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By H. Phil. College Misericordia.

A red dye is extracted from the root and barks of Oldenlandia umbellata (Dye root) generic viagra 25 mg visa erectile dysfunction at the age of 24. Timber plants Timber of commercial value is obtained from Adina cordifolia (Manjakkadambu) and Morinda tinctoria (Nuna tree) purchase cheap viagra on-line erectile dysfunction medicine from dabur. Ornamental plants Gardenia jasminoides (cape jasmine), Ixora coccinea (Iddlipoo) and Mussaenda frondosa (Vellai madandhai) are grown in gardens. Launaea pinnatifida), exstipulate showing reticulate venation, hairy (Tridax procumbens) and spinous (eg. Inflorescence This family is characterized by the presence of head or capitulum type of inflorescence. The number of florets in a head is variable from a few to several hundreds, but in Echinops, the head is reduced to a single flower. In homogamous heads, all the florets are tubular as in Vernonia arborea and Ageratum mexicanum. The disc florets are generally complete, bisexual and actinomorphic, whereas the ray florets are incomplete, pistillate or neutral and zygomorphic. Calyx In many species calyx is reduced to numerous hairy appendages called pappus, arranged on top of the ovary. Corolla Petals 5, gamopetalous showing valvate aestivation, regular and tubular in disc florets and irregular and ligulate or bilabiate in ray florets. Fruit Cypsela, single seeded, dry indehiscent fruit developing from an inferior ovary. Leaf Simple, opposite, exstipulate and margins dentate showing reticulate venation. Inflorescence A terminal heterogamous head and receptacle of the head is convex and surrounded by green involucre. The tubular florets occupy the centre and the ligulate florets are found at the margins. Calyx Reduced into numerous hairy outgrowths called pappus arranged on top of ovary and persistent. Calyx Reduced into numerous hairy outgrowths called pappus arranged on top of the ovary and persistent. Oil plants Oil extracted from the seeds of Helianthus annuus (sunflower) is edible and used as a cooking medium. Oil extracted from the seeds of Carthamus tinctorius (safflower) is edible and also used in the manufacture of soap. It contains less amount of cholesterol and therefore it is recommended for heart patients. Medicinal plants The entire plant, Eclipta prostrata (Karisalankanni) is used in the preparation of bathing oil and also in the treatment of jaundice, spleen and liver disorders. The drug santonin obtained from the heads of Artemesia maritima is used for expelling intestinal round worms. Dye plants A natural red dye obtained from Carthamus tinctorius is used for dyeing silks. A yellow dye obtained from the flowers of Tagetus erecta is used for dyeing cotton. Pesticides A dried powder called Pyrethrum obtained from the flower heads of Chrysanthemum cinerarifolium and C. Beverage Powder obtained from the seeds of Cichorium intybus (chicory/ kasini keerai) is mixed with coffee powder. Ornamental plants Helianthus annuus (sunflower), Tagetus petula (French marigold), Calendula officinalis (pot marigold) and Zinnia elegans are grown in gardens for their beautiful flowers. Datura stramonium) or extra axillary scorpioid cyme called rhipidium (fan shaped cyme) as in S. Androecium Stamens 5, epipetalous, alternate with the petals, usually not equal in length and filaments are inserted in the middle or basal region of corolla tube and basifixed. Anthers dithecous, introrse, usually basifixed or dorsifixed, dehiscing longitudinally or through apical pores (eg. In Schizanthus pinnatus, two stamens are fertile and three stamens are reduced to staminodes. In Lycopersicon esculentum, the fruit is a berry and in species of Datura and Petunia, the fruit is a capsule. Androecium Stamens 5, free from one another epipetalous, alternate the petals and are inserted in the middle of the corolla tube. Anthers are basifixed, dithecous with long filament, introrse and longitudinally dehiscent. Datura metal 45 Fruit Spinescent capsule opening by four apical valves with persistent calyx. Food plants Tubers of Solanum tuberosum (potato) are used as common vegetable throughout the world. Leaves and flowers of Datura stramonium are the sources of drug stramonium used to treat asthma and whooping cough. Leaves, flowers, berries of Solanum trilobatum (thoodhuvalai) are used to treat cough. Roots and leaves of Withania somnifera (Amukkara) are used to treat nervous disorder and are diuretic apart from useful tonic. Tobacco Leaves of Nicotiana tabacum (tobacco) contain alkaloids nicotine, nornicotine and anabasine. Nicotine is considered to be the principal alkaloid in commercial tobaccos such as cigarette, bidi, pipes and hukkah as well as