For vaginal infections characterized by excessive vaginal discharge (flujo vaginal) diabetic diet how many grams of sugar dapagliflozin 5mg online, the seeds are taken orally (Vandebroek & Balick 2009) diabetes insipidus yellow urine 5mg dapagliflozin overnight delivery. Leaves are arranged in an alternate pattern and are oval or heart-shaped with a pointed tip diabetic diet lunch ideas generic 5mg dapagliflozin visa, long leaf-stalk and clearly defined veins diabetes prevention in india discount 10mg dapagliflozin otc. Fruit capsules are green to brown and densely covered with soft metabolic disease in newborn dapagliflozin 10mg with visa, pliable zentraler diabetes insipidus symptome 10mg dapagliflozin amex, reddish spines. Each capsule contains numerous small seeds that are covered with a scarlet aril and attached to the inside wall (Bailey Hortorium Staff 1976). Distribution: Native to tropical America, this plant is widely cultivated as a dye and food plant and has become naturalized in tropical areas of the Old World (Bailey Hortorium Staff 1976). In a nutritional and toxicity study, annatto seeds were dried, powdered and analyzed for their chemical constituents and nutritional value. The toxicity level was found to be insignificant and the vitamin and mineral content as well as the fiber fractions were very similar to those of cereals but with a higher level of carotenoids. Results support the safe use of this resource as a food for human nutrition when combined with other foodstuffs (Wurts & Torreblanca 1983). Allergic reactions have been reported: in a human clinical trial, 56 patients suffering from chronic urticaria and/or angioneurotic edema were given annatto extract (dose equivalent to that in 174 25 g of butter) administered orally and within 4 hours of intake 26% of patients reacted with hypersensitivity symptoms (Mikkelsen et al. Animal Toxicity Studies: Numerous animal studies have been conducted on the potential toxicity of this plant. A subchronic oral toxicity study of annatto extract (norbixin), a natural food color made from bija, was conducted. For external use, the aqueous freeze-dried extract and an infusion of the freeze-dried petioles applied topically (0. Contraindications: Internal use should be avoided by those who might be hypersensitive or have an allergic reaction to the plant parts used. Bija is a common condiment and coloring agent (known commercially as annatto) and is used to color red pill capsules. It is also widely utilized as a food-colorant and is considered a spice because of its numerous culinary uses even though it is nearly tasteless. Biologically active constituents of the fruit or seed include bixein, bixin, bixol, crocetin, cyanidin, ellagic acid, histidine, isobixin and norbixin (Duke & Beckstrom-Sternberg 1998). Study on the Mutagenicity and Antimutagenicity of a Natural Food Color (Annatto) in Mouse Bone Marrow Cells. Antileishmanial and antifungal activity of plants used in traditional medicine in Brazil. Antimicrobial Activity of Crude Extracts from Plant Parts and Corresponding Calli of Bixa orellana L. Hagiwara A, Imai N, Ichihara T, Sano M, Tamano S, Aoki H, Yasuhara K, Koda T, Nakamura M, Shirai T. A thirteen-week oral toxicity study of annatto extract (norbixin), a natural food color extracted from the seed coat of annatto (Bixa orellana L. Hypersensitivity reactions to food colours with special reference to the natural colour annatto extract (butter colour). Extraction of an hyperglycaemic principle from the annatto (Bixa orellana), a medicinal plant in the West Indies. A preliminary study of the effects of some West Indian medicinal plants on blood sugar levels in the dog. Screening for antimicrobial activity of ten medicinal plants used in Colombia folkloric medicine: a possible alternative in the treatment of non-nosocomial infections. Note: Although the first species indicated above is most commonly used by Dominicans, the Spanish name palo de brasil can refer to more than one botanical tree species, most of which have similar orangish-reddish heartwood. These species, along with their distinguishing characteristics, are as follows: Caesalpinia violacea (Miller) Standley [Synonyms: Brasilettia violacea (Miller) Britton & Rose, Caesalpinia cubensis Greenman, Peltophorum brasiliense (L. To prepare a cold infusion, a small piece of wood (palo) is immersed in lukewarm or room temperature water until the water turns red which indicates that the infusion is ready. This remedy is kept in a closed container in the refrigerator to prevent spoilage. Traditional Uses: this tree is renowned for its depurative (blood purifying) properties. The wood is nearly without odor, has a slightly sweet taste and imparts red color to water if used to make a cold infusion or tea; it also turns saliva red if chewed. Wood is orangish to dark red in the center and valued for its hard, durable lumber. Leaves occur in an alternate pattern along branches and are twice-divided with 4-10 pinnae and 12-16 leaflets; leaflets are elliptical or oval in shape (2-3 cm). Flowers are arranged in small, branching clusters; petals are greenish-white and covered with glandular dots. Fruits are long, narrow, leguminous seed pods (7-8 cm long) that are pointed at the end and contain dark seeds (Liogier 1985). Distribution: Endemic to the island of Hispaniola, this tree can be found in dry forest areas (Liogier 1985). Antitumor activity and antioxidant status of Caesalpinia bonducella against Ehrlich ascites carcinoma in Swiss albino mice. Cassane- and norcassane-type diterpenes from Caesalpinia crista of Indonesia and their antimalarial activity against the growth of Plasmodium falciparum. Antibacterial activity of crude extracts from Mexican medicinal plants and purified coumarins and xanthones. Note: the common name Bruja may also be used for another species, Kalanchoe gastonis-bonnieri; see entry for Mala madre. One distinguishing feature for differentiating between these two species is that the leaves of Bruja are slightly shorter than those of Mala madre. Traditional Preparation: For external application, the leaves are heated, crushed and applied topically to the affected area. Traditional Uses: the leaves of this plant are best known as a remedy for treating earache (mal de oido or dolor de los oidos), but they are also used for treating several other illnesses. For earache, a fresh leaf is used with all appendages removed (the kidney-like flowers and fruits are said to be harmful to the body), plunged into boiling water or heated over a flame briefly to steam or wilt (marear) the leaf, (care is taken 183 to avoid boiling/heating it for too long so that it will not lose its therapeutic qualities) and then the liquid inside the leaf is squeezed onto a cloth or small cotton-tipped swab that is placed inside the ear and kept there for a short period of time. Eventually the ear will release some water indicating that the ear has been sufficiently treated. For stomach ache, abdominal pain and gastroduodenal ulcers (including bleeding ulcers), the fresh leaves (with flowers and fruits removed) are eaten like a salad in the morning and at night. For headache or sinusitis, the fresh leaves are bruised and applied topically to the forehead. Some