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However insomnia funny quotes purchase sominex with paypal, Cost for minimally antiseptic technique (cost of steroid this flgure must be considered against the potential cost not included) of septic arthritis alteril sleep aid 60-count box cheap 25mg sominex free shipping, which would include hospitalisation (fl200 per day in our institution) insomniax purchase sominex 25 mg with mastercard, arthroscopic washout One needle 1 insomnia 2015 line up purchase sominex 25 mg line. The cost quently septic arthritis of the knee post steroid injection of local anaesthetic is not included in either estimate insomnia baby purchase 25 mg sominex with visa. Ann logical Care (1992) Safety guidelines for performing arthro Phys Med 7:3138 centesis insomnia xbox one order sominex 25mg with mastercard. Multiple risk factors have been commercial use, distribution, and reproduction in any medium, provided the original work is properly described, including breech positioning in utero, being the frst-born child, oligohydramnios, family cited. To understand spinal anomalies, a knowledge of embryonic development is necessary. Starting How to cite this article: on the 17th day of gestation, the neural plate thickens bilaterally to form the neural folds. Therefore, if as incomplete or absent fusion of the midline neural, mesenchymal, the displaced femoral head is followed, the ultrasound plane is no and cutaneous structures and can be classifed into three categories: longer in the standard plane. The direction of displacement of the spina bifida aperta, occult spinal dysraphism, and caudal spinal femoral head means that it is usually the posterior sectional plane anomalies [6,7]. Progressive ossifcation of the posterior elements of the anteriorly, terminating in the femoral head, which rests on the vertebrae hinders satisfactory examinations in older children [6]. Three anatomic landmarks (the iliac line, triradiate cartilage, and labrum) are used to measure the fl and fl angles. Meticulous Developmental Dysplasia of the Hip measurement of the fl angle is necessary because false-positive fndings can occur in the anterior or posterior sectional planes. If the well-established techniques for examination, interpretation, and measurement are meticulously followed, it is easy to manage newborn hip problems via this method [5]. Before 7 evaluation of the hip joint, it is essential to identify the chondro 6 osseous junction. This is because the echo of the chondro-osseous 3 junction is an important landmark used to identify the femoral neck and other anatomical landmarks: the femoral head, iliac bone, lower limb of the ilium, acetabular bony roof, cartilaginous acetabular roof, 2 acetabular labrum, joint capsule, and synovial fold. Next, the transducer is moved backwards and forwards from the basic position to identify the round structure of the hip joint. A lateral coronal ultrasonography image through the posteriorly by 10 to 15 into an oblique coronal plane, the ilium will right hip joint of a 4-week-old girl with a normal clinical hip examination. If a sonogram contains a straight and the cartilaginous part of the femoral neck; 2, cartilaginous part iliac wing contour, triradiate cartilage, and an apparent acetabular of the femoral head (hyaline cartilage); 3, greater trochanter; 4, labrum, this indicates that it has a standard plane. A standard coronal ultrasonography through the right hip joint of a 5-week-old boy with a normal clinical hip examination. Ultrasound linear transducer is placed parallel to the lateral aspect of the infants hip. Ultrasonography of the infant hip in the coronal plane has three landmarks: 1, a straight iliac line; 2, the tip of the acetabular labrum; and 3, the transition from the os ilium to the triradiate cartilage. Schematic image of the acetabular roof shows anterior sectional (1), standard (2), and posterior sectional planes (3). In the anterior sectional plane, the silhouette of the iliac bone bends to the anterior, i. In the middle sectional planes (the standard plane), the contour and the silhouette of the iliac bone are straight and parallel to the probe. In the posterior sectional plane, the silhouette of the iliac bone in the posterior sectional plane bends to the posterior, away from the probe. A transverse fexion ultrasonography through the right hip joint of a 5-week-old boy with a normal clinical hip examination. The hip and knee are flexed 90, and the ultrasound transducer is placed perpendicular to the lateral aspect of the infants hip. Femoral head position relative to the acetabulum of the perichondrium of the cartilage acetabular roof, and structural A normally positioned femoral head is more than 50% covered by changes in the cartilage roof, indicate specifc variations (Table 1) [5]. Lateral coronal ultrasonography through the right hip joint of a 4-week-old girl with a normal clinical hip examination. Second, the bony roof line (2) is drawn tangentially from the lower limb of the os ilium to the bony rim. Finally, the cartilage roof line (3) is drawn from the bony rim through the center of the acetabular labrum. Lateral coronal view through the right hip joint shows measurement of femoral head coverage. Sonographic anatomic classifcations according to the Graf method Type fl angle () fl angle () Description I fl60 <55 Normal, fully mature hip. The joint is dysplastic and requires treatment to prevent further deterioration and dislocation. The purpose of the harness is to maintain the hip in a degrees of subluxation in the neutral position and/or during the fexed and abducted position in order to