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By Y. Tempeck. College of New Rochelle.

The distance between both DRCs tivity can often be avoided if the drug indicates the difference between the does not require the blood route to therapeutic and toxic doses discount 100 mg mycelex-g otc anti fungal oil for nails. This margin reach the target organ buy 100 mg mycelex-g fast delivery fungus gnats myiasis, but is, instead, of safety indicates the risk of toxicity applied locally, as in the administration when standard doses are exceeded. This holds true for both With every drug use, unwanted ef- medicines and environmental poisons. In order to prescribing a drug, the physician should assess the risk of toxicity, knowledge is therefore assess the risk: benefit ratio. If certain body functions develop hyperreactivity, unwanted effects can occur even at nor- mal dose levels. Increased sensitivity of the respiratory center to morphine is found in patients with chronic lung dis- ease, in neonates, or during concurrent exposure to other respiratory depress- ant agents. The DRC is shifted to the left and a smaller dose of morphine is suffi- cient to paralyze respiration. Adverse Drug Effects 71 Decrease in Effect Respiratory depression pain perception Decrease in (nociception) Nociception Respira- Morphine tory overdose Safety activity Morphine margin Dose A. Adverse drug effect: overdosing Increased Effect sensitivity of respiratory Safety center margin Normal dose Dose B. Adverse drug effect: lacking selectivity Lüllmann, Color Atlas of Pharmacology © 2000 Thieme All rights reserved. These complexes mediate the activation The immune system normally functions of complement, a family of proteins that to rid the organism of invading foreign circulate in the blood in an inactive particles, such as bacteria. Immune re- form, but can be activated in a cascade- sponses can occur without appropriate like succession by an appropriate stimu- cause or with exaggerated intensity and lus. Activation as effective antigens or immunogens, of complement on blood cells results in capable by themselves of initiating an their destruction, evidenced by hemo- immune response. Most drugs or their lytic anemia, agranulocytosis, and metabolites (so-called haptens) must thrombocytopenia. During initial con- and an inflammatory reaction is trig- tact with the drug, the immune system gered. Attracted neutrophils, in a futile is sensitized: antigen-specific lympho- attempt to phagocytose the complexes, cytes of the T-type and B-type (antibody liberate lysosomal enzymes that dam- formation) proliferate in lymphatic tis- age the vascular walls (inflammation, sue and some of them remain as so- vasculitis). Usually, these pro- ver, exanthema, swelling of lymph cesses remain clinically silent. During nodes, arthritis, nephritis, and neuropa- the second contact, antibodies are al- thy. A detectable immune re- neously applied drug is bound to the sponse, the allergic reaction, occurs. Four types of lease signal molecules (lymphokines) reactions can be distinguished: into their vicinity that activate macro- Type 1, anaphylactic reaction. Binding of the drug provides the stimulus for the release of histamine and other media- tors. In the most severe form, a life- threatening anaphylactic shock devel- ops, accompanied by hypotension, bronchospasm (asthma attack), laryn- geal edema, urticaria, stimulation of gut musculature, and spontaneous bowel movements (p. Drug- antibody (IgG) complexes adhere to the surface of blood cells, where either circu- lating drug molecules or complexes al- Lüllmann, Color Atlas of Pharmacology © 2000 Thieme All rights reserved. Adverse Drug Effects 73 Reaction of immune system to first drug exposure Production of antibodies Drug (Immunoglobulins) (= hapten) Immune system e. Adverse drug effect: allergic reaction Lüllmann, Color Atlas of Pharmacology © 2000 Thieme All rights reserved. Drugs taken by the mother can be Drugs with established human ter- passed on transplacentally or via breast atogenicity include derivatives of vita- milk and adversely affect the unborn or min A (etretinate, isotretinoin [used the neonate. A peculiar type of dam- Pregnancy (A) age results from the synthetic estrogen- Limb malformations induced by the ic agent, diethylstilbestrol, following its hypnotic, thalidomide, first focused at- use during pregnancy; daughters of tention on the potential of drugs to treated mothers have an increased inci- cause malformations (teratogenicity). Predictable effects that derive from also necessary to consider the benefit the known pharmacological drug for the child resulting from adequate properties. For ization of the female fetus by andro- instance, therapy with antiepileptic genic hormones; brain hemorrhage drugs is indispensable, because untreat- due to oral anticoagulants; bradycar- ed epilepsy endangers the infant at least dia due to! Evaluation of drug use during pregnancy, the follow- risk should be based on factors listed in ing points have to be considered: B. The possible seque- the infant can be averted only by wean- lae of exposure to a drug depend on ing. Thus, the hazard posed by a drug with a specific action is lim- ited in time, as illustrated by the tet- racyclines, which produce effects on teeth and bones only after the third month of gestation, when mineral- ization begins.