say that this plant is called "bruja" because it grows so prodigiously, even if only a single leaf is planted, as long as it finds enough soil. Its other name, "tope-tope" is attributed to the sound that its balloon-like fruits and flowers make when they squeezed until they explode, resulting in a small popping sound. As this is a succulent plant, its leaves do not air-dry like those of other plants, making storage difficult. Because they decompose easily once cut, the leaves are challenging to maintain which affects their availability at stores. However, some individuals who use this plant as a remedy grow it at home because it is a hardy houseplant. Leaves are thick and fleshy, grow in opposite pairs and can be either simple or deeply lobed (6-13 cm long), oblong to lance-shaped with scalloped, reddish edges. Flowers are slightly balloonshaped, hanging down in large branching clusters with petals ranging in color from reddish green to red to salmon. Animal Toxicity Studies: Kalanchoe pinnata orally administered to mice for 30 days did not show signs of toxicity to the liver, heart or kidney. Biologically active compounds in this plant include: acetic acid, alpha-amyrin, beta-amyrin, betasitosterol, bryophyllin, caffeic acid, citric acid, ferulic acid, friedelin, fumaric acid, isocitric acid, kaempferol, lactic acid, malic acid, mucilage, n-hentriacontane, oxalic acid, p-coumaric acid, p-hydroxy- 184 benzoic acid, p-hydroxycinnamic acid, patuletin, quercetin, succinic acid, syringic acid and taraxerol (Duke & Breckstrom-Sternberg 1998). Clinical Data: Kalanchoe pinnata Activity/Effect Antileishmanial Preparation Leaf extract, given orally; 30 g fresh leaves/day for 14 days Design & Model Clinical case report: one human patient (36 yrs) with active skin leishmaniasis lesions Results Treatment halted growth & showed a slight decrease in lesion; no observed adverse reactions or toxicity Reference Torres-Santos et al. Isolation and chemical analysis of a fatty acid fraction of Kalanchoe pinnata with a potent lymphocyte suppressive activity. The anti-leishmanial effect of Kalanchoe is mediated by nitric oxide intermediates. The antileishmanial activity assessment of unusual flavonoids from Kalanchoe pinnata. Toxicological analysis and effectiveness of oral Kalanchoe pinnata on a human case of cutaneous leishmaniasis. Traditional Preparation: the seeds are pulverized and prepared as a decoction to make hot chocolate and taken orally. Traditional Uses: In the Dominican Republic, the leaves are used for kidney and urinary tract disorders due to their diuretic effects (Liogier 2000). Flowers are borne in clusters on short stalks with white, greenish or pale violet petals and no fragrance. Fruits are fleshy, variable in size and shape (10-20 cm long) and generally resemble a small, narrow football with longitudinal grooves or creases; skin turns bright yellow-orange to reddish when ripe. No negative side effects or health risks are known in association with the appropriate therapeutic use of this plant, except for the possibility of allergic reaction or the provocation of migraine headaches due to amine content. Large doses of the seeds can result in constipation due to their high tannin content. Animal Toxicity Studies: Several studies on the potential toxicity of this plant have been conducted. Contraindications: In individuals with a history of allergy or hypersensitivity to cacao seeds, caution is advised due to demonstrated potential for skin reactions, headache and migraine. May also be contraindicated in patients with heart disorders due to the cardiac stimulant effects of the seed constituents theobromine and caffeine (Brinker 1998). Drug Interactions: Phenelzine (monoamine oxidase inhibitor): concomitant use may lead to high blood pressure, although this association is speculative (Brinker 1998). These drugs include: oral contraceptives, cimetidine, furafylline, verapamil, disulfiram, fluconoazole, mexiletine, phenylpropanolamine, numerous quinolone antibiotics. The seeds, seed extracts and/or isolated compounds of this plant have demonstrated the following biological activities in preclinical studies: antibacterial, antioxidant, antiulcer, endocrine and nervous system effects, erythropoiesis stimulation and immunomodulatory (see "Laboratory and Preclinical Data" table below). The mechanism of the antiulcer effects of this plant is linked to its ability to modulate leukocyte function in addition to radical scavenging activity (Osakabe et al. According to secondary references, cacao seeds and seed coats have demonstrated the following effects: diuretic, broncholytic and vasodilatory (due to methylxanthines, mainly theobromine); cardiac muscle stimulant and bronchial muscle relaxant. Due to their caffeine and theobromine content, the seeds are also a central nervous stimulant (Gruenwald et al. The seeds are a significant source of calcium, copper, magnesium, phosphorus and potassium. Clinical Data: Theobroma cacao Activity/Effect Antiulcer & antioxidant Antihemostatic & antioxidant bioavailability Preparation Aqueous extract of dried seed; taken orally Cocoa flavanols & related procyanidin oligomers (234 mg per day ingested for 28 days) Design & Model Human clinical trial Placebo-controlled, blinded paralleldesigned clinical trial (32 healthy subjects) Results Active; demonstrated antioxidant and gastric antiulcer activity Significantly increased plasma epicatechin & catechin concentrations; significantly decreased platelet function; raised levels of plasma ascorbic acid Reference Osakabe et al. In vitro pharmacological activity of the tetrahydroisoquinoline salsolinol present in products from Theobroma cacao L. Effects of cocoa upon the growth of weanling male Sprague-dawley rats fed fluid whole milk diets. Effects of polyphenol substances derived from Theobroma cacao on gastric mucosal lesion induced by ethanol. Ramiro E, Franch A, Castellote C, Andres-Lacueva C, Izquierdo-Pulido M, Castell M. Effect of Theobroma cacao flavonoids on immune activation of a lymphoid cell line. Antioxidant and membrane effects of procyanidin dimers and trimers isolated from peanut and cocoa. Note: In the Dominican Republic, the name cadillo de gato sometimes refers to another species: Achyranthes aspera L. At least two different species of plants are referred to as "cadillo" by Dominicans in New York City, and they both have similar medicinal uses. However, this species is typically known as cadillo de gato whereas the other species is called cadillo tres pies. Due to its relatively low number of use reports in ethnobotanical studies, cadillo tres pies is not included in this guidebook. Traditional Preparation: this herb is typically prepared as a tea by decoction (boiling in water) and administered orally. The leaves are used externally for skin discoloration, blotching or dark marks on the face. This plant is attributed bitter and astringent properties and has been used traditionally for goiter and scrofula (Liogier 1990).