chewing and snuffing. In which of the following plants the midrib and veins are found with yellowish spines a. It is world wide in distribution, but particularly well represented in Africa and South America. It is a collection of unisexual flowers arranged in cymose manner on a condensed axis and enclosed within a cup-shaped involucre. Each cyathium has a single central female flower surrounded by two to many male flowers. In Ricinus communis, it is a panicle where female and male flowers are arranged in racemose manner. In Croton sparsiflorus (Eli amanakku), the inflorescence is simple raceme, whereas in Acalypha indica (Kuppaimeni), it is catkin. In Euphorbia, the male flower is represented by a single stamen and female flower by a single pistil. Perianth In Croton sparsiflorus, the male flowers have two whorls of perianth whereas the female flowers have a single whorl of perianth. The tepals are polyphyllous in Phyllanthus amarus and gamophyllous in Ricinus communis. Leaf Petiolate, exstipulate, alternate, deeply palmately lobed with 7 or more lobes. Androecium Stamens many, polyadelphous, filaments branched and united to form five branches.

Some children feel responsible if a parent has been jailed and this issue must be addressed in therapy discount viagra 25 mg on line impotence under hindu marriage act. Members of these teams are on call to assist Child Care The decision to use child care is an these children in the emergency room or hospital order viagra 25 mg on-line erectile dysfunction vascular causes. As important issue to consider prior to working or obtain- children of abuse grow to adulthood, the management ing further education for parents/guardians. Other of their posttraumatic psychological effects of abuse is issues for consideration include general health and per- ongoing. Parenting and distance to be traveled for child care and/or classes may help inexperienced mothers learn appro- employment and education opportunities. Support groups, and support from family, friends, or others in the community can help. Large urban/suburban com- about the child care environment, from the level of per- munities may have a wider selection of types of child sonal interactions to the physical surroundings. Child care can range from in-home care, home The cost of child care varies widely and may be provider child care, or large child care centers. Nannies may/may not have had formal educa- the inclusion of meals and supplies, in addition to the tion and/or experience taking care of children. Foreign exchange student programs may also be another resource for in-home child care. In-home There are many factors which determine quality of child care usually involves only the child/children child care. Families may choose in-home accreditation by a national child care organization may providers so that children have a consistent provider in be one measure of quality child care. While these mea- a familiar surrounding and transportation is less com- sures may not be available for all child care environ- plex for the parents/guardians. Children in in-home ments, other factors to consider include the ratio of child care may have less exposure to other children for child care providers:children, taking into consideration interactive play and illnesses. If the in-home provider is the age of the children and experience level of the ill, alternative child care arrangements must be made. In addition to the experience level, the edu- In-home child care is often the most expensive type of cational level of the child care provider and opportuni- child care. Responsiveness the home provider for child care, and the children will of staff to the child/children is important with regard to vary in age and number depending on the home child-appropriate activities, addressing needs and provider and state regulations. Home providers should requests of children, and appropriate use of discipline have a criminal record and child abuse background and redirection depending on the childs age. Home Examination of the physical space for safe, clean areas providers may or may not be regulated depending on for children and the presence of child-centered equip- the state. Home providers usually provide consistent ment are other important considerations. Illness of the home provider may techniques, separation of food preparation and toilet- create challenges for a family to arrange alternative ing/diapering areas, and hand washing policies for chil- child care options. Large child care centers are licensed by sider, especially if children have allergies or other health the states and need to meet health, safety, and caregiver problems. There are many agencies that have agreed guidelines in addition to submitting to at least