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By H. Stejnar. University of Maine at Farmington.

Most patients with epi- lepsy remain mentally normal buy levothroid 100 mcg visa thyroid vasculature, although this does depend on the presence 100mcg levothroid with mastercard thyroid symptoms nausea and vomiting, site generic 50 mcg levothroid amex thyroid cancer drugs, and extent of any brain damage underlying the epilepsy (89) cheap levothroid 50 mcg online thyroid nodules and parathyroid disease. However, those patients with epilepsy without significant brain damage do, nonetheless, remain prone to cognitive impairment, particularly memory impairment, as a result of their epilepsy and its treatment. The potential impact of this cognitive impairment must be considered when assessing a patient with epilepsy’s fitness for interview. For example, problems with concentration, memory, and intellectual func- tioning can be seen when anticonvulsant drugs are administered in toxic doses or unsuitable combinations (90). Suspicion should be raised when a suspect complains of mental lethargy or appears to be performing below expected levels, symptoms particularly associated with toxicity. Further problems with the reliability of testimony from epileptics may be related to their personality. Patients with epilepsy are often overprotected in childhood by concerned parents and, later in life, can be exposed to pro- 226 Norfolk and Stark found social and occupational discrimination (91). All these factors can lead to personality problems, which include feelings of insecurity, low self-esteem, and dependency. Individuals with these personality traits are likely to be highly suggestible and may strive to please interviewing officers by giving answers that seem plausible and consistent with the external cues provided, even though the responses are known to be untrue. The neurophysiological consequences of an epileptic seizure can seri- ously distort an individual’s perception of events occurring around the time of the seizure, thus rendering any subsequent account of that event potentially unreliable. Complex disturbances of thinking, memory, or awareness may fea- ture as part of an aura preceding the actual seizure. These may include distor- tion sense of time, mental confusion, or feelings of depersonalization or déjà vu. The seizure may also be ushered in by distorted perceptions or actual hal- lucinations of sight, hearing, taste, or smell. When the ensuing fit is mild or abortive, the connection between these reported experiences and their epilep- tic causation may be missed (91). Typical absences, or petit mal epilepsy, is a disorder that usually starts in childhood, but the attacks can continue into adult life. Absence attacks are brief, with an abrupt onset and termination; several such absences may occur in quick succession, producing significant gaps in memory. Further cognitive disturbances can follow in the wake of seizures, with clouding of consciousness and disorientation lasting for a few minutes or up to an hour or more, so that recollection for events occurring during the postic- tal period may also be unreliable (89). Head Injury Head injuries may occur in several circumstances involving possible criminal offenses, such as road traffic accidents and assaults; therefore, it is not uncommon to encounter detainees with head injuries in police custody. The potential for the head injury to affect the person’s ability to recall the details of the accident or assault can assume considerable importance. Memory loss for events occurring around the time of the injury is likely to occur whenever there has been diffuse brain damage of a degree sufficient to cause concussion. In most cases, loss of consciousness will accompany the head injury, but this is not invariable, and it is possible for patients to display both retrograde and posttraumatic amnesia without losing consciousness (88). Retrograde amnesia refers to the loss of memory for events that immedi- ately precede the head injury. Individuals can often indicate with fair preci- sion the last event that they can clearly recollect. In road traffic accidents, the journey may be recalled up to a specific point, which allows an estimate of the Care of Detainees 227 extent of the pretraumatic gap to be made. Such amnesia is usually short in duration and can usually be counted in minutes or hours rather than days or weeks. Indeed, when the retrograde amnesia lasts for a long time the explana- tion often results from hysteria. Retrograde amnesia may render a suspect unfit for interview immedi- ately after the head injury, but the doctor should be aware that the extent of the amnesia can change with time. At first, it may be long, but it can then shrink over the next days and weeks, eventually ending up as a matter of minutes only. Recovery from retrograde amnesia tends to occur in chrono- logical order, with items in the distant past recovering first. By contrast, posttraumatic amnesia refers to the period from the moment of the injury until normal continuous memory returns, the length of the amne- sia providing a good index, albeit in retrospect, of the severity of the brain damage (92). It should be emphasized that the amnesia only ends when the person becomes able to give a clear and consecutive account of what is hap- pening around him or her. Sometimes “islands of memory” will be exhib- ited, but these should not be taken as indicating the end of the amnesia. There is a similar danger in underestimating the duration of posttraumatic amnesia in those suspects who, although aware of things going on around them, are unable to recall these events at a later date (88). Several behaviors may be exhibited during the period of posttraumatic amnesia, ranging from apparent normality to obvious confusion. However, in general, behavior is unremarkable, and the doctor may be easily misled into believing that there is nothing amiss. The individuals themselves are usually unaware of the abnormal memory at the time and can give superficial or made- up explanations for any defects that are discovered. Migraine Migraine is a common and sometimes incapacitating disorder, affecting approx 20% of women and 15% of men at some time in their lives (94). Anxiety and irrita- bility are common early in the attack and are often followed by drowsiness and lethargy. Cerebration is often slowed with poor concentration, and there may be marked impairment of