtilis, an important model organism. It is also a notable food spoiler, causing ropiness in bread and related food. Some environmental and commercial strains B. coagulans may play a role in food spoilage of highly acidic, tomato based products. An easy way to isolate Bacillus is by placing nonsterile soil in a test tube with water, shaking, placing in melted mannitol salt agar, and incubating at room temperature for at least a day. Colonies are usually large, spreading and irregularly-shaped. Under the microscope, the Bacillus cells appear as rods, and a substantial portion usually contain an oval endospore at one end, making it bulge.

CELL WALL

The cell wall of Bacillus is a structure on the outside of the cell that forms the second barrier between the bacterium and the environment, and at the same time maintains the rod shape and withstands the pressure generated by the cell's turgor. The cell wall is composed of teichoic and teichuronic acids. B. subtilis is the first bacterium for which the role of an actin-like cytoskeleton in cell shape determination and peptidoglycan synthesis was identified, and for which the entire set of peptidoglycan-synthesizing enzymes was localised. The role of the cytoskeleton in shape generation and maintenance is important.

PHYLOGENY

The genus Bacillus was coined in 1835 by Christian Gottfried Ehrenberg (who coined the genus Bacterium seven years prior) to contain rod-shaped bacteria, later amended by Ferdinand Cohn to spore-forming, Gram-positive/variable, rod-shaped bacteria. Like other genera associated with the early history of microbiology, such as Pseudomonas or Vibrio, members of the Bacillus genus (266 species) are found ubiquitously, and it is one of the genera with the largest 16S diversity and environmental diversity. Several studies have tried to reconstruct the phylogeny of the genus. The Bacillus-specific study with the most diversity covered is by Xu and Cote' using 16S and the ITS region, where they divide the genus into 10 groups, which includes the nested genera Paenibacillus, Brevibacillus, Geobacillus, Marinibacillus and Virgibacillus. However, the tree constructed by the living tree project, a collaboration between ARB-Silva and LPSN where a 16S (and 23S if available) tree of all validated species was constructed, the genus Bacillus contains a very large number of nested taxa and majorly in both 16S and 23S it is paraphyletic to Lactobacillales (Lactobacillus, Streptococcus, Staphylococcus, Listeria, etc.), due to Bacillus coahuilensis and others. A gene concatenation study found similar results to Xu and Cote', but with a much more limited number of species in terms of groups, but used Listeria as an outgroup, so in light of the ARB tree, it may be "inside-out". One clade, formed by B. anthracis, B. cereus, B. mycoides, B. pseudomycoides, B. thuringiensis and B. weihenstephanensis under current classification standards, should be a single species (within 97% 16S identity), but due to medical reasons, they are considered separate species, an issue also present for four species of Shigella and Escherichia coli.

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Nigella sativa is an annual flowering plant, native to south and southwest Asia. It grows to 20-30 cm (7.9-12 in) tall, with finely divided, linear (but not thread-like) leaves. The flowers are delicate, and usually coloured pale blue and white, with five to ten petals. The fruit is a large and inflated capsule composed of three to seven united follicles, each containing numerous seeds. The seed is used as a spice.

ETYMOLOGY

COMMON NAMES

The scientific name is a derivative of Latin niger (black). Common namesIn English, Nigella sativa seed is variously called fennel flower, nutmeg flower, Roman coriander, blackseed or black caraway. Other names used, sometimes misleadingly, are onion seed and black sesame, both of which are similar-looking, but unrelated. The seeds are frequently referred to as black cumin (as in Assamese: kaljeera or kolajeera or Bengali kalo jeeray), In south Indian language Kannada it is called "Krishna Jeerige", but this is also used for a different spice, Bunium persicum (= Carum bulbocastanum).

HISTORY

According to Zohary and Hopf, archeological evidence about the earliest cultivation of N. sativa "is still scanty", but they report supposed N. sativa seeds have been found in several sites from ancient Egypt, including Tutankhamun's tomb. Although its exact role in Egyptian culture is unknown, it is known that items entombed with a pharaoh were carefully selected to assist him in the afterlife.

HISTORY OF MEDICINE

In Islam, N. sativa is regarded as one of the greatest forms of healing medicine available. In the Unani Tibb system of medicine, black cumin is regarded as a valuable remedy for a number of diseases. Sayings of Islamic Prophet Muhammad underline the significance of Nigella sativa. According to a hadith narrated by Abu Hurairah, he says, "I have heard the Messenger of Allah, peace be upon him, saying that the black granules (kalonji) is the remedy for all diseases except death." The seeds have been traditionally used in the Middle East and Southeast Asian countries to treat ailments including asthma, bronchitis, rheumatism and related inflammatory diseases, to increase milk production in nursing mothers, to promote digestion and to fight parasitic infections. Its many uses have earned black cumin seed the Arabic approbation Habbatul barakah, meaning the "seed of blessing". Its oil has been used to treat skin conditions, such as eczema and boils, and to treat cold symptoms. Many researchers have recently also studied its reaction towards cancer, and it is said to have many anticancer properties.

BLACK CUMIN

Original black cumin (Carum bulbocastanum) is rarely available, so N. sativa is widely used instead; (in India, Carum carvi is the substitute). Cumins are from Apiaceae or Umbelliferae (both names are allowed by the ICBN) family, but N. sativa is from Ranunculaceae family. Black cumin (not N. sativa) seeds come as paired or separate carpels, and are 3-4mm long. They have a striped pattern of nine ridges and oil canals, and are fragrant (Ayurveda says, "Kaala jaaji sugandhaa cha" (black cumin seed is fragrant itself), blackish in colour, boat-shaped, and tapering at each extremity, with tiny stalks attached; it has been used for medicinal purposes for centuries, both as a herb and pressed into oil, in Asia, the Middle East, and Africa. It has been traditionally used for a variety of conditions and treatments related to respiratory health, stomach and intestinal health, kidney and liver function, circulatory and immune system support, as analgesic, anti-inflammatory, antiallergic, antioxidants, anticancer, antiviral and for general well-being.

SCIENTIFIC RESEARCH

Nigella sativa oil (black cumin seed oil) contains nigellone (dithymoquinone), which protects guinea pigs from histamine-induced bronchial spasms (perhaps explaining its use to relieve the symptoms of asthma, bronchitis, and coughing). The presence of the sterol beta-sitosterol lends credence to its traditional use to treat abscesses and tumors of the abdomen, eyes, and liver. N. sativa oil has been reported to be effective in treating opioid dependence. N. sativa also has been reported to reduce calculi formation in rats' kidneys. The oil contains melanthin, nigilline, damascenine and tannins. Melanthin is toxic in large doses and nigelline is paralytic, so this spice must be used in moderation. Thymoquinone and pancreatic cancer treatmentThe chemical compound thymoquinone isolated from N. sativa seed oil blocks pancreatic cancer cell growth in vitro and kills the cells by enhancing the process of programmed cell death (apoptosis) acting as an HDAC inhibitor. While the studies are in the early stages and no clinical study has started,the researchers speculated thymoquinone may eventually have some use as a preventative strategy in patients who have gone through surgery and chemotherapy or in individuals who are at a high risk of developing cancer. Nigella sativa supplemented manually prepared diet decreases egg yolk cholesterol and suppresses harmful intestinal bacteria in laying hen. N. sativa seed might have potential as an alternative to hazardous antibiotic to formulate low cost and environment-friendly diet for the laying hens for low cholesterol eggs Islam et al. (2011).

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Juglans nigra, the Eastern black walnut, a species of flowering tree in the walnut family, Juglandaceae, is native to eastern North America. It grows mostly in riparian zones, from southern Ontario, west to southeast South Dakota, south to Georgia, northern Florida and southwest to central Texas. Isolated wild trees in the upper Ottawa Valley may be an isolated native population or may have derived from planted trees. The black walnut is a large deciduous tree attaining heights of 30-40 metres (98-130 ft). Under forest competition, it develops a tall, clear bole; the open-grown form has a short bole and broad crown. The bark is grey-black and deeply furrowed. The pith of the twigs contains air spaces. The leaves are alternate, 30-60 cm long, odd-pinnate with 15-23 leaflets, with the largest leaflets located in the center, 7-10 cm long and 2-3 cm broad. The male flowers are in drooping catkins 8-10 cm long, the female flowers are terminal, in clusters of two to five, ripening during the autumn into a fruit (nut) with a brownish-green, semifleshy husk and a brown, corrugated nut. The whole fruit, including the husk, falls in October; the seed is relatively small and very hard. The tree tends to crop more heavily in alternate years. While its primary native region is the Midwest and east-central United States, the black walnut was introduced into Europe in 1629. It is cultivated there and in North America as a forest tree for its high-quality wood. More nuts are produced by open-grown trees. Black walnut is more resistant to frost than the English or Persian walnut, but thrives best in the warmer regions of fertile, lowland soils with a high water table. It is a light-demanding species. The wood is used to make furniture, flooring, and rifle stocks, and oil is pressed from the seeds. Nuts are harvested by hand from wild trees. About 65% of the annual wild harvest comes from the U.S. state of Missouri, and the largest processing plant is operated by Hammons Products in Stockton, Missouri. The black walnut nutmeats are used as an ingredient in food, while the hard black walnut shell is used commercially in abrasive cleaning, cosmetics, and oil well drilling and water filtration. Where the range of J. nigra overlaps that of the Texas black walnut J. microcarpa, the two species sometimes interbreed, producing populations with characteristics intermediate between the two species.

USES

PLANTING

Black walnut plantings can be made to produce timber, nuts, or both timber and nuts. Patented timber-type trees were selected and released from Purdue University in the early 1990's. These trees have been sporadically available from nurseries. Varieties include Purdue #1, which can be used for both timber and nut production, though nut quality is poor compared to varieties selected specifically as nut producers. Grafted, nut-producing trees are available from several nurseries operating in the U.S. Selections worth considering include Thomas, Neel #1, Thomas Myers, Pounds #2, Stoker, Surprise, Emma K, Sparrow, S127, and McGinnis. Several older varieties, such as Kwik Krop, are still in cultivation; while they make decent nuts, they would not be recommended for commercial planting. A variety index and characteristics guide is available from Missouri Extension. Pollination requirements should be considered when planting black walnuts. As is typical of many species in Juglandaceae, Juglans nigra trees tend to be dichogamous, i.e.. produce pollen first and then pistillate flowers or else produce pistillate flowers and then pollen. An early pollen-producer should be grouped with other varieties that produce pistillate flowers so all varieties benefit from overlap. Cranz, Thomas, and Neel #1 make a good pollination trio. A similar group for more northern climates would be Sparrow, S127, and Mintle.

FOOD

Black walnut nuts are shelled commercially in the United States. The nutmeats provide a robust, distinctive, natural flavor and crunch as a food ingredient. Popular uses include ice cream, bakery goods and confections. Consumers include black walnuts in traditional treats, such as cakes, cookies, fudge, and pies, during the fall holiday season. The nuts' nutritional profile leads to uses in other foods, such as salads, fish, pork, chicken, vegetables and pasta dishes. Nutritionally similar to the milder-tasting English walnut, the black walnut kernel is high in unsaturated fat and protein. An analysis of nut oil from five named J. nigra cultivars (Ogden, Sparrow, Baugh, Carter and Thomas) showed that the most prevalent fatty acid in J. nigra oil is linoleic acid (27.80-33.34 g/100g dry kernel), followed (in the same units) by oleic acid (14.52-24.40), linolenic acid (1.61-3.23), palmitic acid (1.61-2.15), and stearic acid (1.07-1.69). The oil from the cultivar Carter had the highest mol percentage of linoleate (61.6), linolenate (5.97%), and palmitate (3.98%); the oil from the cultivar Baugh had the highest mol percentage of oleate (42.7%); the oil from the cultivar Ogden has the highest mol percentage of stearate (2.98%). Tapped in spring, the tree yields a sweet sap that can be drunk or concentrated into syrup or sugar.

NUT PROCESSING BY HAND

The extraction of the kernel from the fruit of the black walnut is difficult. The thick hard shell is tightly bound by tall ridges to a thick husk. The husk is best removed when green as the nuts taste better if it is removed then. Rolling the nut underfoot on a hard surface such as a driveway is a common method; commercial huskers use a car tire rotating against a metal mesh. Some take a thick plywood board and drill a nut sized hole in it (from one to two inches in diameter) and smash the nut through using a hammer. The nut goes through and the husk remains behind. While the flavor of the Juglans nigra kernel is prized, the difficulty in preparing it may account for the wider popularity and availability of the Persian walnut.

DYE

Black walnut drupes contain juglone (5-hydroxy-1,4-naphthoquinone), plumbagin (yellow quinone pigments), and tannin. The brownish-black dye was used by early settlers to dye hair. Extracts of the outer, soft part of the drupe are still used as a natural dye for handicrafts. The tannins present in walnuts act as a mordant, aiding in the dyeing process, and are usable as a dark ink or wood stain.

WOOD

Black walnut is highly prized for its dark-colored, true heartwood. It is heavy and strong, yet easily split and worked. Walnut wood has historically been used for gunstocks, furniture, flooring, paddles, coffins, and a variety of other wood products. Due to its value, forestry officials often are called on to track down walnut poachers; in 2004, DNA testing was used to solve one such poaching case, involving a 55 foot (16m) tree worth US$2,500. Black walnut has a density of 660 kg per cubic meter (41.2 lb/cubic foot), which makes it less dense than oak.

PESTS

Maggots (larvae of Rhagoletis completa and Rhagoletis suavis) in the husk are common, though more a nuisance than a serious problem for amateurs, who may simply remove the affected husk as soon as infestation is noticed. The maggots develop entirely within the husk, thus the quality of the nutmeat is not affected. However, infestations of maggots are undesirable because they make the husk difficult to remove and are unsightly. Maggots can be serious for commercial walnut growers, who tend to use chemical treatments to prevent damage to the crop. Some organic controls also exist, such as removing and disposing of infested nuts. The walnut curculio (Conotrachelus retentus) grows to 5 mm long as an adult. The adult sucks plant juices through a snout. The eggs are laid in fruits in the spring and summer. Many nuts are lost due to damage from the larvae, which burrow through the nut shell. Codling moth (Cydia pomonella) larvae eat walnut kernels, as well as apple and pear seeds. A disease complex known as thousand cankers disease has been threatening black walnut in several western states. This disease has recently been discovered in Tennessee, and could potentially have devastating effects on the species in the eastern United States.

TOXICITY

The roots, nut husks, and leaves secrete a substance into the soil called juglone that is a respiratory inhibitor to some plants. A number of other plants (most notably white birch) are also poisoned by juglone, and should not be planted in close proximity to a black walnut. The plant can cause contact dermatitis in humans. Horses are susceptible to laminitis from exposure to black walnut wood in bedding.

BIG TREE

The national champion black walnut is on a residential property in Sauvie Island, Oregon. It is 8 feet 7 inches (2.62 m) diameter at breast height and 112 feet (34 m) tall, with a crown spread of 144 feet (44 m). The largest black walnut in Europe is located in the Castle Park in the city of Sered, Slovakia. It has a circumference of 6.30 meters, height of 25 meters and estimated age is 300 years old.

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Caprylic acid is the common name for the eight-carbon saturated fatty acid known by the systematic name octanoic acid. It is found naturally in the milk of various mammals, and it is a minor constituent of coconut oil and palm kernel oil. It is an oily liquid that is minimally soluble in water with a slightly unpleasant rancid-like smell and taste. Two other acids are named after goats: caproic (C6) and capric (C10). Along with caprylic acid these total 15% in goat milk fat.

USES

Caprylic acid is used commercially in the production of esters used in perfumery and also in the manufacture of dyes. Caprylic acid is also used in the treatment of some bacterial infections. Due to its relatively short chain length it has no difficulty in penetrating fatty cell wall membranes, hence its effectiveness in combating certain lipid-coated bacteria, such as Staphylococcus aureus and various species of Streptococcus. Caprylic acid is an antimicrobial pesticide used as a food contact surface sanitizer in commercial food handling establishments on dairy equipment, food processing equipment, breweries, wineries, and beverage processing plants. It is also used as disinfectant in health care facilities, schools/colleges, animal care/veterinary facilities, industrial facilities, office buildings, recreational facilities, retail and wholesale establishments, livestock premises, restaurants, and hotels/motels. In addition, caprylic acid is used as an algaecide, bactericide, and fungicide in nurseries, greenhouses, garden centers, and interiorscapes on ornamentals. Products containing caprylic acid are formulated as soluble concentrate/liquids and ready-to-use liquids. Caprylic acid must be covalently linked to the serine residue at the 3-position of ghrelin, specifically, it must acylate the -OH group, for ghrelin to have its hunger-stimulating action on the feeding centers of the hypothalamus, though other fatty acids may have similar effects. The octanoic acid breath test is used to measure gastric emptying.

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Rhamnus purshiana (Cascara Buckthorn, Cascara, Bearberry, and in the Chinook Jargon, Chittam or Chitticum; syn. Frangula purshiana, Rhamnus purshianus) is a species of buckthorn native to western North America from southern British Columbia south to central California, and inland to western Montana. It is the largest species of buckthorn, occasionally growing up to 15 m tall, though more commonly a large shrub or small tree 5-10 m tall, with a trunk 20-50 cm in diameter. The bark is brownish to silver-grey with light splotching. The leaves are deciduous, alternate, clustered near the ends of twigs; they are oval, 5-15 cm long and 2-5 cm broad with a 0.6-2 cm petiole, dark shiny green on top, fuzzy and paler green below. The flowers are tiny, 4-5 mm diameter, with five greenish yellow petals; the flowering season is brief, disappearing by early summer. The fruit is a berry 6-10 mm diameter, bright red at first, quickly maturing deep purple or black, and containing three seeds. It grows in moist, acidic soils in the shady side of clearings or in the marginal forest understory, near the edges of mixed deciduous-coniferous forests. It typically grows as a second-generation tree after alders have colonized a barren plot of land.

USES

The dried, aged bark of this tree has been used continually for at least 1,000 years by both native and immigrant Americans as a laxative natural medicine, commercially called "Cascara Sagrada" and also known as "chitticum bark". The laxative action is due to the Cascara glycosides (cascarosides A,B,C & D). Cascara Sagrada means "sacred bark" in Spanish. It was long used as a laxative by Native American groups of the northwest Pacific coast, and its much more pertinent regional name chitticum means "shit come" in Chinook Jargon;[dubious ? discuss] chittam comes from the Chinook Jargon phrase chittam stick = "laxative tree" which is similar to the English word "shit". The bark is harvested mostly from wild trees; over-harvesting in the middle 1900s eliminated mature trees near many settled areas. Once stripped from the tree, the bark is aged for about 1 year to make its effect milder. Fresh cut, dried bark causes vomiting and violent diarrhea.

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Cefalexin (INN) or more commonly cephalexin is a first-generation cephalosporin antibiotic introduced in 1967 by Eli Lilly and Company. It is an orally administered agent with a similar antimicrobial spectrum to the intravenous agents cefalotin and cefazolin. It was first marketed as Keflex (Lilly), and is marketed under several other trade names. As of 2008, cefalexin was the most popular cephalosporin antibiotic in the United States, with more than 25 million prescriptions of its generic versions alone, for US$255 million in sales (though less popular than two other antibiotics, amoxicillin and azithromycin, each with 50 million prescriptions per year).

MEDICAL USES

Cefalexin is used to treat a number of infections including: otitis media, streptococcal pharyngitis, bone and joint infections, pneumonia, cellulitis, and urinary tract infections. It may be used to prevent bacterial endocarditis.

INFECTIONS

In addition to being a rational first-line treatment for cellulitis, it is a useful alternative to penicillins in patients with penicillin hypersensitivity. In patients with mild or questionable history of penicillin allergy, cephalasporins are now thought to be relatively safe. Caution should always be taken when prescribing cephalosporins to those with strong history of true penicillin hypersensitivity, however, because cefalexin and other first-generation cephalosporins are known to have a modest cross-allergy in patients with penicillin hypersensitivity. Cefalexin may not be effective against bacteria that incorporate a gene for beta-lactamase on their R-plasmid as the beta-lactam ring is present in the chemical structure of cephalosporin derivatives.

FORMULATIONS

Cefalexin is marketed by generic pharmaceutical manufacturers under a wide range of brand names, including: Apo-Cephalex, Biocef, Cefanox, Ceforal, Cephabos, Cephalexin, Cephorum, Ceporex, Cilex, Ialex, Ibilex, Kefexin, Keflet, Keflex, Rekosporin, Keforal, Keftab, Keftal, Lopilexin, Larixin, Novo-Lexin, Ospexin, Tenkorex, Zephalexin, Panixine Disperdose, Sialexin, Sporidex and Ulexin. A version of Keflex 750 mg capsules is marketed for twice-daily dosage, to improve compliance. However, it is not a sustained release formulation, and since it is more expensive than the older strengths, some physicians prescribe three 250 mg capsules to be taken twice daily, as a less expensive alternative. In Finland, cefalexin is marketed under several names. Orion markets Kefexin.

ADVERSE EFFECTS

Common adverse effects include gastrointestinal upset such as diarrhea, nausea, vomiting, indigestion, and abdominal pain. Others may include dizziness, agitation, headache, joint pain, and tiredness. Symptoms of an allergic reaction include rash, itching, swelling, trouble breathing, or red, blistered, swollen or peeling skin. Overall, allergies occur in less than 0.1% of patients; they are seen in about 1% to 10% of patients with penicillin allergy.

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Cleanse is one of the three formulas developed by world renown parasitologist Dr. Omar M. Amin. The formulas are based on Dr. Amin's research and experience that covers known remedies from the Ancient Egyptians and Ancient Chinese to date, and that have been published in refereed journals. For instance, see Amin, O. M. and Amin, K. O. 1998. Herbal Remedies for Parasitic Infections. Explore 8 (6): 1-59 and Amin, O. M. 2003. Ancient Egyptian Medicine. Explore 13 (5): 7-15 It cleanses the colon from toxins and promotes regularity balancing your digestive system. It includes Psyllium Seed Husk, Atlantic Kelp, Corn Silk, Fo-Ti, Chinese Rhubarb, Peppermint Leaf, Black Cumin Seed, Cinnamon Bark, Fennel Seed, Ginger Root, Orange Peel Extract, Clove Bulb, Cascara Sagrada, and Slippery Elm Bark.

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Cloves (Syzygium aromaticum) are the aromatic dried flower buds of a tree in the family Myrtaceae. Cloves are native to the Maluku islands in Indonesia and used as a spice in cuisines all over the world. Cloves are harvested primarily in Indonesia, India, Madagascar, Zanzibar, Pakistan, and Sri Lanka. They have a numbing effect on mouth tissues. The clove tree is an evergreen that grows to a height ranging from 8?12 m, having large leaves and sanguine flowers in numerous groups of terminal clusters. The flower buds are at first of a pale color and gradually become green, after which they develop into a bright red, when they are ready for collecting. Cloves are harvested when 1.5?2 cm long, and consist of a long calyx, terminating in four spreading sepals, and four unopened petals which form a small ball in the center.

TAXONOMY AND NOMENCLATURE

The scientific name of clove is Syzygium aromaticum. It belongs to the genus Syzygium, tribe Syzygieae, and subfamily Myrtoideae of the family Myrtaceae. It is classified in the order of Myrtales, which belong to superorder Rosids, under Eudicots of Dicotyledonae. Clove is an Angiospermic plant and belongs to division of Magnoliophyta in the kingdom Plantae. The English name derives from Latin clavus 'nail' (also the origin of French clou and Spanish clavo, 'nail') as the buds vaguely resemble small irregular nails in shape.

USES

Cloves can be used in cooking either whole or in a ground form, but they are used sparingly because they have an extremely strong flavour. Cloves have historically been used in Indian cuisine (both North Indian and South Indian). In North Indian cuisine, it is used in almost all rich or spicy dishes as an ingredient of a mix named garam masala, along with other spices, although it is not an everyday ingredient for home cuisine, nor is it used in summer very often. In the Maharashtra region of India it is used sparingly for sweet or spicy dishes, but rarely in everyday cuisine. In Ayurvedic medicine it is considered to have the effect of increasing heat in system, hence the difference of usage by region and season. In south Indian cuisine, it is used extensively in biryani along with "cloves dish" (similar to pilaf, but with the addition of other spices), and it is normally added whole to enhance the presentation and flavor of the rice.

