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The general references and glossary have been updated and moved to the end of the book and assigned as Appendices A and B, respectively. Two new appendices (Appendices C and D), explaining and illustrating the botanical terminology frequently encountered in the text, have also been added. It is our hope that this new edition will provide updated information on classical herbs and/or their common ingredients included in xiii xiv Preface to the third edition the previous edition. Such information should continue to be useful to readers with various backgrounds who share an interest in natural product applications in medicine, nutrition, and cosmetics and who are looking for a comprehensive compilation of the recent liter- ature summarizing the most prominent findings in this field. During this period, basic information on most of the traditional ingredients in the encyclopedia has remained essentially the same. A whole new field of food/drug products, loosely categorized as ``health foods,' has established itself in North America; so has the use of herbal teas. Although a few conventional food and drug companies have tried to capitalize on the market generated by these new fields, most members of the medical, pharmaceutical, and food establishments have so far chosen to ignore them. However, these rapidly expanding fields of health foods and herbal teas have made it very difficult for one to ignore. For this reason, up-to-date and accurate information on their ingredients should be made readily available, not only to provide useful data for technologists and consumers interested in these ingredients, but also to counterbalance the proliferation of promotional literature from marketers that is often grossly inaccurate and misleading, as well as negative information from opposing interest groups that is based on bias and self-interest and not on relevant traditional and scientific data available. Consequently, I have included information to support the ``new' uses in this edition. As Chinese herbs constitute a majority of all natural products used in the world, which have increasingly found their way into American cosmetic, health food, and herbal tea products in recent years, new ingredients described in this second edition reflect this trend. Due to other commitments that limited my availability for this revision, I enlisted the capable assistance of Steven Foster who has earned a reputation for his writings. He has been instrumental in updating much of the information in the original entries of the encyclopedia as well as introducing most of the new non-Chinese ingredients in this revision. Concomitant with the development of health foods and herbal teas, many books on natural products have appeared since the first edition was published. Some of these books contain well-researched information, while others are simply indiscriminate compilations of data, which only help to perpetuate the confusion relating to information in the herbal products field. In order to help minimize the spread of dubious data, books containing excessive outdated, secondary, and/or misleading data, as well as those consisting primarily of indiscriminate compilations of data, including some English titles on Chinese medicinal plants (even though aggressively marketed), are not included in the general references. Numerous scientists and practitioners from traditional fields (pharmacognosy, pharmacology, chemistry, medicine, botany, etc. Thus, the Herb Research Foundation, established in 1983 with an advisory board of respected scientists in various fields, has been engaged in promoting research in the various aspects of herbs. Along with the more recently xv xvi Preface to the second edition founded American Botanical Council (1988), it publishes HerbalGram, a quarterly journal that provides accurate information on many commonly used natural products. In this new edition, we have selected as general references some of the books that we find useful and that we believe had an impact in the industry in recent years. Also, the extensive use of information from the Chinese literature in this new edition reflects the greatly increased availability of data on natural products from China during the past decade. As there is no standard translation of Chinese pharmaceutical and biomedical titles, I have used the transliterated titles of such references whenever there is a possibility of confusion. Along with the greatly increased availability of information and books on natural products, I have observed a tendency in both the professional and lay press in the overly simplified interpretation of this information. It is tempting to assign the biological activity of a compound present in a natural product to the product itself prematurely, irrespective of the amount present. For example, taking this approach, the common spice, ginger, could easily be turned into a panacea as it contains dozens of active compounds, each of which by itself has been shown to have various biological activities. These activities include antimicrobial (essential oil components such as linalool, geraniol, chavicol, 1,8-cineole, etc. But to say that the spice ginger is narcotic or hypotensive is an oversimplification in interpretation. This brings up one of the major challenges in natural products research, especially in Chinese herbs, which is to make sense out of their myriad of traditional uses. The bioavailability of these chemicals in a herbal formula or in an ingested herb is most likely very selective and dependent upon the physiological state of the individual consumer.