Professor Barter is a firm believer in using both basic researchers and clinicians on projects diabetes mellitus type 2 normal glucose level dapagliflozin 10mg for sale, largely due to their ability to bring a different perspective to research: `Having clinicians brings a different perspective metabolic disease pdf buy dapagliflozin 10 mg mastercard. They should be pressured to do some basic research blood sugar monitor walmart order dapagliflozin 5 mg with mastercard, because once they have done such research they are always better clinicians definition of diabetes insipidus buy generic dapagliflozin 5 mg on line. Some key techniques used include immunoblotting diabetic nerve pain medication discount 10mg dapagliflozin with amex, gradient gel electrophoresis and gel permeation chromatography diabetes 0-7368-0277-0 order dapagliflozin 10 mg with visa. No specific techniques that served as an input to research had been developed in advance of this work. However, this was not a key input into research, except for it being easier to attract funding and high-quality researchers, which act as inputs to research in themselves. However, this change of environment must have had some impact on the research conducted. Secondly, a number of the researchers (eg Clay) did not move to Wollongong with Barter. This change in staff is likely to have affected the way in which the research was conducted. The facilities provided at Wollongong were of similar quality to those available to the group at the Baker Institute. The grant provided for 80% of this requirement, with the rest coming from other funding sources. In the course of the project, Professor Barter suggests that four or five laboratories around the world were involved and have been involved in subsequent work. However, Rye can only recall one collaboration at that time, with Christian Enholm, Head of Clinical Biochemistry at the National Institute of Health in Helsinki, Finland. Barter had already established a close link with Enholm through a previous sabbatical. Rye believes Enholm would have played a valuable role at the conception stage of the project and made a lot of intellectual contributions. A further related collaboration existed between Rye and Professor Dan Rader from the University of Philadelphia, although this was more concerned with spin-offs from the original observation than this particular grant itself. Standard techniques such as immunoblotting, gradient gel electrophoresis and gel permeation chromatography were to be used. This plan followed directly from the preliminary work that had already been conducted. However, over the course of the project, it became apparent that some of these areas of research were less significant than others. In fact, by the first progress report, the work had taken a different direction with the identification of the nature of the conversion factor. As it was understood to consist of two components, the interplay of these became an area of more significant research focus and forms the basis of much of the work that was published during the grant (Rye, Hime and Barter, 1995; Barter, 1991; and Lagrost and Barter, two articles in Biochimica Et Biophysica Acta, 1991). His situation at the Baker Institute, and later at Wollongong, meant that he was able to move other researchers in his laboratory onto this project as required. He also claims to be proactive in ensuring that his staff develop and their careers progress, taking care to give guidance to his team which was appropriate to their level of experience. The work also involved a large number of researchers within the group and, for two of these, formed a basis for their future research career. It is interesting to note that these outputs, though significant, differ significantly from those imagined at the inception of this project. The key findings outlined above were published in a series of seven papers over the period 1990 to 1995(Barter, 1991; Lagrost and Barter, two articles in Biochimica Et Biophysica Acta, 1991; Rye, Hime and Barter, 1995; Clay et al. According to Professor Barter, no single paper published as a result of this grant has been transformatory, but the family of papers altogether amounted to a significant knowledge output. Altogether, sixteen peer-reviewed articles are directly attributable to the grant, generating a total of 570 citations. More details about the publication output of this grant are presented in Table 1-1 and Figure 1-2. All of these publications were indexed in Web of Science, received 597 citations in total, for a relative citation impact of 10. Barter also suggests that a significant amount of subsequent funding stemmed from this work. Professor Barter is a basic research scientist who is also trained as a clinician. At the time, Barter was an established researcher and Deputy Director at the Baker Medical Research Institute in Victoria. His reputation takes him all over the world to international meetings, and he reviews around 100 papers a year in his role on the editorial board of a number of scientific journals. However, it is likely to have contributed to some extent as part of a broader stream of research conducted over a longer period. Professor Barter believed that part of his role was to develop capacity and he took care to nurture his team as described in the previous section on inputs to research. Rye has now adopted this approach herself and suggested two further benefits of this management approach. A significant output of this grant was the contribution to the development of one of the research team in particular; indeed Professor Barter believes that she perhaps gained the most from this research project. Rye had previously been a PhD student with Barter and her work had identified the conversion factor at the centre of this research. After two and a half years in the United States she returned to Australia and the Baker Institute and was quickly brought in to work on this project as a postdoctoral researcher. Rye published a number of papers in the Journal of Biological Chemistry (Rye et al. Rye believes it was involvement in this grant played a significant role in establishing her as an independent scientist. Following involvement with this grant she received funding from the National Heart Foundation of Australia in her own right, receiving her first sole investigator grant in 1999. Having spent 10 years post-doctoral bench-side and doing things herself, Rye finally stepped out of the laboratory but continued to be active as a career researcher. Her own research group in 2009 comprises seven postdoctoral fellows, four research assistants, seven PhD students and one undergraduate student. Both her publication record and invitations to speak and deliver plenary lectures internationally and nationally in Australia are extensive. She is involved in national and international collaborations, including with Christian Enholm, who was involved with this specific grant. Laurent Lagrost was a postdoctoral student and played an important role in the project. Rye believes that what came out of this grant was a springboard for what Lagrost is doing today, but if he had not been involved in this grant he would have been involved in another and ultimately would have gone down a similar path. Lagrost agrees with this, suggesting that the postdoctoral research had a significant impact on his career, though 3 these fellowships were later abolished. Lagrost returned to France and kept working in the lipoprotein and atherosclerosis field. The