annual upon and recommended nutritional standards for child inspections. Perhaps the most important factor is how ited by national organizations and meet requirements 154 Child Custody above minimum standards for state licensure. Joint physical custody who attend large child care centers may be exposed to does not have to mean an even split of time between a more diverse group of people, but may also have parents. In most joint custody arrangements, the child more illnesses than children in smaller child care envi- will spend more time with one parent than the other, ronments. The cost of large child care centers will vary particularly if the child is in school and the parents do depending on the community, but generally will be less not live close enough to exchange the child frequently. The tender years pre- National Association of Child Care Resource and Referral Agencies. On the other hand, those stereotypes may be a hindrance to women who do not fit the female image that the judge has in mind. When the parents of a child the father may be seen as outstanding and the mother are married and live with the child, questions of child many be seen as usual, even though their roles are custody are rare. Custody itself can be divided in to two parts, phys- When courts are called upon to make a decision, they ical and legal custody. Physical custody refers to pro- can take into consideration the physical and mental viding the day-to-day care for the child. Physical and legal custody can be arranged differently The laws of most states favor custody decisions for the same child. For that reason, Custody can also be separated into two other cate- it is often harder to get a court to change a custody gories, sole custody and joint custody. There may be means that one parent has the responsibility for the a requirement that the child be in danger in order to physical or legal custody or for both. Joint custody make a change in custody soon after a recent court means that the parents share physical or legal custody order. It is possible to have many combinations of Divorces are not the only times that child custody these types of custody. Parents who have never been mar- have sole physical custody of the child while the ried may separate, requiring a custody determination. When one parent gets custody of a child, whether by agreement or through a judges decision, the other Chiropractic Care Anyone who has ever inten- parent will likely get to have visitation with the child. Courts often become Chiropractors derive their theories and techniques involved in families where there is abuse or neglect of from the work of D. If the situation cannot be made safe for the who performed the first chiropractic adjustment. From this incident and his study of mag- Custody determinations can be arranged by agree- netic healing, Palmer developed the idea that a vital ment of the couple, and when the couple cannot agree, force permeates every cell of the body and that mis- a judge makes the decision. In most cases the parents aligned joints (called subluxations in the jargon of reach an agreement, the judge makes sure the agree- the trade) press on the nerves and disrupt the flow of ment is fair, and the judge makes the parents agreement the vital force. It is important to note that Palmer agree to a custody arrangement understand how the believed that any decrease or increase of life-force flow agreement will affect them and the child. Lawyers can caused by bones pressing on nerves results in disease also represent parents in negotiating an agreement, or and that chiropractic treatment restores normal flow. Sometimes free legal assis- conventional medical practice (sometimes called allo- tance can be obtained through a local office of the pathic medicine) was dramatically different than it is Legal Services Corporation, or through other local today. Many people represent themselves in a child in 1910 and which brought about dramatic reform in custody dispute, but this should be a last resort. In such an environment, 156 Chiropractic Care alternative approaches to healing sprang up. They argue that it is unfair to judge one healing Chiropractic was one of these alternative approaches. Because of this, chiropractors have faced of many complementary and alternative approaches to an uphill battle against the forces of mainstream medi- medicine. For example, chiropractors won an antitrust suit ical rejection of conventional scientific approaches to against the American Medical Association in 1987. Allopathic medicine is a However, the victory was a validation of their right to reductionist approach, focusing on symptoms and practice chiropractic rather than a validation of chiro- attempting to identify their root cause.