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Atropine will reverse the muscarinic effects of acetylcholine and is given in a dose of 2 mg as atropine sulphate (intramuscularly or intravenously according to the severity of poisoning) every 20 to 30 minutes until the skin becomes flushed and dry, the pupils dilate, and tachycardia develops. Pralidoxime mesylate, a cholinesterase reactivator, is indicated, as an adjunct to atropine, in moderate or severe poisoning but is any effective if given within 24 hours. Sodium nitrite is used in the treatment of cyanide poisoning in conjunction with sodium thiosulphate. And Flumazenil, a benzodiazepine antagonist, is used in anesthesia and intensive care to reverse benzodiazepine ­ induced sedation; it is also used to treat benzodiazepine over dosage. Antidotes And Other Substances Used In Poisoning Acetylcysteine Injection, 200 mg/ml in 10 ml ampoule Indications: antidote to acetaminophen overdose, to protect against hepatotoxicity. Cautions: patients with history of asthma, conditions predisposing to gastrointestinal hemorrhage such as esophageal varices, peptic ulceration, and in patients sensitive to acetylcysteine. Side effects: drowsiness, fever, nausea, or vomiting, bronchospastic allergic reaction (troubled breathing, tightness in chest, wheezing), skin rash or hives. Second infusion- 50mg per kg of body weight in 500ml of 5% dextrose injection, administered over four hours. Third infusion - 100mg per kg of body weight in 1000ml of 5% dextrose injection, administered over the next sixteen hours. Apomorphine Hydrochloride Injection, 3 mg/ml in 1 ml ampoule Indications: emetic in the treatment of acute poisoning; diagnosis and management of parkinsonism. Cautions: if vomiting does not result from the first dose of apomorphine, then a second dose should not be given. Caution should be taken in children debilitated or elderly patients or those with cardiac decomposition. Drug interactions: the effectiveness of apomorphine as an emetic is diminished by drugs that depress the vomiting center and they in turn may enhance its central depressant effects. Contraindications: respiratory or central nervous system depression, in shock or seizure, or in patients suffering from the effects or corrosive poisons. Dose and Administrations: Adult: subcutaneous 5 or 6 mg as a single dose; Child: subcutaneous 70 to 100 mcg per Kg body weight as a single dose: Note: A glass of water being given before injection. Antidotes And Other Substances Used In Poisoning 457 Atropine Sulphate Injection, 1 mg/ml in 1 ml ampoule Indications: for the treatment of poisoning from cholinesterase inhibitors such as neostigmine, pilocarpine, physiostigmine, and methacholine, and in the treatment of the rapid type of mushroom (muscarine) poisoning. Cautions: pregnancy and breastfeeding in children and in elderly, urinary retention, prostatic enlargement, tachycardia, cardiac insufficiency, paralytic ileus, ulcerative colitis, and pyloric stenosis. Drug interactions: antacids, antidiarrhoeals, other anticholinergics, cyclopropane, ketoconazole, haloperidol. Side effect: dryness of mouth, skin, blurred vision, loss of accommodation constipation, bradycardia followed by tachycardia, difficulty with micturation, flushing. Continue dosage until definite improvement occurs and is maintained, sometimes for two days or more. Storage: at room temperature, protect from freezing Calcium Gluconate (Levulinate, or Chloride) Injection, 10 % in 10 ml ampoule Indications: fluoride toxicity; hypocalcaemia and of calcium deficiency states (see sec. If the short term affected skin and tissue should be injected with a 10 % solution of calcium gluconate at a dose of 0. Note: Inorganic fluoride is corrosive to skin and mucous membranes and acute intoxication disrupts many physiological systems and severe burns and profound hypocalcaemia may ensure. Absorption of the fluoride can be prevented by conversion to an insoluble form such as calcium fluoride and thus irrigation with limewater, milk, or a 1 % solution of calcium chloride or gluconate at the portable of entry (mouth, skin, stomach) is recommended 458 18. Antidotes And Other Substances Used In Poisoning Desferrioxamine Mesylate Powder for injections, 0. Cautions: impaired renal function, if infection is suspected treatment with desferroxamine should be stopped and appropriate antimicrobial treatment given. Drug interactions: prochlorperazine Contraindications: severe renal disease or anuria, pregnant women or women who may become pregnant. Storage: reconstituted solutions of desferrioxamine mesylate are stable for 1 week at room temperature when protected from light. Note: - Inform the patient that the drug may colour the urine reddish brown Digoxin Immune Fab (Ovine)/Digoxin-specific, Antibody fragments Powder for injection, 40mg Indications: treatment of life - threatening or potentially life threatening digoxin intoxication, associated with hyperkalaemia, life- threatening cardiac dysrhythmias or digoxin levels > 6ng/ml. Contraindications: hypersensitivity to sheep products or any component of the formulation. This may be calculated if the amount ingested is known or the post distribution serum drug level is known (round dose to the nearest whole vial). Antidotes And Other Substances Used In Poisoning 459 Digoxin Immune Fab Tablet Ingested Fab Dose (0.