Kapha imbalance may present with excessive sleep generic 100 mg mycelex-g visa antifungal nail pills, 37 mental dullness purchase mycelex-g 100mg otc anti fungal and bacterial cream, sinus congestion or asthma and obesity. Ayurvedic medicine 181 In addition to the elicitation of symptoms by history, signs of dosha imbalance may be evident on visual inspection, as in the evidence of dry skin or motor restlessness indicative of a Vata imbalance. The use of the sense of touch during the physical examination has a special place in ayurveda in the form of the technique of nadi vigyan, or pulse diagnosis. The radial pulse palpated by the examiner is assessed for its quality, in addition to its rate and rhythm. The theoretical basis for the ability to assess the general state of the physiology by means of palpation of the radial pulse is rooted in the understanding that the cardiovascular system both supplies and receives information from all organ systems. Its usefulness as part of a more comprehensive Vedic approach to health has been documented, although no well- controlled study of the technique in isolation is available. Pulse diagnosis is an example of a diagnostic technique with a therapeutic effect as well. Attention to the pulse, including the Vata, Pitta and Kapha components, is considered to have a balancing effect on the three doshas. Patients can be taught self pulse diagnosis, both to aid them in diagnosis of dosha imbalance, so that they can alter their diet or daily routine to correct that imbalance, and as a preventive health measure in itself. TREATMENT OF NEUROLOGICAL ILLNESSES The following modalities are employed in the prevention and treatment of diseases of the nervous system: (1) The TM technique; (2) Herbal mixtures (rasayanas) as noted in the Vedic literature; (3) Behavioral rasayanas; (4) Dietary recommendations; (5) Daily and seasonal routine recommendations; (6) Sound, aroma and environmental recommendations; (7) Purification and elimination therapies. The effects of the TM technique, herbal and behavioral rasayanas are discussed above. The recommendations for diet, daily and seasonal routines are found in the Vedic literature and vary in part by the diagnosis of dosha predominance and imbalance. AYURVEDA AND DIET With respect to diet, ayurvedic texts enumerate six tastes (rasas) and three main pairs of qualities (gunas) of foods, each with its effect of decreasing (pacifying) or increasing (aggravating) one or more of the doshas. In further explanation, breads and rice are considered to have a Complementary therapies in neurology 182 sweet taste. Foods with a bitter taste include green leafy vegetables, and astringent foods include legumes. A Vata-pacifying diet would favor sweet, sour and salty foods, as well as foods that are warm, heavy and oily. Foods to be avoided on a Vata-pacifying diet are those characterized by the tastes and qualities opposite to those enumerated above. Specifically, foods that are cold, light, dry, pungent, bitter and astringent tend to aggravate Vata. A Pitta-pacifying diet favors sweet, bitter and astringent foods, and cold, heavy and slightly oily foods. The Kaphapacifying diet favors pungent, bitter and astringent foods, as well as those that are light, dry and warm. Certain dietary recommendations are considered applicable to all patients, including: (1) Favoring a lactovegetarian diet; (2) Eating freshly prepared, well-cooked food; (3) Avoiding leftovers; (4) Eating until one feels three-quarters full; (5) Eating in a settled atmosphere; (6) Having the main meal at noon; (7) Including all six tastes in each meal. DAILY AND SEASONAL ROUTINES Daily and seasonal routines are based on the Vedic understanding of the normal variation of the predominance of each dosha over time. This forms the basis of the recommendation for eating the main meal at that time, when the digestive fire, governed by Pitta, is at its maximum. Similarly, the recommendations for rising and going to sleep are based on dosha predominance during the day. Other aspects of the daily routine recommended for disease prevention and health promotion include regular elimination in the morning after rising, followed by a warm sesame oil massage (abhyanga), mild stretching exercises (yoga asanas), practice of the TM technique twice daily, moderate exercise, and avoiding both excessive fatigue by overworking and an erratic schedule of eating and sleeping. Seasonal recommendations are governed by the knowledge of the dosha predominance by season. From an ayurvedic perspective, the year is divided into three seasons: (1) Kapha season from March to June, when the weather is cold and wet; (2) Pitta season from July to October, when heat is greatest; Ayurvedic medicine 183 (3) Vata season from November to February, when the weather is cold and windy. The human lifespan, much as the day and year, is also divided into intervals during which one or another dosha predominates. Childhood is considered a time of Kapha predominance, and young adulthood a time of Pitta predominance. In general, no matter which dosha is predominant, the effects of both the season and time of life may cause additional imbalance. As Vata has a tendency to be present in excess in old age, we expect this time of life to be associated with the corresponding symptoms of dry skin, arthritis (dry joints), constipation and sleep difficulties. The dementias and Parkinsonian disorders are also related to Vata derangement, expressed as improper movement and transport on the molecular and synaptic levels within the CNS, and on the grosser level as derangement in the movements of limbs and ambulation.