bring the femoral head as Barlow maneuver. If closed reduction cannot be accomplished aged 6 months remains the Pavlik harness. Ultrasonography of a 5-month-old girl shows that the fl and fl angles are abnormal, measuring 46 and 65, respectively. Ultrasonography of a 2-month-old girl shows that the fl angle is abnormal, measuring 56. Open reduction is usually required above the age of 2 years, outer margin of the hip capsule and the surface of the femoral neck mostly by femoral osteotomy to relieve pressure over the femoral should not be greater than 5 mm, or more than 2 mm thicker than head and to reshape the acetabulum. Septic Arthritis Septic arthritis typically affects the hip, knee, shoulder, elbow, Ultrasound for Transient Synovitis of the and ankle. Staphylococcus aureus is the most common causative Hip and Septic Arthritis in Children organism. In neonates, group B streptococci and coliform bacteria were previously common causative organisms. In children aged Transient Synovitis from 3 months to 5 years, Haemophilus infuenzae is an important Transient synovitis of the hip is the most common cause of acute hip cause, but the incidence has declined considerably due to the use pain and limping. The main differential diagnoses are septic arthritis [11] Additionally, power Doppler may show increased capsular vascularity and juvenile rheumatoid arthritis [10]. Sagittal ultrasonography of a 6-year-old boy with transient synovitis of the hip and a normal contralateral hip. Sagittal ultrasonography shows that the femoral head (F), iliopsoas muscle (M), anterior (A) and posterior (P) layers of the joint capsules are separated by anechoic effusion (E). Sagittal ultrasonography shows the femoral head (F), iliopsoas muscle (M), and both layers of the anterior joint capsule (arrows). Ultrasonography of the spine is performed in the prone position with a small pillow to create kyphosis. The transducer is placed midline over the spinous processes for the longitudinal scan. Ultrasonography transducer is placed perpendicular to the midline over the spinous processes for the transverse scan. Low-risk lesions include simple midline of the back, such as dimples, as well as hemangiomatous or hairy dimples <5 mm in diameter, located within 2. Normal Anatomy An axial scan of the spinal cord shows a hypoechoic spinal cord the longitudinal scan shows a hypoechoic tubular spinal cord with with an echogenic central echo complex and paired dorsal and an echogenic central echo complex. In prominent flum terminale, flar cysts, cauda equina pseudomasses, healthy newborns, the tip of the conus medullaris is no lower than and pseudosinus tract [6]. The flum terminale appears as a thin cord-like Transient dilatation of the central canal echogenic structure, forming a parallel line extending from the conus In newborns, a slight dilatation of the central canal of the spinal medullaris. This is viewed as an incidental Spinal cord Conus medullaris Unossifed coccyx Central echo complex Filum terminale & nerve roots A Dura Unossifed spinous process Spinal cord Dorsal nerve root. Longitudinal and transverse scan through the spines of a Central echo 2-week-old boy. Ventriculus terminalis Prominent flum terminale the ventriculus terminalis is a small, ependyma-lined, oval, cystic If the filum terminale is observed to be particularly echogenic in structure positioned at the distal cord. It can be distinguished as normal variants by a typical the ventriculus terminalis develops during embryogenesis due to midline course and a thickness of less than 2 mm [7]. A flar cyst is distinguished from the ventriculus medullaris by its location just below the conus medullaris. Pseudomass due to positional nerve root clumping When a newborn is scanned in the decubitus position, positional clumping of the nerve roots can occur. Longitudinal scan shows transient dilatation of the central canal (arrows) in a 4-day of the coccyx but are typically found in a more cranial location. Longitudinal ultrasonography in 3-week-old girl shows a well-defned, fusiform-shaped cystic lesion a 4-week-old girl shows prominent flum terminale (<1 mm) (arrow) (arrow) in the distal portion of the conus medullaris. Longitudinal ultrasonography shows a well-defined, fusiform-shaped cystic lesion (arrow) within the filum, just below the conus medullaris. Positional pseudo-mass in an 8-week-old boy with a sacral dimple who was scanned in the left decubitus position. Transverse ultrasonography shows clumping of the nerve roots (arrows) on the left due to the left decubitus position. Those without a mass include spinal lipoma, tethered cord, diastematomyelia, and anterior sacral meningocele. Lipomyelomeningocele and myelocystocele are skin-covered soft 248 Ultrasonography 36(3), July 2017 e-ultrasonography. Myelomeningocele and myelocele show a mass clinical symptoms at any age, such as difficulties in ambulation, located on the back but are without a skin covering [6,20]. Tethered cord Other associated spinal findings include a thickened filum Tethered cord is caused by the incomplete involution of the terminal terminale, spinal dysraphism, congenital spinal lipomas or dermoids, spinal cord. Other L3 disk space with an absence of normal nerve root motion can be non-neurologic anomalies, including tracheoesophageal fistula, diagnosed as a tethered cord. Spinal lipoma Spinal lipomas are composed of normal fat that may change in size with increased weight and tend to grow signifcantly during the frst year of life. Spinal lipomas appear on ultrasound as an echogenic intraspinal mass adjacent to the deformed spinal cord. Eighty-four percent of lipomas