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Dose and Administrations: See under preparation Oral Preparations Ethynodiol Diacetate Tablet, 0. Parentral preparations Medroxyprogesterone Acetate, Injection (aqueous suspension), 150mg/ml in l ml vial 8. Drugs used in Endocrine Disorders and Contraceptives 313 Dose and Administration: by deep intramuscular injection, 150mg within first 5 days of cycle or within first 5 days after parturition (delay until 6 weeks after parturition if breast-feeding); for long-term contraception, repeated every 12 weeks (if interval greater than 12 weeks and 5 days, exclude pregnancy before next injection and advise patient to use additional contraceptive measures. Norethindrone (Norethisterone) Enanthate Injection (oily), 200mg/ml in 1 ml ampoule. Dose and Administration: by deep intramuscular injection given very slowly into gluteal muscle, short-term contraception, 200mg with in first 5 days of cycle or immediately after parturition (duration 8 weeks); may be repeated once after 8 weeks (withhold breast-feeding for neonates with severe or persistent jaundice requiring medical treatment). Dose and Administration: by subdermal implantation, no previous hormonal contraceptive, 1 implant inserted during first 5 days of cycle; parturition or abortion in second trimester, 1 implant inserted between days 21 - 28 after delivery or abortion (if inserted after 28 days additional precautions necessary for next 7 days); abortion in first trimester, 1 implant inserted immediately; changing from an oral contraceptive, consult product literature; remove within 3 years of insertion. Levonorgestrel (D-Norgestrel) Implant capsule (subdermal); 108mg/capsule pack of 2 capsules; 75mg/capsule pack of 2 capsules. Dose and Administration: Implant capsule -by subdermal implantation, set of 6 implant capsules inserted within first 5 days of cycle (preferably on 1st day after 1st day additional precautions necessary for following 7 days) or 21st day after parturition (after this any additional, precautions necessary for following 7 days), remove within 5 years of insertion. Drugs used in Endocrine Disorders and Contraceptives Cautions: in medical or psychosocial conditions where a critical need exists for highly effective contraception. Patients must be sufficiently counseled regarding the need for consistent and correct use of condoms if they are to be effective in preventing pregnancy. Contraindication: sensitivity to latex condom Side effect: burning, stinging, warmth, itching, other irritation of the Skin, penis, rectum, or vagina, vaginal dryness or malodor, allergic vaginitis, contact dermatitis. Note: -Condoms should be completely unrolled into the penis before any genital contact occurs and remain intact throughout intercourse Copper T 380 A Indications: Copper T 380 A is an intra-uterine device used for prevention of pregnancy, most suitable in parous women but should be a last-resort contraceptive for young nulliparous women because of the increased risk of pelvic inflammatory disease and infertility. Cautions: caution should be taken in those with anaemia, heavy menses, history of pelvic inflammatory disease, diabetes, valvular heart disease (antibiotic cover needed) - avoid if prosthetic valve or past attack of infective endocarditis; epilepsy, increased risk of expulsion if inserted before uterine involution; there should be gynaecological examination before insertion, 6 weeks after (or sooner if there is a problem), then after 6 months, then yearly. Note: -Copper T 380A should be fitted into uterine cavity after the end of menstruation and before the calculated time of implantation. An intrauterine device should not be removed in mid cycle unless an additional contraceptive was used for the previous 7 days. Diaphragm with spermicides Indications: Diaphragm is a mechanical barrier method of contraception designed to hold spermicides near the cervical os, which is particularly important in the event that the diaphragm is dislodged or does not form a complete seal around the cervix. Cautions: Caution is required in cases where there was recent abortion or parturition, in chronic allergic conditions, in genital contact dermatitis. Drug interactions: Avoid use of diaphragm (with spermicides) with vaginal or topical medications, and vaginal douch products. Drugs used in Endocrine Disorders and Contraceptives 315 Contraindications: Allergy to spermicides (Nonoxinol, octoxinol), menstruation, toxic-shock syndrome. Side effects: Vulvovaginal candidiasis (thick, white or curd like vaginal discharge), toxic shock syndrome (dizziness, fever, lightheadedness, chills, sunburn-like rash followed by peeling of the skin, muscle aches, hypotension, unusual redness of the mucous membrane inside of the mouth, nose, throat, vagina or conjunctiva; confusion) Dose and Administration: Nonoxinol 9 vaginal cream with diaphragm: Intravaginal, Initially 1 applicatorful (approximately 1 teaspoonful of 0. An additional applicatorful should be inserted into the vagina just prior to each repeat act of intercourse or if intercourse occurs later than six hours after initial diaphragm placement. Nonoxinol 9 vaginal foam with diaphragm: Intravaginal, initially 1 applicatorful placed into vagina and additional spermicide spread along the rim of diaphragm just before