project also played a part in the career development of Moira Clay, although to a lesser degree than for Rye. However, Clay was not involved in the full duration of the grant, leaving the group for the United States shortly before the group moved to Wollongong. Clay has stayed in research but has moved from bench research to the policy arena, holding the position of research manager at National Heart Foundation of Australia along the way. He is first author on three papers published in collaboration with Professor Barter and this may have impacted upon his career. However, we cannot be sure of this as he is no longer in contact with Rye or Barter, and it is not clear whether he remained active in academic research. According to Professor Barter, as part of this grant, he also trained researchers who stayed in research in Australia and overseas, and this is likely because, as described above, a large number of researchers were involved in this project. However, it is not clear to what extent this work had on their careers, particularly as many of them were also working on other projects in the laboratory. Harvey Newnham co-authored with Barter two of the eight publications arising from this grant. It is unknown if involvement with this grant affected the career development of these researchers and others involved in the work. Professor Barter favoured the inclusion of clinicians in basic research, largely due to their ability to bring perspective. By using clinicians in this project, there were also possible benefits in terms of capacity building. Rye said, `I start off with purified protein and assemble the particles just as it happens in people but I do it in a test tube. Therefore, in the sense that it represented significant new thinking, it can certainly be regarded as significant in targeting future research both for this research groups and others. Further research following from this grant is not constrained to the field of cardiovascular research. These anti-inflammatory properties are still an area of ongoing research for Rye today. Funding for future research As can be seen in Figure 1-1 Professor Barter received many grants in the time following this project. She estimates that her total funding to date as sole investigation exceeds Aus$3 million. The dissemination approach adopted by Professor Barter was broad although financial support for dissemination was limited to that available from the supporting institute. Dissemination of information around this project was probably aided by Professor Barter, who had strong communication skills and was willing to address academic, clinical and lay audiences. This has amounted to more than 50 presentations over the years, and some of the work discussed in these presentations will have included reference to the work conducted as part of the grant, although it is not clear to what extent. According to Professor Barter, it was not his intention to spread the message beyond academic peers, but it has happened. After giving lectures people would come up to him and ask where they could find out more. The book, High Density Cholesterol: the New Target: A Handbook for Clinicians (Barter and Rye, 2005), has been very successful and is now in its third edition, having sold around 50,000 copies (according to Barter). Professor Barter believes strongly that the public can be a powerful force of support and can be of great assistance in reaching the government. Barter also believes that attitudes in the research community about talking to the general public about research have changed a lot, with the majority now recognising this is important to do. Barter takes the time to speak with lay audiences, making no assumptions about levels of knowledge. In our interview he commented on a talk he had given in a town hall in Adelaide after which a couple of people came up to him and commented this was the first time they had ever understood this subject, and it transpired they were cardiologists. The Heart Research Institute, of which Professor Barter is Director, today holds an open house four times a year to talk with the public about what they are doing. Barter was a contributor to Lipid Management Guidelines, 2001 (National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand, 2001). Although much later than the work in this project, it can clearly be seen that this work is a result of the workstream initiated by work in this grant. However, it is not possible to quantify the importance of this research in these changes. Professor Barter has had many advisory roles to industry and policy makers, nationally and internationally, though again this is not linked exclusively to this grant, and there is no evidence of specific outputs from this grant contributing to policy though these positions. There is, however, a broader potential for the findings and subsequent research to be used to develop new treatments. For example, there is the potential for a new field of cholesterol-lowering drugs. However, it is by no means clear to what extent this change is a result of this particular piece of work, which is only one part (if a reasonably significant part) of the wide range of research that has been conducted in this area and which has led to a step change in understanding of this field. However, there are a number of more specific examples where the outputs of this research, and the follow-on research from the group, have made a clear contribution. One such example is a recent clinical trial in which Professor Barter was involved. He was asked in 2005 to design a project on the potential for a new field of cholesterol-lowering drugs. Unfortunately unexpected side-effects resulted and some people died in the trials. At the time of interview, it appeared that this had stopped the progress of this particular approach towards treatment, as no drug companies were willing to run trials. Professor Barter believed this may be revisited in the future and in the meantime he has been looking at new targets without direct involvement from pharmaceutical companies at least in the early stages. However, this is difficult to confirm, as although the findings of this study were significant, they only formed part of a wider research picture. It is also possible that these findings could have impacts on health in a more specific way, through the development of new mechanisms to control cholesterol, but this has yet to occur. The findings also had potential implications for other conditions, such as arthritis and diabetes, but there is no evidence so far of health benefits resulting from this grant in these areas.