memory (88). Detainees who claim that they suffered a migraine attack at or around the time of the alleged offense should be questioned closely about any cogni- tive impairment during previous attacks. However, it should be recognized that the pattern of any such impairment can change from attack to attack in the same person. Hypothyroidism A detainee who is being adequately treated for myxedema poses no par- ticular problem for the physician assessing fitness for interview. However, an individual with undiagnosed or undertreated hypothyroidism may exhibit mental manifestations that are as important as the physical. The typical pic- ture is of mental lethargy, general dulling of the personality, and slowing of all cognitive functions. In particular, the patient with hypothyroidism shows deficits in memory, abstraction, conceptual organization, and mathematical ability (95). Diabetes Mellitus Although confusion is a prominent feature in patients who are slipping into hyperglycemic coma, this condition is rarely seen in police custody. Ques- tions relating to fitness for interview and the potential reliability of a detainee’s confession are more likely to involve those with hypoglycemia. Episodes of hypoglycemia are associated with irritability, anxiety, and panic in the early stages. As the episode develops, the individual becomes disinhibited and may exhibit childish or aggressive behavior that often mimics drunkenness. Disorientation and mental confusion are common and, in severe cases, the person may pass into a coma. Anybody suffering from hypoglyce- mia will prove to be a poor witness to events that occur during the episode. Most will have complete amnesia for the content of the attack and occasionally for an additional period before the attack occurred when their behavior will have appeared to be normal (96). The doctor should take a clear history of any hypoglycemic episodes that may have occurred before arrest and should con- sider checking the blood sugar of any diabetic about to be interviewed by the police. The manifestations of hypoglycemia with subsequent impaired intel- lectual function are extremely variable, and it has been recommended that the blood sugar should be kept at 6 mmol/L or more if a person with diabetes person is to give a statement or be interviewed (97). It has been estimated that 5–8% of patients aged 65 yr and older suffer from dementia to an appre- ciable degree, with the proportion probably exceeding 20% in 80-yr-olds (98). However, in many of these patients, dementia is not recognized until there is some form of crisis in their lives. Such a crisis may be precipitated by sudden illness, bereavement, or police arrest.

It is worth noting that this law was enacted almost 50 years after publication of the European Conven- tion of Human Rights and Fundamental Freedoms levothroid 50 mcg discount inspirational quotes thyroid cancer. The future role of the forensic physician within bodies discount levothroid 50mcg with mastercard thyroid gland adenoma, such as the recently established Interna- tional Criminal Court discount levothroid 200mcg without a prescription thyroid gland high, is likely to expand purchase levothroid 50mcg with mastercard thyroid gland x ray. The forensic physician has several roles that may interplay when assess- ing a prisoner or someone detained by the state or other statutory body. Three medical care facets that may conflict have been identified: first, the role of medicolegal expert for a law enforcement agency; second, the role of a treat- ing doctor; and third, the examination and treatment of detainees who allege that they have been mistreated by the police during their arrest, interroga- tion, or the various stages of police custody (18). Grant (19), a police surgeon 8 Payne-James appointed to the Metropolitan Police in the East End of London just more than a century ago, records the following incident: “One night I was called to Shadwell [police] station to see a man charged with being drunk and disorderly, who had a number of wounds on the top of his head…I dressed them…and when I fin- ished he whispered ‘Doctor, you might come with me to the cell door’…I went with him. We were just passing the door of an empty cell, when a police con- stable with a mop slipped out and struck the man a blow over the head…Boiling over with indignation I hurried to the Inspector’s Office [and] told him what had occurred. Grant rightly recognized that he had moral, ethical, and medical duties to his patient, the prisoner. Grant was one of the earliest “police surgeons” in En- gland, the first Superintending Surgeon having been appointed to the Metro- politan Police Force on April 30, 1830. In 1951, the association was reconstituted as a national body under the leadership of Ralph Summers, so that improvements in the education and training for clinical forensic medicine could be made. The Association of Forensic Physicians, formerly the Associa- tion of Police Surgeons, remains the leading professional body of forensic phy- sicians worldwide, with more 1000 members. It shows how clinical forensic medicine operates in a variety of coun- tries and jurisdictions and also addresses key questions regarding how important aspects of such work, including forensic assessment of victims and investigations of police complaints and deaths in custody, are under- taken. The questionnaire responses were all from individuals who were familiar with the forensic medical issues within their own country or state, and the responses reflect practices of that time. The sample is small, but nu- merous key points emerge, which are compared to the responses from an earlier similar study in 1997 (20). In the previous edition of this book, the following comments were made about clinical forensic medicine, the itali- cized comments represent apparent changes since that last survey. There appears to be wider recognition of the interrelationship of the roles of forensic physician and forensic pathology, and, indeed, in many jurisdic- tions, both clinical and pathological aspects of forensic medicine are under- taken by the same individual. The use of general practitioners (primary care physicians) with a special interest in clinical forensic medicine is common; England, Wales, Northern Ireland, Scotland, Australasia, and the Netherlands all remain heavily dependent on such professionals. Academic appointments are being created, but these are often honorary, and