contain not only fat but also neural tissue or meninges. Associated features include tethered cord, dysraphism (4%), fatty filum or lipoma of the filum (12%), and vertebral anomalies. Myelocele and myelomeningocele During embryogenesis, the dorsally localized failure of fusion of the neural folds leads to myelocele and myelomeningocele. Severe neurologic disturbances, mainly of the lower extremities (such as paresis or paralysis and bladder or bowel dysfunction), can occur. Pseudosinus tract in a 4-week-old infant with a sacral in patients with myelocele and myelomeningocele, as well as dimple. Sagittal ultrasonography of the coccygeal region shows a secondary hydrocephalus after repair [6]. Longitudinal ultrasonography shows a hyperechoic thickened flum terminale (arrow) at the L5-S1 level. Longitudinal ultrasonography shows a low-lying conus (arrow) at the L4 vertebra and a thickened, echogenic fatty flum. These malformations consist of tethering of the spinal cord, associated anomalies. Dorsal dermal sinus is caused by incomplete separation of the superficial ectoderm from the neural ectoderm at a circumscribed Supplementary Material point. Various infections, including recurrent meningitis, epidural or subdural abscess, as well as abscess formation at the conus References medulla of the spinal cord, can occur via a dorsal dermal sinus [6]. J Bone Joint Surg Br depending on the risk factors present, or plain radiographs at 4-5 2009;91:655-658. Ultrasound screening for developmental are to normalize the alignment between the femoral head and dysplasia of the hip and its socioeconomic impact: experience of acetabulum, and the distribution of biomechanical forces about the tertiary care health level. Use of ultrasonography in developmental dysplasia of symptoms and secondary degeneration later in life. It has an acute onset in newborns: spectrum of normal findings, variants, congenital anomalies, and acquired diseases. Radiographics 2000;20:923 without trauma and is self-limiting after conservative therapy. Sonography of the neonatal synovitis because it involves a brief examination and the patient is spine: part 1, Normal anatomy, imaging pitfalls, and variations that not exposed to ionizing radiation. Hip sonography: diagnosis and management of infant hip Comparing the image with that of the contralateral normal hip may dysplasia. In patients with normal findings, no synovitis of the hip: Ultrasound appearance: mini-pictorial essay. Indications: Treatment of susceptible bacterial infections, mainly those caused by anaerobes, streptococci, pneumococci, and staphylococci; pelvic inflammatory disease (I. Trade Names: Dosage: -Usual dose: -Oral: 150-450 mg/dose every 6-8 hours; maximum dose: 1800 mg daily -I. Intramuscular injections should be avoided in patients who are receiving anticoagulant therapy. In these circumstances, orally administered regimens should be given whenever possible. Intravenously administered antibiotics should be used for patients who are unable to tolerate or absorb oral medications (Wilson, 2007). Common side effect: pruritus, rash, urticarial, Abdominal pain, diarrhea, esophagitis nausea, pseudomembranous colitis, vomiting, Agranulocytosis, eosinophilia (transient), neutropenia (transient), thrombocytopenia. When no data was available, they were made on professional consensus (expert advice) within the work group. The absence of proof level does not mean that recommendations are not pertinent or useful. Question 2: how can the diagnosis prosthetic device bone and joint infections be provedfl What microbiological techniques should be implemented for the diagnosis and interpretation of samplesfl

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The disease has been confirmed in at least 124 mammalian species or subspecies (Leighton and Wobeser insomnia 26 weeks pregnant order generic sominex on line, 1978) sleep aid puppy buy sominex 25mg free shipping. Among other mammals sleep aid up and up buy generic sominex 25mg line, the disease has been diagnosed in skunks (Mephitis mephitis) in Argentina sleep aid pregnancy cheap 25mg sominex with mastercard, Canada sleep aid starts with t discount sominex 25mg overnight delivery, and the United States insomnia video game order 25 mg sominex mastercard. The Disease in Man and Animals: the only clinically significant form, in man as well as animals, is pulmonary adiaspiromycosis. The fungus causes light gray to yellowish lesions in the lungs, without greatly affecting the animals overall health. The number of spherules (adiaspores) in the lung tissue depends on the number of conidia (spores) inhaled. Adiaspiromycosis usually disappears sponta neously but requires surgical resection if it persists (Englund and Hochholzer, 1993). A fatal case of adiaspiromycosis was recorded in Brazil in a 35-year-old rural worker who had complained of generalized weakness, dry cough, afternoon fever, and a weight loss of 8 kg during the four weeks prior to hospitalization. In 7 out of 25 skunks (Mephitis mephitis) captured and autopsied in Alberta, Canada, lesions were found that varied from slight and only visible microscopically to severe with grayish-white nodules in the pulmonary parenchyma that spread to the bronchotracheal and mediastinal lymphatic ganglia. Histologically, the lesions were characterized by a centrally located spherule surrounded by granulomatous inflammation (Albassam et al. Source of Infection and Mode of Transmission: the great preponderance of pulmonary localizations indicates that the infection is contracted through inhala tion. Differences in the infection rates for three very similar species of