In the larger defects not only was there little defect fill diabetes sure signs order 5 mg dapagliflozin amex, but significant soft tissue recession also occurred diabetes mellitus type 2 eye best 5mg dapagliflozin, exposing the furcation area diabetes insipidus yahoo answers purchase dapagliflozin 5 mg otc. Overall diabetes type 2 history order 5 mg dapagliflozin mastercard, if the defect was > 3 mm in an apico-coronal dimension metabolic disease types discount 5 mg dapagliflozin overnight delivery, gingival recession was more apt to occur with subsequent failure to develop complete new attachment diabetes type 1 concept map dapagliflozin 10mg without prescription. A total of 12 teeth in 10 patients were treated with teflon membranes and replaced flaps. Defect morphology (horizontal versus vertical bone loss [best prognosis]) was viewed as a key factor in predictability of regenerative procedures, reinforcing the concept of space dependent cell migration for regeneration. The new tissue observed at re-entry was termed "open probing new attachment" if it did not have the consistency of bone. New attachment was seen with both types of teflon membranes as early as 5 weeks postsurgery. The topography of the bony lesion was considered as a key controlling factor determining regeneration. In 2 controlled human clinical trials, similar results with membrane exclusion techniques were obtained. This was in contrast to surgically debrided control sites in which only 2 of 21 (< 20%) closures occurred. However, less than 20% of the control defects demonstrated closure following treatment. Histologic evidence of regeneration was not included in the 2 preceding controlled clinical trials. The authors noted that the consistency of the tissue in the defects at the time of re-entry was firm, rubbery, and resistant to the forces of probing. They felt that this material was not bone and noted no radiographic changes in affected areas. This tissue which resisted the forces of probing was termed "open probing clinical attachment. Comparisons of results from this case report to the previous work published by Becker et al. Many of these patients had received long-term maintenance therapy, suggesting the "chronic condition" of the treated furcation sites (Caffesse et al. In addition, decalcified freeze-dried allogeneic bone grafts were placed in 16 of the 30 defects. Twelve months following therapy, an average of 67% of the defects volume was filled with bone, while 43% of treated defects were completely closed by bone fill. No significant differences were observed between defects treated with and without bone grafts. Another treatment approach for furcal defects was reported by Schallhorn and McClain (1988). They reported complete fill in 33 of 46 (72%) furcation defects using the combined approach versus 5 of 16 (31%) furcation defects when membranes alone were used. It also led to a 5 year stability of gains in clinical probing attachment levels, and in furcation fill. While their results were encouraging, they were less than the probing depth reduction and clinical attachment gain reported by Pontoriero et al. The 2-week professional prophylaxis regimen utilized by Pontoriero and coworkers may account for these differences. The use of non-standardized measurements and patient selection criteria raised questions regarding the accuracy of these results. Both modalities resulted in similar clinical improvements, and both were effective in gaining vertical open probing new attachment and both were effective for horizontal defect fill. These results were likely minimized by the reporting mean values and inclusion of healthy sites in the data. The controls were debrided only with the tissue being replaced back to its original height. The control group had no gain in mean attachment level, whereas the experimental group responded with 2. The horizontal measurements did not change for the control group, but improved by a mean of 1. Based on clinical measurements taken during a surgical re-entry procedure, no significant differences were found between the control and the citric acid group. Generally the deeper the vertical component of the defect, the greater the osseous fill. The authors judged success by surgical re-entry at 6 months and measured the hard tissue changes in a horizontal and vertical dimension. These terms should be distinguished from "open probing clinical attachment" (Becker et al. At 6 months a surgical re-entry procedure was performed to assess the hard tissue changes. No significant differences were observed between the 2 sites for recession, probing depth reduction, attachment level changes, or alveolar crest resorption. His data indicated that membrane placement in this area was likely to have a significant gap between the stretched membrane and the tooth surface, and may contribute to failure. He also noted that the improvement in open probing attachment levels seen at the time of membrane removal was lost over the intervening months, more so for the vertical than the horizontal component. The stability of the sites showed that the clinical gains at 6 months had been maintained with 93% present at 1 year, 92% at 2 years, 90% at year 3, and 100% at years 4 and 5. Contrary to Yukna (1992), the authors concluded that the improvement in clinical parameters can be maintained over 5 years in a majority of cases. Nucleopore/Millipore Filters these are non-resorbable and require a second procedure for removal (Magnusson et al. They consist of 2 parts: 1) an open microstructure collar to inhibit epithelial migration and 2) an occlusive apron that isolates the root surface from the surrounding tissues (Gottlow et al, 1986; Becker et al, 1987, 1988; Pontoriero et al, 1987, 1988; Schallhorn and McClain, 1988; Stahl et al, 1990; Caffesse et al, 1990; Lekovic et al, 1990; Seibert and Nyman, 1990). Biobrane Membrane this is a non-resorbable membrane which requires a second procedure for removal. It is a biocomposite consisting of an ultrathin, semi-permeable silicone membrane mechanically bonded to a flexible knitted nylon fabric and coated with hydrophilic collagen peptides. It is primarily a biological dressing that is used in the treatment of skin burns (Aukhil et al, 1986B). Polylactic Acid Membranes these are biodegradable and degradation is primarily by hydrolysis so a second procedure for removal is not required (Magnusson et al, 1988). The commercially available membrane consists of a polymer of polyactic acid which has been softened by a citric acid ester to facilitate handling. Continued Animal Model/ Number Human/5 Experimental Sites Molar/ nonmolar All teeth Experimental Model/Defect Intrabony defects Intrabony defects, est. No difference for recession, probing depth, clinical attachment gain; results unpredictable. Gore-Tex membrane 12 months 93% of all defects had 50% or greater fill Chung (1990) Human/10 Molar/nonmolar Intrabony defects 12 months Probing Attachment Level Gain (mean values) 0. Miscellaneous Ellegaard (1974) Human N/A Intrabony defects Free gingival grafts/ Autogenous bone grafts N/A Complete regeneration in 60% of defects; 10% with residual pockets > 3 mm 67% defect fill (average) 43% of defects with complete closure with bone fill. Clinical and volumetric analysis of three-wall intrabony defects following open flap debridement. The use of collagen membrane barriers in conjunction with combined demineralized bone-collagen gel implants in human infrabony defects. Clinical evaluation of a biodegradable collagen membrane in guided tissue regeneration. New periodontal attachment procedure based on retardation of epithelial migration. Periodontal tissue response to a new bioresorbable guided tissue regeneration device. Guided tissue regeneration with and without citric acid treatment in vertical osseous defects. Progenitor cell kinetics during guided tissue regeneration in experimental