until governments and states recognize the importance of the work by fully funding full-time academic posts and support these with funds for research, then the growth of the discipline will be slow. In the United Kingdom and Europe much effort has gone into trying to establish a monospecialty of legal medicine, but the process has many obstacles, laborious, and, as yet, unsuc- cessful. The Diplomas of Medical Jurisprudence and the Diploma of Forensic Medicine (Society of Apothecaries, London, England) are internationally rec- ognized qualifications with centers being developed worldwide to teach and examine them. The Mastership of Medical Jurisprudence represents the high- est qualification in the subject in the United Kingdom. Further diploma and degree courses are being established and developed in the United Kingdom but have not yet had first graduates. Monash University in Victoria, Australia, in- troduced a course leading to a Graduate Diploma in Forensic Medicine, and the Department of Forensic Medicine has also pioneered a distance-learning Internet-based continuing-education program that previously has been serial- ized in the international peer-reviewed Journal of Clinical Forensic Medicine. In addition to medical pro- fessionals, other healthcare professionals may have a direct involvement in matters of a clinical forensic medical nature, particularly when the number of medical professionals with a specific interest is limited. Undoubtedly, the multiprofessional approach can, as in all areas of medicine, have some benefits. It needs to be recognized globally as a distinct subspecialty with its own full- time career posts, with an understanding that it will be appropriate for those undertaking the work part-time to receive appropriate training and postgraduate education. Forensic physicians and other forensic healthcare professionals must ensure that the term clinical forensic medicine is recognized as synonymous with knowl- edge, fairness, independence, impartiality, and the upholding of basic human rights. Forensic physicians and others practicing clinical forensic medicine must be of an acceptable and measurable standard (20). Some of these issues have been partly addressed in some countries and states, and this may be because the overlap between the pathological and clini- cal aspects of forensic medicine has grown. Many forensic pathologists under- take work involved in the clinical aspects of medicine, and, increasingly, forensic physicians become involved in death investigation (21). Forensic work is now truly multiprofessional, and an awareness of what other specialties can contribute is an essential part of basic forensic education, work, and continu- ing professional development. Those involved in the academic aspects of fo- rensic medicine and related specialties will be aware of the relative lack of funding for research. This lack of funding research is often made worse by lack of trained or qualified personnel to undertake day-to-day service work. However, clinical forensic medicine continues to develop to support and enhance judicial systems in the proper, safe, and impartial dispen- sation of justice. A worldwide upsurge in the need for and appropriate imple- mentation of human rights policies is one of the drivers for this development, and it is to be hoped that responsible governments and other world bodies will continue to raise the profile of, invest in, and recognize the absolute necessity for independent, impartial skilled practitioners of clinical forensic medicine. T a b l e 3 C l i n i c a l F o r e n s i c M e d i c i n e : I t s P r a c t i c e A r o u n d t h e W o r l d Q u e s t i o n s a n d R e s p o n s e s J a n u a r y 2 0 0 3 Question A Is there a formal system in your country (or state) by which the police and judicial system can get immediate access to medical and/or forensic assessment of individuals detained in police custody (prisoners)? Police surgeons (forensic medical examiners/forensic physicians) are contracted (but not generally employed) by both police and courts to undertake this. Police surgeons do not necessarily have specific forensic training or qualifications. The formal and generic mechanism is for the individual to be taken to an emergency department of a nearby hospital. Rarely he or she may be sent for a specific purpose to a specialist forensic doctor. Under a Section of the Criminal Procedure Code, a police officer can immediately bring an arrested person to a doctor for examination. If the arrested person is a female, only a female registered medical practitioner can examine her. The accused/detained person can contact the doctor and have himself or herself examined. In larger institutions, senior doctors and, at times, forensic pathologists may examine them. The Netherlands Yes Nigeria Yes (for medical reasons) dependent on the availability of the physician. Spain Yes, any individual detained in police custody has the right to be examined by a doctor. In certain cases, one has the right to have a forensic assessment (by the Forensic Surgeon Corps of the Ministry of Justice). Sweden Yes Switzerland Yes Question B Who examines or assesses individuals who are detained in police custody to determine whether they are medi- cally fit to stay in police custody? Response Australia Nurses or medical practitioners who are employed or retained by police. Recent changes to statutory Codes of Practice suggest that an appropriate health care professional may be called. Hong Kong Currently, the duty police officer looks and asks if medical attention is required. Most duty officers are quite liberal in referring the individuals to the emergency department. The Netherlands Generally speaking: Public health officers, who are qualified in clinical forensic medicine. Nigeria Any doctor attached to prison services, the police or doctors in the local hospitals, depending on who is available. Serbia If there is an obvious health problem or if they have certain diseases that need medical attention, police will take them to a public healthcare facility or, in the case of emergency, call an ambulance. Spain When a person is under arrest (without having being put under regulation), he asks to be examined by a doctor, he is usually transferred to the Spanish Health Public System doctors. Switzerland The “prison doctor”: either a doctor of internal medicine of university hospital or in rural regions the district physician (acute cases).