Use the tip of your finger to feel for the point of maximum Insert a soft drain cheap viagra 100 mg without a prescription erectile dysfunction cvs, suture it in place buy discount viagra 100 mg on-line jacksonville impotence treatment center, and apply a dry tenderness. You may pack a cavity swelling: you may feel that its centre is slightly softer than initially if there is significant bleeding, but remove it after its edges. There is no need to make a main incision, and another Suppuration in the axilla can take several forms: counter incision inferiorly to provide free drainage. Open a deep abscess promptly, anaplastic carcinoma or the highly aggressive because pus can track along the nerve trunks into the neck. If milk flows from the wound, advise that it will stop, provided breast-feeding is re-established. Let the baby continue the fold of the pectoralis major, so as to avoid the axillary to suck from the normal breast and, as soon as possible, vessels. But do not let him suck from an its handles parallel to important structures, and open the infected breast if: abscess. If the whole axilla is a bag of pus, incise low in the If so, express the milk, by hand or with a breast pump. As soon as the baby can fix onto the nipple, If there is a large subacute or chronic abscess, consider encourage him to suck from it. Start expressing the breast as soon as possible, and follow up until breast-feeding has been re-established. Otherwise start a Be sure to take a biopsy for tuberculosis and cancer, and therapeutic trial with chemotherapy for tuberculosis; examine pus for acid, alcohol-fast bacilli. Regular swabbing with surgical spirit after reappear at the same site, near the areola, this is a showering helps to open up the excretory ducts. See if you can pass a probe from formation and contracture, and may need wide excision the site of the abscess, through to the nipple. If you can, a leaving a 2cm adjacent and deep margin of soft unaffected fistula is present and you may be able to excise the whole tissue. Make the incision round the fistulous track, and continue it 2cm distal to the fistula. Be sure to excise the central part of the duct, because if you leave it behind, the lesion is sure to recur. You may not and defining a retroperitoneal collection, and can know for certain if it is perinephric, subphrenic (especially distinguish this from a subphrenic collection. You can also in the posterior or subhepatic spaces, 10-5B), or has spread gain information on the kidney in this way, and use from osteitis of the spine. Treat with chloramphenicol or a ultrasound to localize where to insert a needle for cephalosporin. Take care to avoid the iliohypogastric nerve at (1);Pyomyositis of the abdominal wall or paraspinal the lower end of the incision. If the pus is in the (4);Osteomyelitis of the spine, with spread to the muscles (pyomyositis), you will discover this before you paraspinal tissues. If it is spreading from the spine or is into the tumour, you will lose the chance to excise it subphrenic, you will also find it. The lumbotomy incision is easier than the 12th rib bed incision, but gives poorer access to the kidney itself; it is, however, perfectly satisfactory for drainage of an abscess. The infection may have reached the iliac nodes from the leg, the perineal area (including the genitalia), or the buttocks. The abscess lies near the psoas muscle; this goes into spasm and sharply flexes the hip, so that extension beyond 90 and walking is impossible. Fluctuation is rare, and only occasionally will you find the site of the primary infection. C, patient in the left lateral different, and is inside the peritoneum, whereas all these position. D, true renal capsule is closely applied to the surface of the other conditions are retro-peritoneal. It has several and vomiting, less spasm, and only mild flexion of the hip important differential diagnoses, and is often (14. This is equivalent to osteomyelitis because the epiphyseal plate is inside the capsule of the hip joint (7. Suggesting tuberculosis of the hip: a chronic history and radiograph signs of tuberculosis (5. Suggesting a tuberculous psoas abscess arising from the spine: a chronic history, radiographic changes in the spine. A psoas abscess does not usually need drainage, unless it is very large and causing pain. It will resolve slowly on therapy for tuberculosis; incising it can lead to secondary infection. Suggesting acute and usually staphylococcal osteomyelitis of the spine (uncommon): more pain, spasm of the sacrospinalis, radiographic signs in the spine. Feel the