squirrels indicate that the fungus may be present in certain habitats (Leighton and Wobeser, 1978), possibly linked to the root microflora of certain plants. Other authors (cited by Mason and Gauhwin, 1982) suggest that predator-prey interactions affect its distribution: upon ingesting infected animals, carnivores eliminate adiaspores in their feces, where the spores germinate and develop. This was demonstrated in cats, in a mustelid (Mustela nivalis), and in birds of prey. Under very windy conditions, both animals and humans may inhale airborne coni dia released from the soil. Role of Animals: the soil is the reservoir for the fungus and the source of infec tion in humans and other animals. Diagnosis: Diagnosis may be made by observation of spherules in lung tissue, by stained histological preparations, and by culture and inoculation into laboratory ani mals. The most effective method for detecting adiaspores in the lungs of animals is tissue digestion with a 2% sodium hydroxide solution (Leighton and Wobeser, 1978). The spherules are stained with acid-Schiff and Gomori methenamine silver nitrate reagents (Englund and Hochholzer, 1993). The prevalence of adiaspiromycosis in three sympatric species of ground squirrels. Etiology: Aspergillus fumigatus and occasionally other species of the genus Aspergillus, such as A. These sapro phytic fungi are common components of the soil microflora; they play an important role in the decomposition of organic matter. Its incidence, as is that of other opportunistic mycoses1 (candidiasis, zygomycosis), is increasing due to the growing use of antibiotics, antimetabolites, and cortico steroids. Small nosocomial out breaks have also been reported (see section on the disease in man). Occurrence in Animals: Sporadic cases have been described in many species of domestic and wild mammals and birds. The disease in fowl and cattle has economic 1 Mycoses that attack debilitated persons or those treated over a long period with antibi otics, antimetabolites, or corticosteroids. The incidence is low in adult domestic fowl, but outbreaks in chicks and young turkeys can cause considerable losses on some farms. The Disease in Man: Aspergillosis establishes itself in patients debilitated by chronic diseases (such as diabetes, cancer, tuberculosis, deep mycoses) and diseases of the immune system, as well as in persons treated with antibiotics, antimetabolites, and corticosteroids for prolonged periods. Persons occupationally exposed for long periods to materials contaminated by fungus spores (grain, hay, cotton, wool, and others) run a greater risk. There are two differentiated clinical forms of the disease: localized and invasive. Aspergillosis is essentially a respiratory system infection acquired through inhala tion of Aspergillus spp. Patients with pronounced granulocytopenia may contract an acute and rapidly progressing pneumonia. Normal children who inhale a large num ber of conidia may develop fever, dyspnea, and miliary infiltration (Bennett, 1990). Eosinophilia, precipitant antibodies, and high serum IgE concen tration are found in these patients; the intradermal [skin prick] test produces an immediate reaction to Aspergillus antigens, with papules and reddening. Despite recurring exacerbations, some patients do not experience any permanent loss of pul monary function. Other patients, however, suffer corticoid-dependent asthma or per manent obstructive disease (Bennett, 1990). Even during remission, 33% of patients evidenced circulating immune complexes, primarily involving IgG (Bhatnagar et al. Allergic bronchopulmonary aspergillosis is more common than was thought in the past. The disease may begin during childhood and continue without being clinically recognized for many years or decades, until the patient begins to suffer from fibrotic pulmonary disease. In this regard, it must be noted that aspergillosis infection may be asymptomatic and suspected only due to a significant increase in serum IgE. When corticoids are discontinued, dyspnea and wheezing occur, requiring a return to med ication with prednisolone (Greenberger, 1986). Though rare, the cutaneous form of the disease may appear in immunodeficient patients. Cases of pulmonary aspergillosis have also been described in patients who are not immunodeficient. There is general insistence that the invasive form of the disease occurs only in patients with neutropenia. Neutrophil polymorphonuclear leukocytes are very important in the defense against aspergillosis or in those who have serious defects in cell-mediated immunity (Karam and Griffin, 1986). Karam and Griffin describe three cases over five years in a uni versity hospital and cite 32 cases found in the literature. Surgical intervention in the case of pulmonary or pleuropulmonary aspergillosis may be indicated to treat pleural empyemas and bronchopleural fistulae. In these cases, myoplasty, thoracomyoplasty, and omentoplasty are the procedures most rec ommended (Wex et al. Surgical removal is also justified in the case of inva sive aspergillosis in the brain and paranasal sinuses, as well as in noninvasive colo nization of the paranasal sinuses (Bennett, 1990). When colonization is invasive, it is advisable to discontinue or reduce the use of immunosuppressants and to start treatment with intravenous amphotericin B or itraconazole. Several small outbreaks have occurred during the renovation, expansion, or remodeling of hospitals and the construction of highways near hospitals. During these projects, large numbers of conidia are made airborne, and may become con centrated due to ventilation systems with defective filters. Between July 