insertion of diaphragm and not longer than one hour prior to intercourse. An additional applicatorful should be inserted into vagina just prior to, and not longer than one hour before, each repeat of intercourse. Nonoxinol 9 vaginal gel with diaphragm: Intravaginal, initially 2 teaspoonful of a 2% gel placed into cup and additional spermicide spread along the rim of diaphragm just before insertion of diaphragm and not longer than six hours prior to intercourse. An additional applicatorful should be inserted into vagina, just prior to each repeat act of intercourse or if intercourse takes place later than six hours after initial diaphragm placement. Octoxinol 9 vaginal cream with diaphragm: Intravaginal, initially 2 teaspoonful placed into cup and additional spermicide spread along the rim of diaphragm just before insertion of diaphragm and not longer than six hours prior to intercourse. An additional applicatorful should be inserted into vaginal just prior to each repeat act of intercourse or if intercourse occurs later than six hours after initial diaphragm placement. Octoxinol 9 vaginal jelly with diaphragm: Intravaginal, initially 1 applicatorful placed into cup and additional spermicide spread along the rim of diaphragm just before insertion of diaphragm and not longer than six hours prior to intercourse.

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The long-acting peg-filgrastim has several advantages including convenience of administration to patient, improved compliance and greater potency [7]. The risk of systemic infections and sepsis increases in direct proportion to the severity and duration of neutropenia [3]. Patients with a score greater than 21 are considered low risk, and patients with lower scores are considered at a higher risk and need more intensive management. Poor predictors of prognosis include age greater than 60, moderate symptoms with febrile neutropenia, hypotension, dehydration, inpatient status, and prior fungal infection [18]. This tool was endorsed in 2002 by the Infectious Diseases Society of America and has also been adopted by the European Society of Medical Oncology [16]. Characteristics Burden of febrile neutropenia with or no mild symptoms1 No Hypotension (systolic blood pressure > 90 mmof Hg) No dehydration requiring parenteral fluids Outpatient status Age < 60 No chronic obstructive pulmonary disease Weight 5 4 4 3 3 3 2 5 Solid tumor orhematological malignancy with no previous fungal infection Burden of neutropenia with moderate symptoms Burden of febrile neutropenia refers to general clinical status under the influence of the neutropenic episode. Score no or mild symptom -5, moderate symptom -3, severe symptom -0, moribund -0. A score of > 21 is considered low risk and a score of < 21 is considered high risk. Figure 3: Neutropenic nadir duration and depth depends on therapy, dose, route of treatment and patient status. Also clear protocols for patient assessment, treatment and hospital admission were not available or properly implemented. A recent report on projected economic burden and loss of productivity associated with cancer related mortalities estimated approximately 233,000 projected deaths from all invasive cancers occurring in Ireland between 2011 and 2030 [18]. An annual 1 % reduction in mortality reduces productivity losses due to all invasive cancers by 8. Of this the major cost was the hospital stay at 6851 ± 549, and additional costs include antibiotics 760 ± 156 laboratory tests 538 ± 47 and blood transfusions 525 ± 189 [21]. Therefore, there is an immediate and urgent clinical need for rapid detection of neutropenia and prevention of sepsis to improve patient survival and outcome of cancer treatment. Any chemotherapy patient who has a fever associated with neutropenia should be regarded as a "medical emergency". On referral to hospital, all patients with febrile neutropenia must be treated rapidly to prevent serious infections and sepsis. Patients can be alerted and themselves contact the appropriate hospital care for further evaluation and treatment. In addition patients diagnosed with neutropenia could be given ex-vivo expanded neutrophils to prevent onset of serious infections as well as to rapidly bring any ongoing infections under control, giving patient the chance to recover fast and continue on their treatment regimen. The current clinical need can be addressed by introducing a regular system of monitoring blood cell counts in patients at a near patient or point of care setting. Marshall E, H Innes (2008) Chemotherapy induced febrile neutropenia: management and prevention. If neutrophil count is low, a patient might not receive their next cycle of chemotherapy until they have enough neutrophils. Additional neutrophil counts will enable the accurate and timely detection of a fall in neutrophils, which may indicate that the administration of growth factors may be beneficial. Where neutrophil levels fall too low, intravenous antibiotic administration may also be advised. Therefore further research needs to be focused on identifying new and novel methods for monitoring neutrophil counts in cancer patients receiving chemotherapy. Copyright@ Ananya Gupta tients-a micro-costing study in the Irish healthcare setting. Indeed, infectious complications have been a leading cause of morbidity