TRADITIONAL MEDICAL USES

Cloves are used in Indian Ayurvedic medicine, Chinese medicine, and western herbalism and dentistry where the essential oil is used as an anodyne (painkiller) for dental emergencies. Cloves are used as a carminative, to increase hydrochloric acid in the stomach and to improve peristalsis. Cloves are also said to be a natural anthelmintic. The essential oil is used in aromatherapy when stimulation and warming are needed, especially for digestive problems. Topical application over the stomach or abdomen are said to warm the digestive tract. Clove oil, applied to a cavity in a decayed tooth, also relieves toothache. It also helps to decrease infection in the teeth due to its antiseptic properties. In Chinese medicine cloves or ding xiang are considered acrid, warm and aromatic, entering the kidney, spleen and stomach meridians, and are notable in their ability to warm the middle, direct stomach qi downward, to treat hiccough and to fortify the kidney yang. Because the herb is so warming it is contraindicated in any persons with fire symptoms and according to classical sources should not be used for anything except cold from yang deficiency. As such it is used in formulas for impotence or clear vaginal discharge from yang deficiency, for morning sickness together with ginseng and patchouli, or for vomiting and diarrhea due to spleen and stomach coldness. This would translate to hypochlorhydria. Clove oil is used in various skin disorders like acne, pimples etc. It is also used in severe burns, skin irritations and to reduce the sensitivity of skin. Cloves may be used internally as a tea and topically as an oil for hypotonic muscles, including for multiple sclerosis. This is also found in Tibetan medicine. Some recommend avoiding more than occasional use of cloves internally in the presence of pitta inflammation such as is found in acute flares of autoimmune diseases. In West Africa, the Yorubas use cloves infused in water as a treatment for stomach upsets, vomiting and diarrhea. The infusion is called Ogun Jedi-jedi.

MEDICINAL USES AND PHARMACEUTICAL PREPARATIONS

Western studies have supported the use of cloves and clove oil for dental pain. However, studies to determine its effectiveness for fever reduction, as a mosquito repellent and to prevent premature ejaculation have been inconclusive. Clove may reduce blood sugar levels. Tellimagrandin II is an ellagitannin found in S. aromaticum with anti-herpesvirus properties. The buds have anti-oxidant properties. Clove oil can be used to anesthetize fish, and prolonged exposure to higher doses (the recommended dose is 400mg/l) is considered a humane means of euthanasia. In addition, Clove oil is used in preparation of some toothpastes, laxative pills and Clovacaine solution which is a local anesthetic and used in oral ulceration and anti-inflammations. Eugenol (or clove oil generally) is mixed with Zinc oxide to be a temporary filling.

ACTIVE COMPOUNDS

Eugenol comprises 72-90% of the essential oil extracted from cloves, and is the compound most responsible for the cloves' aroma. Other important essential oil constituents of clove oil include acetyl eugenol, beta-caryophyllene and vanillin, crategolic acid, tannins such as bicornin, gallotannic acid, methyl salicylate (painkiller), the flavonoids eugenin, kaempferol, rhamnetin, and eugenitin, triterpenoids like oleanolic acid, stigmasterol and campesterol and several sesquiterpenes. Eugenol has pronounced antiseptic and anaesthetic properties. Of the dried buds, 15 - 20 percent is essential oils, and the majority of this is eugenol. A kilogram (2.2 lbs) of dried buds yields approximately 150 ml (1/4 of pint) of eugenol. Eugenol can be toxic in relatively small quantities as low as 5 ml.

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Colon cleansing (also known as colon therapy) encompasses a number of alternative medical therapies intended to remove feces and nonspecific toxins from the colon and intestinal tract. Colon cleansing may take the form of colon hydrotherapy (also called a colonic or colonic irrigation) or oral cleansing regimens, such as dietary supplements. During the 2000s internet marketing and infomercials of colon supplements increased. Some forms of colon hydrotherapy use tubes to inject water, sometimes mixed with herbs or with other liquids, into the colon via the rectum using special equipment. Oral cleaning regimes use dietary fiber, herbs, dietary supplements, or laxatives. People who practice colon cleansing believe that accumulations of putrefied feces line the walls of the large intestine and that these accumulations harbor parasites or pathogenic gut flora, causing nonspecific symptoms and general ill-health. This "auto-intoxication" hypothesis is based on medical beliefs of the Ancient Egyptians and Greeks and was discredited in the early 20th century. No scientific evidence supports the alleged benefits of colon cleansing and it "has no known medical value and risks damage to the rectum or bowel." The bowel itself is "not dirty” and, unless disease or medication interfere, "nature does a fine job of clearing out wastes." Certain enema preparations have been associated with heart attacks and electrolyte imbalances, and improperly prepared or used equipment can cause infection or damage to the bowel. Frequent colon cleansing can lead to dependence on enemas to defecate and some herbs may reduce the effectiveness of prescription drugs.

HISTORY

The rationale for colon cleansing is the concept of "auto-intoxication", the idea that food enters the intestine and rots. The ancient Egyptians believed that toxins formed as a result of decomposition within the intestines, and moved from there into the circulatory system causing fever and the development of pus. The Ancient Greeks adopted and expanded the idea, applying their belief in the four humours. In the 19th century, studies in biochemistry and microbiology seemed to support the autointoxication hypothesis, and mainstream physicians promoted the idea. The idea was promoted most strongly by Ilya Ilyich Mechnikov (1845-1916), who thought that these toxins could shorten the lifespan. Over time, the concept broadened to "auto-intoxication", which supposes that the body cannot fully dispose of its waste products and toxins, which then accumulate in the intestine. In some cases, the concept led to radical surgeries to remove the colon for unrelated symptoms. Auto-intoxication enjoyed some favor in the medical community from the late nineteenth to the early twentieth century, but was discarded as advances in science failed to support its claims. A 1919 paper Origin of the so-called auto-intoxication symptom in the Journal of the American Medical Association marked the beginning of the rejection of the auto-intoxication hypothesis by the medical community. Despite this, "auto-intoxication" persists in the public imagination. The practice of colon cleansing has undergone a resurgence in the alternative medical community, supported by testimonials and anecdotal evidence and promoted by manufacturers of colon-cleansing products.

MEDICAL IMAGING

Colon cleansing is done for its own sake, prior to surgery, colonoscopy, or similar procedures. The colon is cleansed of solid matter with a regimen of liquid foods then a day before the procedure a whole bowel irrigation can be performed.

RELATIONSHIP TO MEDICAL SYMPTOMS

The symptoms that are attributed to auto-intoxication—headache, fatigue, loss of appetite and irritability—are actually caused by mechanical distention within the bowel, such as irritable bowel syndrome, rather than toxins from putrefying food. The benefits anecdotally attributed to colon cleansing are vague and the claims made by manufacturers and practitioners are based on a flawed understanding of the body. There is little evidence of actual benefit to the procedure, and no evidence that it can alleviate the symptoms that are attributed to the theories of colon cleansing. No surgeries, autopsies or other observations of colons have discovered any evidence of compacted feces or other evidence to support the theory of auto-intoxication or the need for colon cleansing.

COMPLICATIONS AND RISKS

The human body naturally removes waste material, and colon cleansing is not necessary except preparatory to a colonoscopy. Colon cleansing may disrupt the balance between bacteria and natural chemicals in the bowel, and may interfere with the colon's ability to shed dead cells. Other rare but serious complications include gastrointestinal perforation from improper insertion, and amoebic infection from poorly sterilised equipment. Some colon-cleansing regimens disrupt fluid and electrolyte balance, which may lead to dehydration and salt depletion, whilst repeated or excessive cleansing programs can lead to anemia and malnutrition. Excessive use of enemas has also been associated with cardiac problems, such as heart failure, and heart attacks related to electrolyte imbalances when performed as coffee enema. The frequent use of enemas or other colon-cleansing tools may lead to dependence and an inability to defecate without assistance or withdrawal symptoms. Herbs that are consumed for colon cleansing and taken as oral preparations may also interfere with drug absorption and effectiveness of prescription drugs.

SUPPLEMENT EFFECTIVENESS

Marketplace conducted a consumer trial with 3 women on the effectiveness of two colon supplements versus fiber. The results showed the supplements did not assist in weight loss and provided no additional benefit over a basic fiber supplement.

REGULATION

UNITED STATES

The U.S. Food and Drug Administration (FDA) regulates the production of equipment used in colon hydrotherapy in the USA but does not regulate their use, or the supplements used in oral colon-cleansing regimens and manufacturer claims do not require verification or supporting evidence. The contents of the products are also not verified or tested. The FDA has issued several letters warning manufacturers and suppliers of colon hydrotherapy equipment about making false claims of effectiveness, safety issues and quality control violations.

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An enema (plural enemata or enemas) is the procedure of introducing liquids into the rectum and colon via the anus. The increasing volume of the liquid causes rapid expansion of the lower intestinal tract, often resulting in very uncomfortable bloating, cramping, powerful peristalsis, a feeling of extreme urgency and complete evacuation of the lower intestinal tract. An enema has the advantage over any laxative in its speed and certainty of action, and some people prefer it for this reason. Enemas can be carried out as treatment for medical conditions, such as constipation and encopresis, and as part of some alternative health therapies. They are also used to administer certain medical or recreational drugs. Enemas have been used for rehydration therapy (proctoclysis) in patients for whom intravenous therapy is not applicable.Some people find enemas sexually arousing (Klismaphilia).

HISTORY

Enema comes from Greek (enema), from (eniemi), "(I) inject". Clyster, also spelled glister in the 17th century, comes from Greek (klyster), from (klyzo), "(I) wash". It is an archaic word for enema, more particularly for enemas administered using a clyster syringe – that is, a syringe with a rectal nozzle and a plunger rather than a bulb. Clyster syringes were used from the 17th century (or before) to the 19th century, when they were largely replaced by enema bulb syringes, bocks, and bags. The patient was placed in an appropriate position (kneeling, with the buttocks raised, or lying on the side); a servant or apothecary would then insert the nozzle into the anus and depress the plunger, resulting in the liquid remedy (generally, water, but also some preparations) being injected into the colon. Because of the embarrassment a woman might feel when showing her buttocks (and possibly her genitals, depending on the position) to a male apothecary, some contraptions were invented that blocked all from the apothecary's view except for the anal area. Another invention was syringes equipped with a special bent nozzle, which enabled self-administration, thereby eliminating the embarrassment. Clysters were administered for symptoms of constipation and, with more questionable effectiveness, stomach aches and other illnesses. In his early-modern treatise, The Diseases of Women with Child, François Mauriceau records that both midwives and man-midwives commonly administered clysters to labouring mothers just prior to their delivery. In Roper's biography of his father-in-law Sir Thomas More, he tells of Thomas More's eldest daughter falling sick of the sweating sickness. She could not be awakened by doctors. After praying, it came to Thomas More: There straightway it came into his mind that a clyster would be the one way to help her, which when he told the physicians, they at once confessed that if there were any hope of health, it was the very best help indeed, much marveling among themselves that they had not afore remembered it. — Utopia, Thomas More Clysters were a favourite medical treatment in the bourgeoisie and nobility of the Western world up to the 19th century. As medical knowledge was fairly limited at the time, purgative clysters were used for a wide variety of ailments, the foremost of which were stomach aches and constipation. Molière, in several of his plays, introduces characters of incompetent physicians and apothecaries fond of prescribing this remedy, also discussed by Argan, the hypochondriac patient of Le Malade Imaginaire. More generally, clysters were a theme in the burlesque comedies of that time. According to Claude de Rouvroy, duc de Saint-Simon, clysters were so popular at the court of King Louis XIV of France that the duchess of Burgundy had her servant give her a clyster in front of the King (her modesty being preserved by an adequate posture) before going to the comedy. However, he also mentions the astonishment of the King and Mme de Maintenon that she should take it before them.

MEDICAL USAGE

As a bowel stimulant, not unlike a laxative – the main difference being that laxatives are commonly thought of as orally administered while enemas are administered directly into the rectum, and thereafter, into the colon. When the enema injection into the rectum is complete, and after a set "holding time", the patient expels feces along with the enema in the bedpan or toilet. Enemas may also be used to relieve constipation and fecal impaction, although in the U.S.A. and some other parts of the world, their use has been replaced in most professional health-care settings by oral laxatives and laxative suppositories. In-home use of enemas for constipation and alternative health purposes is somewhat harder to measure. Bowel stimulating enemas usually consist of water, which works primarily as a mechanical stimulant, or they may be made up of water with baking soda (sodium bicarbonate) or water with a mild hand soap dissolved in it. Buffered sodium phosphate solution draws additional water from the bloodstream into the colon to increase the effectiveness of the enema, but can be rather irritating to the colon, causing intense cramping or "griping." Mineral oil functions as a lubricant and stool softener, but often has the side effect of sporadic seepage from the patient's anus which can soil undergarments for up to 24 hours. Glycerol is a specific bowel mucosa irritant and when introduced in very dilute solution serves to induce peristalsis. Other types of enema solutions are also used, including equal parts of milk and molasses heated together to slightly above normal body temperature. In the past, castile soap was a common additive in an enema, but it has largely fallen out of use because of its irritating action in the rectum and because of the risk of chemical colitis as well as the ready availability of other enema preparations that are perhaps more effective than soap in stimulating a bowel movement. At the opposite end of the spectrum, an isotonic saline solution is least irritating to the rectum and colon, having a neutral concentration gradient. This neither draws electrolytes from the body – as can happen with plain water – nor draws water into the colon, as will occur with phosphates. Thus, a salt water solution can be used when a longer period of retention is desired, such as to soften an impaction. Cleansing the lower bowel prior to a surgical procedure such as sigmoidoscopy or colonoscopy. Because of speed and supposed convenience, enemas used for this purpose are commonly the more costly, sodium phosphate variety – often called a disposable enema. A more pleasant experience preparing for testing procedures can usually be obtained with gently-administered baking soda enemas; cleansing the lower bowel for colonoscopy and other bowel studies can be effectively achieved with water-based, or water with baking soda, enema administration. The administration of substances into the bloodstream. This may be done in situations where it is undesirable or impossible to deliver a medication by mouth, such as antiemetics given to reduce nausea (though not many antiemetics are delivered by enema). Additionally, several anti-angiogenic agents, which work better without digestion, can be safely administered via a gentle enema. Medicines for cancer, for arthritis, and for age-related macular degeneration are often given via enema in order to avoid the normally-functioning digestive tract. Interestingly, some water-based enemas are also used as a relieving agent for irritable bowel syndrome, using cayenne pepper to squelch irritation in the colon and rectal area. Finally, an enema may also be used for hydration purposes. See also route of administration. Emergency blood expansion. Emergency pre-hospital treatment of haemorrhage requires immediate fluid replacement therapy. In mass casualty, remote or rural settings, the lack of sterile fluids, intravenous equipment or the knowledge to use them might limit the treatment options available. In such situations proctoclysis remains an easy and effective way to provide fluid replacement. It does not require sterile fluids, special equipment or complex training, and it is useful when alternative routes are not readily available. The topical administration of medications into the rectum, such as corticosteroids and mesalazine used in the treatment of inflammatory bowel disease. Administration by enema avoids having the medication pass through the entire gastrointestinal tract, therefore simplifying the delivery of the medication to the affected area and limiting the amount that is absorbed into the bloodstream. General anesthetic agents for surgical purposes are sometimes administered by way of an enema. Occasionally, anesthetic agents are used rectally to reduce medically-induced vomiting during and after surgical procedures, in an attempt to avoid aspiration of stomach contents. A barium enema is used as a contrast substance in the radiological imaging of the bowel. The enema may contain barium sulfate powder, or a water-soluble contrast agent. Barium enemas are sometimes the only practical way to "view" the colon in a relatively safe manner. Following barium enema administration, patients often find that flushing the remaining barium with additional water, baking soda, or saline enemas helps restore normal colon activity without complications of constipation from the administration of the barium sulfate. Rectal corticosteroid enemas are sometimes used to treat mild or moderate ulcerative colitis. They also may be used along with systemic (oral or injection) corticosteroids or other medicines to treat severe disease or mild to moderate disease that has spread too far to be treated effectively by medicine inserted into the rectum alone. In certain countries, such as the United States, customary enema usage went well into the 20th century; it was thought a good idea to cleanse the bowel in case of fever; also, pregnant women were given enemas prior to labor, supposedly to reduce the risk of feces being passed during contractions. Under some controversial discussion, pre-delivery enemas were also given to women to speed delivery by inducing contractions. This latter usage has since been largely abandoned, because obstetricians now commonly give pitocin to induce labor and because women generally found the procedure unpleasant. Now obsolete, the tobacco smoke enema was the principal medical method for resuscitating victims of drowning during the 18th century.

HOME USES

Many self-given enemas used at home are the pre-packaged, disposable, sodium phosphate solutions in single-use bottles sold under a variety of brand names, or in generic formats. These units come with a pre-lubricated nozzle attached to the top of the container. Some enemas are administered using so-called disposable bags connected to disposable tubing (despite the names, such units can commonly be used for many months or years without significant deterioration). Patients who want easier, more gently-accepted enemas often purchase combination enema syringes which are commonly referred to as "closed top" syringes, and which can also be used as old-fashioned hot water bottles, so as to relieve aches and pains via gentle heat administrations to parts of the body. Cost for each enema can be as little as the cost of baking soda added to ordinary tap water. In Asian countries, particularly in Japan, commercially available disposable enemas typically contain glycerin (at concentrations varying from 30-50%) or sodium chloride. They are not pre-lubricated and the amount of liquid contained in them may vary, although most contain about 20-40ml of diluted glycerin. In medical or hospital environments, reusable enema equipment is now rare because of the expense of disinfecting a water-based solution. For a single-patient stay of short duration, an inexpensive disposable enema bag can be used for several days or weeks, using a simple rinse out procedure after each enema administration. The difficulty comes from the longer time period (and expense) required of nursing aides to give a gentle, water-based enema to a patient, as compared to the very few minutes it takes the same nursing aide to give the more irritating, cold, pre-packaged sodium phosphate unit. For home use, disposable enema bottle units are common, but reusable rubber or vinyl bags or enema bulbs may also be used. In former times, enemas were infrequently administered using clyster syringes. If such commercially-available items are not at hand, ordinary water bottles are sometimes used.

ALTERNATIVE MEDICINE

The term "colonic irrigation" is commonly used in gastroenterology to refer to the practice of introducing water through a colostomy or a surgically constructed conduit as a treatment for constipation. The Food and Drug Administration has ruled that colonic irrigation equipment is not approved for sale for the purpose of general well-being and has taken action against many distributors of this equipment, including a Warning Letter. The use of enemas for reasons other than the relief of constipation is currently regulated in some parts of the United States[citation needed] while practitioners in other states may go through a voluntary certification process.

COLON CLEANSING

The same term is also used in alternative medicine where it may involve the use of substances mixed with water in order to detoxify the body. Practitioners believe the accumulation of fecal matter in the large intestine leads to ill health. This resurrects the old medical concept of autointoxication which was orthodox doctrine up to the end of the 19th century but which has now been discredited.

COFFEE ENEMAS

In the controversial Gerson therapy, coffee enemas are administered. These enemas are known to have caused three deaths in the United States.

RECTAL DRUG ADMINISTRATION

An enema might be used to clean the colon of feces first to help increase the rate of absorption in rectal administration of dissolved drugs, including alcohol. Enemas have also been used for ritual rectal drug administration such as balché, alcohol, tobacco, peyote, and other hallucinogenic drugs and entheogens, most notably by the Maya and also some other American Indian tribes. Some tribes continue the practice in the present day. People who wish to become intoxicated faster have also been known to use an enema as a method to instill alcohol into the bloodstream, absorbed through the membranes of the colon. However, great care must be taken as to the amount of alcohol used. Only a small amount is needed as the intestine absorbs the alcohol more quickly than the stomach. Deaths have resulted due to alcohol poisoning via enema.

PUNITIVE USAGE

Antagonistic factions in unstable nations have often forcibly applied enemas as a means of punishment. In the vastly influential Latin American text Facundo, or Civilization and Barbarism, for example, Domingo Faustino Sarmiento describes the use of pepper and turpentine enemas by police forces as a way of discouraging political dissent in post-independence Argentina.

PRECAUTIONS

Improper administration of an enema may cause electrolyte imbalance (with repeated enemas) or ruptures to the bowel or rectal tissues resulting in internal bleeding. However, these occurrences are rare in healthy, sober adults. Internal bleeding or rupture may leave the individual exposed to infections from intestinal bacteria. Blood resulting from tears in the colon may not always be visible, but can be distinguished if the feces are unusually dark or have a red hue. If intestinal rupture is suspected, medical assistance should be obtained immediately. The enema tube and solution may stimulate the vagus nerve, which may trigger an arrhythmia such as bradycardia. Enemas should not be used if there is an undiagnosed abdominal pain since the peristalsis of the bowel can cause an inflamed appendix to rupture. It is highly arguable for and against Colonic irrigation in people with diverticulitis, ulcerative colitis, Crohn's disease, severe or internal hemorrhoids or tumors in the rectum or colon. And is also recommended not be used soon after bowel surgery (unless directed by one's health care provider). Regular treatments should be avoided by people with heart disease or renal failure. Colonics are inappropriate for people with bowel, rectal or anal pathologies where the pathology contributes to the risk of bowel perforation. Recent research has shown that ozone water, which is sometimes used in enemas, can immediately cause microscopic colitis. A recent case series of 11 patients with five deaths illustrated the danger of phosphate enemas.

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An essential oil is a concentrated hydrophobic liquid containing volatile aroma compounds from plants. Essential oils are also known as volatile oils, ethereal oils or aetherolea, or simply as the "oil of" the plant from which they were extracted, such as oil of clove. An oil is "essential" in the sense that it carries a distinctive scent, or essence, of the plant. Essential oils do not form a distinctive category for any medical, pharmacological, or culinary purpose. Essential oils are generally extracted by distillation. Other processes include expression, or solvent extraction. They are used in perfumes, cosmetics, soaps and other products, for flavoring food and drink, and for adding scents to incense and household cleaning products. Various essential oils have been used medicinally at different periods in history. Medical applications proposed by those who sell medicinal oils range from skin treatments to remedies for cancer, and often are based solely on historical accounts of use of essential oils for these purposes. Claims for the efficacy of medical treatments and treatment of cancers in particular, are now subject to regulation in most countries. As the use of essential oils has declined in evidence-based medicine, one must consult older textbooks for much information on their use. Modern works are less inclined to generalize; rather than refer to "essential oils" as a class at all, they prefer to discuss specific compounds, such as methyl salicylate, rather than "oil of wintergreen". Interest in essential oils has revived in recent decades with the popularity of aromatherapy, a branch of alternative medicine that claims that essential oils and other aromatic compounds have curative effects. Oils are volatilized or diluted in a carrier oil and used in massage, diffused in the air by a nebulizer, heated over a candle flame, or burned as incense. The techniques and methods first used to produce essential oils were first mentioned by Ibn al-Baitar (1188–1248), an Andalusian physician, pharmacist and chemist.

PRODUCTION

DISTILLATION

Today, most common essential oils, such as lavender, peppermint, and eucalyptus, are distilled. Raw plant material, consisting of the flowers, leaves, wood, bark, roots, seeds, or peel, is put into an alembic (distillation apparatus) over water. As the water is heated, the steam passes through the plant material, vaporizing the volatile compounds. The vapors flow through a coil, where they condense back to liquid, which is then collected in the receiving vessel. Most oils are distilled in a single process. One exception is ylang-ylang (Cananga odorata), which takes 22 hours to complete through a fractional distillation. The recondensed water is referred to as a hydrosol, hydrolat, herbal distillate or plant water essence, which may be sold as another fragrant product. Popular hydrosols include rose water, lavender water, lemon balm, clary sage and orange blossom water. The use of herbal distillates in cosmetics is increasing. Some plant hydrosols have unpleasant smells and are therefore not sold.

EXPRESSION

Most citrus peel oils are expressed mechanically, or cold pressed (similar to olive oil extraction). Due to the relatively large quantities of oil in citrus peel and low cost to grow and harvest the raw materials, citrus-fruit oils are cheaper than most other essential oils. Lemon or sweet orange oils that are obtained as byproducts of the citrus industry are even cheaper. Prior to the discovery of distillation, all essential oils were extracted by pressing.

SOLVENT EXTRACTION

Most flowers contain too little volatile oil to undergo expression and their chemical components are too delicate and easily denatured by the high heat used in steam distillation. Instead, a solvent such as hexane or supercritical carbon dioxide is used to extract the oils. Extracts from hexane and other hydrophobic solvent are called concretes, which are a mixture of essential oil, waxes, resins, and other lipophilic (oil soluble) plant material. Although highly fragrant, concretes contain large quantities of nonfragrant waxes and resins. Often, another solvent, such as ethyl alcohol, which is more polar in nature, is used to extract the fragrant oil from the concrete. The alcohol is removed by evaporation, leaving behind the absolute. Supercritical carbon dioxide is used as a solvent in supercritical fluid extraction. This method has many benefits including avoiding petrochemical residues in the product and the loss of some "top notes" when steam distillation is used. It does not yield an absolute directly. The supercritical carbon dioxide will extract both the waxes and the essential oils that make up the concrete. Subsequent processing with liquid carbon dioxide, achieved in the same extractor by merely lowering the extraction temperature, will separate the waxes from the essential oils. This lower temperature process prevents the decomposition and denaturing of compounds. When the extraction is complete, the pressure is reduced to ambient and the carbon dioxide reverts to a gas, leaving no residue. An animated presentation describing the process is available for viewing. Supercritical carbon dioxide is also used for making decaffeinated coffee. Although it uses the same basic principles, it is a different process because of the difference in scale.