exact site of the mass and its consistency and boundaries, and feel for fluctuation. A, typically the hip more flexed than is shown adenitis with periadenitis and without pus formation does here. Suggesting iliac adenitis with periadenitis or an The abscess will have pushed the peritoneal lining of the abscess: a septic lesion on the skin which may be minimal right iliac fossa medially and superiorly. Make an incision and have healed (adenitis may appear 2wks after the 5-10cm or more over the swelling about 2cm above primary lesion has settled), a markedly flexed hip with a the inguinal ligament, starting just medial to the short history, a mass in the groin or right iliac fossa just antero-superior iliac spine (6-12D). Take a long haemostat above the inguinal ligament, no pain when you percuss the and push this through the muscle over the abscess until greater trochanter; you can flex the hip a bit more, no you find pus. Then, using your fingers, enlarge the spasm of the sacrospinalis, and no radiographic changes. Suggesting pyomyositis of the iliopsoas: the same signs If the leg remains in spasm, apply traction as above. Draining an iliac abscess is potentially impossible, and is not important because the treatment is dangerous: you may injure the caecum or the iliac vessels. An anorectal abscess usually originates in an anal gland, and may communicate through a tiny opening with the A perianal abscess presents as a red tender swelling close anal canal, at the pectinate line. On rectal examination, there is little or no skin and the anus (a fistula) is the reason why about half of tenderness, induration, or bulging in the anal canal. Most abscesses settle by An ischiorectal abscess lies deeper than a perianal one, discharging spontaneously, or being drained, but a serious is larger and further from the anus; it forms a deep tender life-threatening infection can sometimes spread in the soft brawny swelling and is not fluctuant until late. Presentation is usually acute because the pain is intense: On rectal examination you may feel a tender induration severe throbbing pain keeps the patient awake at night. The infection On examination, you find a tense tender swelling near the may spread posteriorly and then to the other side as a anus.

Occasionally you will be able to lift a whole ruptured ovarian lutein cyst) clump of bowel out of the abdomen buy genuine viagra on line erectile dysfunction caused by obesity, and be able to work pale straw-coloured fluid on it outside buy generic viagra from india erectile dysfunction drugs muse, whilst packing away the rest of the incision. If it is walled off from the rest of the abdominal porridge-like material cavity and this is unaffected by sepsis, just drain it and (ruptured dermoid cyst) leave the remaining abdomen alone or you will spread sticky mucous fluid infection into a clean peritoneal area. Generalized peritonitis, particularly of some days peritonitis by adding more organisms to the bacterial soup duration, will always have distended loops of bowel already present and you increase the chances of a faecal present. Do not waste sucker; or else, mobilize the bowel out of the abdominal time at this stage by repairing the perforation: do this after cavity, and drain the contents into a bowl holding the open you have freed all the bowel. This is messy, but as You may need to sacrifice an impossibly matted segment long as you take care to avoid spillage of contents into the of bowel (11. If then you do perforate it, you wont spill its a small hole on the anti-mesenteric border of the bowel, contents. Physiology takes the anaesthetist is inexperienced, or the patient is a child precedence over anatomy. You should know where this might If the peritonitis is localized, pack off the affected area be from: and then lavage or mop out the infected space. You do not need to use saline: 10l of warm (3);If you find localized pus, try to minimize its spread sterile water is preferable to 500ml of saline! Otherwise you may damage the viscera or bowel, simply in a vain attempt to make the abdomen Inspect the abdominal cavity thoroughly, unless you are look clean! All necrotic tissue must be removed; this may multiple intra-abdominal collections, because the area to entail resection of bowel. Trendelenburg for pelvic sepsis, and pack away the suction, and irrigate it with liquid to keep it open. If the intra-abdominal tension remains high, First, you will have to find it, and this may not be easy. Look for signs of (1);you expect to have to look inside again within 48hrs, inflammation (pus or