and mortality in patients with cancer. This review chronicles the progress in defining and developing approaches to the management of fever and neutropenia through observational and controlled clinical trials done by single institutions, as well as by national and international collaborative groups. The resultant data have led to recommendations and guidelines from professional societies and frame the current principles of management. Recommendations include those guiding new treatment options (from monotherapy to oral antibiotic therapy) and use of prophylactic antimicrobial regimens in high-risk patients. Of note, risk factors have changed with the advent of hematopoietic cytokines (especially granulocyte colony-stimulating factor) in shortening the du- ration of neutropenia, as well as with the discovery of more targeted cancer treatments that do not result in cytotoxicity, although these are still the exception. Most guiding principles that were developed decades ago-about when to begin empirical treatment after a neutropenic patient becomes febrile, whether and how to modify the initial treatment regimen (especially in patients with protracted neutropenia), and how long to continue antimicrobial therapy-are still used today. This review describes how the treatment principles related to the management of fever and neutropenia have responded to changes in the patients at risk, the microbes responsible, and the tools for their treatment, while still being sustained over the arc of time.

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Other types of drugs can be used to treat prostate cancer that has spread to the bones. Survival: the majority (92%) of prostate cancers are discovered at a local or regional stage, for which the 5-year relative survival rate approaches 100%. Over the past 25 years, the 5-year relative survival rate for all stages combined has increased from 68% to 99% (Table 8, page 21), some of which is due to the detection of indolent disease. According to the most recent data, 10- and 15-year relative survival rates are 98% and 95%, respectively. However, the actual number of the most common types ­ basal cell and squamous cell skin cancer. Melanoma accounts for only 1% of all skin cancer cases, but the vast majority of skin cancer deaths. It is most commonly diagnosed in non-Hispanic whites; the annual incidence rate is 1 (per 100,000) in blacks, 4 in Hispanics, and 25 in non-Hispanic whites. Incidence rates are higher in women than in men before age 50, but by age 65, rates in men are double those in women, and by age 80 they are triple. This pattern reflects differences in occupational and recreational exposure to ultraviolet radiation by sex and age, which have changed over time. Incidence trends: Overall, the incidence of cutaneous melanoma has risen rapidly over the past 30 years. However, the past 5 years of data indicate that rates are declining or plateauing among those younger than 50. For example, from 2008 to 2012, incidence rates declined by about 3% per year in both men and women ages 20-29. Regional: a malignant cancer that 1) has extended beyond the limits of the organ of origin directly into surrounding organs or tissues; 2) involves regional lymph nodes; or 3) has both regional extension and involvement of regional lymph nodes. Distant: a malignant cancer that has spread to parts of the body remote from the primary tumor either by direct extension or by discontinuous metastasis to distant organs, tissues, or via the lymphatic system to distant lymph nodes. Changes that progress over a month or more should be evaluated by a health care provider. Basal cell carcinoma may appear as a growth that is flat, or as a small, raised pink or red translucent, shiny area that may bleed following minor injury. Squamous cell carcinoma may appear as a growing lump, often with a rough surface, or as a flat, reddish patch that grows slowly. Risk factors: For melanoma, major risk factors include a personal or family history of melanoma and the presence of atypical, large, or numerous (more than 50) moles. Children should be especially protected from the sun because severe sunburns in childhood may greatly increase the risk of melanoma. The purpose of this initiative is to increase awareness and encourage all Americans to engage in behaviors that reduce the risk of skin cancer. Early detection: the best way to detect skin cancer early is to recognize new or changing skin growths, particularly those that look different from other moles. Not all melanomas have these signs, so be alert for any new or changing skin growths or spots. Cancer Facts & Figures 2016 21 Treatment: Most early skin cancers are diagnosed and treated by removal and microscopic examination of the cells. For melanoma, the primary growth and surrounding normal tissue are removed and sometimes a sentinel lymph node is biopsied to determine stage. More extensive lymph node surgery may be needed if the sentinel lymph nodes contain cancer. Melanomas with deep invasion or that have spread to lymph nodes may be treated with surgery, immunotherapy, chemotherapy, and/or radiation therapy. Chemotherapy might be used, although it is usually less effective than newer treatments. The 5- and 10-year relative survival rates for people with melanoma are 92% and 89%, respectively.