FLORASOLS EXTRACTION

Florasol (R134a), a refrigerant, was developed to replace Freon. Florasol is an ozone friendly product and it poses little danger to the environment. One advantage is that the extraction of essential oils occurs at or below room temperature so degradation through high temperature extremes does not occur. The essential oils are mostly pure and contain little to no foreign substances.

PHARMACOLOGY

Although there is currently something of a dismissive attitudeconcerning essential oils in pharmacology, various essential oils retain considerable popular use, partly in fringe medicine and partly in popular remedies. Therefore it is difficult to obtain reliable references concerning their pharmacological merits. Taken by mouth, many essential oils can be dangerous in high concentrations. Typical effects begin with a burning feeling, followed by salivation. In the stomach, the effect is carminative, relaxing the gastric sphincter and encouraging eructation (belching). Further down the gut, the effect typically is antispasmodic. Typical ingredients for such applications include eucalyptus oils, menthol, capsaicin, anise and camphor. Other essential oils work well in these applications, but it is notable that others offer no significant benefit. This illustrates the fact that different essential oils may have drastically different pharmacology. Those that do work well for upper respiratory tract and bronchial problems act variously as mild expectorants and decongestants. Some act as locally anaesthetic counterirritants, and thereby exert an antitussive effect. Some essential oils, such as those of juniper and agathosma are valued for their diuretic effects. With relatively recent concerns about the overuse of antibacterial agents, many essential oils have seen a resurgence in off-label use for such properties and are being examined for this use clinically. Many essential oils affect the skin and mucous membranes in ways that variously are valuable or harmful. They are used in antiseptics and liniments in particular. Typically, they produce rubefacient irritation at first, and then counterirritant numbness. Turpentine oil and camphor are two typical examples of oils that cause such effects. Menthol and some others produce a feeling of cold followed by a sense of burning. This is caused by its effect on heat-sensing nerve endings. Some essential oils, such as clove oil or eugenol, were popular for many years in dentistry as antiseptics and local anaesthetics. Thymol also is well known for its antiseptic effects.

USE IN AROMATHERAPY

Aromatherapy is a form of alternative medicine in which healing effects are ascribed to the aromatic compounds in essential oils and other plant extracts. Many common essential oils have medicinal properties that have been applied in folk medicine since ancient times and are still widely used today. For example, many essential oils have antiseptic properties. Many are also claimed to have an uplifting effect on the mind. Such claims, if meaningful, are not necessarily false, but are difficult to quantify in the light of the sheer variability of materials used in the practice.

DILUTION

Essential oils are usually lipophilic (literally: "oil-loving") compounds that usually are not miscible with water. Also, they can be diluted in solvents like pure ethanol, and polyethylene glycol.

RAW MATERIALS

Essential oils are derived from various sections of plants. Some plants, like the bitter orange, are sources of several types of essential oil.

EUCALYPTUS OIL

Apart from essential oils used mainly in foods, the best-known essential oil world-wide might be eucalyptus oil, produced from the leaves of Eucalyptus globulus. Steam-distilled eucalyptus oil is used throughout Asia, Africa, Latin America and South America as a primary cleaning/disinfecting agent added to soaped mop and countertop cleaning solutions; it also possesses insect and limited vermin control properties. Note, however, there are hundreds of species of eucalyptus, and perhaps some dozens are used to various extents as sources of essential oils. Not only do the products of different species differ greatly in characteristics and effects, but also the products of the very same tree can vary grossly.

ROSE OIL

The second most well-known essential oil is probably rose oil, produced from the petals of Rosa damascena and Rosa centifolia. Steam-distilled rose oil is known as "rose otto", while the solvent extracted product is known as "rose absolute".

LAVENDER ESSENTIAL OIL

One of the most popular essential oils in the world, Lavender essential oil has a reputation of being mild, relaxing and appropriate for all age and gender. Its an all-around essential oil that can be used to treat burns, cuts and other wounds as it has been said to promote rapid healing and reduce pain. Lavender essential oil is also a great bug repellant.

DANGERS

The potential danger of an essential oil is generally relative to its level or grade of purity. Many essential oils are designed exclusively for their aroma-therapeutic quality; these essential oils generally should not be applied directly to the skin in their undiluted or "neat" form. Some can cause severe irritation, provoke an allergic reaction and, over time, prove hepatotoxic. Non-therapeutic grade essential oils are never recommended for topical or internal use. Essential oils should not be used with animals, as they possess extreme hepatotoxicity and dermal toxicity for animals, especially for cats. Instead, essential oils should be blended with a vegetable-based carrier oil (as a base, or "fixed" oil) before being applied. Common carrier oils include olive, almond, hazelnut and grapeseed. Only neutral oils should be used. A common ratio of essential oil disbursed in a carrier oil is 0.5–3% (most under 10%), depending on its purpose. Some essential oils, including many of the citrus peel oils, are photosensitizers, increasing the skin's vulnerability to sunlight. Industrial users of essential oils should consult the material safety data sheets (MSDS) to determine the hazards and handling requirements of particular oils. Even certain therapeutic grade oils can pose potential threats to individuals with epilepsy, or pregnant women.

HANDELING

Essential oils can be aggressive toward rubbers and plastics, so care must be taken in choosing the correct handling equipment. Glass syringes are often used, but have coarse volumetric graduations. Chemistry syringes are ideal, as they resist essential oils, are long enough to enter deep vessels, and have fine graduations, facilitating quality control. Unlike traditional pipettes, which have difficulty handling viscous fluids, the chemistry syringe has a seal and piston arrangement which slides inside the pipette, wiping the essential oil off the pipette wall. This improves accuracy, and the inside of the pipette is easy to clean and reuse immediately. Chemistry pipetting syringes are equal in accuracy to the best laboratory equipment and are available in sizes from 1 mL through 25 mL.

PREGNANCY

The use of essential oils in pregnancy is not recommended due to inadequate published evidence to demonstrate evidence of safety.[citation needed] Pregnant women often report an abnormal sensitivity to smells and taste, essential oils can cause irritation and nausea.

GYNECOMASTIA

Estrogenic and antiandrogenic activity have been reported by in vitro study of tea tree oil and lavender essential oils. Case reports suggest the oils may be implicated in some cases of gynecomastia, an abnormal breast tissue growth, in prepubescent boys.

PESTICIDE RESIDUES

There is some concern about pesticide residues in essential oils, particularly those used therapeutically. For this reason, many practitioners of aromatherapy buy organically produced oils. Not only are pesticides present in trace quantities, but also the oils themselves are used in tiny quantities and usually in high dilutions. Where there is a concern about pesticide residues in food essential oils, such as mint or orange oils, the proper criterion is not whether the material is alleged to be organically produced, but whether it meets the government standards based on actual analysis of its pesticide content.

INGESTION

Essential oils are used extensively as GRAS flavoring agents in foods, beverages and confectioneries according to strict Good Manufacturing Practice (GMP) and flavorist standards. Therapeutic grade essential oils are generally safe for human consumption in small amounts. Pharmacopoeia standards for medicinal oils should be heeded. Some oils can be toxic to some domestic animals, cats in particular. The internal use of essential oils can pose hazards to pregnant women, as some can be abortifacients in dose 0.5–10 ml, and thus should not be used during pregnancy.

FLAMMABILITY

The flash point of each essential oil is different. Many of the common essential oils, such as tea tree, lavender, and citrus oils, are classed as a Class 3 Flammable Liquid, as they have a flash point of 50–60 °C.

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Freedom is one of the strongest anti-parasitic formulas on the market yet still gentle on the body. It is one of the three formulas developed by world renown parasitologist Dr. Omar M. Amin. The formulas are based on Dr. Amin's research and experience that covers known remedies from the Ancient Egyptians and Ancient Chinese to date, and that have been published in refereed journals. For instance, see Amin, O. M. and Amin, K. O. 1998. Herbal Remedies for Parasitic Infections. Explore 8 (6): 1-59 and Amin, O. M. 2003. Ancient Egyptian Medicine. Explore 13 (5): 7-15 It is a great alternative to anti-biotics which will cause a yeast infection and kill off your good bacteria weakening your immune system. Its ingredients include Oregano Leaf, Clove Flower, Black Walnut Husk, Peppermint Leaf, Black Cumin Seed, Winter Melon Seed, Gentian Root, Wormwood Bark, Hyssop Leaf, Cramp Bark, Thyme Leaf, Fennel Seed, Pumpkin Seed, Caprylic Acid, Pagoda Fruit, Rosemary, Aloe Vera, Betel Nut Palm, Papaya, Citrus Extract, Pomegranate, Rangoon Creeper, and Tansy.

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Gentiana lutea (Great Yellow Gentian) is a species of gentian native to the mountains of central and southern Europe. Other names include 'Yellow Gentian', 'Bitter Root', 'Bitterwort', 'Centiyane', and 'Genciana'.

GROWTH

It is a herbaceous perennial plant, growing to 1-2 m tall, with broad lanceolate to elliptic leaves 10-30 cm long and 4-12 cm broad. The flowers are yellow, with the corolla separated nearly to the base into 5-7 narrow petals. It grows in grassy alpine and sub-alpine pastures, usually on calcareous soils.

USES

It is remarkable for the intensely bitter properties residing in the root and every part of the herbage, hence they are valuable tonic medicines. The root is the principal vegetable bitter employed in medicine, though the roots of several other species are said to be equally efficacious. Before the introduction of hops, Gentian, with many other bitter herbs, was used occasionally in brewing. It is a principal ingredient in Angostura bitters. The medicinal parts are the dried, underground parts of the plant and the fresh, above-ground parts. The name is a tribute to Gentius, an Illyrian king who was thought to have found out that the herbs had tonic properties. It was used in the Middle Ages as an antidote to certain poisons. Gentian root has a long history of use as a herbal bitter in the treatment of digestive disorders and is an ingredient of many proprietary medicines. The bitter principles of gentian root are secoiridoid glycosides amarogentin and gentiopicrin. The former is one of the most bitter natural compounds known and is used as a scientific basis for measuring bitterness. Its blossoms are very similar to the Amnara Senczaina flowertips: a pale creamy, icy color and white/hazel tipped. They sometimes have red spots on the inner side, and plants with these are said to ease breathing if cooked and vapors are smelt. It was considered especially useful in states of exhaustion from chronic disease and in all cases of debility, weakness of the digestive system and lack of appetite. It was also considered one of the best fortifiers of the human system, stimulating the liver, gall bladder and digestive system, and was thought to be an excellent tonic to combine with a purgative in order to prevent its debilitating effects. In veterinary pharmacopeia in the 1860's Gentian root or Gentian radix was considered useful as a tonic and stomachic.

CHEMICAL CONSTITUENTS

The root is anthelmintic, anti-inflammatory, antiseptic, bitter tonic, cholagogue, emmenagogue, febrifuge, refrigerant and stomachic. It is taken internally in the treatment of liver complaints, indigestion, gastric infections and anorexia. It should not be prescribed for patients with gastric or duodenal ulcers. The root, which can be over 5 cm thick and has few branches, is harvested in the autumn and dried for later use. It is quite likely that the roots of plants that have not flowered are the richest in medicinal properties.

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Ginger or ginger root is the rhizome of the plant Zingiber officinale, consumed as a delicacy, medicine, or spice. It lends its name to its genus and family (Zingiberaceae). Other notable members of this plant family are turmeric, cardamom, and galangal. Ginger cultivation began in South Asia and has since spread to East Africa and the Caribbean.

ETYMOLOGY

The English name ginger comes from French: gingembre, Old English: gingifere, Medieval Latin: ginginer, Greek: zing beris. Ultimately the origin is from Tamil: inji ver. The botanical term for root in Tamil is ver, hence inji root or inji ver.

HORTICULTURE

Ginger produces clusters of white and pink flower buds that bloom into yellow flowers. Because of its aesthetic appeal and the adaptation of the plant to warm climates, ginger is often used as landscaping around subtropical homes. It is a perennial reed-like plant with annual leafy stems, about a meter (3 to 4 feet) tall. Traditionally, the root is gathered when the stalk withers; it is immediately scalded, or washed and scraped, to kill it and prevent sprouting. The fragrant perisperm of Zingiberaceae is used as sweetmeats by Bantu, also as a condiment and sialogogue.

USES

Ginger produces a hot, fragrant kitchen spice. Young ginger rhizomes are juicy and fleshy with a very mild taste. They are often pickled in vinegar or sherry as a snack or just cooked as an ingredient in many dishes. They can also be steeped in boiling water to make ginger tea, to which honey is often added; sliced orange or lemon fruit may also be added. Ginger can also be made into candy. Mature ginger roots are fibrous and nearly dry. The juice from old ginger roots is extremely potent and is often used as a spice in Indian recipes, and is a quintessential ingredient of Chinese, Korean, Japanese and many South Asian cuisines for flavoring dishes such as seafood or goat meat and vegetarian cuisine. Ginger acts as a useful food preservative. Fresh ginger can be substituted for ground ginger at a ratio of 6 to 1, although the flavors of fresh and dried ginger are somewhat different. Powdered dry ginger root is typically used as a flavoring for recipes such as gingerbread, cookies, crackers and cakes, ginger ale, and ginger beer. Candied ginger is the root cooked in sugar until soft, and is a type of confectionery. Fresh ginger may be peeled before eating. For longer-term storage, the ginger can be placed in a plastic bag and refrigerated or frozen.

REGIONAL USE

In Western cuisine, ginger is traditionally used mainly in sweet foods such as ginger ale, gingerbread, ginger snaps, parkin, ginger biscuits and speculaas. A ginger-flavored liqueur called Canton is produced in Jarnac, France. Green ginger wine is a ginger-flavored wine produced in the United Kingdom, traditionally sold in a green glass bottle. Ginger is also used as a spice added to hot coffee and tea.India and Pakistan, ginger is called adrak in Hindi, Punjabi and Urdu, aad in Maithili, aadi in Bhojpuri, aada in Bengali, Adu in Gujarati, hashi shunti in the Kannada, allam in Telugu, inji in Tamil and Malayalam, inguru in Sinhalese, alay in Marathi, and aduwa in Nepali. Fresh ginger is one of the main spices used for making pulse and lentil curries and other vegetable preparations. Fresh, as well as dried, ginger is used to spice tea and coffee, especially in winter. Ginger powder is also used in certain food preparations, particularly for pregnant or nursing women, the most popular one being katlu which is a mixture of gum resin, ghee, nuts, and sugar. Ginger is also consumed in candied and pickled form. In Bangladesh, ginger is finely chopped or ground into a paste to use as a base for chicken and meat dishes alongside shallot and garlic. In Burma, ginger is called gyin. It is widely used in cooking and as a main ingredient in traditional medicines. It is also consumed as a salad dish called gyin-thot, which consists of shredded ginger preserved in oil, and a variety of nuts and seeds. In Indonesia, a beverage called wedang jahe is made from ginger and palm sugar. Indonesians also use ground ginger root, called jahe, as a common ingredient in local recipes. In Malaysia, ginger is called halia and used in many kinds of dishes, especially a soup. In the Philippines it is brewed into a tea called salabat. In Vietnam, the fresh leaves, finely chopped, can also be added to shrimp-and-yam soup (canh khoai mo) as a top garnish and spice to add a much subtler flavor of ginger than the chopped root. In China, sliced or whole ginger root is often paired with savory dishes such as fish, and chopped ginger root is commonly paired with meat, when it is cooked. However, candied ginger is sometimes a component of Chinese candy boxes, and a herbal tea can also be prepared from ginger. In Japan, ginger is pickled to make beni shoga and gari or grated and used raw on tofu or noodles. It is also made into a candy called shoga no sato zuke. In the traditional Korean kimchi, ginger is finely minced and added to the ingredients of the spicy paste just before the fermenting process. In the Caribbean, ginger is a popular spice for cooking, and making drinks such as sorrel, a seasonal drink made during the Christmas season. Jamaicans make ginger beer both as a carbonated beverage and also fresh in their homes. Ginger tea is often made from fresh ginger, as well as the famous regional specialty Jamaican ginger cake. Two varieties of ginger as sold in Haikou, Hainan, China On the island of Corfu, Greece, a traditional drink called tsytsypa (tsitsibira), a type of ginger beer, is made. The people of Corfu and the rest of the Ionian islands adopted the drink from the British, during the period of the United States of the Ionian Islands. In Arabic, ginger is called zanjabil, and in some parts of the Middle East, ginger powder is used as a spice for coffee and for milk, as well. In Somaliland, ginger is called sinjibil, and is served in coffee shops in Egypt. In the Ivory Coast, ginger is ground and mixed with orange, pineapple and lemon to produce a juice called nyamanku. Ginger powder is used in hawaij, a spice mixture used mostly by Yemenite Jews for soups and coffee.

GINGER TEA

Ginger tea is a beverage in many countries, made from ginger root. In China, the tea is made by boiling peeled and sliced ginger to which brown sugar is often added. Sliced orange or lemon fruit may also be added to give a flavor. In Korean cuisine, ginger tea is called saenggang cha. It can be made either by boiling the ginger or by mixing hot water and preserved sweetened ginger. For the latter, sliced ginger root is stored with honey for a few weeks like jam. In Japanese cuisine it is called shogayu. In Philippine cuisine it is called salabat and served in the relatively cold month of December. From its main ingredient ginger tea derives a flavor that is spicy and stimulating.

PRELIMINARY RESEARCH

Preliminary research indicates that nine compounds found in ginger may bind to human serotonin receptors which may influence gastrointestinal function. Research conducted in vitro tests show that ginger extract can control the quantity of free radicals and the peroxidation of lipids. Thus it could possibly prevent or decrease the damage in the human body caused by free radicals. Possible preliminary studies involving the effect of ginger on nausea occurring with pregnancy may suggest that intake of ginger may cause belching after ingestion. In a 2010 study, daily consumption of ginger was shown to help ease muscle pain associated with exercise by 25%, suggesting a new cost-effective treatment to pain associated with recent exercise. Ginger root supplement has been identified in a study to help reduce colon inflammation markers such as PGE2, thus providing a possible cost-effective preventative measure to colon cancer. In limited studies, ginger was found to be more effective than placebo for treating nausea caused by seasickness, morning sickness and chemotherapy, although ginger was not found superior to placebo for pre-emptively treating post-operative nausea. Other preliminary studies showed that ginger may affect arthritis pain or have blood thinning and cholesterol lowering properties, but these effects remain unconfirmed. Advanced glycation end-products are possibly associated in the development of diabetic cataract for which ginger was effective in preliminary studies, apparently by acting through antiglycating mechanisms. Zingerone may have activity against enterotoxigenic Escherichia coli in enterotoxin-induced diarrhea.

FOLK MEDICINE

The traditional medical form of ginger historically was called Jamaica ginger; it was classified as a stimulant and carminative and used frequently for dyspepsia, gastroparesis, slow motility symptoms, constipation, and colic. It was also frequently employed to disguise the taste of medicines. Some studies indicate ginger may provide short-term relief of pregnancy-related nausea and vomiting. Studies are inconclusive about effects for other forms of nausea or in treating pain from rheumatoid arthritis, osteoarthritis, or joint and muscle injury. Side effects, mostly associated with powdered ginger, are gas, bloating, heartburn, and nausea. Tea brewed from ginger is a common folk remedy for colds. Ginger ale and ginger beer are also drunk as stomach settlers in countries where the beverages are made. In Burma, ginger and a local sweetener made from palm tree juice (htan nyat) are boiled together and taken to prevent the flu. In China, ginger is included in several traditional preparations. A drink made with sliced ginger cooked in water with brown sugar or a cola is used as a folk medicine for the common cold."Ginger eggs" (scrambled eggs with finely diced ginger root) is a common home remedy for coughing. The Chinese also make a kind of dried ginger candy that is fermented in plum juice and sugared, which is also commonly consumed to suppress coughing. Ginger has also been historically used to treat inflammation, which several scientific studies support, though one arthritis trial showed ginger to be no better than a placebo or ibuprofen for treatment of osteoarthritis. In Congo, ginger is crushed and mixed with mango tree sap to make tangawisi juice, which is considered a panacea. In India, ginger is applied as a paste to the temples to relieve headache, and consumed when suffering from the common cold. Ginger with lemon and black salt is also used for nausea. In Indonesia, ginger (jahe in Indonesian) is used as a herbal preparation to reduce fatigue, reducing "winds" in the blood, prevent and cure rheumatism and control poor dietary habits. In Nepal, ginger is called aduwa and is widely grown and used throughout the country as a spice for vegetables, used medically to treat cold and also sometimes used to flavor tea. In the Philippines, ginger is known as luya and is used as a throat lozenge in traditional medicine to relieve sore throat. It is also brewed into a tea known as salabat. In the United States, ginger is used to prevent motion and morning sickness. It is recognized as safe by the Food and Drug Administration and is sold as an unregulated dietary supplement. Ginger water was also used to avoid heat cramps in the United States. In Peru, ginger is sliced in hot water as an infusion for stomach aches as infusin de Ki-n. In Japan it is purported to aid blood circulation. Scientific studies investigating these effects have been inconclusive.

SAFETY

Ginger is on the FDA's "generally recognized as safe" list, though it does interact with some medications, including warfarin. Ginger is contraindicated in people suffering from gallstones, as it promotes the production of bile. An acute overdose of ginger is usually in excess of about 2 grams of ginger per kilogram of body mass, dependent on level of ginger tolerance, and can result in a state of central nervous system over-stimulation called ginger intoxication or colloquially the "ginger jitters". Allergic reactions to ginger generally result in a rash, and although generally recognized as safe, ginger can cause heartburn, bloating, gas, belching and nausea, particularly if taken in powdered form. Unchewed fresh ginger may result in intestinal blockage, and individuals who have had ulcers, inflammatory bowel disease or blocked intestines may react badly to large quantities of fresh ginger. Ginger can also adversely affect individuals with gallstones. There are also suggestions that ginger may affect blood pressure, clotting, and heart rhythms. Products in Taiwan made from Hebo Natural Products Limited of China contained ginger contaminated with DIBP, some 80,000 nutritional supplement capsules made with imported ginger powder were seized by the Public Health Department of Taiwan in June 2011.

PRODUCTION

From 1585, Jamaican ginger was the first oriental spice to be grown in the New World and imported back to Europe. India, with over 30% of the global share, now leads in global production of ginger, replacing China, which has slipped to the second position (-20.5%), followed by Indonesia (-12.7%), Nepal (-11.5%) and Thailand (-10%).

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The grapefruit (Citrus paradisi) is a subtropical citrus tree known for its sour fruit, an 18th-century hybrid first bred in Barbados. When found, it was named the "forbidden fruit"; and it has also been misidentified with the pomelo or shaddock (C. maxima), one of the parents of this hybrid, the other being sweet orange (C. ? sinensis). These evergreen trees usually grow to around 5-6 meters (16-20 ft) tall, although they can reach 13-15 meters (43-49 ft). The leaves are dark green, long (up to 150 mm, 6 inches) and thin. It produces 5 cm (2 in) white four-petaled flowers. The fruit is yellow-orange skinned and largely an oblate spheroid; it ranges in diameter from 10-15 cm. The flesh is segmented and acidic, varying in color depending on the cultivars, which include white, pink and red pulps of varying sweetness. The 1929 US Ruby Red (of the Redblush variety) has the first grapefruit patent. The fruit has become popular since the late 19th century; before that it was only grown as an ornamental plant. The United States quickly became a major producer of the fruit, with groves in Florida, Texas, Arizona, and California. In Spanish, the fruit is known as toronja or pomelo.

HISTORY

One ancestor of the grapefruit was the Jamaican sweet orange (Citrus sinensis), itself an ancient hybrid of Asian origin; the other was the Indonesian pomelo (C. maxima). One story of the fruit's origins is that a certain "Captain Shaddock" brought pomelo seeds to Jamaica and bred the first fruit. However, it probably originated as a naturally-occurring hybrid.