periodontal wounds. The significance of coronal growth of periodontal ligament tissue for new attachment formation. Collagen these membranes are biodegradable and do not require a second procedure for removal. Forms of collagen include: membranes, gels, atelocollagen (telopeptides pepsinized making it less antigenie), and avitene (microfibrillar collagen hemostat from purified bovine corium collagen) (Pfeifer et al. Freeze-Dried Dura Mater Allografts this is a resorbable human allograft material that is composed mainly of collagen and is devoid of immunogenicity (Yukna, 1992). While some risk of disease transmission exists, it can be reduced by the lyophilization and sterilization processes used. Salonen and Persson (1990) analyzed the growth and migration of gingival epithelial cells on materials with different surface properties. Differences in epithelial cell attachment and migration to varying substrata may be explained by their ability to bind glycoproteins to varying degrees. Scanning electron microscopic examination of these materials disclosed surface differences. Overall, these data suggested that the substrata not only provided contact guidance which influenced cell migration by the shape of the substratum surface, but also induced mitosis and migration because of their protein-binding capacity and wettability characteristics (Table 1). Clinical evaluation of the use of decalcified freeze-dried bone allograft with guided tissue regeneration in the treatment of molar furcation invasions. Connective tissue attachment formation following exclusion of gingival connective tissue and epithelium during healing. New attachment formation following controlled tissue regeneration using biodegradable membranes. Long-term assessment of combined osseous composite grafting, root conditioning, and guided tissue regeneration. Cells from bone synthesize cementum-like and bone-like tissue in vitro and may migrate into periodontal ligament in vivo. Use of a collagen barrier to enhance healing in human periodontal furcation defects. Epithelial exclusion and tissue regeneration using a collagen membrane barrier in chronic periodontal defects: A histologic study. Periodontal regenerative therapy with coverage of previously restored root surfaces: case reports. Combined osseous composite grafting, root conditioning, and guided tissue regeneration. Localized ridge augmentation in dogs: A pilot study using membranes and hydroxylapatite. Human histologic responses to guided tissue regenerative techniques in intrabony lesions. Clinical human comparison of expanded polytetrafluoroethylene barrier membrane and freeze-dried dura mater allografts for guided tissue regeneration of lost periodontal support. Fibroblast Growth Factor: A family of growth factors with mitogenic properties for fibroblasts and mesoderm-derived cell types. Cytokines: A broad family of humoral factors that mediate considerable roles in growth, differentiation, and tissue damage by cellular receptors. The ligand-receptor complex internalization is followed by marked changes in cellular morphology, including rapid growth and division. Secretion is enhanced if the macrophage is activated by lipopolysaccharide, concanavalin A, fibronectin, or phorbol esters. It serves as a powerful chemoattractant for smooth muscle cells, fibroblasts, and leukocytes and has major mitogenic effects in serum that are dependent upon the presence of other growth factors. Platelet activation and degranulation follow platelet exposure to thrombin or fibrillar collagen. After initiation of this inflammatory phase of wound healing, it serves to activate mesenchymal cells essential to the proliferative phase, including endothelial cells and smooth muscle cells. It can stimulate the growth of various diploid fibroblasts and some tumor cell lines. It inhibits the activity of thrombomodulin, augments the secretion of inhibitors of plasminogen activators, and induces the synthesis and transient cell surface expression of tissue factor procoagulant activity. It will also stimulate chondrocytes to degrade proteoglycans and will elicit the secretion of proteolytic enzymes, such as collagenase, from synovial cells and fibroblasts surrounding bone and cartilage. It is synthesized and secreted in precursor form and is activated by proteolytic cleavage. Each appears to be derived from a single gene with differences in the multiple similar growth factors within the same class resulting from post-translational processing. It is secreted in a latent form by macrophages and activated in conditions such as the low pH of wound healing and bone resorptive environments. It is also present in high concentrations in endochondral growth plates, and at lower levels in diaphyses, epiphyses, and calvaria. It may act by altering the cellular response to other growth factors, either at the receptor or postreceptor level. Migration distances were determined by photographs quantifying the stained leading front cells. The authors concluded that assays for specific cell migration were useful in selecting potential biological response modifiers capable of promoting healing at the dentin-soft tissue interface. Terranova and Wikesjo (1987) reviewed extracellular matrices and polypeptide growth factors as mediators of function of periodontium cells. Fibronectin binds fibroblasts to the matrix, and also binds to many different collagen types, heparin sulfate, fibrin, and other glycoproteins. Chondronectin also attaches to proteoglycan, collagen, and cell surface receptors. Heparin sulfate forms a charged barrier in the basement membrane which prevents passage of proteins, while laminin constitutes 30% to 50% of the total protein in basement membranes. Fibroblasts, chondrocytes, and epithelial cells produce and use different cell specific attachment factors.
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But all of this makes sense only when the people in the country are actually in a position to choose freely. This is contained in the concept of Western values, and is not at all the right to force their systems on others. Let us say, the question of the reunification of Germany, which is causing nervousness in both our countries, and even among Europeans. So that reunification takes place according the principles of openness, pluralism, and a free market. We do not at all want the reunification of Germany done on the model of 1937-1945 which, obviously, concerns you. But if you raise it to a political, philosophical level, then everything falls into place. For if the process is deep, affects fundamental matters, and involves millions of people and entire nations, then how could it proceed easily and simply It is necessary to proceed from an understanding of the enormous importance of the current changes. It is necessary to avoid possible mistakes and use the historic opportunities which are opening up to bring East and West together. Even in the Soviet Union, in one country, the differences between the republics and various regions are evident to the naked eye. I am in favor of our constant cooperation on the basis of this understanding for this entire difficult transition period. Otherwise this process can break down and we will all end up in a chaotic situation which