1981 and July 1988, 11 immunodeficient patients in a military hospital contracted dissemi nated aspergillosis and died as a result. The hospitals project involved the renova tion of the intensive care unit and several other rooms. However, a certain percentage of patients with lymphoma who received bone marrow transplants and were located in single-occupancy rooms with positive air pressure and high efficiency air filters did acquire aspergillosis. These 22 patients were treated with amphotericin B, 17 of them prior to being diagnosed with aspergillosis; seven survived. The Disease in Animals: Although aspergillosis occurs sporadically in many animal species, where it primarily causes respiratory system disorders, the follow ing discussion only deals with the disease in cattle, horses, dogs, and fowl. As brucel losis, campylobacteriosis, and trichomoniasis are brought under control, the relative role of fungi as a cause of abortions increases. It is thought that the fungus first localizes in the lungs or the digestive system, where it multiplies before invad ing the placenta via the bloodstream and causing placentitis. The fun gus may invade the fetus as well, causing dermatitis and bronchopneumonia. There is also an association between enterocolitis (Salmonella, Ehrlichia ristici) and invasive pulmonary aspergillosis (Hattel et al. The disease was characterized by granulomas in several organs, particularly in the kidneys, spleen, and bones. Lumbar diskospondylitis and focal osteomyelitis were common, generally in the epiphysis of the long bones (Day et al. Six cases of disseminated aspergillosis were recorded in the United States with characteristics similar to those in Australia (Dallman et al. The symptoms include fever, loss of appetite, labored breathing, diarrhea, and emaciation. In chronic aspergillosis, which occurs sporadically in adult birds, the clinical picture is varied and depends on the local ization. The affected birds may survive for a long time in a state of general debilita tion. Yellowish granulomas of 1 to 3 mm (or larger, if the process is chronic) appear in the lungs. Plaques develop in the air sacks and may gradually cover the serosa; the same lesions or a mucoid exodate are found in the bronchial tubes and the tra chea. Granulomatous lesions are also found frequently in different organs, as either nodules or plaques. Osteomycosis and encephalitis are probably spread through the bloodstream (Chute and Richard, 1991). The infecting element is the conidia (exospores) of the fungus, which are transmitted to man and animals through the air. The causal agent is ubiquitous and can survive in the most varied environmental conditions. Despite this, the disease does not occur frequently in man, indicating natural resistance to the infection. In domestic mammals and birds, as well as in people who work with them, an important source of infection is fodder and bedding con taminated by the fungus, which releases conidia upon maturing. Apparently, expo sure must be prolonged or massive for the infection to become established. Airborne conidia are found in incubators, hatcheries, incubation rooms, and air ducts; these may be the source of infection for chicks or young turkeys (Chute and Richard, 1991). Role of Animals in Epidemiology: the source of infection is always the envi ronment. Diagnosis: Due to the ubiquitous nature of the agent, isolation by culture is not a reliable test, since the agent may exist as a contaminant in the environment (labora tory or hospital) or as a saprophyte in the upper respiratory tract. A conclusive test may be obtained by simultaneously conducting a histological examination using biopsy material and confirming the presence of the fungus in the preparations. The agent may also be isolated by culturing aseptically obtained specimens from lesions not exposed to the environment. Serological tests are useful for diagnosing aspergillomas and in allergic bron chopulmonary aspergillosis, but not in invasive aspergillosis (Bennett, 1990). In fowl, it is enough to confirm the presence of the fungus through direct observation or by cul turing materials from lesions of sacrificed birds. Control: Due to the ubiquitous nature of the fungus, it is impossible to establish practical control measures. Prolonged treatment with antibiotics or corticosteroids should be limited to cases in which such therapy is essential. It is advisable to take special precautionary measures to avoid nosocomial outbreaks and to protect immunodeficient patients when construction work is done inside or near hospitals. Patients with lymphoma who receive bone marrow transplants should receive pro phylactic treatment with amphotericin B (Iwen et al. Moldy bedding or fod der should not be handled or given to domestic mammals and birds. Hygienic con ditions in incubators and incubation rooms are important in preventing avian aspergillosis. Serological findings in patients with allergic bronchopulmonary aspergillosis during remission. Disseminated aspergillosis in a dog with diskospondylitis and neurologic deficits. Current status of serology for diagnosis and prognostic evaluation of oppor tunistic fungus infections. Usefulness of inhaled high-dose corticosteroids in allergic bron chopulmonary aspergillosis. Nosocomial invasive aspergillosis in lymphoma patients treated with bone marrow or peripheral stem cell transplants. Enzyme-linked immunosorbent assay in the detection of specific antibodies against Aspergillus in patient sera. Invasive aspergillosis in patients with acquired immunodeficiency syndrome: Report of 33 cases. Efficacy of infection control measures dur ing a nosocomial outbreak of disseminated aspergillosis associated with hospital construction. Etiology: Blastomyces dermatitidis,adimorphic fungus existing in mycelial form in cultures and as a budding yeast in the tissues of infected mammals. The mycelial form in culture media at 25C is cottony white, turning to brown over time. Sandy, acidic soil close to rivers or other freshwater reservoirs is the micro ecosystem most favorable to B. It remains in an infective sporulated state in this biotope, as its spores (conidia) can detach and become airborne. Strains examined from India, Israel, and the United States, and one strain examined from Africa all contained A antigen (serotype 1).