FORBIDDEN-FRUIT-TREE

The Trunk, Leaves, and Flowers of this Tree, very much resemble those of the Orange-tree. The Fruit, when ripe, is something longer and larger than the largest Orange; and exceeds, in the Delicacy of its Taste, the Fruit of every Tree in this or any of our neighbouring Islands. It hath somewhat of the Taste of a Shaddock; but far exceeds that, as well as the best Orange, in its delicious Taste and Flavour.

'Description from Hughes' 1750 Natural History of Barbados. The hybrid fruit, then called "the forbidden fruit", was documented in 1750 by a Welshman, Rev. Griffith Hughes, who described specimens from Barbados. Currently, the grapefruit is said to be one of the "Seven Wonders of Barbados." The grapefruit was brought to Florida by Count Odette Philippe in 1823 in what is now known as Safety Harbour. Further crosses have produced the tangelo (1905), the Minneola tangelo (1931), and the oroblanco (1984). The grapefruit was known as the shaddock or shattuck until the 19th century. Its current name alludes to clusters of the fruit on the tree, which often appear similar to grapes. Botanically, it was not distinguished from the pomelo until the 1830s, when it was given the name Citrus paradisi. Its true origins were not determined until the 1940s. This led to the official name being altered to Citrus paradisi. An early pioneer in the American citrus industry was Kimball Chase Atwood, a wealthy entrepreneur who founded the Atwood Grapefruit Co. in the late 19th century. The Atwood Grove became the largest grapefruit grove in the world, with an annual production of 80,000 boxes of fruit. It was there that pink grapefruit was first discovered in 1906.

VARIETIES

The Florida Department of Citrus states "the primary varieties of Florida grapefruit are Ruby Red, Pink, Thompson, Marsh and Duncan. The fresh grapefruit season typically runs from October through June."

COLORS AND FLAVORS

Grapefruit comes in many varieties, determinable by color, which is caused by the pigmentation of the fruit in respect of both its state of ripeness. The most popular varieties cultivated today are red, white, and pink hues, referring to the internal pulp color of the fruit. The family of flavors range from highly acidic and somewhat sour to sweet and tart. Grapefruit mercaptan, a sulfur-containing terpene, is one of the substances which has a strong influence on the taste and odor of grapefruit, compared with other citrus fruits.

DRUG INTERACTIONS

Grapefruit can have a number of interactions with drugs, often increasing the effective potency of compounds. Grapefruit contains a number of polyphenolic compounds, including the flavanone naringin, alongside the two furanocoumarins bergamottin and dihydroxybergamottin. These inhibit the drug-metabolizing enzyme isoform CYP3A4 predominately in the small intestine, but at higher doses also inhibit hepatic CYP3A4. It is via inhibition of this enzyme that grapefruit increases the effects of a variety of drugs by increasing their bioavailability. In particular grapefruit and bitter oranges are known to interact with statins. Because of this unique property, grapefruit has a very bitter taste when mixed with milk or similar dairy products. Grapefruit juice may be the first drug-interacting fruit juice documented, but apple and orange juices have been also implicated in interfering with etoposide, a chemotherapy drug, some beta blocker drugs used to treat high blood pressure, and cyclosporine, taken by transplant patients to prevent rejection of their new organs. Some citrus-based carbonated beverages (e.g., "Sun Drop") also contain enough grapefruit juice to cause drug interactions, particularly in patients taking cyclosporine. Unlike other fruits, grapefruit contains a large amount of naringin, and it can take up to 72 hours before the effects of the naringin on the CYP3A4 enzyme are seen. This is particularly problematic due to the fact that only 4 oz of grapefruit contain enough naringin to inhibit the metabolism of substrates of CYP3A4.

NUTRITIONAL INFORMATION

100g of grapefruit contains the following nutritional information according to the USDA:
Calories : 32
Fat: 0.10
Carbohydrates: 8.08
Fibers: 1.1
Protein: 0.63
Cholesterol: 0

OTHER USES

Grapefruit has also been investigated in cancer medicine pharmacodynamics. Its inhibiting effect on the metabolism of some drugs may allow smaller doses to be used, which can help to reduce costs.

NUTRITIONAL PROPERTIES

Grapefruit is an excellent source of many nutrients and phytochemicals that contribute to a healthy diet. Grapefruit is a good source of vitamin C, contains the fiber pectin, and the pink and red hues contain the beneficial antioxidant lycopene. Studies have shown grapefruit helps lower cholesterol, and there is evidence that the seeds have antioxidant properties. Grapefruit forms a core part of the "grapefruit diet", the theory being that the fruit's low glycemic index is able to help the body's metabolism burn fat. Grapefruit seed extract (GSE) has been shown to have strong antimicrobial properties against fungi. It is also believed to have antimicrobial properties for bacteria, however there are no known studies that demonstrate its efficacy. Additionally, although GSE is promoted as a highly effective plant-based preservative by some natural personal care manufacturers, studies have shown that the apparent antimicrobial activity associated with GSE preparations is merely due to contamination with synthetic preservatives. Since grapefruit juice is known to inhibit enzymes necessary for the clearance of some drugs and hormones, some have hypothesized that grapefruit juice may play an indirect role in the development of hormone-dependent cancers. A 2007 study found a correlation between eating a quarter of grapefruit daily and a 30% increase in risk for breast cancer in post-menopausal women. The study points to the inhibition of CYP3A4 enzyme by grapefruit, which metabolizes estrogen. However, a 2008 study has shown that grapefruit consumption does not increase breast cancer risk and found a significant decrease in breast cancer risk with greater intake of grapefruit in women who never used hormone therapy. Grapefruit contains large quantities of a simple polyamine called spermidine, which may be related to aging. It is known to be necessary for cell growth and maturation, and as cells age their level of spermidine is known to fall. Scientists have shown that feeding spermidine to worms, fruit flies and yeast significantly prolongs their lifespan. In addition, adding spermidine to the diet of mice decreased molecular markers of aging, and when human immune cells were cultured in a medium containing spermidine, they also lived longer.

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Liquorice or licorice is the root of Glycyrrhiza glabra from which a somewhat sweet flavour can be extracted. The liquorice plant is a legume (related to beans and peas) that is native to southern Europe and parts of Asia. It is called Athimathuram in Tamil, "Yashtimadhu" in Sanskrit and "Mulethi" in Northern India. It is not related to anise, star anise, or fennel, which are the sources of similar-tasting flavouring compounds. The word 'liquorice'/'licorice' is derived (via the Old French licoresse), from the Greek a (glukurrhiza), meaning "sweet root", from (glukus), "sweet" "root". It is a herbaceous perennial, growing to 1 m in height, with pinnate leaves about 7-15 centimeters (3-6 in) long, with 9-17 leaflets. The flowers are 0.8-1.2 cm ( in) long, purple to pale whitish blue, produced in a loose inflorescence. The fruit is an oblong pod, 2-3 centimetres (1 in) long, containing several seeds. The roots are stoloniferous. The flavor of liquorice comes mainly from a sweet-tasting compound called anethole ("trans"-1-methoxy-4-(prop-1-enyl)benzene), an aromatic, unsaturated ether compound also found in anise, fennel, and several other herbs. Much of the sweetness in liquorice comes from glycyrrhizin, a compound sweeter than sugar.

CULTIVATION AND USES

Liquorice grows best in deep valleys, well-drained soils, with full sun, and is harvested in the autumn, two to three years after planting. Liquorice extract is produced by boiling liquorice root and subsequently evaporating most of the water, and is traded both in solid and syrup form. Its active principle is glycyrrhizin, a sweetener between 30 to 50 times as sweet as sucrose, and which also has pharmaceutical effects. Liquorice flavour is found in a wide variety of liquorice candies or sweets. In Britain and the US these are usually sweet. In most of these candies the taste is reinforced by aniseed oil, and the actual content of liquorice is very low. In continental Europe however, strong, salty candies are popular. In the Netherlands, where liquorice candy ("drop") is one of the most popular forms of sweet, only a few of the many forms that are sold contain aniseed, although mixing it with mint, menthol or with laurel is quite popular. Mixing it with ammonium chloride is also popular, and is known as Salmiak, but mixing it with table salt creates what is probably the most popular liquorice, known in the Netherlands as zoute drop. Pontefract in Yorkshire was the first place where liquorice mixed with sugar began to be used as a sweet in the same way it is in the modern day. Pontefract Cakes were originally made there. In Yorkshire and Lancashire it is colloquially known as Spanish, supposedly because Spanish monks grew liquorice root at Rievaulx Abbey near Thirsk. Liquorice flavouring is also used in soft drinks, and in some herbal infusions where it provides a sweet aftertaste. The flavour is common in medicines to disguise unpleasant flavours. Liquorice is popular in Italy (particularly in the South) and Spain in its natural form. The root of the plant is simply dug up, washed and chewed as a mouth freshener. Throughout Italy unsweetened liquorice is consumed in the form of small black pieces made only from 100% pure liquorice extract; the taste is bitter and intense. In Calabria a popular liqueur is made from pure liquorice extract. Liquorice is also very popular in Syria where it is sold as a drink. Dried liquorice root can be chewed as a sweet. Black liquorice contains approximately 100 calories per ounce (15 kJ/g). Chinese cuisine uses liquorice as a culinary spice for savoury foods. It is often employed to flavour broths and foods simmered in soy sauce. Other herbs and spices of similar flavour include anise, star anise, tarragon, sassafras, and fennel. It is also the main ingredient of a very well known soft drink in Egypt, called (erk-soos). Sticks of liquorice typically have a diameter between two and ten millimetres. Although they resemble plain wooden sticks, they are soft enough to be chewed on. They used to be popular among Dutch, Danish and Swedish children. In Lancashire and Yorkshire in the early 1950s & 1960s, wooden sticks of liquorice, around 8mm diameter, were readily available (and popular) in sweet shops. Also in Essex during late 50s. They were bought as 'sticks of liquorice', and they were chewed by young children. The wood was yellowish, and fibrous when chewed. Liquorice root can have either a salty or sweet taste. The thin sticks are usually quite salty and sometimes taste like salmiak (salty liquorice), whereas the thick sticks are usually quite sweet, with a salty undertone. Liquorice root is also widely available in Denmark. It is also sold by the drugstore and drysalter chain Matas and many greengrocers.

MEDICINE

The compound glycyrrhizic acid, found in liquorice, is now routinely used throughout Japan for the treatment and control of chronic viral hepatitis, and there is a possible transaminase-lowering effect. Hepatoprotective mechanisms have been demonstrated in mice. Recent studies indicate that glycyrrhizic acid disrupts latent Kaposi sarcoma (as also demonstrated with other herpesvirus infections in the active stage), exhibiting a strong anti-viral effect. The Chinese use licorice to treat Tuberculosis Liquorice affects the body's endocrine system as it contains isoflavones (phytoestrogens). It might lower the amount of serum testosterone slightly, but whether it affects the amount of free testosterone is unclear. Consuming liquorice may prevent the development of hyperkalemia in persons on hemodialysis. Large doses of glycyrrhizinic acid and glycyrrhetinic acid in liquorice extract can lead to hypokalemia and serious increases in blood pressure, a syndrome known as apparent mineralocorticoid excess. These side effects stem from the inhibition of the enzyme 11-hydroxysteroid dehydrogenase (type 2) and subsequent increase in activity of cortisol on the kidney. 11B-hydroxysteroid dehydrogenase normally inactivates cortisol in the kidney; thus, liquorice's inhibition of this enzyme makes the concentration of cortisol appear to increase. Cortisol acts at the same receptor as the hormone aldosterone in the kidney and the effects mimic aldosterone excess, although aldosterone remains low or normal during liquorice overdose. To decrease the chances of these serious side effects, deglycyrrhizinated liquorice preparations are available. The disabling of similar enzymes in the gut by glycyrrhizinic acid and glycyrrhetinic acid also causes increased mucus and decreased acid secretion. As it inhibits Helicobacter pylori, is used as an aid for healing stomach and duodenal ulcers, and in moderate amounts may soothe an upset stomach. Liquorice can be used to treat ileitis, leaky gut syndrome, irritable bowel syndrome and Crohn's disease as it is antispasmodic in the bowels.

ALTERNATIVE MEDICINE

Glycyrrhiza uralensis (Chinese liquorice) In traditional Chinese medicine, liquorice is commonly used in herbal formulae to "harmonize" the other ingredients in the formula and to carry the formula to the twelve "regular meridians and to relieve a spasmodic cough. In herbalism it is used in the Hoxsey anti-cancer formula, and is a considered adaptogen which helps reregulate the hypothalamic-pituitary-adrenal axis. It can also be used for auto-immune conditions including lupus, scleroderma, rheumatoid arthritis and animal dander allergies. Glycyrrhizin from Glycyrrhiza root has been shown to modulate airway constriction, lung inflammation and infiltration of eosinophils in bronchial areas by stimulating CD4 and CD8 immune cell function. Liquorice may be useful in conventional and naturopathic medicine for both mouth ulcers and peptic ulcers.

TOXICITY

Excessive consumption of liquorice or liquorice candy is known to be toxic to the liverand cardiovascular system, and may produce hypertensiiion and edema. In occasional cases blood pressure has increased with excessive consumption of liquorice tea, but such occasions are rare and reversible when the herb is withdrawn. Most cases of hypertension from liquorice were caused by eating too much concentrated liquorice candy. Doses as low as 50 grams (2 oz) of liquorice daily for two weeks can cause a significant rise in blood pressure. The European Commission 2008 report suggested that "people should not consume any more than 100mg of glycyrrhizic acid a day, for it can raise blood pressure or cause muscle weakness, chronic fatigue, headaches or swelling, and lower testosterone levels in men." Haribo, manufacturer of Pontefract cakes, stated: "Haribo advises, as with any other food, liquorice products should be eaten in moderation." A 56-year-old Yorkshire woman was hospitalized after liquorice overdose (200 grams or 7 ounces a day), which caused muscle failure. The hospital restored her potassium levels, by intravenous drip and tablets, allowing her to recover after 4 days. Comparative studies of pregnant women suggest that excessive amounts of liquorice (100g a week) may also adversely affect both IQ and behaviour traits of offspring.

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Mebendazole or MBZ is a benzimidazole drug developed by Janssen Pharmaceutica and marketed as Vermox, Ovex, Antiox, and Pripsen. It is used to treat infestations by worms including pinworms, roundworms, tapeworms, hookworms, and whipworms.

MEDICAL USE

The drug is a highly effective broad spectrum antihelmintic indicated for the treatment of nematode infestations, including roundworm, whipworm, threadworm, and hookworm. It is poorly absorbed and has no systemic effects.

MECHANISM

Mebendazole is thought to work by selectively inhibiting the synthesis of microtubules in parasitic worms, and by destroying extant cytoplasmic microtubes in their intestinal cells: thereby blocking the uptake of glucose and other nutrients, resulting in the gradual immobilization and eventual death of the helminths.

DOSAGE

Oral dosage for treatment of pinworms is 100 mg taken once. This regimen is repeated two weeks later if the infestation has not cleared up. Oral dosage for treatment of whipworm, common roundworm and hookworm is one 100-mg tablet morning and evening for 3 consecutive days. Dosage is the same for both adults and children.

ADVERSE EFFECTS

Mebendazole is relatively free of toxic side effects or adverse reactions, although patients may complain of transient abdominal pain, diarrhea, slight headache, fever, dizziness, exanthema, urticaria and angioedema.

CONTRAINDICATIONS

PREGNANCY

Mebendazole is contraindicated in pregnant women because it has been shown to be embryotoxic and teratogenic in experimental animals.

DRUG INTERACTIONS

Carbamazepine and phenytoin lower serum levels of mebendazole. Cimetidine does not appreciably raise serum mebendazole, consistent with its poor systemic absorption. Stevens–Johnson syndrome (toxic epidermal necrolysis) can occur when mebendazole is combined with high doses of metronidazole.

ONCOLOGIC TREATMENT POTENTIAL

Several studies show mebendazole exhibits a potent antitumor properties. MZ significantly inhibited cancer cell growth, migration and metastatic formation of adrenocortical carcinoma, both in vitro and in vivo. Treatment of lung cancer cell lines with MZ caused mitotic arrest, followed by apoptotic cell death with the feature of caspase activation and cytochrome c release. MZ induced a dose- and time-dependent apoptotic response in human lung cancer cell lines, and apoptosis via Bcl-2 inactivation in chemoresistant melanoma cells.

DISCONTINUATION IN UNITED STATES

The last manufacturer of mebendazole in the United States, Teva Pharmaceuticals, announced on October 7, 2011, that they have ceased manufacture of this product. As of December, 2011, it is no longer available from any manufacturer in the USA. No reason was given for this discontinuation.

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Metronidazole is an antibiotic, amebicide, and antiprotozoal. It is the drug of choice for first episodes of mild-to-moderate Clostridium difficile infection. It is marketed in the U.S.A. by Pfizer and globally by Sanofi under the trade name Flagyl, in Bangladesh as "Filmet" by Beximco Pharmaceuticals Ltd, "Metrogyl" by Rephco Pharmaceuticals Limited, in Pakistan as Nidagyl by Star Laboratories also Marketed as Flagyl by Sanofi and in Thailand, as Mepagyl by Thai Nakhorn Patana. It is also marketed in UK by Milpharm Limited and Almus Pharmaceuticals. Metronidazole was developed in 1960. Metronidazole is used also as a gel preparation in the treatment of the dermatological conditions such as rosacea (Rozex and MetroGel by Galderma) and fungating tumours (Anabact, Cambridge Healthcare Supplies).

MEDICAL USES

Metronidazole is indicated for the treatment of:

BACTERIAL

Bacterial vaginosis, commonly associated with overgrowth of Gardnerella species and coinfective anaerobes (Mobiluncus, Bacteroides), in symptomatic patients Pelvic inflammatory disease in conjunction with other antibiotics such as ofloxacin, levofloxacin, or ceftriaxone Anaerobic infections such as Bacteroides fragilis, spp, Fusobacterium spp, Clostridium spp, Peptostreptococcus spp, Prevotella spp, or any other anaerobes in intra-abdominal abscess, peritonitis, diverticulitis, empyema, pneumonia, aspiration pneumonia, lung abscess, diabetic foot ulcer, meningitis and brain abscesses, bone and joint infections, septicemia, endometritis, or endocarditis Pseudomembranous colitis due to Clostridium difficile Helicobacter pylori eradication therapy, as part of a multi-drug regimen in peptic ulcer disease Dental infection of bacterial origin, such as periapical abscess, periodontal abscess, acute pericoronitis of impacted or partially erupted teeth; often used in conjunction with Amoxicillin.

PROTOZOAL

Amoebiasis: Infections caused by Entamoeba histolytica. Giardiasis: infection of the small intestine caused by the ingestion of infective cysts of protozoan Giardia lamblia. Trichomoniasis: infection caused by Trichomonas vaginalis, which is a common cause of vaginitis and is the most frequently presenting new infection of the common sexually transmitted diseases.

NONSPECIFIC

Prophylaxis for those undergoing potentially contaminated colorectal surgery or appendectomies and may be combined with neomycin[citation needed] Crohn's disease with colonic or perianal involvement (non-FDA approved) – believed to be more effective in combination with ciprofloxacin. Topical metronidazole is indicated for the treatment of rosacea, and in the treatment of malodorous fungating wounds.

PRETERM BIRTHS

Metronidazole has also been used in women to prevent preterm birth associated with bacterial vaginosis, amongst other risk factors including the presence of cervicovaginal fetal fibronectin (fFN). A randomised controlled trial demonstrated that metronidazole was ineffective in preventing preterm delivery in high-risk pregnant women and, conversely, the incidence of preterm delivery was actually higher in women treated with metronidazole. In a study it has been found that metronidazole is not the right antibiotic to administer in these circumstances and that it was often administered too late to be of use. Clindamycin administered early in the second trimester to women who test positive for bacterial vaginosis seemed to be more effective.

VETERINARY USE

Metronidazole is not labeled for animal use but is widely used to treat infections of Giardia in dogs, cats, and other companion animals, although it does not reliably clear infection with this organism and is being supplanted by Fenbendazole for this purpose in dogs and cats. Metronidazole is also used for the management of chronic inflammatory bowel disease in cats and dogs. Another common usage is the treatment of systemic and/or GI clostridial infections in horses. Metronidazole or simply "Metro" is used in the aquarium hobby to treat ornamental fish and as a wide spectrum treatment for bacterial and protozoan infections in reptiles and amphibians. It is also used to treat human enteric (gi) and systemic infections. In general, the veterinary community may use metronidazole for any potentially susceptible anaerobic infection. The U.S. Food and Drug Administration (FDA) prohibits the use of metronidazole in food animals.

ADVERSE EFFECTS

Common adverse drug reactions (=1% of patients) associated with systemic metronidazole therapy include: nausea, diarrhea, and/or metallic taste in the mouth. Intravenous administration is commonly associated with thrombophlebitis. Infrequent adverse effects include: hypersensitivity reactions (rash, itch, flushing, fever), headache, dizziness, vomiting, glossitis, stomatitis, dark urine, and/or paraesthesia. High doses and/or long-term systemic treatment with metronidazole is associated with the development of leukopenia, neutropenia, increased risk of peripheral neuropathy and/or CNS toxicity. Metronidazole is listed by the US National Toxicology Program (NTP) as reasonably anticipated to be a human carcinogen. Although some of the testing methods have been questioned[citation needed], oral exposure has been shown to cause cancer in experimental animals. The relationship between exposure to metronidazole and human cancer is unclear. One study (Beard et al. 1988) found an excess in lung cancer among women (even after adjusting for smoking), while other studies (IARC 1987; Thapa et al. 1998) found either no increased risk, or a statistically insignificant risk. Metronidazole is listed as a possible carcinogen according to the WHO International Agency for Research on Cancer (IARC). Due to its potential carcinogenic properties, metronidazole is banned in the EU and the USA for veterinary use in the feed of animals and is banned for use in any food animals in the USA. In the USA, this type of restriction is covered under the Delaney clause. Earlier studies suggested a relation between metronidazole and various birth defects. Those studies are now considered flawed and more recent studies "do not support a significant increased risk for birth defects or other adverse effects on the fetus." Common adverse drug reactions associated with topical metronidazole therapy include local redness, dryness, and/or skin irritation; and eye watering (if applied near eyes).

METRONIDAZOLE TOXICITY OF THE BRAIN

Toxic levels of metronidazole can cause symmetrical lesions in the brain in the corpus callosum and dentate nuclei. Metronidazole toxicity is rare (though the actual incidence is not known with certainty). Patients present with nausea, vomiting, dysarthria, vertigo, and confusion. Other side effects of the metronidazole can include dry mouth, diarrhea, headache, dizziness, or peripheral neuropathy. An examination of a patient reveals that the patient is confused and has dysarthria (difficult or unclear articulation of speech that is otherwise linguistically normal), ataxia (loss of full control of bodily movements), abnormal eye movements including nystagmus and ophthalmoparesis. Magnetic resonance imaging (MRI) most often shows bilateral symmetric fluid-attenuated inversion recovery (FLAIR) hyperintense lesions of the dentate nuclei (which is one of the deep cerebellar nuclei), as well as symmetric lesions of the corpus callosum and basal ganglia. The brain lesions seen on the MRI rarely enhance and may be Diffusion-Weighted Imaging (DWI) hyperintense. It has a subacute to acute course. Most reports have been seen in patients who receive approximately one gram a day of metronidazole for over 30 days. Metronidazole can rarely cause central nervous system toxicity; it does not seem to be a dose- or duration-related phenomenon. Most patients will have MRI abnormalities. Prognosis is excellent with metronidazole cessation.

INTERACTION WITH ALCOHOL

Consuming ethanol (alcohol) while taking metronidazole has long been thought to have a disulfiram-like reaction with effects that can include nausea, vomiting, flushing of the skin, tachycardia (accelerated heart rate), and shortness of breath. Typically a 2006 Medicines Handbook warns that consumption of alcohol should be avoided by patients during systemic metronidazole therapy and for at least 48 hours after completion of treatment. However there are studies calling into question the interaction of alcohol and metronidazole, and the mechanism of this reaction in the clinical setting has been questioned by some authors, and a possible central toxic serotonin reaction for the alcohol intolerance suggested.

STEVENS-JOHNSON SYNDROME WITH MEBENDAZOLE

Metronidazole alone rarely causes Stevens–Johnson syndrome but is reported to occur at high rates when combined with mebendazole.

POTENTIALLY FATAL SEROTONIN SYNDROME

It is important to note that serotonin syndrome is not fully understood. The complex drug interaction can happen after a couple days or take up to months. The exact mechanism is not known, a theory of serotonin dysfunction helps explain how the syndrome presents and how it is to be treated. Signs and symptoms are muscle rigidity, headache, elevated blood pressure, and changes in blood chemistry. The only direct treatment is to discontinue the offending drugs. Recently, there have been reported cases of SSRI/SNRI antidepressant drugs (e.g. paroxetine, citalopram, fluoxetine, sertraline, venlafaxine, duloxetine) and metronidazole induced serotonin syndrome, but this information is not included on the metronidazole patient information leaflet.