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In cases of strong suspicion overlying intact tegmen tympani or sinus plate is deliberately removed to evacuate any collection of pus. Follow-up Patient should be closely observed for further intracranial complications, such as sinus thrombosis, meningitis or brain abscess. The subdural space is divided into several large compartments, which are anatomically confined, by foramen magnum, tentorium cerebelli, base of the brain and falx cerebri. An extradural abscess pathology Infection can spread either by erosion of bone and dura or by thrombophlebitic process (intervening bone remains intact). Thrombophlebitis of cortical veins of cerebrum: Aphasia, contralateral hemiplegia and hemianopia. Preformed pathways Patent petrosquamosal suture Perineural spaces to the internal auditory canal (uncommon via endolymphatic ducts) via labyrinth through round and oval windows Retrograde venous thrombophlebitis Direct erosion of bone (mastoiditis and petrositis) and dura microbiology Major pathogens are Hemophilus influenzae and Streptococcus pneumoniae. The raised intracranial tension and meningeal and cerebral irritations vary with the extent of disease. Earliest symptoms include­ Fever (102­104° F) often with chills and rigors Headache Vomiting (sometimes projectile) Photophobia Irritability and restlessness Seizures: Infants may have seizures. Lumbar puncture is contraindicated as it can result in herniation of cerebellar tonsil. If there is no satisfactory response to medical treatment, early surgery is required. Antibiotics: Crystalline penicillin, ampicillin, chloromycetin or third generation cephalosporin (drugs of choice) intravenously for 7­10 days. Stage of invasion (Initial encephalitis) of 1­3 days: the mild symptoms include headache, low grade fever, malaise and drowsiness. Stage of localization (Latent abscess) of 4­10 days: In this asymptomatic stage, which may last for several weeks, pus is getting localized by the formation of a capsule. Stage of enlargement or early capsule formation (manifest abscess) of 10­13 days: the enlarging abscess surrounded by a zone of edema aggravates the severity of clinical manifestations, which are due to raised intracranial tension and the focal involvement of brain. Stage of termination or late capsule formation (rupture of abscess) of 14 days: the enlarging abscess ruptures into either the ventricle or subarachnoid space. It is surrounded by an area of inflammation (encephalitis) · Fifty percent cases of brain abscesses in adults and 25% in children are otogenic. As the brain abscess is often associated with extradural abscess, perisinus abscess, meningitis, sinus thrombosis and labyrinthitis, the clinical picture may be overlapping. Clinical features are mainly due to raised intracranial tension and the area of brain affected. Raised intracranial tension Headache is severe and generalized, worse in the morning. Nausea and vomiting (usually projectile): It is more common in cerebellar abscess. Bimodal Age Distribution: Peak incidences are in pediatric age and 4th decade of life. Retrograde thrombophlebitis of dural vessels, which terminate in white matter, is usually caused by the osteitis and granulation tissue. Cerebral abscess: Cerebral abscess is often associated with extradural abscess that occurs due to erosion of the tegmen. It is often associated with extradural abscess, perisinus abscess, sigmoid sinus thrombophlebitis or labyrinthitis. Aerobic: Gram-positive: Pyogenic staphylococci, Streptococcus pneumoniae and Streptococcus haemolyticus Gram-negative: Proteus mirabilis, Escherichia coli, Klebsiella and Pseudomonas aeruginosa Anaerobic: Peptostreptococcus and Bacteroides fragilis. Localizing features of temporal lobe abscess Nominal aphasia: It occurs if the lesion is of dominant cerebral hemisphere, which is left side in right handed persons. Contralateral homonymous hemianopia: It indicates pressure on the optic radiations. Contralateral motor paralysis: They are: ­ Upward spread: Facial palsy is followed by palsy of arm and leg. Localizing features of cerebellar abscess Suboccipital headache associated with neck rigidity. Dysdiadokokinesia: Rapid pronation and supination movements become slow and irregular on the affected side. Raised intracranial tension: Dexamethasone, 4 mg intravenous 6 hourly or mannitol 20% in doses of 0.