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On the Malay Peninsula the pounded root is used as a poultice for sores; the leaves are employed for headache and ulcerated nose (for the latter insomnia facts buy cheap sominex on-line, fumigation from burning leaves and bark is another treatment) equate sleep aid liquidcaps 96ct generic 25 mg sominex visa, and a decoction of the leaves is administered post partum; in Indonesia the juice insomnia restaurant toronto buy generic sominex 25 mg online, pressed or pounded out of the leaves insomnia 8 month old baby buy sominex 25mg lowest price, is used both as a medication for fever and a vermifuge insomnia 5 am purchase sominex now, and may be given to lying-in women (Perry 1980) sleep aid for anxiety sominex 25mg lowest price. Nordal (1963), Agricultural Corporation (1980), Perry (1980), Forest Department (1999). Myanmar: kwet, mak-pyen-sum, thi, san-phak (Kachin), sanut-khar (Mon), san sph-ka, thanakha, thi-ha-yaza. In Myanmar, grows naturally in hot zone, in townships such as Pakokku, Myin-kyan, Pyay, Shwe-bo, Sagaing, Myaing, Nwa-hto-gyi, and Taungthar. Can also be found in some of the semi-desert dry and scrubby areas of Upper Myanmar. Patients bathed in water the leaves have been boiled in and this is followed up by inducing a sweat. Used in making medicine for neutralizing poisons, strength-giving tonics, and high fevers. Paste, together with water in which betle (Piper betle) leaves have been soaked, given to children with bronchitis. Taking 5 pei (1/16th tical) each of the root and pan-nu (Hemistrepta lyratat or Saussurea afnis) used to neutralize the venom of snakebites. In Indo-China the ripe fruit is cooling, astringent, tonic, very efca cious to treat salivation and ulcers in the mouth; a decoction of the aromatic leaves is taken as stomachic and carminative; the bark, chewed with that of Barringtonia acutangula, is applied to bites and stings, and also used to treat nausea; an infusion of the thorns with other ingredients is ingested as hemostatic to treat metrorrhagia (Perry 1980). Marmosin has been isolated from the bark, feronialactones from the bark and roots, bergapten from the leaves, and stigmasterol from the leaves and unripe fruits (Perry 1980). China, Bangladesh, Bhutan, India, Indonesia, Laos, Malaysia, Myanmar, Nepal, Tailand, and Vietnam. In China the fruit is used for dysentery and stomachache; the seed as a sudorifc, febrifuge, and for tooth powder. Medicinal uses of this species in India are discussed in Jain and DeFilipps (1991) as follows: The bark is used as a prenatal and postnatal treatment for women to purify the blood (with roots of two other plants); the fruit is used for biliousness and liver complaints. Perry (1980) discusses the uses of this species in Indo-China and the Malay Peninsula. China, India, Indonesia, Malaysia, Myanmar, Pakistan, Philippines, Tai land, and Vietmam. On the Malay Peninsula a cold decoction of the leaves is used as a lotion for an ulcerated nose (Perry 1980). Brought to Myanmar from India; cultivated in Yangon, around the Kaba Aye pagoda, in Pyin Oo Lwin and around the base of Mount Popa. Oil: A mixture of the oil and lime juice is applied topically to relieve itch ing. Inner wood: A paste made from the inner wood mixed with menthol is applied topically to the head for high fevers and hot water burns on the body, as well as to the limbs to ease fatigue, aches, and pains; mixed with rice washing water, honey, and sugar the paste is given to alleviate pain during uri nation and diarrhea. The medicinal uses of this species in India are discussed in Jain and De Filipps (1991). Leaf: In Upper Myanmar, leaves are powdered and a paste is made for use in a local antiphylogistic application. In India the whole plant is used for puss formation; from the leaf a poultice is made for neuralgia, and ash is placed on itching skin (Jain and DeFilipps 1991). In Indo China young children are bathed in a decoction of the plant to treat fevers (Perry 1980). Boiled in water to one-third the starting volume, and the resulting decoction taken with sugar to cure urinary tract disorders and diseases, as well as laryngitis, fever, aches and pains. Liquid from boiling the plant and jaggery cooled, a cloth bundle of fve kinds of fen nel soaked in the liquid, and roasted salt added; the resulting preparation is taken three times a day for urinary diseases, indigestion and gas, eye disorders, heart disease, uterine ailments, edema, muscle fatigue and aches, throat problems (possibly cancer), and weak ness. Leaf: Decoction ingested as a remedy for rheumatism or applied in an oil as an embrocation. Juice from the crushed leaves applied around the eyes or mixed with mothers milk and used as eye drops to treat eye disorders caused by anemia, sore eyes, and cataracts. Juice from the crushed leaves is also used to make thanakha, a paste applied to the face and body to alleviate skin disorders, such as