would give birth to many problems, halt the changes, and throw us back to the times of suspicion and mistrust. I stress that a special responsibility rests on the Soviet Union and the United States at this historic moment. These values are not something new or expedient but long-shared by us and the West Europeans, and they unite the West. We greet the changes in the Soviet Union or in Poland but do not at all set Western values against them. Therefore I want to understand your point of view as much as possible in order to avoid any misunderstandings. Gorbachev: the main principle which we have adopted and which we follow in our new thinking is the right of each country to free choice, including the right to reexamine and change their original choice. You personally have laid the foundation for these changes, the movement toward democracy and openness. It is actually considerably clearer today that you and we share these values than, say, 20 years ago. Yakovlev: When they insist on Western values, then Eastern and Southern values unavoidably appear. Let us avoid careless words and talk more about the substance of the values themselves. Gorbachev: this is very important since, as I have said, the main thing is that the changes lead to greater openness in our relations with one another. We are beginning to be organically integrated and liberated from everything which divided us. Therefore, for my part, I support your suggestionlet us not have a discussion on a theological level. Baker: Could we possibly say as a compromise that this positive process is proceeding on the basis of democratic values Secretary of State Baker and Foreign Minister Shevardnadze agreed to call an international conference on Open Skies scheduled for February 1990 in Ottawa, Canada. The Rabta facility may have produced as much as 100 tons of blister and nerve agents before a fire closed it down in 1990. Comrade Raoul Castro expressed his heartfelt thanks for these words of welcome [] Currently the escalation in imperialist pressure is perceived very clearly in Cuba. The Bush administrations reaction to international events has been increasingly aggressive in the Caribbean sphere. The situation has escalated to the point that any shot could lead to a serious military conflict. Cubas leadership is very concerned about this situation and is following it closely. Addressing the recent trials of members of the military and Ministry of the Interior, Raoul Castro characterized them as very serious proceedings that led to a regrettable outcome of four death sentences and stiff sentences for a large number of officers. Given the trial of Abrantes, the former Minister of the Interior, the Ministry has been completely reorganized. All high-ranking officers at both the Ministry and Province level have been dismissed. In terms of the trial of General Ochoa, all of the trial materials have actually been published. The Granma official party organ published a detailed lead article on the trial several days ago. Raoul Castro remarked that imperialist propaganda is attempting to exploit these internal problems for intensified subversive action against Cuba. Intensive preparations are currently underway in Cuba to record American television propaganda broadcasts. Given these conditions, it is a great consolation to Cuba that it has dependable allies. The stability of the German socialist state is demonstrated by the fact that it has been possible to increase national income by 4 per cent. It is increasingly apparent that crises and erosion are occurring in some socialist countries, that is, in our own backyard. He asked Comrade Raul to convey to Comrade Fidel brotherly regards from Comrade Honecker. We thank the Rosenthal Center for Complementary and Alternative Medicine Research at Columbia University for their long-standing partnership and collaboration over many years. Finally, we gratefully acknowledge the Educational Foundation of America for their support for the ethnobotanical and medical anthropology research on Dominican traditional medicine in New York City upon which this book was initially developed. Additional information on Dominican medicinal plants and their uses has been added to this revised edition of the guidebook based on the preliminary results of the "Dominican Ethnomedicine in New York City" project funded by an R21 grant from the National Institutes of Health, National Center for Complementary and Alternative Medicine (Principal Investigator: Michael J. Ina Vandebroek, the director of that project, who has generously shared this information with us to enhance the scope and relevance of the ethnomedicial data in this publication. Balick is a MetLife Fellow, and we gratefully acknowledge the following foundations which have supported his work on this project: the MetLife Foundation, Edward P. Bass and the Philecology Trust, the Prospect Hill Foundation and the Freed Foundation. Finally, as the primary authors of this guidebook, we express our heartfelt gratitude and sincere appreciation to our family and friends for their support and encouragement throughout the process of writing and editing this publication. Jolene Yukes gives special thanks to Anthony Louis Piscitella for his patience, support and joyful companionship throughout the compilation of this manuscript. Knowing the difference between potentially harmful substances and beneficial therapies is of crucial importance for anyone, especially health care providers and individuals who self-medicate with herbal remedies. As physicians have known since the time of Paracelsus, the difference between poison and medicine is in the dose. Even foods or pharmaceutical drugs that are generally regarded as safe can be toxic or cause adverse effects depending on the context of their use. Herb-drug interactions are another important concern as research has shown that many popular botanical therapies may negatively affect drug metabolism. Reliable information on the safety, contraindications and potential drug interactions of complementary and alternative therapies is needed now more than ever before. Although abundant research data is available for mainstream dietary supplements and herbs, very little attention has been given to the botanical therapies and traditional remedies used by immigrant communities and minority ethnic groups here in the United States, particularly among low-income and underserved populations. In an era of globalization characterized by increasing urbanization and transnational migration, health care providers frequently encounter patients from diverse backgrounds. Clinicians may not speak the same language as their patients or be familiar with their health-related cultural beliefs and practices, some of which may affect adherence to treatment protocols and health outcomes. With widespread use of complementary and alternative therapies, including traditional herbal remedies, how can clinicians determine the safety of the non-pharmaceutical therapies that their patients may be using, especially if they are unfamiliar or referred to by regional vernacular or unknown names The primary aim of this book is to address these questions with respect to immigrants from the Dominican Republic in New York City by providing information