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Infectious mononucleosis: Amoxicillin or ampicillin can cause a salmon-colored rash. The openings of crypts present yellowish spots of pus which may coalesce, and form a membrane on the surface of tonsil (acute membranous tonsillitis). Spread: Mostly through aerosolized microdroplets; less commonly by direct contact, and rarely through ingestion of contaminated non-pasteurized milk or food. Clinical features the disease often affects school going children (peak 5­6 years), but may affect infants and individuals above 50 years of age. Abdominal pain: It is due to mesenteric lymphadenitis, and simulates acute appendicitis. Tonsils red and swollen with yellowish spots of pus at the opening of crypts (acute follicular tonsillitis) which Diagnosis Characteristic feature: Petechiae at the junction of hard and soft palate. Serological tests: Monospot and Paul Bunnell or Ox-cell hemolysis test shows high titers of heterophil antibody. Leukemia: In children, acute lymphoblastic leukemia is more common (75%) than acute or chronic myelogenous (25%) leukemia. Aphthous ulcers: Small/large, single/multiple painful ulcers on any part of oral cavity or oropharynx. Clinical Features: It has insidious onset with mild fever and discomfort in throat. Diagnosis Sore throat and fever with cervical adenopathy and pharynx with exudative covering are highly suggestive of Streptococcus pyogenes. Throat culture: Swab the posterior pharynx and tonsillar area when body temperature is greater than 38. Chapter 39 w Pharyngitis and adenotonsillar Disease Treatment General: Bed rest and plenty of fluids. Specific: Antibiotics for 7­10 days reduces the chances of suppurative complications and acute rheumatic fever, but not poststreptococcal glomerulonephritis. If there is no response then suspect beta-lactamase producing organisms and anaerobes, and start ­ Amoxicillin + clavulanic acid or ­ Clindamycin or ­ Erythromycin + metronidazole Asymptomatic carriers: They usually do not need any treatment except when: Family member is having rheumatic fever. Group A beta-hemolytic streptococci: It is the most common cause of acute tonsillitis and can also result in rheumatic fever and poststreptococcal glomerulonephritis. Differential Diagnoses of white Patches on Tonsils In addition to the above-mentioned causes of membranous pharyngitis-tonsillitis, certain conditions (Box 1), most of which are described in the sections of this chapter, can present with white lesions on the tonsils. Complications Scarlet fever Rheumatic fever Acute glomerulonephritis Acute otitis media: It may coincide with recurrent tonsillitis. Chronic/Recurrent tonsillitis due to incomplete resolution of tonsil infection, which may persist in lymphoid follicles of the tonsil like microabscesses. However, it should be kept in mind whenever any membrane is seen on the tonsils of a child (Table 1). Treatment Pharynx and esophagus · Tonsillar cyst (Congenital or acquired): Yellowish white · Tonsillar keratosis: whitish horny outgrowths · Tonsillolith: Hard whitish lesion · Aphthous ulcer: Intensely painful Clinical features Section 5 Children are affected more. The dirty gray tenacious membrane extends beyond the tonsils on to the soft palate and posterior pharyngeal wall and after removal, leaves a raw bleeding surface. Cervical lymph nodes (jugulodigastric) get enlarged and tender, and may present as "bull-neck" appearance. Sensitivity test: Horse serum is tested by conjunctival or intracutaneous test with diluted antitoxin. The blocked tonsillar crypt causes retention of debris, which consists of inorganic salts of calcium and magnesium (formation of stone). Distinguishing features of acute follicular tonsillitis and diphtheria Acute follicular tonsillitis Recurrent sore throat with fever taken No age bar Acute Severe High grade Never Absent In proportion to fever Absent Limited to tonsil and easily removed Streptococci No albumin Antibiotics Nil Diphtheria Contact with diphtheria patient Not taken Children Insidious mild Low grade present in advanced disease Not uncommon Out of proportion to fever and weak present in advanced disease May extend adjacent structures, and difficult to remove, and leaves raw bleeding area Corynebacterium diphtheriae Albumin often present Antidiphtheric serum High Features past history Diphtheria vaccination Age Onset throat pain Fever Hoarseness of voice and respiratory distress Neck bull due to cervical lymphadenopathy pulse rate toxemia tonsillar membrane throat swab Urine First line of treatment mortality Clinical features Clinical features the affected crypt gradually enlarges, and may ulcerate on medial surface of tonsil. Retained material may have bacterial growth and then present with halitosis and sore throat. Whitish foul-tasting and foul-smelling cheesy material can be expressed from tonsils.