ringworm, discoloration, and acne, as well as rashes related to menstrual irregularities. Equal amounts of powder from the dried leaves and garlic clove are mixed into a paste that is rolled, dried in the sun, and used as an in halant to clear nasal passages; it is also rubbed on the tongue and inside the mouth to heal sores, to alleviate problems caused by eating the wrong foods or from inhaling cooking fumes, and to treat bronchitis. In addition, the same preparation is dissolved in sesame oil and applied topically as a remedy for skin disorders, such as scabies and eczema, edema, varicose veins, anemia, chills, and fever, as well as for thrush, indigestion, and bloating in infants. Root: Employed as a laxative, diuretic, emetic, purgative, and diaphoretic; also administered to treat catarrh of the bladder and urinary tract. Medicinal uses of this species in India are discussed in Jain and DeFilipps (1991). In China the feshy part of the fruit is used as a nutrient-roborant, benefting the spleen, heart, kidneys, lungs, and mental faculties, and is also employed as an anti dote and anthelmintic; the powdered kernel is used as a styptic (Perry 1980). In Indo China the seed as an alexiteric, and oil from the seed is used on snakebites;. Arizona to South America, West Indies, and widely distributed in the Old World Tropics. In Taiwan and Palau the leave are used as a remedy for fever; in the Philip pines a decoction of the bark serves as an astringent applied to treat eczema and simple ulcers, also used as a febrifuge (Perry 1980). The leaves have been found to contain an alkaloid, glucoside, tannin, and resins (Perry 1980). Medicinal uses of this species in India are discussed in Jain and DeFilipps (1991). Litchi chinensis is reported to be used as a tonic, analgesic, anodyne, antitus sive, and astringent; also for thirst, stomachache, adenopathy, anemia, angina, cancer, colic, diarrhea, eruptions, fux, gastralgia, gastritis, hernia, intestinal problems, neural gia, orchitis, quinsy, smallpox, and tumor (Duke 2009). In areas of the world where the plant is present, the fruit is used as soap (Perry 1980). In India the fruit is used an emetic and expectorant, for epilepsy, excessive salivation, and chlorosis; in China and Taiwan the fowers are a used for conjunctivitis and other eye diseases, a lotion made from the nuts is said to cause freckles and tan to 240 Robert A. Krupnick / PhytoKeys 102: 1341 (2018) disappear, the kernel is used to correct fetid breath and gum boils as well as to prevent tooth decay, a solution of macerated bark is used to wash the hairy parts of the body to kill lice and other vermin, and the seeds serve as a laxative and a decoction is taken as an expectorant (they are also used as a fsh poison and insecticide) (Perry 1980). The medicinal uses of this species in India are discussed in Jain and DeFilipps (1991). Me dicinal uses of this species in China are discussed in Duke and Ayensu (1985). In Indo-China, used in a maceration or infusion, the bark is said to be anti-malarial; also used as a dressing for adenitis and immature boils, and made into a paste with rice water and powdered gypsum for spreading on lesions (Perry 1980). In Indonesia the bark is used as a for itch, wounds, and as a stimulating agent for cleans ing the scalp and promoting hair growth (Perry 1980). The seeds are more than half oil, in which a small part of prussic acid is found (Perry 1980). Medicinal uses of this species in India are discussed in Jain and DeFilipps (1991). Indigenous medicinal uses of this species in the Andaman and Nicobar Islands (India) are described by Dagar and Singh (1999). Bark: Liquid from boiling the bark together with the bark of zee-hpyu (Phyl lanthus emblica) and shah (or A. Bark, Flower and Fruit: Used for heart problems, a decoction of the bark is taken, the fowers are inhaled, and the fruit is eaten. Flower: Fresh fowers are used for treating white vaginal discharge and dental diseases. Dried fowers, ground together with thanakha (paste of bark of Chloranthus erectus, especially useful for its astringent properties), are applied to cure heat rashes and prickly heat. Fruit and Seed: Paste of seeds is made with cold water or the ripe fruits are ingested for persistent diarrhea. The medicinal uses of this species in India are discussed in Jain and De Filipps (1991). West Pakistan and central India to southern China, Taiwan, south to the Malay Archipelago and the Mariana Islands. This species is used as an abortifacient and intoxicant; for dermatosis, in fammation, malaria; and to treat tumors (Duke 2009). Krupnick / PhytoKeys 102: 1341 (2018) Simaroubaceae (Tree of Heaven or Quassia family) 1. Medicinal uses of this species in Indo-China, where the native name of the tree is tree of 100 maladies; Vietnam, where it is much used in the Vietnamese phar macopeia; Cambodia; and the Malay Peninsula are discussed in Perry (1980). The speices has been reported as used for headache, fever, malaria, parturition, smallpox, sores, syphilis, and wounds (Duke 2009). Bark: On account of the bitterness of quassin in the bark, it has been substi tuted for quinine in Myanmar. The species is reported to be used as an antidote and larvicide; also for dys pepsia and fever (Duke 2009). Perry (1980) discusses the medicinal uses of this species in East and Southeast Asia. From Myanmar and Indo-China to the Solomon Islands, but not in Sumatra, Java, and the Lesser Sunda Islands; also cultivated. In Indonesia the bark, wood, and seeds serve as a febrifuge and tonic, and a decoction is prescribed for bilious fever; the seed, chewed or ground with water, is both emetic and purgative, and