on traditional Dominican uses of medicinal plants and a review of the available scientific literature on their safety and efficacy. The present volume, Dominican Medicinal Plants: A Guide for Health Care Providers, is intended as a reference manual for clinicians to support culturally effective health care and greater understanding of the traditional medical practices of immigrants from the Dominican Republic in New York City. As an informational and educational tool, this book can support patient-provider communication and enhance cross-cultural understanding in a clinical setting. In addition to information about the plants themselves, this guidebook also provides explanations of key ethnomedical concepts and customs related to the use of herbal medicine to clarify the cultural context of Dominican ethnomedical traditions. Ultimately, the main goal of this guidebook is to enhance the quality of patient care for Dominicans in New York City by supporting informed patient-provider communication and raising awareness about the use of home remedies and their relevance to health care. We sincerely hope that this book can serve as a model for other educational initiatives to enhance the quality of health care for 7 underserved, minority or immigrant populations with strong traditions of herbal medicine through relevant cultural competency training and curricular materials. The ethnobotanical information in this book is based on ongoing ethnographic fieldwork conducted in New York City with immigrants from the Dominican Republic between 1995-2009. Although there are notable cross-cultural similarities between traditional medical practices among Spanish-speaking populations from different Latin American countries, the reader is advised that common names and ethnomedical uses of medicinal plants may vary considerably between different Latino/Hispanic cultural groups or even within a particular community. Therefore, the Dominican ethnomedical information included in this book may not reflect the herbal medicine practices of other Latin American or Caribbean populations. In 1995, this research team chose to focus on Dominican healing traditions as practiced in an urban, cosmopolitan setting and conducted ethnobotanical research with specialists in Dominican herbal medicine from predominantly Latin-American and Caribbean immigrant neighborhoods in the Bronx and Northern Manhattan. Balick, PhD), included questions about herbs used for a wide range of common health conditions (Vandebroek et al. As a result of the past decade of research on Dominican urban ethnomedical practices, the authors embarked on the present applied research project to facilitate the dissemination of information on Dominican medicinal plants to health care providers who work with Dominican patients. Throughout the preparation of this publication, the authors have collaborated with an Advisory Board consisting of physicians, ethnobotanists, medical anthropologists and representatives from Dominican community-based organizations (see "Advisory Board and Collaborators" listed on the title page. Rangel Community Health Center; New York University School of Medicine, Emergency Medicine and the New 8 York Poison Control Center. Support for this project was generously provided by the United Hospital Fund, the New York Community Trust and the Jacob and Valeria Langeloth Foundation. From January through March 2006, the first edition of this guidebook was pilot tested with a select group of twenty-five health care providers and medical professionals in the New York City area. The goal of this pilot testing was to determine the usefulness of this book as a clinical reference and as a tool for facilitating cultural understanding in a primary care setting. Participants in this pilot-testing phase completed a short survey after consulting the book, evaluating its relevance, ease-of-use and efficacy in supporting culturally sensitive and knowledgeable discussion of the use of botanical therapies with Dominican patients. Feedback and suggestions for improvement from these pilot-testing surveys have been incorporated into the revised second edition of this guidebook. Ethnobotany and Medical Anthropology Ethnobotany is the study of the complex relationships between people and plants, such as cultural beliefs and practices associated with the use of plants for food, medicine and ritual, local systems for naming and classifying plants species, traditional knowledge about ecological relationships and botany-related songs, stories and legends. Medical anthropology, including the sub discipline ethnomedicine, is the academic field devoted to the cultural dimensions of medicine and health care, including traditional systems of healing. Both disciplines are interrelated, especially medical ethnobotany and ethnomedicine, and are highly relevant to health care in an era of medical pluralism in which multiple systems of medicine operate simultaneously. In this book, the term "traditional medicine" is used to describe medical traditions, health beliefs and healing practices that historically have been passed down orally and which are typically associated with a particular cultural group or region. The terms "biomedicine" or "conventional medicine" are used to describe allopathic health care, particularly the dominant system of standard practice medicine. Dominican health-related cultural practices and beliefs as reported in this guidebook are based on research conducted using ethnomedical and ethnobotanical methods. These methods include semistructured interviews, exploratory ethnography, market studies, participant-observation and qualitative data analysis. Specialists were defined as recognized experts in plant-based healing, such as herbalists and practitioners of traditional medicine, whereas generalists included individuals who reported that they used home remedies for self-care or sought the health advice of traditional healers but were not considered experts themselves. All study participants stated that they acquired their knowledge of medicinal plants while in the Dominican Republic or from Dominican family members, friends, relatives or healers in the United States. Interview questions addressed the following topics: concepts of health and illness, disease etiology, anatomical terms, methods of diagnosis, spiritual aspects of healing, treatment choice and health decision making. Botany and Plant Taxonomy One key component of ethnobotanical research is determining the correct scientific name for Dominican medicinal plants because the biomedical literature on botanical therapies is typically indexed by Latin binomial rather than the Dominican Spanish common name as reported by participants in ethnobotanical interviews. To determine the correct scientific names of medicinal plants included in this guidebook, botanical specimens were collected whenever possible for identification by ethnobotanists and plant taxonomy specialists at the New York Botanical Garden. However, since most plants used were only available as food items from grocery stores or sterile plant fragments, in many cases a reference collection of plant photographs and purchased plant material was used.
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