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Another important step is the recognition and enforcement of the right of a child to retain contact with both parents. The European Commission anticipates that application of this Regulation by the Member States may have "a deterrent effect" on future abduction cases. The first authorizes the Council to adopt measures in the area of judicial cooperation in civil matters, and the latter allows the Members States to share the right of initiative to introduce a new piece of legislation with the Commission for a limited period. The Regulation was based on a proposal from 1 Many civil law countries require that in order for a foreign judgment to be enforced domestically, an exequatur must be issued. An exequatur proceeding is a requested court order declaring that a foreign judgment is enforceable. Scope the scope of this Regulation is not limited to issues related to child abduction. In general, it intends to solve conflicting issues related to jurisdiction, recognition, and enforcement of judgments in family relations and questions of parental responsibility. Protection of children and according respect to their basic rights are reflected in a number of provisions. Certain principles which are common to the legal systems and traditions of the Members, such as equality of all children before the law irrespective of marriage of parents and the best interest of the child, are recognized in the Preamble of the Regulation. Definitions Several of the terms and concepts used in the Regulation were modeled after the Hague Convention. Thus, "wrongful removal or retention" of a child occurs when: · the removal or retention violates the rights of custody acquired by judgment or by operation of law or by an agreement of the Member State where the child had its habitual residence immediately prior to being removed or retained; the custody rights were actually exercised, either jointly or alone, at the time of removal or retention. Central Authority the Members are required to designate one or more Central Authorities to ensure the smooth and effective application of the Regulation. These authorities may communicate through the European Judicial Network established in 2001. Return of the Child7 Recital 17 of the Preamble clarifies that in case of wrongful removal or retention of a child, the provisions of the Hague Convention will continue to apply, as complemented by article 11 of the Regulation. A parent whose custody rights have been violated has the right to file an application to request the return of the child based on the Hague Convention. In this case, the Regulation imposes a number of procedural safeguards, which must be followed by the courts of the Member States. These require that: · · · · the child be given a chance to be heard during the proceedings, depending on his age and maturity; the court must act expeditiously in such proceedings based on national law provisions; the court should render its decision within 6 weeks after the application is filed before the court, unless it is impossible to do so; the court cannot refuse to return a child based on article 13b of the Hague Convention if it has been established that security measures have been taken to protect the child after his return; the court cannot refuse to return the child unless it has heard the person who requested the return of the child. Enforceability of Judgments concerning Rights of Access and Judgments Requiring the Return of the Child9 An important innovation introduced by this Regulation is the abolition of exequatur, or the filing of a request in a domestic court to declare a foreign judgment enforceable. As a result, the rights of access granted in a judgment are recognized and enforceable automatically in another Member State, provided that the judge who decided on question of visitation rights has issued a certificate. On May 31, 1998, pursuant to article 45 of the Convention, the Argentinean government transmitted a declaration rejecting the extension of the Convention to the Falkland Islands by the United Kingdom of Great Britain and Northern Ireland. Argentina also reaffirmed its sovereign rights over the Malvinas (Falkland Islands), South Georgia, and South Sandwich Islands. Domestic Laws and Regulations Implementing the Hague Convention the Central Authority for the Convention in Argentina is the Direcciуn General de Asuntos Jurнdicos-Direcciуn de Asistencia Judicial Internacional of the Ministry of Foreign Affairs, International Commerce and Worship. Return Requested from Abroad the Central Authority addresses only the administrative and informational functions, because the judiciary always decides on the return of a child or the visitation schedule. Once an application for return has been received, the Central Authority will verify that the petition complies with all the requirements provided for under the Convention. The Central Authority will provide the appropriate court with a general background of the Convention and will also offer its assistance to the court during the proceedings. Ministry of Foreign Affairs, International Trade and Worship, General Department for Legal Matters, Division for International Legal Assistance, address: Esmeralda 1212 4th floor (1007) - Federal Capital - Argentine Republic, Telephone: (54) 11 4 819-7000 extensions: 7629/7187, Fax: (54) 11 4 819-7170/7121 email: menores@mrecic. A private lawyer will have to be hired to carry out the judicial aspect of the request. Those who cannot afford a private lawyer, and who qualify, may obtain the assistance of a public funded attorney. Return Requested from Argentina the petitioner must fill out a standard set of forms from the Central Authority and return them to the Central Authority in triplicate. A copy of the judicial decision or agreement on the custody of the child may also be attached.

References:

  • https://www.aapa.org/wp-content/uploads/2018/03/Carrie-Munk-Bio.pdf
  • http://www.e-mjm.org/2010/v65n3/Spontaneous_pneumothorax.pdf
  • https://www.state.nj.us/humanservices/dmhas/initiatives/managed/Tips%202%2026%20edit%20clinical%20Authppt%20(1).pdf
  • https://weightagnostic.github.io/papers/turing1948.pdf
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