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By M. Vak. Southern Utah University. 2018.

If the entire skin is affected buy generic aleve 500 mg, it is termed erythrodermic (the von Zumbusch variant) cheap aleve 500mg without a prescription. Prognosis This may be associated with systemic upset (malaise, Psoriasis is a lifelong disease with variability in severity fever, diarrhoea) and is potentially life-threatening. Localised forms of pustular psoriasis also occur, such as palmoplantar pustulosis. Pityriases r Flexural or inverse psoriasis affects the inguinal re- gion, axillae and submammary areas. There may not Pityriasis rosea be scales visible due to moisture, the plaques therefore appear erythematous and smooth. Definition r Nail involvement includes pitting, ridging and ony- Pityron is Greek word for bran. Nail involvement is specifically associated diseases characterised by fine, bran-like scales. Aetiology Microscopy The cause is unknown, human herpes virus 7 has been There is infiltration of the strium corneum with neu- suggested; however, the virus is not always detectable in trophils, epidermal hyperplasia with hyperkeratosis and patients with pityriasis rosea. Chapter 9: Erythematous lesions 389 Clinical features Clinical features Most cases commence with a herald patch, a single Lesions are superficial hypopigmented macules appear- salmonpinklesion2–5cmindiameterwithcentralclear- ing light brown or salmon coloured with a fine scale. Days later crops of similar They are most seen commonly on the upper trunk and smaller oval plaques appear and proximal extremities. The lesions distribute along dermatomal lines, which is most evident on the back appearing in a ‘Christmas tree’ Management pattern. Recurrence is common, and frequent relapses may require prophy- Management laxis with topical selenium sulfide or an oral conazole. Steroids and phototherapy may be of value for associated The loss of colour in the skin may persist for several itching. Definition Theichthyosesaredisordersofkeratinisation,whichmay Pityriasis versicolor be congenital or acquired characterised by a generalised scaling of the skin due to hyperkeratosis (see Table 9. Definition Pityriasis (bran-like) versicolour (varying in colour) is Management achronic infection characterised by multiple macular Topical emollients and bath additives are used to help patches varying in size and degree of brown pigmenta- avoid the dryness. Aetiology Caused by infection by the commensal yeast Pityrospo- Erythematous lesions rumorbiculare (also known as Malessezia furfur, Pity- rosporum ovale and Malassezia ovalis). Infection results Erythema multiforme from conversion of the yeast to the mycelial or hyphal form, which may be triggered by heat and humidity and Definition immunosuppression. Theyeastreleasescarboxylicacids, Aself-limiting hypersensitivity reaction affecting the which inhibit melanin production. Lamellar ichthyosis Autosomal recessive 1 in 60,000, may at birth cause the collodion baby with red scaly skin and ectropion, may resolve or progress to other forms Acquired ichthyosis Non-inherited Associated with inflammatory disorders, endocrine anomalies, and neoplasia especially Hodgkin’s disease 390 Chapter 9: Dermatology and soft tissues Aetiology Sex 50% of cases have no obvious underlying cause. Aetio- F > M logical agents include: r Herpes simplex in 33% of cases; may cause recurrent Aetiology attacks. Clinical features r Gastrointestinal disorders: Inflammatory bowel dis- Lesions are pinkish red erythematous papules/plaques ease, Behc¸et’sˆ syndrome and bacterial gastroenteri- with central clearing or concentric rings (target lesions). Disseminated rash with mucosal Clinical features involvement with conjunctivitis and necrotic mucosal Painfulbluish-rednodulesupto5cmindiameterappear ulcers is termed Stevens–Johnson syndrome. This is of- in crops over 2 weeks on the anterior surface of both ten associated with systemic symptoms. The withdrawal of any causative drug and treatment of any associated infection is essential. Short courses of Management oral steroids are sometimes used but their efficacy and Symptomatic treatment and management of any under- safetyareunclear. Recovery may take weeks, and tiforme resulting from herpes simplex can be prevented there may be recurrence. Urticaria Prognosis Disease is usually self-limiting clearing in 2–3 weeks but Definition death can occur with Stevens–Johnson syndrome. Urticaria is an itchy erythematous eruption ranging from nettle rash to large weals/plaques with palpable skin oedema. Most cases of urticaria are acute and self- Erythema nodosum limiting within a few hours, occasionally with recurrent episodes for up to 6 weeks. Chronic urticaria lasts from 6 weeks Erythema nodosum is an immune-mediated disorder and up to 10 years. There is often no identifiable trigger resulting in red tender pretibial subcutaneous nodules. Any trigger factor should be identified and avoided IgE mediated Food allergy (egg, milk, wherever possible. Medical treatment is used for symp- peanut) Drug reaction (penicillin, tomrelief in acute urticaria and chronic urticaria where cephalosporin) triggers are not identifiable. Insect stings (bees, wasps) 1 Antihistamines Contact allergy (latex) r H receptor blockers such as loratadine are the 1 Complement mediated Hereditary angio-oedema mainstay of treatment.