Thus levothroid 200 mcg with amex thyroid symptoms hungry, gene therapy for the treatment of cancer has been directed at (1) replacing mutated tumor suppressor genes generic levothroid 50mcg with mastercard thyroid cancer and depression, (2) inactivating overexpressed oncogenes discount 50 mcg levothroid visa thyroid cancer leukemia, (3) delivering the genetic com- ponent of targeted prodrug therapies 100mcg levothroid otc thyroid cancer gerd, and (4) modifying the antitumor immune response. Diagrammatic representation of sequential mutations needed to develop colorectal carcinoma from normal epithelial cells. Tissue- specific and cellular-specific factors as well as other gene products mediate the processes of differentiation, growth, and apoptosis. Alterations in these gene prod- ucts can lead to premalignant, benign tumors or malignancy. Thus, numerous genes can be implicated in oncogenesis, or the development of a malignant tumor. These include oncogenes, or the activation of growth-promoting genes, and tumor suppressor genes, or the inactivation of growth-suppressing genes. Two important characteristics in carcinogenesis are integral to the genetic alterations: (1) multistep oncogenesis and (2) clonal expansion. The mulitstep formation of tumor develop- ment requires that several genetic alterations or,“hits,” occur in sequence for normal cells to progress through various stages to malignancy, as represented in Figure 10. Clonal expansion indicates that a growth advantage is conferred to a cell by virtue of a genetic alteration (mutation) that occurs as part of the multistep carcinogenesis. Cell Cycle The cell cycle is comprised of five phases based on cellular activity (Fig. Cells commit to a cycle of replication in the G1 phase at the R (restriction) point. Regulation of the cell cycle is critical at the G1/S junction and at the G2/M transition. For instance, cyclinD1 has been shown both in vitro and vivo to initiate oncogenic properties and is amplified and overexpressed in certain esophagus squamous cell carcinomas as well as other head, neck, bladder, and breast cancers. The cyclin A gene is the site of integration of the hepatitis B virus (Chapter 6), thereby promoting hepatitis virus integration into the genome. Cip1 is activated by the p53 tumor suppressor gene product and by cell senescence. In esophageal and pancreas tumors, deletion or point mutations at this locus are observed. Apoptosis Apoptosis,genetically programmed cell death,involves specific nuclear events. These include the compaction and segregation of chromatin into sharply delineated masses against the nuclear envelope, condensation of cytoplasm, nuclear fragmentation, convolution of the cellular surface, and formation of membrane-bound apoptotic bodies. However, another protein, termed bax, forms a dimer with bcl-2, and bax contributes to programmed cell death. It is the cellular ratio of bcl-2 to bax that determines whether a cells survives or dies. Alternatively, bak,a proapoptotic member of the bcl-2 gene family has been recently described. On the other hand, localized immune cells fighting malignant cells could provide added pro- tection through the transfer of genes that protect from apoptosis. Cellular Transformation Cells are said to be “transformed” when they have changed from a normal pheno- type to a malignant phenotype. Malignant cells exhibit cellular characteristics that are distinguished from normal cells. In the transformation to a malignant phenotype, epithelial cells become nonpolar, pleo- morphic, display variable levels of differentiation, contain mitotic figures, rapidly divide, and express tumor-associated antigens on the cell surface. The expression of tumor-associated antigens has been used to target tumor cells via monoclonal anti- bodies, liposomes, and the like for drug- or toxin-induced cell death. Cells can also be transformed by chemical treatment, radiation, spontaneous mutations of endoge- nous genes, or viral infection. Transformed cells generated by these mechanisms display rounded morphology, escape density-dependent contact inhibition (clump), are anchorage independent, and are not inhibited in growth by restriction point reg- ulation of the cell cycle (Fig. In addition, transformed cells are tumorgenic when adoptively transferred to naïve animals. Note the rounded morphology, aggregation, clumping, and satellite colonies of growth. Although replication- defective viral vectors are used in viral vector gene transfer (see Chapter 4), the remote possibility of viral recombination of vector with naturally occurring patho- genic virus to produce a competent transforming virus remains. Oncogenes Cellular oncogenes are normal cellular genes related to cell growth, proliferation, differentiation, and transcriptional activation. Cellular oncogenes can be aberrantly expressed by gene mutation or rearrangement/translocation, amplification of expression, or through the loss of regulatory factors controlling expression. The aberrant expression results in the development of cellular proliferation and malignancy. There have been over 60 oncogenes identified to date and are associated with various neoplasms. Oncogenes can be classi- fied in categories according to their subcellular location and mechanisms of action. An example of an oncogene is the normally quiescent ras oncogene which com- prises a gene family of three members: Ki-ras, Ha-ras, and N-ras. In association with the plasma membrane, p21 directly interacts with the raf serine- theonine kinase. This pathway provides signaling for cell cycle progression, differentiation, protein transport, secretion, and cytoskeletal organization. Ras is particularly susceptible to point mutations at “hot spots” along the gene (codons 12, 13, 59, and 61). The result is constitutive activa- tion of the gene and overproduction of the p21 protein. Ras mutations are common in at least 80% of pancreatic cancers, indicating that this genetic alteration is part of the multistep oncogenesis of pancreatic cells. The c-myc cellular expression is associated with cellular proliferation and inversely related to cellular differentiation. It has been noted that constitutive expression of c-myc results in the inability of a cell to exit the cell cycle. In certain cancers, such as colon cancer, no genetic mutation in c-myc has been found. Thus, loss of posttranscriptional regulation is, at least, partially responsible for cellular proliferation. In all cases, the genetic abnormalities of onco- gene expression represent specific targets for gene therapy. Some retro- virus contain transforming genes called v-onc, for viral oncogene, in addition to the typically encoded genes such as gag, pol, and env (see Chapter 4). Viral oncogenes are derived from cellular oncogenes with differences arising from genetic alterations such as point mutations, deletion, insertions, and substitutions. Cellular oncogenes are presumed to have been captured by retroviruses in a process termed retroviral transduction. This occurs when a retrovirus inserts into the genome in proximity to a cellular oncogene. A new hybrid viral gene is created and, after transcription, the new v-onc is incorporated into the retroviral particles and introduced into neighboring cells by transfection. Tumor Suppressor Genes Tumor suppressor genes encode for molecules that modify growth of cells through various mechanisms including regulation of the cell cycle. An abnormality in a tumor suppressor gene could result in a loss of functional gene product and susceptibility to malignant transformation. Thus, restoration of tumor suppressor gene function by gene therapy, particularly in a premalignant stage, could result in conversion to a normal cellular phenotype.