MECHANISMS OF ACTION

Metronidazole, taken up by diffusion, is selectively absorbed by anaerobic bacteria and sensitive protozoa. Once taken up by anaerobes, it is non-enzymatically reduced by reacting with reduced ferredoxin, which is generated by pyruvate oxido-reductase. Many of the reduced nitroso intermediates will form sulfinamides and thioether linkages with cysteine-bearing enzymes, thereby deactivating these critical enzymes. As many as 150 separate enzymes are affected. In addition or alternatively, the metronidazole metabolites are taken up into bacterial DNA, and form unstable molecules. This function only occurs when metronidazole is partially reduced, and because this reduction usually happens only in anaerobic cells, it has relatively little effect upon human cells or aerobic bacteria.

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Mezlocillin is a broad-spectrum penicillin antibiotic. It is active against both Gram-negative and some Gram-positive bacteria. Unlike most other extended spectrum penicillins, it is excreted by the liver, therefore it is useful for biliary tract infections, such as ascending colangitis.

MECHANISM OF ACTION

Like all other beta-lactam antibiotics, mezlocillin inhibits the third and last stage of bacterial cell wall synthesis by binding to penicillin binding proteins. This ultimately leads to cell lysis.

SUSCEPTIBLE ORGANISMS

GRAM-NEGATIVE

Bacteroides spp., including B. fragilis
Enterobacter spp.
Escherichia coli
Haemophilus influenzae
Klebsiella species
Morganella morganii
Neisseria gonorrhoeae
Proteus mirabilis
Proteus vulgaris
Providencia rettgeri
Pseudomonas spp., including P. aeruginosa
Serratia marcescens

GRAM-POSITIVE

Enterococcus faecalis
Peptococcus spp.
Peptostreptococcus spp.

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Oregano scientifically named Origanum vulgare by Carolus Linnaeus, is a common species of Origanum, a genus of the mint family (Lamiaceae). It is native to warm-temperate western and southwestern Eurasia and the Mediterranean region. Oregano is a perennial herb, growing from 20?80 cm tall, with opposite leaves 14 cm long. Oregano will grow in a pH range between 6.0 (mildly acid) and 9.0 (strongly alkaline) with a preferred range between 6.0 and 8.0. The flowers are purple, 34 mm long, produced in erect spikes. It is sometimes called wild marjoram, and its close relative O. majorana is known as sweet marjoram.

MEDICINAL

Hippocrates used oregano as an antiseptic, as well as a cure for stomach and respiratory ailments. A Cretan oregano (O. dictamnus) is still used today in Greece as a palliative for sore throat. Oregano is high in antioxidant activity, due to a high content of phenolic acids and flavonoids. It also has shown antimicrobial activity against strains of the food-borne pathogen Listeria monocytogenes. In 2005, the US Federal Trade Commission brought legal action against a firm that had claimed oil of oregano treated colds and flus, and that oil of oregano taken orally treated and relieved bacterial and viral infections and their symptoms, saying the representations were false or were not substantiated at the time the representations were made, and that they were therefore a deceptive practice and false advertisements. The final stipulation on the matter said no representation as to any health benefit could be made without "competent and reliable scientific evidence".

BIOCHEMISTRY

The main chemical constituents include carvacrol, thymol, limonene, pinene, ocimene, and caryophyllene. The leaves and flowering stems are strongly antiseptic, antispasmodic, carminative, cholagogue, diaphoretic, emmenagogue, expectorant, stimulant, stomachic and mildly tonic.

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Penicillin (sometimes abbreviated PCN or pen) is a group of antibiotics derived from Penicillium fungi. They include penicillin G, procaine penicillin, benzathine penicillin, and penicillin V. Penicillin antibiotics are historically significant because they are the first drugs that were effective against many previously serious diseases, such as syphilis, and infections caused by staphylococci and streptococci. Penicillins are still widely used today, though many types of bacteria are now resistant. All penicillins are B-lactam antibiotics and are used in the treatment of bacterial infections caused by susceptible, usually Gram-positive, organisms.

MEDICAL USES

The term "penicillin" is often used generically to refer to benzylpenicillin (penicillin G), procaine benzylpenicillin (procaine penicillin), benzathine benzylpenicillin (benzathine penicillin), and phenoxymethylpenicillin (penicillin V). Procaine penicillin and benzathine penicillin have the same antibacterial activity as benzylpenicillin but act for a longer time span. Phenoxymethylpenicillin is less active against Gram-negative bacteria than benzylpenicillin. Benzylpenicillin, procaine penicillin and benzathine penicillin are given by injection (parenterally), but phenoxymethylpenicillin is given orally.

ADVERSE EFFECTS

Common adverse drug reactions (>1% of patients) associated with use of the penicillins include diarrhoea, hypersensitivity, nausea, rash, neurotoxicity, urticaria, and superinfection (including candidiasis). Infrequent adverse effects (0.1–1% of patients) include fever, vomiting, erythema, dermatitis, angioedema, seizures (especially in epileptics), and pseudomembranous colitis.

MECHANISM OF ACTION

Bacteria constantly remodel their peptidoglycan cell walls, simultaneously building and breaking down portions of the cell wall as they grow and divide. B-Lactam antibiotics inhibit the formation of peptidoglycan cross-links in the bacterial cell wall; this is achieved through binding of the four-membered B-lactam ring of penicillin to the enzyme DD-transpeptidase. Consequently, DD-transpeptidase cannot catalyze formation of these cross-links, and an imbalance between cell wall production and degradation develops, causing the cell to rapidly die. More specifically, the enzymes that hydrolyze the peptidoglycan cross-links continue to function, even while those that form such cross-links do not. This weakens the cell wall of the bacterium, and osmotic pressure continues to rise—eventually causing cell death (cytolysis). In addition, the build-up of peptidoglycan precursors triggers the activation of bacterial cell wall hydrolases and autolysins, which further digest the cell wall's peptidoglycans. The small size of the penicillins increases their potency, by allowing them to penetrate the entire depth of the cell wall. This is in contrast to the glycopeptide antibiotics vancomycin and teicoplanin, which are both much larger than the penicillins. Gram-positive bacteria are called protoplasts when they lose their cell walls. Gram-negative bacteria do not lose their cell walls completely and are called spheroplasts after treatment with penicillin. Penicillin shows a synergistic effect with aminoglycosides, since the inhibition of peptidoglycan synthesis allows aminoglycosides to penetrate the bacterial cell wall more easily, allowing their disruption of bacterial protein synthesis within the cell. This results in a lowered MBC for susceptible organisms. Penicillins, like other B-lactam antibiotics, block not only the division of bacteria, including cyanobacteria, but also the division of cyanelles, the photosynthetic organelles of the glaucophytes, and the division of chloroplasts of bryophytes. In contrast, they have no effect on the plastids of the highly developed vascular plants. This supports the endosymbiotic theory of the evolution of plastid division in land plants.

STRUCTURE

The term "penam" is used to describe the common core skeleton of a member of the penicillins. This core has the molecular formula R-C9H11N2O4S, where R is the variable side chain that differentiates the penicillins from one another. The penam core has a molecular weight of 243 g/mol, with larger penicillins having molecular weights near 450—for example, cloxacillin has a molecular weight of 436 g/mol. The key structural feature of the penicillins is the four-membered B-lactam ring; this structural moiety is essential for penicillin's antibacterial activity. The B-lactam ring is itself fused to a five-membered thiazolidine ring. The fusion of these two rings causes the B-lactam ring to be more reactive than monocyclic B-lactams because the two fused rings distort the B-lactam amide bond and therefore remove the resonance stabilisation normally found in these chemical bonds.

BIOSYNTHESIS

Overall, there are three main and important steps to the biosynthesis of penicillin G (benzylpenicillin).
The first step is the condensation of three amino acids—L-a-aminoadipic acid, L-cysteine, L-valine into a tripeptide. Before condensing into the tripeptide, the amino acid L-valine must undergo epimerization to become D-valine. The condensed tripeptide is named S-(L-a-aminoadipyl)-L-cysteine-D-valine (ACV). The condensation reaction and epimerization are both catalyzed by the enzyme S-(L-a-aminoadipyl)-L-cysteine-D-valine synthetase (ACVS), a nonribosomal peptide synthetase or NRPS.

The second step in the biosynthesis of penicillin G is the oxidative conversion of linear ACV into the bicyclic intermediate isopenicillin N by isopenicillin N synthase (IPNS), which is encoded by the gene pcbC. Isopenicillin N is a very weak intermediate, because it does not show strong antibiotic activity.
The final step is a transamidation by isopenicillin N N-acyltransferase, in which the a-aminoadipyl side-chain of isopenicillin N is removed and exchanged for a phenylacetyl side-chain. This reaction is encoded by the gene penDE, which is unique in the process of obtaining penicillins.

PRODUCTION

Penicillin is a secondary metabolite of certain species of Penicillium and is produced when growth of the fungus is inhibited by stress. It is not produced during active growth. Production is also limited by feedback in the synthesis pathway of penicillin. a-ketoglutarate AcCoA - homocitrate - L-a-aminoadipic acid - L-lysine B-lactam The by-product, l-lysine, inhibits the production of homocitrate, so the presence of exogenous lysine should be avoided in penicillin production. The Penicillium cells are grown using a technique called fed-batch culture, in which the cells are constantly subject to stress, which is required for induction of penicillin production. The available carbon sources are also important: Glucose inhibits penicillin production, whereas lactose does not. The pH and the levels of nitrogen, lysine, phosphate, and oxygen of the batches must also be carefully controlled. The biotechnological method of directed evolution has been applied to produce by mutation a large number of Penicillium strains. These techniques include error-prone PCR, DNA shuffling, ITCHY, and strand-overlap PCR. Semisynthetic penicillins are prepared starting from the penicillin nucleus 6-APA.

HISTORY

DISCOVERY

The discovery of penicillin is attributed to Scottish scientist and Nobel laureate Alexander Fleming in 1928. He showed that, if Penicillium rubens were grown in the appropriate substrate, it would exude a substance with antibiotic properties, which he dubbed penicillin. This serendipitous observation began the modern era of antibiotic discovery. The development of penicillin for use as a medicine is attributed to the Australian Nobel laureate Howard Walter Florey, together with the German Nobel laureate Ernst Chain and the English biochemist Norman Heatley. The first published reference appears in the publication of the Royal Society in 1875, by John Tyndall. Joaquim Monteiro Caminhoá, Professor of Botany and Zoology of the Faculty of Medicine of the Federal University of Rio de Janeiro in Brazil, also recognised the antibiotic activity of Penicillium and other fungi in 1877. In his book, Elements of General and Medical Botany (under a section titled "Useful fungi, harmful and curious"), he stated:

"The mould (Penicillium infestans, Penicillium glaucum, figure 1680, Ascophora and many others) is useful because it feeds on decaying organic matter and destroys putrifaction so that, as a rule, the odour of infection does not occur, or is produced in infinitely smaller amounts."

In 1895, Vincenzo Tiberio, physician of the University of Naples published a research about a mold (Penicillium) in a water well that had an antibacterial action. Ernest Duchesne documented it in an 1897 paper, which was not accepted by the Institut Pasteur because of his youth. In March 2000, doctors at the San Juan de Dios Hospital in San José, Costa Rica, published the manuscripts of the Costa Rican scientist and medical doctor Clodomiro (Clorito) Picado Twight (1887–1944). They reported Picado's observations on the inhibitory actions of fungi of the genus Penicillium between 1915 and 1927. Picado reported his discovery to the Paris Academy of Sciences, yet did not patent it, even though his investigations started years before Fleming's. Joseph Lister was experimenting with Penicillum in 1871 for his aseptic surgery. He found that it weakened the microbes, but then he dismissed the fungi. These early investigations did not lead to the use of antibiotics to treat infection because they took place in obscure circumstances, and the idea that infections were caused by transmissible agents was not widely accepted at the time. Sterilization measures had been shown to limit the outbreak and spread of disease; however, the mechanism of transmission of disease by parasites, bacteria, viruses and other agents was unknown. In the late 19th century, knowledge was increasing of the mechanisms by which living organisms become infected, how they manage infection once it has begun and, most importantly in the case of penicillin, the effect that natural and man-made agents could have on the progress of infection. Fleming recounted that the date of his discovery of penicillin was on the morning of Friday, September 28, 1928. It was a fortuitous accident: in his laboratory in the basement of St. Mary's Hospital in London (now part of Imperial College), Fleming noticed a Petri dish containing Staphylococcus plate culture he mistakenly left open, was contaminated by blue-green mould, which formed a visible growth. There was a halo of inhibited bacterial growth around the mould. Fleming concluded the mould released a substance that repressed the growth and lysing the bacteria. He grew a pure culture and discovered it was a Penicillium mould, now known to be Penicillium notatum. Charles Thom, an American specialist working at the U.S. Department of Agriculture, was the acknowledged expert, and Fleming referred the matter to him. Fleming coined the term "penicillin" to describe the filtrate of a broth culture of the Penicillium mould. Even in these early stages, penicillin was found to be most effective against Gram-positive bacteria, and ineffective against Gram-negative organisms and fungi. He expressed initial optimism that penicillin would be a useful disinfectant, being highly potent with minimal toxicity compared to antiseptics of the day, and noted its laboratory value in the isolation of Bacillus influenzae (now Haemophilus influenzae). After further experiments, Fleming was convinced penicillin could not last long enough in the human body to kill pathogenic bacteria, and stopped studying it after 1931. He restarted clinical trials in 1934, and continued to try to get someone to purify it until 1940.

MEDICAL APPLICATION

In 1930, Cecil George Paine, a pathologist at the Royal Infirmary in Sheffield, attempted to use penicillin to treat sycosis barbae, eruptions in beard follicles, but was unsuccessful, probably because the drug did not penetrate the skin deeply enough. Moving on to ophthalmia neonatorum, a gonococcal infection in infants, he achieved the first recorded cure with penicillin, on November 25, 1930. He then cured four additional patients (one adult and three infants) of eye infections, and failed to cure a fifth. In 1939, Australian scientist Howard Florey (later Baron Florey) and a team of researchers (Ernst Boris Chain, Arthur Duncan Gardner, Norman Heatley, M. Jennings, J. Orr-Ewing and G. Sanders) at the Sir William Dunn School of Pathology, University of Oxford made significant progress in showing the in vivo bactericidal action of penicillin. Their attempts to treat humans failed because of insufficient volumes of penicillin (the first patient treated was Reserve Constable Albert Alexander), but they proved it harmless and effective on mice. Some of the pioneering trials of penicillin took place at the Radcliffe Infirmary in Oxford, England. These trials continue to be cited by some sources as the first cures using penicillin, though the Paine trials took place earlier. On March 14, 1942, John Bumstead and Orvan Hess saved a dying patient's life using penicillin. Notably, survivors of the November 28, 1942 Cocoanut Grove fire in Boston, which killed 492 people, were treated with penicillin. Merck and Company rushed a 32-liter supply of the drug, in the form of culture liquid in which the Penicillium mold had been grown, from New Jersey to Boston in early December. The drug was crucial in combating staphylococcus bacteria which typically infect skin grafts. As a result of the success of penicillin in preventing infections, the US Government decided to support the production and distribution of penicillin to the armed forces.

HUMAN EXPERIMENTATION

In a 1946 to 1948 study in Guatemala, U.S. researchers used prostitutes to infect prison inmates, insane asylum patients, and Guatemalan soldiers with syphilis and other sexually transmitted diseases (STDs), to test the effectiveness of penicillin in treating such diseases. They later tried infecting people with "direct inoculations made from syphilis bacteria poured into the men's penises and on forearms and faces that were slightly abraded ... or in a few cases through spinal punctures". Approximately 1300 people were infected as part of the study (including orphaned children). The study was sponsored by the Public Health Service, the National Institutes of Health and the Pan American Health Sanitary Bureau (now the World Health Organization's Pan American Health Organization) and the Guatemalan government. The team was led by John Charles Cutler, who later participated in the Tuskegee syphilis experiments. Cutler chose to do the study in Guatemala because he would not have been permitted to do it in the United States. The Presidential Commission for the Study of Bioethical Issues determined that 83 people died; however, it was not possible to determine whether the experiments were the direct cause of death.

TOTAL SYNTHESIS

Chemist John C. Sheehan at the Massachusetts Institute of Technology (MIT) completed the first chemical synthesis of penicillin in 1957. Sheehan had started his studies into penicillin synthesis in 1948, and during these investigations developed new methods for the synthesis of peptides, as well as new protecting groups—groups that mask the reactivity of certain functional groups. Although the synthesis developed by Sheehan was not appropriate for mass production of penicillins, one of the intermediate compounds in Sheehan's synthesis was 6-aminopenicillanic acid (6-APA), the nucleus of penicillin. Attaching different groups to the 6-APA 'nucleus' of penicillin allowed the creation of new forms of penicillin.

DEVELOPMENTS FROM PENICILLIN

The narrow range of treatable diseases or "spectrum of activity" of the penicillins, along with the poor activity of the orally active phenoxymethylpenicillin, led to the search for derivatives of penicillin that could treat a wider range of infections. The isolation of 6-APA, the nucleus of penicillin, allowed for the preparation of semisynthetic penicillins, with various improvements over benzylpenicillin (bioavailability, spectrum, stability, tolerance). The first major development was ampicillin, which offered a broader spectrum of activity than either of the original penicillins. Further development yielded B-lactamase-resistant penicillins, including flucloxacillin, dicloxacillin, and methicillin. These were significant for their activity against B-lactamase-producing bacterial species, but were ineffective against the methicillin-resistant Staphylococcus aureus (MRSA) strains that subsequently emerged. Another development of the line of true penicillins was the antipseudomonal penicillins, such as carbenicillin, ticarcillin, and piperacillin, useful for their activity against Gram-negative bacteria. However, the usefulness of the B-lactam ring was such that related antibiotics, including the mecillinams, the carbapenems and, most important, the cephalosporins, still retain it at the center of their structures.

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A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease. The word pharmaceutical comes from the Greek word Pharmakeia. The modern transliteration of Pharmakeia is Pharmacia.

CLASSIFICATION

Medications can be classified in various ways, such as by chemical properties, mode or route of administration, biological system affected, or therapeutic effects. An elaborate and widely used classification system is the Anatomical Therapeutic Chemical Classification System (ATC system). The World Health Organization keeps a list of essential medicines.

A sampling of classes of medicine includes:
1.Antipyretics: reducing fever (pyrexia/pyresis)
2.Analgesics: reducing pain (painkillers)
3.Antimalarial drugs: treating malaria
4.Antibiotics: inhibiting germ growth
5.Antiseptics: prevention of germ growth near burns, cuts and wounds

TYPES OF MEDICATIONS (TYPE OF PHARMACOTHERAPY)

FOR THE GASTROINTESTINAL TRACT(DIGESTIVE SYSTEM)

Upper digestive tract:
antacids, reflux suppressants, antiflatulents, antidopaminergics, proton pump inhibitors (PPIs), H2-receptor antagonists, cytoprotectants, prostaglandin analogues

Lower digestive tract:
laxatives, antispasmodics, antidiarrhoeals, bile acid sequestrants, opioid

FOR THE CARDIOVASCULAR SYSTEM

General:
B-receptor blockers ("beta blockers"), calcium channel blockers, diuretics, cardiac glycosides, antiarrhythmics, nitrate, antianginals, vasoconstrictors, vasodilators, peripheral activators

Affecting blood pressure (antihypertensive drugs):
ACE inhibitors, angiotensin receptor blockers, a blockers, calcium channel blockers

Coagulation:
anticoagulants, heparin, antiplatelet drugs, fibrinolytics, anti-hemophilic factors, haemostatic drugs
Atherosclerosis/cholesterol inhibitors: hypolipidaemic agents, statins.

FOR THE CENTRAL NERVOUS SYSTEM

Drugs affecting the central nervous system include:

hypnotics, anaesthetics, antipsychotics, antidepressants (including tricyclic antidepressants, monoamine oxidase inhibitors, lithium salts, and selective serotonin reuptake inhibitors (SSRIs)), antiemetics, anticonvulsants/antiepileptics, anxiolytics, barbiturates, movement disorder (e.g., Parkinson's disease) drugs, stimulants (including amphetamines), benzodiazepines, cyclopyrrolones, dopamine antagonists, antihistamines, cholinergics, anticholinergics, emetics, cannabinoids, and 5-HT (serotonin) antagonists.

FOR PAIN AND CONSIOUSNESS(ANALGESIC DRUGS)

The main classes of painkillers are NSAIDs, opioids and various orphans such as paracetamol.

FOR MUSCULO-SKELETAL DISORDERS

The main categories of drugs for musculoskeletal disorders are: NSAIDs (including COX-2 selective inhibitors), muscle relaxants, neuromuscular drugs, and anticholinesterases.

FOR THE EYE

General:
topical anesthetics, sympathomimetics, parasympatholytics, mydriatics,cycloplegics Anti-bacterial:
antibiotics, topical antibiotics, sulfa drugs, aminoglycosides, fluoroquinolones Antiviral drug Anti-fungal:
imidazoles, polyenes Anti-inflammatory: NSAIDs, corticosteroids Anti-allergy:
mast cell inhibitors Anti-glaucoma:
adrenergic agonists, beta-blockers, carbonic anhydrase inhibitors/hyperosmotics, cholinergics, miotics, parasympathomimetics, prostaglandin agonists/prostaglandin inhibitors. nitroglycerin

FOR THE EAR, NOSE AND OROPHARYNX

sympathomimetics, antihistamines, anticholinergics, NSAIDs, steroids, antiseptics, local anesthetics, antifungals, cerumenolyti

FOR THE RESPIRATORY SYSTEM

bronchodilators, NSAIDs, anti-allergics, antitussives, mucolytics, decongestants corticosteroids, Beta2-adrenergic agonists, anticholinergics, steroids

FOR ENDOCRINE PROBLEMS

androgens, antiandrogens, gonadotropin, corticosteroids, human growth hormone, insulin, antidiabetics (sulfonylureas, biguanides/metformin, thiazolidinediones, insulin), thyroid hormones, antithyroid drugs, calcitonin, diphosponate, vasopressin analogues

FOR THE REPRODUCTIVE SYSTEM OR URINARY SYSTEM

antifungal, alkalising agents, quinolones, antibiotics, cholinergics, anticholinergics, anticholinesterases, antispasmodics, 5-alpha reductase inhibitor, selective alpha-1 blockers, sildenafils, fertility medications

FOR CONTRACEPTION

Hormonal contraception
Ormeloxifene
Spermicide

FOR OBSTETRICS AND NSAID'S

anticholinergics, haemostatic drugs, antifibrinolytics, Hormone Replacement Therapy (HRT), bone regulators, beta-receptor agonists, follicle stimulating hormone, luteinising hormone, LHRH gamolenic acid, gonadotropin release inhibitor, progestogen, dopamine agonists, oestrogen, prostaglandins, gonadorelin, clomiphene, tamoxifen, Diethylstilbestrol

FOR THE SKIN

emollients, anti-pruritics, antifungals, disinfectants, scabicides, pediculicides, tar products, vitamin A derivatives, vitamin D analogues, keratolytics, abrasives, systemic antibiotics, topical antibiotics, hormones, desloughing agents, exudate absorbents, fibrinolytics, proteolytics, sunscreens, antiperspirants, corticosteroids

FOR INFECTIONS AND INFESTATIONS

antibiotics, antifungals, antileprotics, antituberculous drugs, antimalarials, anthelmintics, amoebicides, antivirals, antiprotozoals

FOR THE IMMUNE SYSTEM

vaccines, immunoglobulins, immunosuppressants, interferons, monoclonal antibodies

FOR ALLERGIC DISORDERS

anti-allergics, antihistamines, NSAIDs

FOR NUTRITION

tonics, electrolytes and mineral preparations (including iron preparations and magnesium preparations), Parental nutritional supplements, vitamins, anti-obesity drugs, anabolic drugs, haematopoietic drugs, food product drugs

FOR NEOPLASTIC DISORDERS

cytotoxic drugs, therapeutic antibodies, sex hormones, aromatase inhibitors, somatostatin inhibitors, recombinant interleukins, G-CSF, erythropoietin

ADMINISTRATION

Administration is the delivery of a pharmaceutical drug to a patient. It can be performed in various dosage forms such as pills, tablets, or capsules. There are also many variations in the routes of administration, including intravenous (into the blood through a vein) and oral administration (through the mouth). They can be administered all at once as a bolus, at frequent intervals or continuously. Frequencies are often abbreviated from Latin, such as every 8 hours reading Q8H from Quaque VIII Hora.