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Results: Ninety patients were recruited for the study The Effect of Balloon Catheter Swallowing on the from March cheap aleve 500 mg line, 2013 to June buy 250mg aleve amex, 2013; among them, 18 patients suf- Penetration-Aspiration Scale in Stroke Patients fered aspiration at the semisolid swallowing step and 72 patients without aspiration moved to the liquid swallowing step, leaving *Y. Dysphagia therapy ing training will improve swallowing diffculty of stroke patients that includes balloon swallowing is known to enhance swallowing as part of rehabilitation program. All rights are reserved, wether the whole or part of the material is concerned, specifcally the rights of translation, reprinting, reuse of illustrations, recitation, broad-casting, reproduction on microflm or any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer. Product liability: the publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. About 200,000 natural products of plant origin are known and many more are being identifed from higher plants and microorganisms. Some plant-based drugs have been used for centuries and there is no alternative medicine for many drugs, such as cardiac glycosides. Therefore, medici- nal plants and their bioactive molecules are always in demand and are a central point of research. While planning this book, we endeavored to incorporate ar- ticles that cover the entire gamut of current medicinal plants research. The aim of this book was to review the current status of bioactive molecules and medicinal plants research in light of the surge in the demand for herbal medicine. We hope that this book will be useful for researchers in academia, industry, and agriculture planning. Finally, we would like to acknowledge our contributors, who have made seri- ous efforts to ensure the high scientifc quality of this book. Sukhadia University as an Associate Professor in 1991 and became a Professor in 2001. He did his postdoctoral study at the University of Tours, France (1983–85) and subsequently worked as visiting professor at the University of Tours (1991) and University of Bor- deaux 2, France (1995, 1999, 2003, 2006). He has published more than 100 research papers and review articles in reputed journals and books. He joined the Uni- versity of Tours as a faculty member in 1982, became associate professor in 1987, and a full Professor in 1993 at the faculty of Pharmacy, University of Bor- deaux 2, Bordeaux, France. He is currently group leader of a “study group on biologically active plant substances” at the Institute of Vine and Wine Sciences, which comprises 20 scientists and research students. He has published more than 80 research papers in internationally recognized journals. He is involved in developing courses and research on phytochemistry and biological properties of compounds from vine and wine in France and has traveled widely as a senior professor. Scientists from several countries are working in his laboratory and his research is supported by funds from the Vinegrowers Association, Ministry of Higher Education and Research, and various private enterprises. Sukhadia University Laboratory of Biomolecular Udaipur-313001 Technology, Department of Botany India M. Brisson 37007-Salamanca Department of Biochemistry Spain and Microbiology, Research in Heath corchpu@usal. Ganeshaiah Quebec Department of Genetics and Plant Canada Breeding G1K 7P4 University of Agricultural Sciences louise. Geszprych Department of Forest Biology Department of Vegetable College of Forestry and Medicinal Plants Sirsi 581401 Warsaw Agricultural University India Nowoursynowska 159 02-776 Warsaw Sumita Jha Poland Centre of Advanced Study in Cell and Chromosome Research Seemanti Ghosh Department of Botany Centre of Advanced Study in University of Calcutta Cell and Chromosome Research 35 Ballygunge Circular Road Department of Botany Calcutta 700019 University of Calcutta India 35 Ballygunge Circular Road