After leaving for 4hours which was the time required producing proper gastric ulcerations order levothroid 200 mcg on-line thyroid cyst, the animals were sacrificed and stomachs were opened cut along greater curvature to examine by using magnifying glass levothroid 200 mcg low price thyroid cancer on ultrasound. Ulcers were measured using different parameters such as total length best 200 mcg levothroid thyroid nation, numbers of ulcers and numbers of haemorrhagas buy cheap levothroid 200mcg line thyroid and anxiety. Significant effect of the extract on the ulcers regarding above parameters was observed. The procedures as above were repeated for positive and negative control agents-cimetidine and water. The anti-peptic ulcer activity of extract was comparable to that of standard drug, cimetidine. For the healing effect of extract on aspirin- induced gastric ulcerations in rats, only the dose of extract, found to be optimal in the first part, was selected and employed. It was different for the first as the extract was given after the gastric ulcers had been induced by the ulcerogenic agent, aspirin. The extract was given two times, the first after 4hours and the second; 20hours after aspirin had been administered. As before, cimetidine (200gm/kg) and water used as the positive and negative controls. The plant extract was found to have significant anti-peptic ulcer activity as in the previous part of the study. Consequently, the results in the first part seggested the protective effect and that in the second part suggested the healing effect of the plant extract on the peptic ulcerations induced by aspirin. This protective or healing effect is reflected by whether the extract was given prior to after the administration of the ulcerogenic agent, aspirin. The present study was done to evaluate the anti- peptic ulcer activity of ethanolic extract of rhizome of Curcuma longa Linn. The phytochemical analysis was done for both ethanolic extract and dried powder of rhizome of Curcuma longa Linn. The ethanolic extract and dried powder contained glycosides, flavonoids, alkaloid, steroids/triterpene, polyphenol, tanninoids, saponin and reducing sugar. The anti-peptic ulcer effect of extract was studied on albino rats of both sexes weighing 180 to 200gm. Aspirin was used as ulcerogenic agent and ranitidine was used as positive control drug. Group 3 to Group 6 served as extract treated group, which received four different doses of extract 0. One hour after giving the test agents, 600mg/kg body weight of aspirin was given as ulcerogenic agent. The different parameters such as total number of ulcers, total length of ulcers and number of hemorrhages were measured. It was found that increasing dose of the extract caused increasing protective effect. The difference from the study of protective effect was that the same dose of ulcerogenic agent aspirin was given first to all groups. The operative procedure, measured parameters and measuring methods were same as the first part of the study. In conclusion, this study proved scientifically that 95% ethanolic extract of rhizome of Curcuma longa Linn. Mu Mu Sein Myint; Kyin Hla Aye; Ye Htut; May Aye Than; Khin Tar Yar Myint; Than Than Lwin; Phyu Phyu Win; Thin Thin Aye. The aim of this study is to evaluate the anti-plasmodial effect of Ocimum sanctum Linn. Ocimum sanctum is known its reputed hypoglycemic, antiasthmatic, antimalarial, antiptretic, antiviral antibacterial effects. Phytochemical analysis, acute toxicity, test of leaf power, aqueous and 50% ethanol of O. Alkaloids, flavonoids, glycosides, amino acid, polyphenol, reducing sugar, saponin and protein were present in all three tested samples. Screening of aqueous and 50% ethanol extracts for anti-plasmodial effect on Plasmodium bergheii infected mice model was done. The test doses for suppressive effect of both extracts were 6, 9 and 12gm/kg body weight. The result were expressed in terms of percent parasite extracts of 6, 9 and 12gm/kg body weight were 7. In the therapeutic test, the results were expressed in terms of percent parasite suppression on day 7. Therefore, it was concluded that 50% ethanol extract of Ocimum sanctum leaves showed mild anti-plasmodial effect. Khin Chit; Moongkarndi, Primchanien; Thongsoi, Jirapan; Thaw Zin; Khine Khine Lwin; Khin Hnin Pwint; Mu Mu Sein Myint; Nilar Aung. This study was aimed to identify the antiproliferative and antioxidant activities (in vitro) of 9 Myanmar medicinal plant extracts such as Azadirachta indica A. The results of this preliminary study indicated a potential role of medicinal plants in ovarian cancer therapy. However in vitro and in vivo studies using active compounds from these plants should be continued to evaluate efficacy and safety. Each of these drugs is a mixture of many ingredients of both plant and animal orgin. Anti-tuberculous activities and chemical investigation of Myanmar traditional medicine used for the treatment of tuberculosis. The traditional medicine and its individual constituents were successively extracted with solvents of different polarity. These different crude extracts were screened for the antibacterial activities employing 29 species of bacteria by utilizing agar disk diffusion method. The antituberculous activities of these different crude extracts were also determined by Ogawa Method (or) Absolute Concentration Method. These compounds were then tested for antituberculous activities with sensitive strains and resistant strains of Mycobacterium tuberculosis. This study was intended to explore the antiulcer activity of the aqueous extract of the leaves of Azadirachta indica A. The possible mechanism of antiulcer activity of the extract was investigated on pylorus ligation-induced gastric ulcer also in Wistar albino rats. The possible mechanism for antiulcer activity, whether anti-secretory activity or improving mucosal barrier, was investigated on the pylorus ligation-induced ulcer in 36 hours-fasted wister albino rats according to the method of Shay et al (1945). All the doses tested, both in aspirin-induced and pylorus ligation-induced ulcer significantly elevated the gastric adherent mucus (P<0. Mean ulcer index was also significantly lowered in the group of rats pretreated with aqueous extract (P<0. Although it elevated the gastric adherent mucus, it did not significantly ruduce both the volume and acidity of gastric juice produced. These findings indicated that the aqueous extract of the leaves of Azadirachta indica A. These doses were two to four times higher than the highest dose tested for antiulcer activity in this study. The mechanism for antiulcer activity seems to be enhancing mucosal resistance by increasing gastric adherent mucus amount.