adhesions), of perforation, e. For this (2) there is gross faecal soiling or sepsis requiring repeated reason, keep these books in theatre! Remember damage control a septic abdomen, even wearing 2 pairs of gloves: laparotomy. The decision how to proceed depends on the no amount of soap or perfume will remove the odour, condition. Review the charts carefully each You should not have to pull the abdominal wall together day for complications. Go back and decompress the general state of alertness, the abdominal girth, the bowel bowel. If there is generalized peritonitis, (1) Abdominal sepsis (may lead to septic shock). Intra-abdominal sepsis is an extremely output (if possible 2hrly for the first 48hrs). Use a Pauls difficult diagnosis to make, particularly post-operatively, tubing (condom catheter) in a young male; remember and you will often wish you had made it earlier. Direct your attention to the the fluid balance is stable (at least for 48hrs, usually source of the problem, rather than randomly extracting 3-6days). The common error is not to infuse enough fluid loops of bowel and dividing adhesions unnecessarily. If the Re-open a patient with severe generalized peritonitis initial fluid resuscitation was inadequate, there may still be routinely after 48hrs in order to: a deficit to make up. Start them (4) check bowel anastomoses for patency, when the postoperative diuresis begins. If there was major blood loss during the corners of the abdominal cavity, operation (>2l), especially if previously anaemic and this (6). Look at the clinical response, rather than by the Make sure you do not fail to treat tuberculosis. Do not wait for a complete burst abdomen; return to theatre for closure of any residual defect with interrupted sutures. If fever persists, there may be a postoperative wound, chest or urinary infection, deep vein thrombosis or there is further intra-abdominal sepsis. If there is a mass which was not present previously, get an abdominal radiograph: it may be a retained swab! If there is diarrhoea, especially with the passage of mucus, suspect a pelvic abscess (10. If this is upper small bowel fluid (thin yellow), it may produce disastrous fluid and Fig. C, pelvic abscess fistula, and the output is <500ml/day, it should close pointing into the vagina. Use low-pressure suction to keep the fistula wound dry, and make sure feeding continues and you correct potassium losses. Localized septic collections (these are rarely true (3);A laparotomy during which the abdominal cavity was abscesses) in the abdominal cavity can be the result of: contaminated (10. Generalized peritonitis: they are one of its major (4) A ruptured liver abscess (15. Some primary focus of infection, such as appendicitis Suspect that there is a subphrenic abscess if there is a or salpingitis. If loops of the bowel the right or left subphrenic space, or under the liver in the pass through the abscess, they may become obstructed, right or left subhepatic space in the lesser sac. This is dangerous and misleading: do it with harm; missing a subphrenic abscess and doing nothing is ultrasound guidance. A subphrenic abscess, pyelonephritis, pyonephros or perinephric abscess can all cause similar tenderness posteriorly. If the patient is thin and the pus is superficial, you may feel a tender indurated mass under the costal margin in front (right subphrenic space), in the right flank (right subhepatic space), or posteriorly. He had shoulder-tip pain, but he also said he had pain when he put the tongue out, so it was first thought that he might be hysterical. The following day the abdomen started to distend, and aspiration of the abdominal cavity withdrew greenish fluid. A laparotomy was done, and an ulcer on the greater curve of the stomach was found and repaired. C, explore the right posterior subphrenic drain a subphrenic abscess through the original laparotomy incision, but abscess. You can use the ultrasound to guide you to drain If you suspect a subphrenic abscess, and the general the abscess. Approach it anteriorly, if possible through the old Make an incision which is big enough to take your hand laparotomy wound, unless there are very clear signs that it over the 12th rib posteriorly (10-7E, 10-8). Occasionally, you may need to tie the intercostal preference, and the posterior approach only if you are vessels. Dont hesitate to explore the abscess above the renal fascia to enter the abscess (10-7C,D). This way you can often drain the septic collection without entering the general abdominal cavity.

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