LEGAL CONSIDERATIONS

Depending upon the jurisdiction, medications may be divided into over-the-counter drugs (OTC) which may be available without special restrictions, and prescription only medicine (POM), which must be prescribed by a licensed medical practitioner. The precise distinction between OTC and prescription depends on the legal jurisdiction. A third category, behind-the-counter medications (BTMs), is implemented in some jurisdictions. BTMs do not require a prescription, but must be kept in the dispensary, not visible to the public, and only be sold by a pharmacist or pharmacy technician. Doctors may also prescribe prescription drugs for off-label use - purposes which the drugs were not originally approved for by the regulatory agency. The Classification of Pharmaco-Therapeutic Referrals helps guide the referral process between pharmacists and doctors. The International Narcotics Control Board of the United Nations imposes a world law of prohibition of certain medications. They publish a lengthy list of chemicals and plants whose trade and consumption (where applicable) is forbidden. OTC medications are sold without restriction as they are considered safe enough that most people will not hurt themselves accidentally by taking it as instructed. Many countries, such as the United Kingdom have a third category of pharmacy medicines which can only be sold in registered pharmacies, by or under the supervision of a pharmacist. For patented medications, countries may have certain mandatory licensing programs which compel, in certain situations, a medication's owner to contract with other agents to manufacture the drug. Such programs may deal with the contingency of a lack of medication in the event of a serious epidemic of disease, or may be part of efforts to ensure that disease treating drugs, such as AIDS drugs, are available to countries which cannot afford the drug owner's price.

PRESCRIPTION PRACTICE

Drugs which are prescription only are regulated as such because they can impose adverse effects and should not be used unless necessary. Medical guidelines and clinical trials required for approval are used to help inform doctors' prescription of these drugs, but errors can happen. Reasons to not prescribe drugs such as interactions or side effects are called contraindications. Errors include overprescription and polypharmacy, misprescription, contraindication and lack of detail in dosage and administrations instructions. In 2000 the definition of a prescription error was studied using a Delphi method conference; the conference was motivated by ambiguity in the what a prescription error and a need to use a uniform definition in studies.

DEVELOPMENT

Drug development is the process by which a drug is created. Drugs can be extracted from natural products (pharmacognosy) or synthesized through chemical processes. The drug's active ingredient will be combined with a "vehicle" such as a capsule, cream, or liquid which will be administered through a particular route of administration. Child-resistant packaging will likely be used in the ultimate package sold to the consumer.

ENVIROMENTAL IMPACT

Since the 1990s water contamination by pharmaceuticals has been an environmental issue of concern. Most pharmaceuticals are deposited in the environment through human consumption and excretion, and are often filtered ineffectively by wastewater treatment plants which are not designed to manage them. Once in the water they can have diverse, subtle effects on organisms, although research is limited. Pharmaceuticals may also be deposited in the environment through improper disposal, runoff from sludge fertilizer and reclaimed wastewater irrigation, and leaky sewage. In 2009 an investigative report by Associated Press concluded that U.S. manufacturers had legally released 271 million pounds of drugs into the environment, 92% of which was the antiseptics phenol and hydrogen peroxide. It could not distinguish between drugs released by manufacturers as opposed to the pharmaceutical industry. It also found that an estimated 250 million pounds of pharmaceuticals and contaminated packaging were discarded by hospitals and long-term care facilities. Pharmacoenvironmentology is a branch of pharmacology and a form of pharmacovigilance which deals entry of chemicals or drugs into the environment after elimination from humans and animals post-therapy. It deals specifically with those pharmacological agents that have impact on the environment via elimination through living organisms subsequent to pharmacotherapy, while Ecopharmacology is concerned with the entry of chemicals or drugs into the environment through any route and at any concentration disturbing the balance of ecology (ecosystem), as a consequence. Ecopharmacology is a broad term that includes studies of “PPCPs” irrespective of doses and route of entry into environment. Ecopharmacovigilance is the science and activities associated with the detection, evaluation, understanding and prevention of adverse effects of pharmaceuticals in the environment. This is close to the WHO definition of pharmacovigilance, the science aiming to capture any adverse effects of pharmaceuticals in humans after use. The term Environmental Persistent Pharmaceutical Pollutants (EPPP) was suggested in the 2010 nomination of pharmaceuticals and environment as an emerging issue to Strategic Approach to International Chemicals Management (SAICM) by the International Society of Doctors for the Environment (ISDE).

HISTORY

ANCIENT PHARMACOLOGY

Using plants and plant substances to treat all kinds of diseases and medical conditions is believed to date back to prehistoric medicine. The Kahun Gynaecological Papyrus, the oldest known medical text of any kind, dates to about 1800 BC and represents the first documented use of any kind of medication. It and other medical papyri describe Ancient Egyptian medical practices, such as using honey to treat infections. Ancient Babylonian medicine demonstrate the use of prescriptions in the first half of the 2nd millennium BC. Medicinal creams and pills were employed as treatments. On the Indian subcontinent, the Atharvaveda, a sacred text of Hinduism whose core dates from the 2nd millennium BC, although the hymns recorded in it are believed to be older, is the first Indic text dealing with medicine. It describes plant-based medications to counter diseases. The earliest foundations of ayurveda were built on a synthesis of selected ancient herbal practices, together with a massive addition of theoretical conceptualizations, new nosologies and new therapies dating from about 400 BC onwards. The student of Ayurveda was expected to know ten arts that were indispensable in the preparation and application of his medicines: distillation, operative skills, cooking, horticulture, metallurgy, sugar manufacture, pharmacy, analysis and separation of minerals, compounding of metals, and preparation of alkalis. The Hippocratic Oath for physicians, attributed to 5th century BC Greece, refers to the existence of "deadly drugs", and ancient Greek physicians imported medications from Egypt and elsewhere. The first drugstores were created in Baghdad in the 8th century AD. The injection syringe was invented by Ammar ibn Ali al-Mawsili in 9th century Iraq. Al-Kindi's 9th century AD book, De Gradibus, developed a mathematical scale to quantify the strength of drugs. The Canon of Medicine by Ibn Sina (Avicenna), who is considered the father of modern medicine, reported 800 tested drugs at the time of its completion in 1025 AD. Ibn Sina's contributions include the separation of medicine from pharmacology, which was important to the development of the pharmaceutical sciences. Islamic medicine knew of at least 2,000 medicinal and chemical substances.

MEDIEVAL PHARMACOLOGY

Medieval medicine saw advances in surgery, but few truly effective drugs existed, beyond opium and quinine. Folklore cures and potentially poisonous metal-based compounds were popular treatments. Theodoric Borgognoni, (1205–1296), one of the most significant surgeons of the medieval period, responsible for introducing and promoting important surgical advances including basic antiseptic practice and the use of anaesthetics. Garcia de Orta described some herbal treatments that were used.

MODERN PHARMACOLOGY

For most of the 19th century, drugs were not highly effective, leading Oliver Wendell Holmes, Sr. to famously comment in 1842 that "if all medicines in the world were thrown into the sea, it would be all the better for mankind and all the worse for the fishes". During the First World War, Alexis Carrel and Henry Dakin developed the Carrel-Dakin method of treating wounds with an irrigation, Dakin's solution, a germicide which helped prevent gangrene. In the inter-war period, the first anti-bacterial agents such as the sulpha antibiotics were developed. The Second World War saw the introduction of widespread and effective antimicrobial therapy with the development and mass production of penicillin antibiotics, made possible by the pressures of the war and the collaboration of British scientists with the American pharmaceutical industry. Medicines commonly used by the late 1920s included aspirin, codeine, and morphine for pain; digitalis, nitroglycerin, and quinine for heart disorders, and insulin for diabetes. Other drugs included antitoxins, a few biological vaccines, and a few synthetic drugs. In the 1930s antibiotics emerged: first sulfa drugs, then penicillin and other antibiotics. Drugs increasingly became "the center of medical practice". In the 1950s other drugs emerged including corticosteroids for inflammation, rauwolfia alkloids as tranqulizers and antihypertensives, antihistamines for nasal allergies, xanthines for asthma, and typical antipsychotics for psychosis. As of 2008, thousands of approved drugs have been developed. Increasingly, biotechnology is used to discover biopharmaceuticals. Recently, multi-disciplinary approaches have yielded a wealth of new data on the development of novel antibiotics and antibacterials and on the use of biological agents for antibacterial therapy. In the 1950s new psychiatric drugs, notably the antipsychotic chlorpromazine, were designed in laboratories and slowly came into preferred use. Although often accepted as an advance in some ways, there was some opposition, due to serious adverse effects such as tardive dyskinesia. Patients often opposed psychiatry and refused or stopped taking the drugs when not subject to psychiatric control. Governments have been heavily involved in the regulation of drug development and drug sales. In the U.S., the Elixir Sulfanilamide disaster led to the establishment of the Food and Drug Administration, and the 1938 Federal Food, Drug, and Cosmetic Act required manufacturers to file new drugs with the FDA. The 1951 Humphrey-Durham Amendment required certain drugs to be sold by prescription. In 1962 a subsequent amendment required new drugs to be tested for efficacy and safety in clinical trials. Until the 1970s, drug prices were not a major concern for doctors and patients. As more drugs became prescribed for chronic illnesses, however, costs became burdensome, and by the 1970s nearly every U.S. state required or encouraged the substitution of generic drugs for higher-priced brand names. This also led to the 2006 U.S. law, Medicare Part D, which offers Medicare coverage for drugs. As of 2008, the United States is the leader in medical research, including pharmaceutical development. U.S. drug prices are among the highest in the world, and drug innovation is correspondingly high. In 2000 U.S. based firms developed 29 of the 75 top-selling drugs; firms from the second-largest market, Japan, developed eight, and the United Kingdom contributed 10. France, which imposes price controls, developed three. Throughout the 1990s outcomes were similar.

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Praziquantel (Biltricide) is an anthelmintic effective against flatworms. Praziquantel is not licensed for use in humans in the UK; it is, however, available as a veterinary anthelmintic, and is available for use in humans on a named-patient basis.

USES

Praziquantel is used to treat diseases in humans and other mammals that are caused by infection with several types of internal/ gastrointestinal parasites including the following: Hydatid disease caused by infection of various organs with larval stages of tapeworms of the genus Echinococcus
Cysticercosis caused by infection of the brain and/ or muscles with the eggs and larvae of the pork tapeworm Taenia solium (though it has been judged less effective than albendazole in treatment of neurocysticercosis)
Feline taeniasis caused in cats by gastrointestinal infection with adult tapeworms of the species Taenia taeniaeformis; used either alone or in combination with pyrantel pamoate
Toxocariasis in cats and dogs whose gut is infected with the roundworms/ nematodes Toxocara cati or Toxocara canis respectively; use is often combined with pyrantel Schistosomiasis caused by trematodes of the genus Schistosoma. As of 2005, praziquantel is the primary treatment for human schistosomiasis, for which it is usually effective in a single dose.
Clonorchiasis brought on by the Chinese liver fluke Clonorchis sinensis
Paragonimiasis caused by infection with lung flukes, mostly of the species Paragonimus westermani.
Fascioliasis ("liver rot") brought on by either Fasciola hepatica (the common liver fluke) or Fasciola gigantica

HISTORY

Praziquantel was developed in the laboratories for parasitological research of Bayer AG and Merck KGaA in Germany (Elberfeld and Darmstadt) in the mid 1970s. The World Health Organization includes it on its Model List of Essential Medicines.

PHARMACOKINETICS

Praziquantel is well absorbed (approximately 80%) from the gastrointestinal tract. However, due to extensive first-pass metabolism, only a relatively small amount enters systemic circulation. Praziquantel has a serum half-life of 0.8 to 1.5 hours in adults with normal renal and liver function. Metabolites have a half-life of 4 to 5 hours. In patients with significantly impaired liver function (Child Pugh classes B ll///d C), the serum half-life is increased to 3 to 8 hours. Praziquantel and its metabolites are mainly excreted renally; within 24 hours after a single oral dose, 70 to 80% is found in urine, but less than 0.1% as the unchanged drug. Praziquantel is metabolized through the cytochrome P450 pathway via CYP3A4. Agents that induce or inhibit CYP3A4 such as phenytoin, rifampin, and azole antifungals will affect the metabolism of praziquantel. Praziquantel has a particularly dramatic effect on patients with schistosomiasis. Studies of those treated have shown that within six months of receiving a dose of praziquantel, up to 90% of the damage done to internal organs due to schistosomiasis infection can be reversed.

MODE OF ACTION

Although the mode of action is not exactly known at present, there is experimental evidence that praziquantel increases the permeability of the membranes of schistosome cells towards calcium ions. The drug thereby induces contraction of the parasites, resulting in paralysis in the contracted state. The dying parasites are dislodged from their site of action in the host organism and may enter systemic circulation or may be destroyed by host immune reaction (phagocytosis). Additional mechanisms including focal disintegrations and disturbances of oviposition (laying of eggs) are seen in other types of sensitive parasites. Another hypothesis concerning the mechanism of action of praziquantel has been recently reported. The drug seems to interfere with adenosine uptake in cultured worms. This effect may have therapeutical relevance given that the schistosome, as the taenia and the echinococcus (other praziquantel sensitive parasites), is unable to synthesize purines such as adenosine de novo. Bayer's Animal Health Division website states, "Praziquantel is active against cestodes (tapeworms). Praziquantel is absorbed, metabolized in the liver and excreted in the bile. Upon entering the digestive tract from the bile, cestocidal activity is exhibited. Following exposure to praziquantel, the tapeworm loses its ability to resist digestion by the mammalian host. Because of this, whole tapeworms, including the scolices (plural of "scolex"), are very rarely passed after administration of praziquantel. In many instances only disintegrated and partially digested pieces of tapeworms will be seen in the stool. The majority of tapeworms are digested and are not found in the feces." Praziquantel is administered as a racemate, but only the (R)-enantiomer is biologically active; the enantiomers may be separated using a resolution of an amine obtained from praziquantel.

SIDE EFFECTS

The majority of side effects develop due to the release of the contents of the parasites as they are killed and the consequent host immune reaction. The heavier the parasite burden, the heavier and more frequent the side effects normally are. Central nervous system: Frequently occurring side effects are dizziness, headache, and malaise. Drowsiness, somnolence, fatigue, and vertigo have also been seen. Almost all patients with cerebral cysticercosis experience CNS side effects related to the cell-death of the parasites (headache, worsening of pre-existing neurological problems, seizures, arachnoiditis, and meningism). These side effects may be life-threatening and can be reduced by coadministration of corticosteroids. It is strongly recommended that all patients with cerebral cysticercosis are hospitalized during treatment. GI Tract: Approximately 90% of all patients have abdominal pain or cramps with or without nausea and vomiting. Diarrhea may develop and may be severe with colic. Sweating, fever, and sometimes bloody stools may occur together with diarrhea. Liver: Asymptomatic and transient increases of liver enzymes (AST and ALT) are noted frequently (up to 27%). No case of symptomatic liver damage has ever been seen so far. Sensitivity reactions: Urticaria, rash, pruritus and eosinophilia in white blood cell counts Other locations/body as a whole: Lower back pain, myalgia, arthralgia, fever, sweating, various cardiac arrhythmias, and hypotension.

DRUG INTERACTIONS

ANTIBIOTICS

A study found that the antibiotic rifampicin decreases plasma concentrations of praziquantel.

ANTIEPILEPTICS

Carbamazepine and phenytoin are reported to reduce the bioavailability of praziquantel.

ANTIMALARIALS

Chloroquine reduces the bioavailability of praziquantel

ANTACIDS / HISAMINE H2- ANTAGONISTS

At least 2 studies indicate the drug cimetidine heightens praziquantel bioavailability.

DOSAGE

For schistosomiasis, the dose is 20 milligrams/kilogram by mouth every 4–6 hours for one day. For tapeworms, the dose is 5–25 mg/kg by mouth once. For liver fluke, the dose is 25 mg/kg by mouth every 4–6 hours for one day. These dosages are for patients over 4 years old, and are to be taken with food or a few minutes before a meal.

BRAND NAMES

Biltricide (Bayer) 600 mg Tablets (for human use)
Cesol (Merck) Tablets
Cestoved (Vedco) both tablets and injectable for veterinary use Cysticide (Merck) Tablets
Droncit (Bayer) for veterinary use
Drontal (combination with pyrantel pamoate) (Bayer) for veterinary use
D-Worm (Farnum) for veterinary use; note that D-Worm also makes roundworm medicine containing piperidine which is not effective against tapeworms.
Kaicide (Taiwan)
Milbemax (combination with milbemycin oxime) (Novartis) for veterinary use
Popantel (Jurox)
PraziPro (Hikari) for aquarium use
Profender (combination with emodepside) (Bayer) for veterinary use
Tape Worm Tabs (Trade Winds) for veterinary use
Zentozide (Berich (Thailand) Co)
Distoside (Chandra Bhagat Pharma Pvt Ltd) 600mg tablet (for human use)

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Psyllium seed husks also known as ispaghula, isabgol, or psyllium, are portions of the seeds of the plant Plantago ovata, (genus Plantago), a native of India. They are hygroscopic (that is they absorb water expanding and become mucilaginous. Ayurveda recommends its use for colon cleansing/ bowel regulation as well as for better blood circulation. Psyllium seed husk are indigestible and are a source of soluble dietary fiber. They are used to relieve constipation, irritable bowel syndrome, and diarrhea. They are also used as a regular dietary supplement to improve and maintain regular GI transit. The inert bulk of the husks helps provide a constant volume of solid material irrespective of other aspects of the diet or any disease condition of the gut. Some recent research is also showing them to be promising in lowering cholesterol and controlling diabetes. Other uses include gluten-free baking, where ground psyllium seed husks bind moisture and help make the bread less crumbly. The husks are used whole in their natural state, or dried and chopped or powdered for easier consumption. In either of these forms, one takes them by mixing them with water or another fluid. Sometimes they are combined with clay as a detoxification drink. Most commonly this clay is Bentonite Clay which is a volcanic clay which is claimed to have many detoxing properties. The psyllium husks are also available in capsules. Over-the-counter laxatives and fiber supplements such as Metamucil, Colon Cleanse, Serutan, Fybogel, Bonvit, and Effersyllium have psyllium husks as their main ingredient. The husks may also be combined with other ingredients. For example, Blackstrap molasses is sometimes used with psyllium seed husks for its high mineral and vitamin content, as well as being an excellent carrier. A typical dose is one to three teaspoons per glass of water. Psyllium seeds can be used for the same purpose at a lower cost. The standard dose is 3.5gm dissolved in 250 ml of water. The U.S. Food and Drug Administration (FDA) has established a tangible benefit of psyllium seed husk intake and a decreased risk of coronary heart disease (CHD). Psyllium's soluble fiber thus has the potential to decrease the risk of CHD.

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Pepita (from Mexican Spanish: pepita de calabaza, "little seed of squash") is a Spanish culinary term for the pumpkin seed, the edible seed of a pumpkin or other cultivar of squash (genus Cucurbita). The seeds are typically rather flat and asymmetrically oval, and light green in color inside a white hull. The word can refer either to the hulled kernel or unhulled whole seed, and most commonly refers to the roasted end product. The pressed oil of the roasted seeds of a specific pumpkin variety is also used in Central and Eastern European cuisine (see Pumpkin seed oil). Pepitas are a popular ingredient in Mexican cuisine and are also roasted and served as a snack. Marinated and roasted, they are an autumn seasonal favorite in the rural United States, as well as a commercially produced and distributed packaged snack, like sunflower seeds, available year-round. Pepitas are known by their Spanish name (usually shortened), and typically salted and sometimes spiced after roasting (and today also available as a packaged product), in Mexico and other Latin American countries, in the American Southwest, and in speciality and Mexican food stores. In the Americas, they have been eaten since at least the time of the Aztecs and probably much earlier, since squash was one of the three earliest plant domesticates in the Western Hemisphere, along with maize (corn) and common beans (collectively the Native American agricultural "Three Sisters", originating in Mexico). As an ingredient in mole dishes, they are known in Spanish as pipi?n. A Mexican snack using pepitas in an artisan fashion is referred to as Pepitor?a. Lightly roasted, salted, unhulled pumpkin seeds are popular in Greece with the descriptive Italian name, passatempo ("pastime").

NUTRITION

The seeds are also good sources of protein, as well as iron, zinc, manganese, magnesium, phosphorus, copper, and potassium. In regards to iron, 25 grams of pepitas (about a US quarter-cup) can provide over 20 percent of the recommended daily iron intake. In 2007, Stevenson, et al., of the USDA's New Crops Products Research Unit searched the primary literature for information about the lipid content of pepitas, and then grew and analyzed pepitas from seven cultivars of C. maxima.The reported concentration of myristate and palmitate (the cholestrogenic fatty acids) for the pepitas ranged from 1.6% to 4.9%. The total unsaturated fatty acid concentration ranged from 9% to 21% of the pepita. The total fat content ranged from 11% to 52%. Based on the quantity of alpha-tocopherol extracted in the oil, the vitamin E content of the twelve C. maxima cultivar seeds ranged from 4 to 19 mg/100 g of pepita.

NUTRACEUTICAL USES

The seeds of pumpkins, such as Cucurbita pepo varieties have been subject to a great deal of research, especially into the treatment of prostate ailments.

WHOLE SEEDS AND KERNALS

According to the USDA, one gram of roasted pepita contain 5.69 mg L-tryptophan and one gram of pepita protein contains 17.2 mg of L-tryptophan. One cup of milk contains 183 mg. This high tryptophan content makes pepita of interest to researchers studying the treatment of anxiety disorders. Some eat the seeds as preventative measure against onset of anxiety attacks, clinical depression and other mood disorders. Some studies have also found pumpkin seeds to prevent arteriosclerosis (hardening of the arteries) and to regulate cholesterol levels in the body. A 2011 Egyptian study found that in rats, pumpkin seed oil has anti-hypertensive and cardio-protective properties. A 2009 double-blind, placebo-controlled Korean study found that in men suffering from benign prostatic hyperplasia (n=47), pumpkin seed oil is an effective treatment.

THE OIL

The oil of pumpkin seeds, a culinary speciality in (and important export commodity of) Central European cuisine as a salad oil and a cooking oil, is also used to treat irritable bowel syndrome and various other ailments, both in folk medicine and in modern medical practice and research. Long an Eastern European folk remedy for the prostate problems of men, the oil has in fact been shown to improve symptoms associated with an enlarged prostate due to benign prostatic hyperplasia. Components in pumpkin seed oil appear to interrupt the triggering of prostate cell multiplication by testosterone and DHT. It is questionable whether eating the seeds whole in snack quantities, rather than taking therapeutic doses of the concentrated oil, would provide any prostate benefit. In German folk medicine, the oil is also used to quell parasitic infestations such as tapeworms. In Vietnam, consumption of relatively large numbers of seeds was seen to increase the evacuation rate of thread worms from the gastrointestinal tract.

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Pyrantel pamoate (under US Pharmacopoeia) or Pyrantel Embonate (under European Pharmacopoeia), is used as a deworming agent in the treatment of hookworms (all species) and roundworms (Ascaris lumbricoides, aka ascarids in humans) in domesticated animals such as horses, cattle, sheep, pigs, cats, dogs, and many other species. It is a combination of pyrantel and pamoic acid. Some drug companies pair pyrantel pamoate with praziquantel for tapeworms, and sometimes febantel for whipworms in order to provide more complete treatment for intestinal parasites in one dose. It is also used for pinworm treatment for humans in many brands, including "Reese's Pinworm Medicine", "Pin-X", "Pin-Rid", "Combantrin", "Anthel", "Helmintox", "Helmex". Pyrantel pamoate is also commonly included in monthly administered chewable heartworm tablets for cats and dogs.

DRUG ACTION

Pyrantel pamoate acts as a depolarizing neuromuscular blocking agent, thereby causing sudden contraction, followed by paralysis, of the helminths. This has the result of causing the worm to "lose its grip" on the intestinal wall and be passed out of the system by natural process. Since Pyrantel is poorly absorbed by the host's intestine, the host is unaffected by the small dosage of medication used. Spastic (tetanic) paralyzing agents, in particular pyrantel pamoate, may induce complete intestinal obstruction in a heavy worm load. This obstruction is usually in the form of a worm impaction and happens when a very small, but heavily parasitized animal is treated and tries to pass a large number of dislodged worms at once. Worms usually pass in normal stool or with diarrhea, straining, and occasional vomiting. Dosage for pyrantel base is 11 mg/kg not to exceed 1 g as a single dose.