Incubators should generate a uniform eggs to be artificially incubated are collected and temperature throughout the cabinet and maintain disinfected promptly purchase levothroid 50 mcg overnight delivery thyroid symptoms heart palpitations. Ostriches typically lay in the the temperature within narrow limits generic levothroid 200 mcg mastercard thyroid symptoms during pregnancy, preferably evening hours buy 100 mcg levothroid thyroid nodules growth, while emus frequently lay shortly one- or two-tenths of a degree generic 50mcg levothroid free shipping thyroid cancer emedicine. Eggs should be gently collected from the are particularly sensitive to decreasing tempera- nest and transported by hand to the preparation tures, and it is imperative that backup electrical area. Excessive jarring of the egg contents or damage power be available for incubation equipment so that to the shell can be fatal to the developing embryo. Cold storage of eggs allows the use of efficient batch Ventilation is the amount of fresh air brought into incubation and brooding systems and is a routine the incubator. Egg- calculated at 50 cubic feet of fresh air per hour per turning is not necessary for storage periods of less 100 eggs. Ideally, eggs are stored directly in the lation of carbon dioxide and severely reduces hatch- incubation trays and the entire tray may then be ability. Circulation functions to maintain uni- Egg washing is a controversial issue in ratite produc- formity of temperature, humidity and gas levels tion. It is better to provide the breeding pair with a throughout the incubator cabinet. Rapid air circula- clean, dry area in which to lay eggs rather than tion is critical with the large ratite eggs to effectively attempting to clean or disinfect dirty moist eggs. Wet dissipate the high temperature and humidity that washing of eggs involves the use of warm dilute develops at the egg surface. The embryo did not pip the shell, and the air cell has been displaced by the embryo (courtesy of David Ley, reprinted with permission38). Chapter 29) is especially common in ostrich eggs incubation, and weighing an egg weekly can be used incubated in the horizontal position and results in to monitor an embryo’s development and guide ad- poor hatchability. Losing ten per cent of fertile eggs during incubation is considered normal, with peaks Eggs are rotated during incubation in order to stir of loss at 3 to 4 days (organogenesis) and 40 days the liquid layers of nutrients and waste products (respiration change) of incubation. Inadequate turning at other times may be caused by incorrect incubation increases both embryonic and post-hatch mortality. This is best done early in the incu- achieve the desired evaporative water loss during the bation cycle rather than at day 43, because embryos course of incubation (13 to 14% for ostrich eggs and that die early in incubation decompose rapidly. Egg monitoring during the course of incubation should include determination of Fluctuating incubation temperatures result in un- weight loss and candling for embryonic development. Low tempera- water units designed for poultry and gamebirds can tures result in soft, large, weak chicks with a delayed be effectively used in recently hatched young. Excessive humidity (inadequate moisture loss merous commercial starter and grower rations are from the egg) may cause a delayed hatch, small air available for ratites. Chicks should be expected to cells, wet edematous chicks and mild degeneration of lose weight for three to five days following hatch and the leg muscles (Color 48. Hatching Brushed concrete, with or without perforated plastic Ratite eggs are transferred to a hatcher with the or rubber matting, is commonly used. In order to same temperature and humidity settings as the incu- prevent gastric impactions, hay or wood chips should bator three to five days prior to the anticipated date not be used. The general consideration for air cir- gives the chick time to switch from chorioallantoic to culation is 0. For example, if the tempera- from the chorioallantois is absorbed, and the navel ture is 70° and ten birds weighing 50 lbs each are in closes during the last 24 hours of incubation. Daily candling of As soon after hatching as ambient temperatures per- ostrich and rhea eggs allows for careful monitoring of mit, chicks should be moved to outdoor grazing areas the chicks’ progress, and assisted hatches are a com- with fencing that is low to the ground and with holes mon management procedure. Chicks should be considered of cassowary and emu eggs prohibit effective can- cold-intolerant and provided supplemental heat in dling, and various techniques of percussion and aus- cold weather until they are six months of age. Chicks cultation have been used to evaluate embryo devel- should be housed with birds of similar age to prevent opment in these species. Young chicks require constant attention to help a chick out of the shell and begin to assist with keep them tame and to quickly detect any develop- the hatching process prematurely. Using a grassy area that has been well groomed (cut to three inches) and placing chicks with slightly older birds to serve as feeding models are the best techniques to introduce Chick Management chicks to pasture. Initial introduction periods should be 10 to 15 minutes in length with daily doubling of the time in the paddocks. Ratite chicks are precocial, hatching with a full coat of natal feathers, open eyes and the ability to stand Chick Problems within hours. Eating and drinking birds may or may not be capable of an unassisted are behaviors that must be learned from older birds, hatch. Diuretics have been suggested to reduce the and dehydration or starvation are common in chicks edema but they are rarely necessary. Improper incubation tem- that do not have sufficient surface area to allow perature as well as inappropriate gas exchange (poor adequate water loss; 2) Poor egg shell quality, such circulation or ventilation) between the embryo and as low pore