sjbot@caluniv. Mathur Laboratory of Plant Physiology Laboratory of Biomolecular Faculty of Agricultural Technology, Department of Botany Biotechnology M. Sukhadia University Agricultural University of Athens Udaipur-313001 Iera Odos 75 India 11855 Athens Greece Professor Jean-Michel Mérillon spiroskintzios@usa. Salim Laboratory of Biomolecular College of Pharmacy Technology, Department of Botany The Ohio State University M. Węglarz Ashoka Trust for Research in Department of Vegetable Ecology and the Environment #659 and Medicinal Plants 5th A Main Warsaw Agricultural University Hebbal Nowoursynowska 159 Bangalore 560024 02-776 Warsaw India Poland weglarz@alpha. Plant secondary metabolites can also serve as drug precursors, drug prototypes, and pharmacological probes. Re- cent developments in drug discovery from plants, including information on approved drugs and compounds now in clinical trials, are presented. There are also several plant extracts or “phytomedicines” in clinical trials for the treat- ment of various diseases. Keywords Natural products, Plant-derived drugs, Drug discovery, Drug development, Drug precursors, Drug prototypes, Pharmacological probes, New therapeutic agents, Clinical trials, Accelerated discovery techniques 1. Plants have also been utilized for additional purposes, namely as arrow and dart poisons for hunting, poisons for murder, hallucinogens used for ritualistic purposes, stimulants for endur- ance, and hunger suppression, as well as inebriants and medicines. The plant chemicals used for these latter purposes are largely the secondary metabolites, which are derived biosynthetically from plant primary metabolites (e. These secondary metabolites can be classifed into several groups according to their chemical classes, such alkaloids, terpenoids, and phenolics [1]. Kinghorn Arrow and dart poisons have been used by indigenous people in certain parts of the world with the principal ingredients derived from the genera Aco- nitum (Ranunculaceae), Akocanthera (Apocynaceae), Antiaris (Moraceae), Chondrodendron (Menispermaceae), Strophanthus (Apocynaceae), and Strych- nos (Loganiaceae) [2].

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Cyst in the high cord buy aleve 250 mg with visa, the transparency by translumination aleve 250mg for sale, in front of the strangulated hernia opacity will help us for the diagnosis. Prolonged testicular torsion will result in the death of the testicle and surrounding tissues. It is also believed that torsion occurring during fetal development can lead to the so-called neonatal torsion. Testicular torsion can be extra or intravaginal (in between the testicle and the epididymis). Doppler shows normal blood flux in the normal testicle with low or absence in the torsionated one. Controversy continues on the optimal timing of surgical intervention in children with antenatal detected hydronephrosis. Before the routine fetal ultrasonography, the commonest presentation was with abdominal flank mass. Some patients present with urinary tract infection, irritability, vo- miting and failure to thrive. These infecting micro- organisms initially contaminate the infant’s skin and/or mucous membranes, reaching the circulating blood after penetration through the cutaneous-mucosal barrier2. According to the mechanisms involved in the colonization of pathogens, sepsis of vertical transmission, nosocomial sepsis and community-acquired sepsis should be distinguished. Sepsis of vertical transmission2 is caused by pathogens found in the maternal genital ca- nal, contaminating the fetus by an ascending mechanism (progressing through the birth canal to reach the amniotic fluid) or by direct contact of the fetus with contaminated secre- tions during labor. Community-acquired sepsis is caused by microorganisms contamina- ting infants at home, and is very infrequent. Neonatal sepsis usually presents with non-specific clinical manifestations, including decrea- se in spontaneous activity, instability of temperature (hypothermia or fever), feeding diffi- culties (gastric retention, regurgitation, diminished or abolished suck reflex), and in the preterm newborn, episodes of bradycardia, tachycardia and/or apnea. As infection progre- sses, gastrointestinal symptoms are more pronounced (vomiting, abdominal distention, diarrhea) and frequently cardiorespiratory symptoms (tachycardia, tachypnea, apneas, signs of respiratory distress) and neurological symptoms (apathy, irritability, convulsions) develop. In later stages, signs of severity of infection are apparent, such as reduced sponta- neous mobility, hypotonia and jaundice: «septic appearance». At this stage, manifestations of disseminated intravascular coagulation (petechia, ecchymosis, mucosal bleeding) or shock (tachycardia, weak pulse, slow capillary filling, hypotension, etc. Therefore, the presence of pathogens in the genital tract of pregnant woman is the main risk factor for infection4. Maternal genital colonization is also related to premature rupture of amniotic membranes, chorioamnionitis, and preterm delivery5. In pregnant women, the detection of pathogens in the vagina has shown a variable prevalence, ranging from 10 to 30% in the United States6 and from 10 to 18% in Spain7, and the best method for pre- dicting the status of vaginal colonization at the time of labor is to analyze recto-vaginal exudates at 5 weeks before delivery (between 35-37 weeks’ gestation). Symptoms of sepsis of vertical transmission usually appear at, 3–7 days of life and for this reason, many authors have defined sepsis according to the onset of disease, that is, early- onset infection (,3-7 days of age) for sepsis of vertical transmission and late-onset infec- tion (occurring after 3-7 days of life) for nosocomial-acquired neonatal sepsis8. However, on the basis of this criterion it may be possible to exclude vertical transmission sepsis of late onset and to include nosocomial sepsis of early onset. Therefore, it seems more appropriate to classify neonatal sepsis according to the mechanism of transmission rather than according to the time of onset of disease, avoiding mixing infections of different pa- thogenesis, etiology, and treatment4. The epidemiology of sepsis of vertical transmission in Spain is the objective of an ongoing multicenter surveillance study («Grupo de Hospitales Castrillo»). Along the study years, a significant decrease in the overall incidence of sepsis of vertical transmission has been observed, from 2,4 per 1. The incidence of these infections showed significant variations according to the birthweight, being more frequent in neonates weighing ,1. The etiology of sepsis of vertical transmission is mostly bacterial; sepsis caused by fungi and viruses account for less than 1% of cases. The percentage of 75% of cases caused by Gram positive bacteria in the 80’s and 90’s has decreased to around 50% at the present time9–11. On the other hand, in our study in agreement with data reported by others, des- Figure 2. Coli 0,29 0,23 0,3 0,24 0,27 0,28 0,32 0 1996 1997 1999 2000 2001 2002 2003 2004 2005 Table 1. Distribution of causative pathogens in sepsis of vertical transmission from 1996 to 2005. Because neonatal sepsis presents with non-specific clinical manifestations, particularly in preterm newborns that may be asymptomatic, diagnostic suspicion may be based on the presence of risk factors for infection of vertical transmission. The presence of bacterial pa- thogens in the maternal genital tract is the main risk factor, with other indirect risk factors, such as spontaneous premature labor, premature and/or prolonged rupture of membranes (more than 18 hours before delivery) and/or chorioamnionitis (maternal fever, pain in the lower abdomen and/or foul-smelling amniotic fluid). Diagnostic confirmation of sepsis of vertical transmission requires the following criteria:2 clinical signs of sepsis, laboratory abnormalities with altered hemogram (leukopenia or leukocytosis, immature to mature leukocyte ratio.