TOXICITY

Pyrantel pamoate is considered a Pregnancy category C drug for use during pregnancy for humans, but is in category A for canines and felines. Pyrantel is considered safe to use in nursing animals.

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Rheum palmatum, commonly called Turkey rhubarb, Chinese rhubarb, Indian rhubarb, Russian rhubarb or rhubarb root (and within Chinese herbal medicine da-huang), is a highly regarded medicinal plant, known for its health benefits.

DESCRIPTION

The species R. tanguticum and R. officinale, also under the categorical term of the Chinese drug da-huang, are closely related to Rheum palmatum. Today, these three species are regarded as superior in performance to other species-existing rhubarbs. Though Rheum palmatum is commonly misinterpreted to be one in the same with the familiar R. rhubarbarum garden rhubarb we eat, there are several facets falsifying this assumption. Size is the most evident of the facets used to differentiate these two closely related species. While most garden species only grow to a mere few feet in height, Chinese rhubarb can produce as high as a six to ten foot jointed stalk, with loosely branched clusters of flowers along the tips that mature red in color from their oftentimes yellow or white blooms. Its leaves are rather large, jagged and hand shaped, growing in width of at least two to three feet. It is important to recognize that only those species of rheum with lobed leaves are accredited for their medicinal use. Subsequently, garden rhubarb, R. rhubarbarum, as well as any other variety of species with either wavy or undulating leaves are not founded for any medicinal purpose. Additionally, one can decipher Chinese rhubarb by its rather thick, deep roots whereas the perennial garden plant is composed predominantly of fleshy rhizomes and buds.

HABITAT, CULTIVATION AND PREPARATION

Though native in the regions of western China, northern Tibet, and the Mongolian Plateau, Chinese Rhubarb was used immensely in other parts of the world, such as Europe, for hundreds of years before its source of plant identity was actually discovered in the 18th century. As a consequence of these findings, today Chinese rhubarb is also found flourishing in the West and in the wild. It is extensively cultivated, no doubt for its great medicinal advantages and uses. Like all flowering plants, it is grown from the protective coat of a seed in the spring, or by root division in the seasons of Spring or Autumn, where the temperature is not yet too hot or too cold. A rather spacious environment where it can receive an abundance of sunlight for the production of sugars, as well as its development in well-drained soil, proves to be most efficient for the augmentation of this species. Since it is the roots and rhizome which serve as this plant source of medicinal usage, special care is taken in their preparation. When 6-10 years old, the rhizomes of these plants are removed from the ground in the Autumn when both its stems and leaves changed to yellow wild. Furthermore, the removal of the lateral rootlets and the crown are removed, leaving only the root. Any debris around the root is cleaned off, the coarse exterior bark removed, and the root cut and divided into cube-like pieces to increase its surface area, thereby decreasing the time needed for drying.

TRADITIONAL AND CURRENT MEDICINAL USES

Out of the numerous herbs founded for their medicinal benefits toward health ailments in early civilizations, Chinese rhubarb remains one of the mere few which is still used today both conventional and herbal medicine. The very first accounts are found in ancient Chinese writings, dating all the way back to 2700 B.C... By studying Chinese history over time, it becomes evident that it was renowned, even then, for its purging effects, as well as its ability to suppress feverish conditions (Foster): it was taken by an emperor in the Liang dynasty (557-579) for fever, used as gift-bearing means to an emperor of the Tang dynasty (618-907), used to combat the plague in the years which the Song dynasty ruled (960-1127), and used as a suicidal measure by a general of the Ming dynasty (1368-1644). With its several medicinal uses, it wasn't long before this potent plant began making its way to other parts of the world. In fact, it became one of the most prominent items traded along the Silk Road. A rhubarb monopoly initiated in Imperial Russia in 1731, stiffly regulating its trade from China via the Asian steppes to Moscow and St. Petersburg, where its root was shipped to the rest of Europe.". For 125 years thereafter, rhubarb-root imports were governed solely by what was known as the Rhubarb Office. This, office of course ceased once China opened its ports to the Western nations, allowing for free trade. Some of the common names associated with Rheum palmatum: Russian rhubarb, Turkey rhubarb, and Indian rhubarb, are directly affiliated with the trade routes for rhubarb from China. In ancient China, rhubarb root was taken and recognized as a means to cure stomach ailments and as a cathartic (an agent used to relieve severe constipation), as well as its use as a poultice (a preparation of fresh, moistened, or crushed dried herbs, applied externally) for fevers and edema (swelling caused by fluid retention in the tissues of the body). It was given its Latin name by the renowned Carolus Linnaeus in the year 1759, and made to augment its proliferation to British botanical gardens around 1762. The conditions treated by Chinese rhubarb in ancient times, are the same it is used to treat today. The root (the predominantly medicinal part of the species) is still known for its astringent capabilities (as well as a strong laxative); the tannins in the root caused an astringent action making it useful in the early stages of diarrhea, dysentery, and other intestinal problems." It also serves antibacterial use in its ability to treat toothaches, shingles, fevers, hypertension, burns, acute appendicitis, acute infectious hepatitis, conjunctivitis, swelling and pain of gums, and sores of the mouth or tongue." Today, Rhubarb festivals persist in areas all over the U.S., Canada, England, and Australia. These gatherings appeal to both travellers and rhubarb buffs all around the world. For instance, the first International Symposium on Rhubarb was held in China in 1990 (Foster). Its objective was to verify the scientific data and treatment of Chinese Rhubarb used by Chinese pharmacopoeias!

RESEARCH AND HIGHLIGHTS

Rhubarb extract may have beneficial effects on patients with diabetes. In an animal study conducted on diabetic rats with nephropathy, rhubarb extract was found to inhibit the swelling associated with diabetes, at an early stage. Subsequently, the extract may have become significant in the early stages of human diabetic kideney disease. In a clinical trial testing patients with terminal end-stage kidney failure, a decrease in negative blood markers and an overall increase in positive blood markers was observed in the blood tests examining the effect of rhubarb extract. Taking emodin orally, an active ingredient of rhubarb root, was shown to cure intravaginal infections in mice. In a 10-year controlled clinical double-blind trial at the Xiang Shan TCM Hospital in Shanghai, it was found that all patients using the three types of alcohol-extracted rhubarb tablets to treat chronic upper digestive bleeding, stopped bleeding within a remarkable 56 hours. Researcher Deng Wenlong, of the Sichuan Provincial Institute of Chinese Materia Medica, advocated immensely for the beneficial use rhubarb has in medicine. He presented his case at Chengdu University of TCM in China, focusing on rhubarb's ability to treat both fevers and inflammatory diseases effectively. He led a discussion describing how endotoxins (chemicals that are released into the host as a result of the breakdown of the cell walls of gram-negative bacteria) can be controlled and suppressed with the human body. It is evident from many findings that endotoxin levels increase significantly in the blood when in stressful environments and situations, inflammation, or infection. The bowel, as it would have it, is heavily affected by this increase in blood endotoxin. With the use of rhubarb, however, Wenlong was able to convey how endotoxin was effectively removed from the bowel, resulting in a faster recovery time from animals affected with a variety of febrile diseases. In lab tests conducted with mice, Emodin has also been proved to inhibit leukemia cells and other cancerous cells. In humans, rhubarb has significant influence on the prevention and delay of renal failure, and the reduction of symptoms such as nausea and anorexia nervosa.

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Rosemary, Rosmarinus officinalis, is a woody, perennial herb with fragrant, evergreen, needle-like leaves and white, pink, purple or blue flowers, native to the Mediterranean region. It is a member of the mint family Lamiaceae, which includes many other herbs, and is one of two species in the genus Rosmarinus. The name "rosemary" derives from the Latin name rosmarinus, derived from "dew" (ros) and "sea" (marinus), or "dew of the sea" because in many locations it needs no water other than the humidity carried by the sea breeze to live. The plant is also sometimes called Anthos, from the ancient Greek word meaning "flower". Rosemary is used as a decorative plant in gardens and has many culinary and medical uses. The plant is said to improve the memory and is used as a symbol of remembrance, especially in Australia and New Zealand to commemorate ANZAC Day. The leaves are used to flavor various foods, like stuffings and roast meats. Rosemary contains the antioxidants carnosic acid and rosmarinic acid, and other bioactive compounds including camphor, caffeic acid, ursolic acid, betulinic acid, rosmaridiphenol, and rosmanol. Some of these may be useful in preventing or treating cancers, strokes, and Alzheimer's Disease.

TAXONOMY

Rosmarinus officinalis is one of two species[dubious - discuss] in the genus Rosmarinus. The other species is the closely related, but less commercially viable, Rosmarinus eriocalyx, of the Maghreb of Africa and Iberia. Named by the 18th-century naturalist and founding taxonomist Carolus Linnaeus, it has not undergone much taxonomic change since.

DESCRIPTION

Rosemary is an aromatic evergreen shrub that has leaves similar to pine needles. The leaves are used as a flavouring in foods like stuffings and roast lamb, pork, chicken and turkey. It is native to the Mediterranean and Asia, but is reasonably hardy in cool climates. It can withstand droughts, surviving a severe lack of water for lengthy periods. Forms range from upright to trailing; the upright forms can reach 1.5 m (5 ft) tall, rarely 2 m (6 ft 7 in). The leaves are evergreen, 2-4 cm (0.8-1.6 in) long and 2-5 mm broad, green above, and white below, with dense short woolly hair. The plant flowers in spring and summer in temperate climates but the plants can be in constant bloom in warm climates; flowers are white, pink, purple or deep blue.

MYTHOLOGY

According to legend, it was draped around the Greek goddess Aphrodite when she rose from the sea, born of Ouranos's semen. The Virgin Mary is said to have spread her blue cloak over a white-blossomed rosemary bush when she was resting, and the flowers turned blue. The shrub then became known as the 'Rose of Mary'.

USAGE

CULTIVATION

Since it is attractive and drought tolerant, Rosemary is used as an ornamental plant in gardens and for xeriscape landscaping, especially in regions of Mediterranean climate. It is considered easy to grow and pest-resistant. Rosemary can grow quite large and retain attractiveness for many years, can be pruned into formal shapes and low hedges and has been used for topiary. It is easily grown in pots. The groundcover cultivars spread widely, with a dense and durable texture. Rosemary grows on friable loam soil with good drainage in an open sunny position. It will not withstand waterlogging and some varieties are susceptible to frost. It grows best in neutral to alkaline conditions (pH 7-7.8) with average fertility. It can be propagated from an existing plant by clipping a shoot (from a soft new growth) 10-15 cm (4-6 in) long, stripping a few leaves from the bottom, and planting it directly into soil.

CULINARY USE

The leaves, both fresh and dried, are used in traditional Mediterranean cuisine. They have a bitter, astringent taste and are highly aromatic, which complements a wide variety of foods. A tisane can be made from the leaves. When burnt, they give off a mustard-like smell and a smell similar to burning wood, which can be used to flavor foods while barbecuing. Rosemary is high in iron, calcium and vitamin B6, 317 mg, 6.65 mg and 0.336 mg per 100 g, respectively. Rosemary extract has been shown to improve the shelf life and heat stability of omega 3-rich oils, which are prone to rancidity.

MEDICINE

Hungary water was first prepared for the Queen of Hungary Elisabeth of Poland to " ... renovate vitality of paralyzed limbs ... " and to treat gout. It was used externally and prepared by mixing fresh rosemary tops into spirits of wine. Don Quixote (Chapter XVII, 1st volume) mixes it in his recipe of the miraculous balm of Fierabras. Rosemary has a very old reputation for improving memory and has been used as a symbol for remembrance during weddings, war commemorations and funerals in Europe and Australia. Mourners would throw it into graves as a symbol of remembrance for the dead. In Shakespeare's Hamlet, Ophelia says, "There's rosemary, that's for remembrance." (Hamlet, iv. 5.) A modern study lends some credence to this reputation. When the smell of rosemary was pumped into cubicles where people were working, they showed improved memory, though with slower recall. 1,8-cineole (1,3,3-trimethyl-2-oxabicyclooctane), one of rosemary's main chemical components was found to improve speed and accuracy in cognitive performance in a study in 2012.

POTENTIAL MEDICINAL USE

The results of a study suggest carnosic acid, found in rosemary, may shield the brain from free radicals, lowering the risk of strokes and neurodegenerative diseases like Alzheimer's disease and Amyotrophic lateral sclerosis, and is anti-inflammatory. Carnosol is also a promising cancer chemoprevention and anti-cancer agent. A study found that rosemary "produced a significant enhancement of performance for overall quality of memory and secondary memory factors, but also produced an impairment of speed of memory compared to controls. Rosemary contains a number of potentially biologically active compounds, including antioxidants carnosic acid and rosmarinic acid. Other bioactive compounds include camphor (up to 20% in dry rosemary leaves), caffeic acid, ursolic acid, betulinic acid, rosmaridiphenol and rosmanol. Rosemary antioxidants levels are closely related to soil moisture content. Rosemary may have some anticarcinogenic properties. A study where a powdered form of rosemary was given to rats in a measured amount for two weeks showed a reduction in the binding of a certain carcinogen by 76%, and greatly reduced the formation of mammary tumors.

FOLKLORE AND CUSTOMS

In the Middle Ages, rosemary was associated with wedding ceremonies. The bride would wear a rosemary headpiece and the groom and wedding guests would all wear a sprig of rosemary, and from this association with weddings, rosemary evolved into a love charm. Newlywed couples would plant a branch of rosemary on their wedding day. If the branch grew, it was a good omen for the union and family. In A Modern Herbal, Mrs Grieves says A rosemary branch, richly gilded and tied with silken ribands of all colours, was also presented to wedding guests, as a symbol of love and loyalty. If a young person would tap another with a rosemary sprig and if the sprig contained an open flower, it was said that the couple would fall in love. Rosemary was used as a divinatory herb. Several herbs were grown in pots and assigned the name of a potential lover. They were left to grow and the plant that grew the strongest and fastest gave the answer. Rosemary was stuffed into poppets (cloth dolls) to attract a lover or attract curative vibrations for illness. It was believed that placing a sprig of rosemary under a pillow before sleep would repel nightmares, and if placed outside the home it would repel witches. Somehow, the use of rosemary in the garden to repel witches turned into signification that the woman ruled the household in homes and gardens where rosemary grew abundantly. By the 16th century, men were known to rip up rosemary bushes to show that they, not their wives, ruled the roost. In Australia sprigs of rosemary are worn on ANZAC Day and sometimes Remembrance Day to signify remembrance; the herb grows wild on the Gallipoli peninsula.

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Salvia officinalis (garden sage, common sage) is a perennial, evergreen subshrub, with woody stems, grayish leaves, and blue to purplish flowers. It is a member of the family Lamiaceae and is native to the Mediterranean region, though it has naturalized in many places throughout the world. It has a long history of medicinal and culinary use, and in modern times as an ornamental garden plant. The common name "sage" is also used for a number of related and unrelated species.

TAXONOMY

Salvia officinalis was described by Carl Linnaeus in 1753. It has been grown for centuries in the Old World for its food and healing properties, and was often described in old herbals for the many miraculous properties attributed to it. The specific epithet, officinalis, refers to the plant's medicinal use?the officina was the traditional storeroom of a monastery where herbs and medicines were stored. S. officinalis has been classified under many other scientific names over the years, including six different names since 1940 alone.

DESCRIPTION

Cultivars are quite variable in size, leaf and flower color, and foliage pattern, with many variegated leaf types. The Old World type grows to approximately 2 ft (0.61 m) tall and wide, with lavender flowers most common, though they can also be white, pink, or purple. The plant flowers in late spring or summer. The leaves are oblong, ranging in size up to 2.5 in (6.4 cm) long by 1 in (2.5 cm) wide. Leaves are grey-green, rugose on the upper side, and nearly white underneath due to the many short soft hairs. Modern cultivars include leaves with purple, rose, cream, and yellow in many variegated combinations.

HISTORY

Salvia officinalis has been used since ancient times for warding off evil, snakebites, increasing women's fertility, and more. The Romans likely introduced it to Europe from Egypt as a medicinal herb. Theophrastus wrote about two different sages, a wild undershrub he called sphakos, and a similar cultivated plant he called elelisphakos. Pliny the Elder said the latter plant was called salvia by the Romans, and used as a diuretic, a local anesthetic for the skin, a styptic, and for other uses. Charlemagne recommended the plant for cultivation in the early Middle Ages, and during the Carolingian Empire, it was cultivated in monastery gardens. Walafrid Strabo described it in his poem Hortulus as having a sweet scent and being useful for many human ailments?he went back to the Greek root for the name and called it lelifagus. The plant had a high reputation throughout the Middle Ages, with many sayings referring to its healing properties and value. It was sometimes called S. salvatrix (sage the savior), and was one of the ingredients of Four Thieves Vinegar, a blend of herbs which was supposed to ward off the plague. Dioscorides, Pliny, and Galen all recommended sage as a diuretic, hemostatic, emmenagogue, and tonic.

USES

Common sage is grown in parts of Europe for distillation of an essential oil, though other species, such as Salvia fruticosa may also be harvested and distilled with it. As a kitchen herb, sage has a slight peppery flavor. In British cooking, it is used for flavoring fatty meats, Sage Derby cheese, poultry or pork stuffing, Lincolnshire sausage, and in sauces. Sage is also used in Italian cooking, in the Balkans, and the Middle East. It is one of the major herbs used in the traditional turkey stuffing for the Thanksgiving Day dinner in the United States. Despite the common use of traditional and available herbs in French cuisine, sage never found favour there. Salvia and "sage" are derived from the Latin salvere (to save), referring to the healing properties long attributed to the various Salvia species. It has been recommended at one time or another for virtually every ailment by various herbals. Modern evidence shows possible uses as an antisweating agent, antibiotic, antifungal, astringent, antispasmodic, estrogenic, hypoglycemic, and tonic. In a double blind, randomized and placebo-controlled trial, sage was found to be effective in the management of mild to moderate Alzheimer's disease. The strongest active constituents of sage are within its essential oil, which contains cineole, borneol, and thujone. Sage leaf contains tannic acid, oleic acid, ursonic acid, ursolic acid, cornsole, cornsolic acid, fumaric acid, chlorogenic acid, caffeic acid, niacin, nicotinamide, flavones, flavonoid glycosides, and estrogenic substances. Investigations have taken place into using sage as a treatment for Alzheimer's disease patients. Sage leaf extract may be effective and safe in the treatment of hyperlipidemia.

COMMON NAMES

Salvia officinalis has numerous common names. Some of the best known include sage, common sage, garden sage, golden sage, kitchen sage, true sage, culinary sage, Dalmatian sage, and broadleaf sage. Cultivated forms include purple sage and red sage. In Turkey, salvia officinalis is widely known as adacayi meaning "island tea". in the levant its called maramia.

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A sitz bath is a bath in which a person sits in water up to the hips. It is used to relieve discomfort and pain in the lower part of the body, for example, due to hemorrhoids (piles), anal fissures, rectal surgery, an episiotomy, uterine cramps, inflammatory bowel disease, and infections of the bladder, prostate or vagina. It works by keeping the affected area clean and increasing the flow of blood to it. A sitz bath may be created simply by filling a bathtub with some water and sitting in it for a few minutes. Alternatively, a large basin can be used. There are also special devices that fit into toilet bowls. Sitz baths may either be warm or cool. Some people find alternating between hot and cold water soothing. Sitz baths may be filled with just water, or substances such as salt, baking soda or vinegar can be added.

ORIGIN OF TERM

The term sitz bath is derived from the German word Sitzbad, meaning a bath (Bad) in which one sits (sitzen). A sitz bath is a hip-bath, that is, a bath in which a person sits covered with water up to the hips. Hip baths were originally a European custom, although nowadays sitz baths are used mainly for therapeutic purposes.

USES

Sitz baths are used to relieve discomfort and pain in the lower part of the body, for example, as a result of hemorrhoids (piles), anal fissures, rectal surgery, an episiotomy, cramps of the uterus, inflammatory bowel disease, and infections of the bladder, prostate or vagina. They work by cleansing the affected area and increasing the flow of blood to it.

PREPARATION

Sitz baths may either be warm or cool. Warm baths are recommended for reducing the itching, pain and discomfort associated with conditions such as hemorrhoids and genital problems. An ordinary bathtub can be filled with 3 to 4 inches (7.6 to 10 cm) of hot water (about 110 °F (43 °C)), and sat in for 15–20 minutes or until the water cools down. Alternatively, a large basin can be used, and there are specially built devices that fit into toilet bowls. Cool sitz baths are said to be helpful in easing constipation, inflammation and vaginal discharges, and, in cases of fecal or urinary incontinence, in toning the muscles. Some people find that alternating three to five times between a hot bath for 3–4 minutes and an ice-cold bath for 30–60 seconds is soothing. A towel soaked in cold water can be used in place of a cold bath. For most purposes sitz baths with water are sufficient, though some people prefer to use saline water or water mixed with baking soda. The use of such additives helps to reduce infections. Women with candidiasis (a vaginal yeast infection) may benefit from a warm bath with salt and vinegar.

RISKS

Sitz baths are regarded as of very low risk. However, because hot baths cause blood vessels to dilate, on rare occasions some people can feel dizzy or have palpitations (rapid or abnormal heartbeat).Individuals prone to such occurrences are advised to have someone standing by to assist them.

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Ulmus rubra, the Slippery Elm, is a species of elm native to eastern North America (from southeast North Dakota, east to Maine and southern Quebec, south to northernmost Florida, and west to eastern Texas). Other common names include Red Elm, Gray Elm, Soft Elm, Moose Elm, and Indian Elm.

CLASSIFICATION

This widespread, common North American forest tree species was named several times, with Pennsylvania botanist Gotthilf Heinrich Ernst Muhlenberg's 1793 name Ulmus rubra now accepted as the first formally published. The slightly later name U. fulva, published by French botanist Andr? Michaux in 1803, is used in much of the older literature, and is still widely used in dietary-supplement and alternative-medicine information. The slippery elm has almost universally been treated taxonomically as a distinct species without named subspecies or varieties. However, it was sometimes considered a variety of the American Elm, Ulmus americana var. rubra, in the late 18th century. The species is similar to American Elm (U. americana) in general appearance, but more closely related to the European Wych Elm (U. glabra), which has a very similar flower structure.

DECSRIPTION

Ulmus rubra, the Slippery Elm, is a deciduous tree which can grow to 65 feet (20 m) in height with a 20-inch (50 cm) d.b.h. trunk. The tree's more upright branching pattern differs from the deliquescent branching of the American elm. Its heartwood is reddish-brown, giving the tree its alternative common name 'Red Elm'. The leaves are 4-6 in (10?18 cm) long and have a rough texture (especially above), coarsely double-serrate margins, acuminate apices and oblique bases. The perfect, apetalous, wind-pollinated flowers are produced before the leaves in early spring, usually in clusters of 10?20. The fruit is an oval winged samara about 3/4 in (20 mm) long that containing a single, central seed. Slippery elm may be distinguished from American elm by the hairiness of its buds and twigs (both smooth on the American elm) and by its very short-stalked flowers.

PESTS AND DISEASES

The tree is reputedly less susceptible to Dutch elm disease than other species of American elms, but is severely damaged by the Elm Leaf Beetle (Xanthogaleruca luteola).

USES

MEDICINAL

Slippery elm (Ulmus rubra) has had various traditional medicinal uses. The mucilagenous inner bark of the slippery elm has long been used as a demulcent, and is still produced commercially for this purpose in the United States with approval for sale as a nutritional supplement by the U.S. Food and Drug Administration. A tea brewed from the inner bark helps ease a sore throat and irritated stomach ? in addition to other mucous membranes. Sometimes slippery elm leaves are dried and ground into a powder, then made into a tea. Both slippery elm gruel and tea are said to soothe the digestive tract. Whole bark of slippery elm was used as an abortifacient, but not without serious consequences, such as death of the mother.

OTHER USES

The wood of the slippery elm is used for the hubs of wagon wheels, as it is very shock resistant owing to the interlocking grain. The tree's fibrous inner bark produces a strong and durable fiber that can be spun into thread, twine, or rope useful for bow strings, ropes, jewellery, clothing, snowshoe bindings, woven mats, and even some musical instruments. Once cured, the wood is also excellent for starting fires with the bow-drill method, as it grinds into a very fine flammable powder under friction.

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Tansy (Tanacetum vulgare) is a perennial, herbaceous flowering plant of the aster family, native to temperate Europe and Asia. It has been introduced to other parts of the world and in some areas has become invasive. It is also known as Common Tansy, Bitter Buttons, Cow Bitter, Mugwort, or Golden Buttons.