density or excessive thickness; 3) High the air surrounding the shell can cause retention of incubation humidity. Ventilation defects are thought to have bator should be 20 to 25% as a starting point. Adjust- their most profound effects late in the incubation ments must be made to achieve a 13 to 15% egg process and may be most common when an incubator weight loss throughout incubation. Incuba- “Sticky” Chicks tion problems are suspected if infectious agents can- This condition occurs when the inner shell mem- not be cultured from the yolk sac of affected chicks. Assisted hatching is mandatory in Inflammation of the umbilicus shortly after hatching these chicks or they will not survive. To correct this can be an early warning sign of an impending yolk problem, the humidity in the hatcher must be in- sac infection (Color 48. Affected chicks have sub- creased (perhaps as high as 80 to 90% relative hu- normal weight gains over a two- to three-week period midity) to a point that allows the membrane and its and intermittently appear depressed or chilled. This problem can occur if and may not have a severely distended abdomen the humidity in the incubator is too low. Applying an antibi- otic ointment to the umbilicus of recently hatched External Yolk Sac chicks may help prevent infections. If the umbilicus does not close properly, the yolk will protrude from the abdomen to varying degrees (Color Retained or infected yolk sacs may represent 15 to 48. High incubation temperatures (early hatch), 40% of a chick’s total body weight and should be poor gas exchange (may occur with high altitude or surgically removed in conjunction with the admini- high humidity) and egg infections are thought to be stration of broad-spectrum antibiotics. The cause can best be determined by carefully To remove the yolk sac, the chick is placed in dorsal evaluating the incubation and hatching parameters recumbency and the abdomen is prepared for sur- and culturing affected embryos. The skin is incised circumferentially around the yolk can be placed in the abdomen, the umbilicus umbilicus and the incision is extended transversely covered with antibiotic ointment and gauze, and the at the three and nine o’clock positions to the lateral abdomen wrapped with self-adherent bandage. Sys- distance required to allow easy removal of the intact temic antibiotic therapy should be initiated immedi- yolk sac. If a large quantity of the yolk sac is external- sponding pattern being careful to not damage the ized or the umbilicus has sealed (Color 48. Weight gain is a good indicator of a healthy chick, and weight loss often precedes clinical signs of disease. These birds will continue to lose weight beyond the Exposure of chicks to infectious agents can be reduced by normal weight loss seen the first four to five days restricting access of all visitors, utilizing sound hygiene pro- after hatch. Congenital de- the intestine to allow the stalk to be transected and fects in chicks may be attributable to genetics, the the yolk sac to be removed. The body wall is closed effects of nutritional deficiencies or teratogens in the with a monofilament, absorbable material in a sim- laying hen, or may be caused by inadequate egg ple continuous pattern. Some chicks begin to eat and gain Cloacal Prolapse weight within a day or two of surgery while others Prolapse of the cloaca may occur in neonates. This require nutritional support by tube-feeding for sev- condition is most common in birds less than four eral days before they resume normal growth.

Low vita- Birds prone to hypoglycemia should be fed frequently min A in the diet may result in a suboptimal immune with nutrients that are slowly converted to glucose (a response order 100mcg levothroid visa thyroid gland origin. In most cases generic 200mcg levothroid free shipping thyroid journal impact factor, hypo- glycemia is dietary-induced purchase levothroid 50 mcg without a prescription can your thyroid gland hurt, and placing the bird on Numerous clinical problems may be associated with a diet appropriate for that species is all that is re- hypovitaminosis A generic levothroid 200 mcg thyroid gland jokes. Hyperkeratosis, a related condition, may affect epi- Vitamins 13 thelial surfaces (Figure 31. Vitamins are a mixed group of organic compounds Small white pustules may be seen in the mouth, that are essential for a variety of metabolic proc- esophagus, crop or nasal passages. Most birds require the same vitamins as mam- metaplasia causes blockage of salivary ducts, small mals with the exception that vitamin D (not vitamin3 swellings (often symmetrical) may be noted dorsally D2, as in mammals) is the active form of this com- around the choana, around the larynx and laterally pound. Exogenous vitamin C is required in fruit-eat- under the tongue or mandibles (see Figure 19. Debilitated sinuses, particularly if hypovitaminosis A is associ- birds may have higher requirements and a reduced ated with a concurrent sinus infection. Squamous ability to synthesize vitamin C, and should be sup- metaplasia may also lead to thickening and slough- plemented orally or parenterally. Vitamins A, C, E and B complex are material may accumulate under the eyes (see Color all involved with immune responses, and deficiencies 26). In chicks, acute hypovitaminosis A has been in these compounds may increase the severity of associated with weakness, incoordination and infectious diseases. These symptoms must be differentiated from “crazy chick disease” caused by hypovitaminosis E. Antibiotics may induce vitamin deficiencies by inter- fering with normal intestinal microflora. In most In mild cases of hypovitaminosis A, particularly in cases, birds given long-term antibiotics should also budgerigars, the only clinical signs may be polyuria receive multivitamin supplementation. Protozoan and polydypsia, but squamous metaplasia may be infections such as coccidiosis or giardiasis may inter- seen histologically along the gastrointestinal and fere with the absorption of vitamins (such