oil from the seeds is a constituent in an embrocation for rheumatism; leaves are crushed and applied to erysipelas, also an infusion of the leaves is used to kill insects, especially white ants (Perry 1980). In the Philippines the bark and wood, macerated in water, alcohol, or wine are said to have tonic, stomachic, anticholeric, antifebrile, and emmenagogue properties; juice from the pounded bark serves as a remedy for skin diseases, and the bark, scraped or powdered, is given in water or oil to treat malignant fever (Perry 1980). In the Solomon Islands water from the macerated bark is drunk as a remedy for constipation; macerated leaves mixed with coconut oil are applied to the hair to kill lice; and an infusion of the seeds is utilized as a febrifuge (Perry 1980). In India the root is used on skin eruptions; also as a substitute for Indian sarsaparilla (Hemidesmus sp. In India fresh roots are decocted for sores and venereal diseases (Jain and DeFilipps 1991). In China the aerial tuber, boiled in water, is used for abscesses, arthri this, boils, cystitis, diarrhea, dyspepsia, furuncles, lymphadenopathy, rheumatism, and syphilis; the rhizome is used to treat cancer, as well as for mercury poisoning, syphilis, 244 Robert A. Krupnick / PhytoKeys 102: 1341 (2018) and acute bacterial dysentery (Duke and Ayensu 1985). The plant is said to contain the antitumor hormones, beta-sitosterol and stigmas terol, and the tubers are nearly 70% starch; also, alcohol extracts contain a glucoside (Duke and Ayensu 1985). In India and Nepal, the root is used as a substitute for sarsaparilla in the treatment of syphilis and gonorrhea. Also, a decoction of the root is given for swellings, abscesses, and boils (Nadkarni 1976). Duke (2009) reports that this species is used for treating asthma, pain, and tumor; and is used as a suppurative and fumitory; also, as an intoxicant, narcotic, poison, and psychedelic. In Dominica, it has been observed that the dried fowers, smoked in ciga rettes, are hallucinogenic (Adjanohoun et al. Juice of Brugmansia suaveolens is the strongest hallucinogen used by the Shuar Jivaroan group of indigenous people in Amazonian Ecuador and Peru, who employ it to communicate with the spirits, and also use it medicinally to remedy menstrual pain, and against infections and weakness (Bennett 1992). Uses of tree datura (Brugmansia) species, cited as Datura candida (Persoon) Saford and Datura sanguinea Ruiz & Pavon, for medicinal and psychotropic (hallucinogenic, narcotic) purposes among Amerindians in the Valley of Sibundoy, Colombia are discussed by Bristol (1969, cf. Leaves and fruits of Brugmansia suaveolens contain hyoscyamine which is highly toxic, anticholinergic, and used to treat motion sickness and induce anaesthesia; and also contain atropine, a highly toxic anticholinergic substance which causes delirium, blurred vision, vasodilation and suppressed salivation (Lan et al. Plants derived from cultivated stock of Brugmansia suaveolens are not known to set fruit; the leaves are very poisonous (Witherell 2001). English: bell pepper, cayenne pepper, chili pepper, hot pepper, red pepper, tabasco. Worldwide medicinal usage, chemical composition, and toxicity of this species are discussed by Duke (1986). Medicinal uses of this species in India are dis cussed in Jain and DeFilipps (1991). Chemical constituents, pharmacological action, and medicinal uses of Capsicum annuum in Indian Ayurveda are discussed in detail by Kapoor (1990). Indigenous medicinal uses of this species (as dual entries Capsicum annuum and Capsicum frutescens) in the Andaman and Nicobar Islands (India) are described by Dagar and Singh (1999). The medicinal uses of this plant in the Caribbean region, as well as its chemistry, biological activity, toxicity, and dosages, are discussed by Germosen-Robineau (1997). The chemistry, pharmacology, toxicology, and use of this species (as Capsicum frutescens) for a hunting poison and medicinal plant in Africa are discussed by Neu winger (1994). A pharmacognostical profle including medicinal uses of this plant (as Capsicum annuum and Capsicum frutescens) in Africa is given in Iwu (1993). Details of the active chemical compounds, efects, herbal usage, and pharmacological literature of Cayenne pepper are given in Fleming (2000). Krupnick / PhytoKeys 102: 1341 (2018) As noted by Bertran (1997), in modern medicine, a purifed extract of the com mon chili pepper is used in a cream. Its pain-relieving qualities are based on the active ingredient capsaicin, and capsaicin cream is used as a substitute for the previously required narcotic analgesics that were used to relieve the excruciating and often intrac table pain of a condition that can follow shingles-postherpetic neuralgia. Pain signals from tissues near the skin are greatly diminished or completely eliminated following continued ap plication of capsaicin. Leaf: Used as a sedative and, when smoked, considered a valuable remedy for asthma. Seed: Mixed in curry and sweets, then employed as a narcotic (too high a dose may kill, the person may take some days to recover their faculties even at lower doses). The medicinal uses of this species in East and Southeast Asian countries are listed in Perry (1980). Medicinal uses of the species in India are discussed in Jain and DeFilipps (1991). Indigenous medicinal uses of the species in the Andaman and Nicobar Islands (India) are described by Dagar and Singh (1999). The active principle is an alkaloid, hyoscine, found in both seeds and leaves; in too large quantities, it can cause delirium, coma, and death (Perry 1980).

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