DESCRIPTION

Tansy is a flowering herbaceous plant with finely divided compound leaves and yellow, button-like flowers. It has a stout, somewhat reddish, erect stem, usually smooth, 50?150 cm tall, and branching near the top. The leaves are alternate, 10?15 cm long and are pinnately lobed, divided almost to the center into about seven pairs of segments, or lobes, which are again divided into smaller lobes having saw-toothed edges, giving the leaf a somewhat fernlike appearance. The roundish, flat-topped, button-like, yellow flower heads are produced in terminal clusters from mid-to-late summer. The scent is similar to that of camphor with hints of rosemary. The leaves and flowers are toxic if consumed in large quantities; the volatile oil contains toxic compounds including thujone, which can cause convulsions and liver and brain damage. Some insects, notably the tansy beetle Chrysolina graminis, have evolved resistance to the toxins and subsist almost exclusively on the plant.

HISTORY AND DISTRIBUTION

Tansy is native to Eurasia; it is found in almost all parts of mainland Europe. It is absent from Siberia and some of the Mediterranean islands. The ancient Greeks may have been the first to cultivate it as a medicinal herb. In the sixteenth century it was considered to be "necessary for a garden" in Britain.

HISTORY OF USE

Tansy has a long history of use. It was first recorded as being cultivated by the ancient Greeks for medicinal purposes. In the 8th century AD it was grown in the herb gardens of Charlemagne and by Benedictine monks of the Swiss monastery of Saint Gall. Tansy was used to treat intestinal worms, rheumatism, digestive problems, fevers, sores, and to bring out measles. During the Middle Ages and later, high doses were used to induce abortions. Contradictorily, tansy was also used to help women conceive and to prevent miscarriages. In the 15th century, Christians began serving tansy with Lenten meals to commemorate the bitter herbs eaten by the Israelites. Tansy was thought to have the added Lenten benefits of controlling flatulence brought on by days of eating fish and pulses and of preventing the intestinal worms believed to be caused by eating fish during Lent. Tansy was used as a face wash and was reported to lighten and purify the skin. In the 19th century, Irish folklore suggested that bathing in a solution of tansy and salts would cure joint pain. Although most of its medicinal uses have been discredited, tansy is still a component of some medicines and is listed by the United States Pharmacopeia as a treatment for fevers, feverish colds, and jaundice.

INSECT REPELLENT

Tansy has also been cultivated and used for its insect repellent and preservative effects. It has been used for centuries as an insect and in the worm warding type of embalming. It was packed into coffins, wrapped in funeral winding sheets, and tansy wreaths were sometimes placed on the dead. Henry Dunster, the first president of Harvard University, was buried wearing a tansy wreath in a coffin packed with tansy; when God's Acre was moved in 1846 the tansy had maintained its shape and fragrance, helping to identify the president's remains. By the 19th century, tansy was used so much at New England funerals that people began to disdain it for its morbid association with death. During the American colonial period, meat was frequently rubbed with or packed in tansy leaves to repel insects and delay spoilage. Tansy was frequently worn at that time in shoes to prevent malaria and other fevers; it has been shown, however, that some mosquito species including Culex pipiens take nectar from tansy flowers.

ORGANIC INSECTICIDE

Tansy can be used as in companion planting, and for biological pest control in organic gardens and sustainable agriculture. It is planted alongside potatoes to repel the Colorado potato beetle, with one study finding tansy reduced the beetle population by 60 to 100%. In England tansy is placed on window sills to repel flies; sprigs are placed in bed linen to drive away pests, and it has been used as an ant repellent. In the 1940s, distilled tansy oil mixed with fleabane, pennyroyal and diluted alcohol was a well known mosquito repellent; collectors were paid five cents a pound for tansy in full bloom. Research has found that tansy extracts do indeed repel mosquitoes, but not as effectively as chemical pesticide products containing diethyltoluamide (i.e. DEET.) In 2008, researchers in Sweden investigated the use of tansy to repel ticks, showing a 64-72% repellency for each oil constituent

TOXICITY

Tansy contains a volatile oil which can cause contact dermatitis in sensitive individuals. If taken internally, toxic metabolites are produced as the oil is broken down in the liver and digestive tract. It is highly toxic to internal parasites, and for centuries tansy tea has been prescribed by herbalists to expel worms. Tansy is an effective insecticide, and is highly toxic to arthropods. Because it contains thujone, the U.S. FDA limits the use of tansy to alcoholic beverages, and the final product must be thujone-free. The active components of the volatile oil include 1,8-cineole, trans-thujone, camphor and myrtenol, with the quantities and proportions of each varying seasonally and from plant to plant. 1,8-cineole is a toxin believed to defend the plant leaves against attacks by herbivores. It has many biological activities including allelopathy, anesthetic, antibacterial, carcinogenic, fungicide, herbicide, insectifuge, nematicide, sedative, testosterone hydroxylase inducer, and others. Thujone is a GABA receptor antagonist that sensitises neurons; it is reputed to be an aphrodisiac, increasing brain activity and causing hallucinations, spasms, convulsions, and even death. Camphor has various uses, including manufacture of plastics, lacquers and varnishes, explosives and pyrotechnics; as a moth repellent; as a preservative in pharmaceuticals and cosmetics; to relieve itching and pain by creating a cooling effect on the skin; as an injectable antibacterial for root canals in dentistry; as a food flavor enhancer; and as a medical ingredient in chest rubs. Myrtenol has been used as an insect pheromone in insect trapping, as a beverage preservative, a flavoring and a fragrance.

CULINARY USES

Tansy was formerly used as a flavoring for puddings and omelets, but is now almost unknown. The herbalist John Gerard noted that tansy was well known as pleasant in taste, and he recommends tansy sweetmeats as an especial thing against the gout, if every day for a certain space a reasonable quantitie thereof be eaten fasting. In Yorkshire, tansy and caraway seeds were traditionally used in biscuits served at funerals. During the Restoration, a "tansy" was a sweet omelette flavoured with tansy juice. In the BBC documentary "The Supersizers go ... Restoration", a chef described the flavour as "fruity, sharpness to it and then there's a sort of explosion of cool heat a bit like peppermint." However, the programme's presenter Sue Perkins experienced tansy toxicity. According to liquor historian A. J. Baime, in the 19th century Tennessee whiskey magnate Jack Daniel enjoyed drinking his own whiskey with sugar and crushed tansy leaf.

ETHNOMEDICAL USE

For many years, tansy has been used as a medicinal herb despite its toxicity. 19th-century Irish folklore suggests bathing in a solution of tansy and salt as a cure for joint pain. A bitter tea made with tansy flowers has been used for centuries as an anthelmintic to treat parasitic worm infestations, and tansy cakes were traditionally eaten during Lent because it was believed that eating fish during Lent caused intestinal worms. Various Tanacetum species are used ethmomedically to treat migraine, neuralgia and rheumatism and as anthelmintics. Traditionally, tansy was often used for its emmenagogue effects to bring on menstruation or end an unwanted pregnancy, and pregnant women are advised to not use this herb. Research published in 2011 identified 3,5-dicaffeoylquinic acid (3,5-DCQA) and axillarin in tansy as antiviral compounds that are active against herpes simplex virus.

OTHER USES

In England, bunches of tansy were traditionally placed at windows to keep out flies. Sprigs were placed in bedding and linen to drive away pests. Tansy has been widely used in gardens and homes in Melbourne, Australia to keep away ants. Some traditional dyers use tansy to produce a golden-yellow colour. The yellow flowers are dried for use in floral arrangements. Tansy is also used as a companion plant, especially with cucurbits like cucumbers and squash, or with roses or various berries. It is thought to repel ants, cucumber beetles, Japanese beetles, squash bugs, and some kinds of flying insects, among others. Dried tansy is used by some bee-keepers as fuel in a bee smoker.

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Tetracycline is a broad-spectrum polyketide antibiotic produced by the Streptomyces genus of Actinobacteria, indicated for use against many bacterial infections. It is a protein synthesis inhibitor. It is commonly used to treat acne today, and, more recently, rosacea, and is historically important in reducing the number of deaths from cholera. Tetracycline is marketed under the brand names Sumycin, Tetracyn, and Panmycin, among others. Actisite is a thread-like fiber formulation used in dental applications. It is also used to produce several semisynthetic derivatives, which together are known as the tetracycline antibiotics. The term "tetracycline" is also used to denote the four-ring system of this compound; "tetracyclines" are related substances that contain the same four-ring system.

MECHANISM OF ACTION

Tetracyclines bind to the 30S subunit of microbial ribosomes. They inhibit protein synthesis by blocking the attachment of charged aminoacyl-tRNA to the A site on the ribosome. Thus, they prevent introduction of new amino acids to the nascent peptide chain. The action is usually inhibitory and reversible upon withdrawal of the drug. Resistance to the tetracyclines results from changes in permeability of the microbial cell envelope. In susceptible cells, the drug is concentrated from the environment and does not readily leave the cells. In resistant cells, the drug is not actively transported into the cells or leaves it so rapidly, inhibitory concentrations are not maintained. This is often plasmid-controlled. Mammalian cells are not vulnerable to the effect of tetracyclines, as these contain no 30S ribosomal subunits, so do not accumulate the drug.

SPECTRUM OF BACTERIAL SUSCEPTIBILITY AND RESISTANCE

Tetracyclines have a broad spectrum of antibiotic action. Originally, they possessed some level of bacteriostatic activity against almost all medically relevant aerobic and anaerobic bacterial genera, both Gram-positive and Gram-negative, with a few exceptions, such as Pseudomonas aeruginosa and Proteus spp., which display intrinsic resistance. However, acquired (as opposed to inherent) resistance has proliferated in many pathogenic organisms and greatly eroded the formerly vast versatility of this group of antibiotics. Resistance amongst Staphylococcus spp., Streptococcus spp., Neisseria gonorrhoeae, anaerobes, members of the Enterobacteriaceae and several other previously sensitive organisms is now quite common. Tetracyclines remain especially useful in the management of infections by certain obligately intracellular bacterial pathogens such as Chlamydia, Mycoplasma and Rickettsia. They are also of value in spirochaetal infections, such as syphilis, leptospirosis and Lyme disease. Certain rare or exotic infections, including anthrax, plague and brucellosis, are also susceptible to tetracyclines. These agents also have activity against certain eukaryotic parasites, including those responsible for diseases such as malaria and balantidiasis.

HISTORY

The tetracyclines, a large family of antibiotics, were discovered as natural products by Benjamin Minge Duggar in 1945 and first described in 1948. Under Yellapragada Subbarao, Benjamin Duggar made his discovery of the first tetracycline antibiotic, chlortetracycline (Aureomycin), at Lederle Laboratories in 1945. In 1950, Harvard University professor Robert Burns Woodward determined the chemical structure of the related substance, oxytetracycline (Terramycin); the patent protection for its fermentation and production was also first issued in 1950. A research team of seven scientists (K.J. Brunings, Francis A. Hochstein, C.R. Stephens, Lloyd Hillyard Conover, Abraham Bavley, Richard Pasternack, and Peter P. Regna) at Pfizer, in collaboration with Woodward, participated in the two-year research leading to the discovery. Pfizer was of the view that it deserved the right to a patent on tetracycline and filed its Conover application in October 1952. Cyanamid filed its Boothe-Morton application for similar rights in March 1953, while Heyden Chemicals filed its Minieri application in September 1953, named after scientist P. Paul Minieri, to obtain a patent on tetracycline and its fermentation process. This resulted in tetracycline litigation in which the winner would have to prove beyond reasonable doubt of priority invention and tetracycline’s natural state. Nubian mummies studied in the 1990s were found to contain significant levels of tetracycline; the beer brewed at the time could have been the source. Tetracycline sparked the development of many chemically altered antibiotics, so has proved to be one of the most important discoveries made in the field of antibiotics. It is used to treat many Gram-positive and Gram-negative bacteria. Like some other antibiotics, it is also used in the treatment of acne.

INDICATIONS

It is first-line therapy for Rocky Mountain spotted fever (Rickettsia), Lyme disease (B. burgdorferi), Q fever (Coxiella), psittacosis and lymphogranuloma venereum (Chlamydia), and to eradicate nasal carriage of meningococci. Tetracycline tablets were used in the plague outbreak in India in 1992.

OTHER USES

Since tetracycline is absorbed into bone, it is used as a marker of bone growth for biopsies in humans. Tetracycline labeling is used to determine the amount of bone growth within a certain period of time, usually a period of approximately 21 days. Tetracycline is incorporated into mineralizing bone and can be detected by its fluorescence. In "double tetracycline labeling", a second dose is given 11–14 days after the first dose, and the amount of bone formed during that interval can be calculated by measuring the distance between the two fluorescent labels. Tetracycline is also used as a biomarker in wildlife to detect consumption of medicine- or vaccine-containing baits. In genetic engineering, tetracycline is used in transcriptional activation. It is also one of the antibiotics used to treat ulcers caused by bacterial infections. In cancer research at Harvard Medical School, tetracycline has been used to switch off leukemia in genetically altered mice, and to do so reliably, when added to their drinking water. A technique being developed for the control of the mosquito species Aedes aegypti uses a strain that is genetically modified to require tetracycline to develop beyond the larval stage. Modified males raised in a laboratory will develop normally as they are supplied with this chemical and can be released into the wild. Their subsequent offspring will inherit this trait, but will find no tetracycline in their environment and so will never develop into adults.

CELL CULTURE

Tetracycline is used in cell biology as a selective agent in cell culture systems. It is toxic to prokaryotic and eukaryotic cells and selects for cells harboring the bacterial tetr gene, which encodes a 399-amino-acid, membrane-associated protein. This protein actively exports tetracycline from the cell, rendering cells harboring this gene more resistant to the drug. The yellow crystalline powder can be dissolved in water (20 mg/ml) or ethanol (5 mg/ml), and is routinely used at 10 mg/l in cell culture. In cell culture at 37°C (99°F), it is stable for days, with a half-life of approximately 24 hours.

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Thymus vulgaris or common thyme is a low growing herbaceous plant, sometimes becoming somewhat woody. It is native to southern Europe, where it is often cultivated as a culinary herb. It typically grows as a sub-shrub, between 15 and 20 cm tall.

CULTIVARS

Nomenclature can be very confusing. French, German and English varieties vary by leaf shape and colour and essential oils. The many cultivars include 'Argenteus' (silver thyme).

USES

Thyme adds a distinctive aromatic flavoring to sauces, stews, stuffings, meats, poultry ? almost anything from soup to salad. In medieval times, the plant symbolized courage, and to keep up their spirits, knights departing for the Crusades received scarves embroidered with a sprig of thyme from their ladies. There was a popular belief, too, that a leaf tea prevented nightmares, while another held that tea made of thyme and other herbs enabled one to see nymphs and fairies. Herbalists of the Middle Ages regarded thyme as a stimulant and antispasmodic and recommended sleeping on thyme and inhaling it as a remedy for melancholy and epilepsy. In 1725, a German apothecary discovered that the plant's essential oil contains a powerful disinfectant called thymol that is effective against bacteria and fungi. Thymol also acts as a expectorant, loosening phlegm in the respiratory tract so it can be coughed up. Later herbalists listed thyme for these uses and as remedy for numerous other complaints, including diarrhoea and fever. They prescribed the oil externally as an antiseptic for fungal infections such as athlete's foot.

TOXICOLOGY

The United States Environmental Protection Agency is not aware of any adverse effects of thymol to humans or the environment when it is used in a manner prescribed by product labeling.

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Ticarcillin is a carboxypenicillin. It is almost invariaby sold and used in combination with clavulanate as Timentin. Because it is a penicillin, it also falls within the larger class of beta-lactam antibiotics. Its main clinical use is as an injectable antibiotic for the treatment of gram-negative bacteria, particularly Pseudomonas aeruginosa. It is also one of the few antibiotics capable of treating Stenotrophomonas maltophilia infections. It is provided as a white or pale-yellow powder. It is highly soluble in water, but should be dissolved only immediately before use to prevent degradation.

MECHANISM AND ACTION

Ticarcillin's antibiotic properties arise from its ability to prevent cross-linking of peptidoglycan during cell wall synthesis, when the bacteria tries to divide, causing cell death. Ticarcillin, like penicillin, contains a B-lactam ring that can be cleaved by B-lactamases, resulting in inactivation of the antibiotic. Those bacteria that can express B-lactamases are, therefore, resistant to B-lactam antibiotics. Due, at least in part, to the common B-lactam ring, ticarcillin can cause reactions in patients allergic to penicillin. Ticarcillin is also often paired with a B-lactamase inhibitor such as clavulanic acid (co-ticarclav).

OTHER USES

In molecular biology, ticarcillin is used to as an alternative to ampicillin to test the uptake of marker genes into bacteria. It prevents the appearance of satellite colonies that occur when ampicillin breaks down in the media. It is also used in plant molecular biology to kill Agrobacterium, which is used to deliver genes to plant cells.

DOSING AND POSOLOGY

Ticarcillin is not absorbed orally, and therefore must be given by intravenous or intramuscular injection.

TRADE NAMES AND PREPARATIONS

Ticarcillin:
Ticar (Formerly marketed by Beecham, then SmithKline Beecham until 1999, when it merged with Glaxo to form GlaxoSmithKline; it is no longer available in the UK. US distribution ceased in 2004. Ticar was replaced by Timentin.)
Ticarcillin/clavulanate: Timentin (Australia, UK and US, marketed by Beecham, then GlaxoSmithKline).

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Tinidazole is an anti-parasitic drug used against protozoan infections. It is widely known throughout Europe and the developing world as treatment for a variety of amoebic and parasitic infections. It was developed in 1972. Tinidazole is marketed by Mission Pharmacal under the brand name Tindamax, by Pfizer under the names Fasigyn and Simplotan, and in some Asian countries as Sporinex.

PHARMACOLOGY

It is chemically similar to metronidazole—a drug with some unpleasant side effects that is used in the United States as first-line therapy for amoebae. Tinidazole has similar side effects but has a shorter treatment course.

USES

A large body of clinical data exists to support use of tinidazole for infections from amoebae, giardia and trichomonas, just like metronidazole. Tinidazole may be a therapeutic alternative in the setting of metronidazole tolerance. Tinidazole may also be used to treat a variety of other bacterial infections, including Helicobacter pylori as part of 10 day sequential therapy (20 mg rabeprazole b.i.d. for 10 days, plus 1 gram amoxicillin b.i.d. for the first 5 days, followed by 500 mg clarithromycin b.i.d. and 500 mg tinidazole b.i.d. for the remaining 5 days).

SIDE EFFECTS

The most common side effects reported with tinidazole are upset stomach, bitter taste, diarrhea and itchiness. Other side effects which occur are headache, physical fatigue, and dizziness. Anecdotally, people who have taken both metronidazole and tinidazole report toxicity is much the same except the side effects don't last as long with the latter. Drinking alcohol while taking tinidazole causes an unpleasant disulfiram-like reaction, which includes nausea, vomiting, headache, increased blood pressure, flushing and shortness of breath.

HALF-LIFE

Elimination half-life is 13.2 ± 1.4 hours. Plasma half-life is 12 to 14 hours.

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The winter melon, also called white gourd, ash gourd, "fuzzy gourd", or "fuzzy melon", is a vine grown for its very large fruit, eaten as a vegetable when mature. It is the only member of the genus Benincasa. The fruit is fuzzy when young. The immature melon has thick white flesh that is sweet when eaten. By maturity, the fruit loses its hairs and develops a waxy coating, giving rise to the name wax gourd, and providing a long shelf life. The melon may grow as large as 80 cm in length. Although the fruit is referred to as a "melon," the fully grown crop is not sweet. Originally cultivated in Southeast Asia, the winter melon is now widely grown in East Asia and South Asia as well. Winter melon is also a common name for members of the Inodorus cultivar group of the muskmelon (Cucumis melo L), more commonly known as casaba or honeydew melons.

USES

The winter melon requires very warm weather to grow but can be stored for many months much like winter squash. It is commonly eaten throughout winter in countries of deciduous vegetation such as China, as one of the few vegetables available during winter, hence its Chinese name literally means 'winter melon'. The winter melon can typically be stored for 12 months. In Chinese cuisine the melons are used in stir fry or usually combined with pork or pork/beef bones to make winter melon soup, often served in the scooped out melon, carved by scraping off the waxy coating. It is also chopped and candied as wintermelon candy (tyng dong gua) to be commonly eaten at New Year festivals, or as filling for Sweetheart cake. It has also been used as the base filling in Chinese and Taiwanese mooncakes for the Moon Festival. In North India and Pakistan, the vegetable is also used to prepare a candy called Petha. In South Indian cuisine, it is used to make curries. In Ayurvedic remedies it used to increase appetite also its fresh juice is used to cure kidney stones. The seeds are cooked in milk and taken to increase "sperm count" and to improve sperm locomotion. Occasionally, it is used to produce a fruit drink which has a very distinctive taste. It is usually sweetened with caramelized sugar, which enhances the taste. In Southeast Asia, the drink is widely marketed as winter melon tea. The shoots, tendrils, and leaves of the plant may also be eaten as greens.

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Artemisia is a large, diverse genus of plants with between 200 to 400 species belonging to the daisy family Asteraceae. It comprises hardy herbs and shrubs known for their volatile oils. They grow in temperate climates of the Northern Hemisphere and Southern Hemisphere, usually in dry or semi-dry habitats. The fern-like leaves of many species are covered with white hairs. Some botanists split the genus into several genera, but DNA analysis does not support the maintenance of the genera Crossostephium, Filifolium, Neopallasia, Seriphidium, and Sphaeromeria; three other segregate genera Stilnolepis, Elachanthemum, and Kaschgaria are maintained by this evidence. Common names used for several species include mugwort, sagebrush, sagewort, and wormwood, while a few species have unique names, notably Tarragon (A. dracunculus) and Southernwood (A. abrotanum). Occasionally some of the species are called sages, causing confusion with the Salvia sages in the family Lamiaceae.

NAME

Artemisia comes from Greek. Artemisia II of Caria (in Greek AptEuioia; died 350 BCE) was the wife and successor of the king Mausolus and a daughter of Hecatomnus, a Greek king.

CULTIVATION AND USES

The aromatic leaves of many species of Artemisia are medicinal, and some are used for flavouring. Most species have an extremely bitter taste. A. dracunculus (Tarragon) is widely used as a herb, particularly important in French cuisine. Artemisia absinthium (Absinth Wormwood) was used to repel fleas and moths, and in brewing (wormwood beer, wormwood wine). The aperitif vermouth (derived from the German word Wermut, "wormwood") is a wine flavored with aromatic herbs, but originally with wormwood. The highly potent spirits absinthe and Malryt also contain wormwood. Polish vodka Zoladkowa Gorzka is flavoured with wormwood. Wormwood has been used medicinally as a tonic, stomachic, febrifuge and anthelmintic. Some have taken dried Wormwood, placed it inside a coffee filter to form a sort of "pod" and then placed them under furniture and such as a natural way of repelling fleas from their home. Artemisia arborescens (Tree Wormwood, or Sheeba in Arabic) is a very bitter herb indigenous to the Middle East that is used in tea, usually with Mentha also known as mint. In small quantities (in tea) its believed to have medicinal properties, pacifying various kinds of digestion turmoils. In larger doses it may have some hallucinogenic properties. In Israel Artemisia is sometimes referred to by the name "Shiva", the Queen of Sheba. Within Wicca, both Wormwood and Mugwort are believed to have effects on psychic abilities. Because of the power believed to be inherent in certain herbs of the genus Artemisia, many believers cultivate the plants in a "moon garden". The beliefs surrounding this genus are founded upon the strong association between the herbs of the genus Artemisia and the moon goddess Artemis, who is believed to hold these powers. It is also said that the genus Artemisia (which includes over 400 plants) may be named after an ancient botanist. Artemisia was the wife and sister of the Greek/Persian King Mausolus from the name of whose tomb we get the word mausoleum. Artemisia, who ruled for three years after the king's death, was a botanist and medical researcher, and died in 350 B.C.

MEDICINAL

Artemisia oils had inhibitory effects on the growth of bacteria (Escherichia coli, Staphylococcus aureus, and Staphylococcus epidermidis); yeasts (Candida albicans, Cryptococcus neoformans);and dermatophytes (Trichophyton rubrum, Microsporum canis, and Microsporum gypseum), Fonsecaea pedrosoi and Aspergillus niger. Artemisinin and its derivatives are a group of drugs that possess the most rapid action of all current drugs against malaria. Treatments containing an artemisinin derivative (artemisinin-combination therapies, ACTs) are now standard treatment worldwide for P. falciparum malaria. The starting compound artemisinin is isolated from the plant Artemisia annua. Wormwood was a common ingredient in old abortion recipes. Colette said "My dream took place under the plant of ill-fame, wormwood ... the terrible age-old inducer of abortions ....".

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