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However discount aleve 250 mg amex, most of the time the secretion of metabolites is obtained by addition of permeability agents (e buy aleve 250mg lowest price. The biosynthesis of valuable metabolites by hairy root cultures is sometimes limited by the availability of its precursor. In this case, the precursor feeding process consists of introducing this precursor into the culture medium to increase production of the metabolite of interest. Nevertheless, this process can be costly if the precursor is diffcult to synthesize or diffcult to obtain from natural sources. In this context, the coculture system has proven to be a judi- cious alternative, since the production of podophyllotoxin, an antitumor drug, by Linum favum hairy roots is increased when the culture is cultivated with a suspension Podophyllum hexandrum cells, which release the coniferin precur- sor of podophylotoxin [26]. Once the metabolite of interest has accumulated in the medium, a trapping system can be put into that medium to specifcally adsorb and harvest the secreted metabolite. Indeed, by introducing a mixture of two adsorbents (alumina and silica; 1:1) into the medium, 97. Likewise, the addi- tion of a trapping system contributes to an increase in the productivity of hairy root cultures; adding a hydrophobic polymeric resin, X-5, to Salvia miltiorrhiza hairy root cultures makes possible the recovery of 80 % of the diterpenoid tan- Chapter 14 Hairy Roots: a Powerful Tool for Plant Biotechnological Advances 277 shinones released from them, which are used for the treatment of menstrual disorders and blood circulation diseases [28]. Finally, these strategies could be combined advantageously to enhance hairy root productivity, since multiple elicitors, in situ adsorption, and repeated medium renewal with an effcient semicontinuous system increases by 15-fold the production of transhinones, with 76. This strategy was adapted to generate tagged hairy roots from Arabidopsis thaliana, Solanum tuberosum, and Nicotiana tabacum by using A. Equally, this technology can be used for regenerating recalcitrant plants such as tree species. Induction of hairy roots has been successfully reported on these woody plant species in order to charac- terize unknown genes necessary for the root biology [31]. In this way, among transcripts, several genes encoding enzymes such as squalene synthase, squalene epoxidase, oxidosqua- lene cyclase, cytochrome p450, and glycosyltransferase involved in the triter- pene glycoside gensenosides could be characterized. Kumagai and Kouchi [34] investigated, in Lotus japonicus hairy roots, an effcient system for loss-of- 278 S. This process has been investigated in Duboisia hybrid hairy roots to overexpress the hyoscyamine-6-hydroxylase (H- 6-H) encoding enzyme, which catalyzes two consecutive steps of the tropane alkaloid biosynthesis pathway [35]. This metabolic engineering strategy was successfully applied to circumvent prob- lems related to precursor availability or negative feedback regulatory loops. If no chemical or physical trap is known, the possibility of introducing a transgene encoding a protein capable of trapping the expected metabolite may be possible. In Solanum khasianum hairy roots, this strategy has been explored to divert the negative feedback regulatory loop performed by solasodine glycoside, an antineoplastic agent, on its own expression [42]. The binding of solasodine glycoside with its recombinant antibody, expressed from a foreign gene after its integration into the genome of the hairy roots, has been successfully developed. By eliminating the negative feedback, the production of solasodine glycoside was enhanced by two to threefold [43]. Chapter 14 Hairy Roots: a Powerful Tool for Plant Biotechnological Advances 279 14. Complex proteins, expressed in plant organs, must often be extracted from tissues and purifed by costly and labourious processes. This fusion protein was tested in mouse as an antigen, showing that proteins fused to ricin B, taken as a mucosal adjuvant in mamma- lian immune responses, can be effciently produced by hairy roots. Moreover, the production of this protein can be improved with a system based on culture confnement. In fact, ricin B is sensitive to the proteases present in the culture medium of hairy roots; nevertheless a two-phase extraction process can im- prove the stability of this protein by increasing its production and facilitating its harvest in the organic phase [46]. A nondestructive rhizosecretion system, coupled to a trapping process, can lead to high amounts of recombinant pro- teins and facilitate their downstream purifcation. These studies demonstrate that hairy roots are becoming a serious alternative to whole plants for the pro- duction of therapeutically functional animal proteins. Toxic organic molecules can accumulate in plant organs in an unchanged form (a process called phytoextraction) or converted enzymati- cally into a harmless form (a process called phytotransformation) [48]. Hairy roots represent a biological study model without interference with other part 280 S. In this way, hairy roots from hyperaccumulator plants able to uptake cadmium, nickel, or uranium have been investigated recently because of their greater penetration, increasing their ability to retrieve contaminants from deeper soils, and enzymatic degradation (Table 14. In addition to the phytoremediation strategies, knowledge of genetic engineering offers new possibilities by which the environment can be cleaned. Depending on the plant species and the organ culture, bioreactors adapted to liquid, air, or both conditions of cultures have recently been designed and optimized (Table 14. In addition, the airlift system designed for microorganisms or plant cells in a liquid medium, has been reported to work effciently for the growth of Arteme- sia annua hairy roots [58] and for producing betalaine from Beta vulgaris hairy roots [57]. The scale up favored both productivity and tissue growth by using Chapter 14 Hairy Roots: a Powerful Tool for Plant Biotechnological Advances 281 Table 14. The diffculty with organ cultures of hairy roots is in achieving good homogenization of the roots in the bioreactor. This problem could be avoided if hairy roots are cultured in an airlift mesh draught reactor, as described by Caspeta et al.

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