as vita- urinary tracts. Vitamins are squamous metaplasia causes partial or complete oc- sensitive to heat and light, so overheated or outdated clusion of the ureters. Reduced egg production, egg binding or poorly Hypervitaminosis, particularly with fat-soluble vita- formed egg shells (pitted) are common in hens with mins, is becoming increasingly common as clients hypovitaminosis A. Fat-soluble Vitamins Vitamin A: Vitamin A is formed in the liver from beta Hypovitaminosis A may cause hyperkeratosis of the carotene. It is involved in mucopolysaccharide bio- plantar skin of the metatarsal and digital pads (see synthesis and is needed for the formation of normal Color 8). The normal papillary scale structure is lost mucous membranes and epithelial surfaces, for and the corneum is thickened. Oral ad- ministration in the food and modification of the diet to include natural sources of beta carotene is recom- mended. Zinc levels in the diet should be sufficient to allow for normal vitamin A function. Vitamin D helps to stimulate gastrointestinal ab- sorption of calcium, has a hormonal effect on regula- tion of calcium and phosphorus excretion in the renal tubules and may be involved in controlling alkaline phosphatase in the blood. An increase in alkaline phosphatase may be an early indication of hypovi- taminosis D3. Ingested vitamin D precursors are converted to the active form of the vitamin (vitamin D in3 birds) in the skin. This process requires natural sun- light or appropriate artificial ultraviolet light. Low levels of calcium in the diet, particularly if associated with high levels of phosphorus, will precipitate hy- povitaminosis D3. Radiographic changes included gaseous distension of the crop, gastrointestinal tract and cloaca. The diagnosis was severe can easily occur in birds raised hypovitaminosis A and syringeal granuloma. The spinal column may undergo lordosis or fracture easily, causing pressure on nerves and subsequent Signs of vitamin D3 deficiency parallel those of cal- paralysis. Adult hens may show thin-shelled or density and pathologic fractures may be apparent soft-shelled eggs, decreased egg production and poor (Figure 31. Clinical evidence will frequently be bent into grossly distorted posi- suggests that young macaws may be particularly susceptible to hypervitaminosis D. Nephrocalcinosis, suspected to be associated with hypervitaminosis D, has been reported in a dove, a toucan, a cardinal and a variety of Psittaciformes (Figure 31. The bird was being fed a commercial hand-feeding formula that was rendered ineffec- tive with the addition of oatmeal, strained meat, mashed fruit, baby vegetables and neo-calglucon. The case was managed by removing the lack of bone density, bending of the bones and pathologic fractures supplements from the hand-feeding formula. This is a frequent finding in African Grey Parrots and its clinical importance is unknown. However, calcium supplementation and injectable vitamin A and D3 in a bird with this condition are contraindicated. Note the extensive air sac capacity, which appears to be normal in African Grey Parrots. Elevated levels of nates) are likely to contain improper levels of many serum creatinine phosphokinase may suggest nutri- nutrients. Hypovitaminosis E may cause encephalomalacia in Vitamin E: Vitamin E is an antioxidant that acts to poultry and other species. This condition can be pre- prevent fat rancidity and fatty acid degeneration in vented by supplementing the diet with linoleic acid foodstuffs, as well as acting in concert with selenium but not arachidonate. Neophema parrots fed a dog and sulfur-containing amino acids to prevent peroxi- food that contained a high amount of rancid fat and dative damage to cell membranes. Birds on high-fat seed soaked in cod liver oil showed incoordination, diets, particularly if the fat has become rancid, re- abnormal body movements and torticollis. At ne- quire higher amounts of antioxidants, and conse- cropsy, affected birds showed cerebellar demyelina- quently are more likely to show signs of vitamin E tion and muscular dystrophy of the heart and skele- deficiency than birds on diets low in fat. Electrocardiographic exudative diathesis, which results in edema of ven- changes may accompany heart muscle dystrophy. Hypovitaminosis digested seed in the droppings may occur with ven- E is one of a number of dietary factors that has been tricular muscular dystrophy. Prolonged ping muscle may occur in neonates, resulting in hypovitaminosis E may cause testicular degenera- decreased hatchability. Exertional rhabdomyolysis or tion in males, and in hens it may result in infertility spraddle legs may be associated with vitamin E and or early embryonic deaths. A similar condition has been recognized been described in cockatiels that responded clinically in birds fed fish with high fat content such as herring, to vitamin E and selenium therapy. Cockatiels fed riboflavin-deficient mammals, was identified histochemically in the fat diets failed to incorporate pigment into their primary from affected birds. In cases where deficient diets may show fatty infiltration of the liver there is irreversible nerve or muscle damage, re- as well as decreased hatchability of their eggs and sponse is poor (see Chapter 18). Primary Vitamin K: Vitamin K is required for the synthesis wing feathers may be excessively long. Deficiency of vitamin K results in treatment with riboflavin will resolve clinical signs; prolonged prothrombin time and delayed blood clot- however, in chronic cases permanent nerve damage ting. Clinical problems Niacin (Nicotinic Acid): Clinical signs of niacin defi- associated with bleeding or petechia from pulled ciency are fairly nonspecific and include poor feath- feathers may respond to injectable vitamin K, but ering, nervousness, diarrhea and stomatitis. Young naturally occurring hypovitaminosis K has not been chickens, turkeys and ducks with niacin deficiency proven in companion birds.

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