Drug concentration in infant´s blood Unwanted effect in child Sensitivity of Effect site of action B generic 100mg mycelex-g otc fungal nail infection. Lactation: maternal intake of drug Lüllmann discount mycelex-g 100 mg fast delivery antifungal insoles, Color Atlas of Pharmacology © 2000 Thieme All rights reserved. A placebo is a dosage form devoid of an Homeopathy (B) is an alternative active ingredient, a dummy medication. In only by minimal doses of the medicinal the care of a physician who projects substance. Consider gravely wounded combatants A direct action or effect on body in war, oblivious to their injuries while functions cannot be demonstrated for fighting to survive, only to experience homeopathic medicines. Therapeutic severe pain in the safety of the field hos- success is due to the suggestive powers pital, or the patient with a peptic ulcer of the homeopath and the expectancy of caused by emotional stress. In the individual influenced by emotional (psychic) fac- case, it may be impossible to decide tors and cannot be treated well by allo- whether therapeutic success is attribu- pathic means, a case can be made in fa- table to the drug or to the therapeutic vor of exploiting suggestion as a thera- situation. Homeopathy is one of sever- comparison of the effects of a drug and al possible methods of doing so. A prospective trial is planned in advance, a retrospective (case-control) study fol- lows patients backwards in time. Pa- tients are randomly allotted to two groups, namely, the placebo and the ac- tive or test drug group. In a double-blind trial, neither the patients nor the treat- ing physicians know which patient is given drug and which placebo. Finally, a switch from drug to placebo and vice versa can be made in a successive phase of treatment, the cross-over trial. Drug-independent Effects 77 Conscious Conscious and and unconscious unconscious Mind signals: expectations language, facial expression, gestures Well-being complaints Placebo Effect: - wanted - unwanted Body Physician Patient A. Therapeutic effects resulting from physician´s power of suggestion “Similia similibus curentur” Homeopath Patient “Drug” Normal, allopathic dose symptom profile Dilution “effect reversal” Very low homeopathic dose elimination of disease symptoms corresponding to allopathic symptom “profile” “Potentiation” increase in efficacy with progressive dilution Profile of disease symptoms Symptom “profile” “Drug diagnosis” Homeopathic Stock- remedy (“Simile”) solution Dilution D9 110 110 110 110 110 110 110 110 110 11000000000 B. Homeopathy: concepts and procedure Lüllmann, Color Atlas of Pharmacology © 2000 Thieme All rights reserved. Systems Pharmacology Lüllmann, Color Atlas of Pharmacology © 2000 Thieme All rights reserved. To ensure adequate supply of oxy- This regulatory system consists of the gen and nutrients, blood flow in skeletal CNS (brain plus spinal cord) and two muscle is increased; cardiac rate and separate pathways for two-way com- contractility are enhanced, resulting in a munication with peripheral organs, viz. The somatic nervous system blood vessels diverts blood into vascular comprising extero- and interoceptive beds in muscle. The auto- that peristalsis diminishes and sphinc- nomic (vegetative) nervous system teric tonus increases. However, in order (ANS), together with the endocrine to increase nutrient supply to heart and system, controls the milieu interieur. It musculature, glucose from the liver and adjusts internal organ functions to the free fatty acid from adipose tissue must changing needs of the organism. The bronchi control permits very quick adaptation, are dilated, enabling tidal volume and whereas the endocrine system provides alveolar oxygen uptake to be increased. The ANS operates largely beyond sympathetic fibers (wet palms due to voluntary control; it functions autono- excitement); however, these are excep- mously. Its central components reside tional as regards their neurotransmitter in the hypothalamus, brain stem, and (ACh, p. The ANS also participates in Although the life styles of modern the regulation of endocrine functions. In many organs innervated by both branches, re- spective activation of the sympathetic and parasympathetic input evokes op- posing responses. In various disease states (organ malfunctions), drugs are employed with the intention of normalizing susceptible organ functions. To understand the bio- logical effects of substances capable of inhibiting or exciting sympathetic or parasympathetic nerves, one must first envisage the functions subserved by the sympathetic and parasympathetic divi- sions (A, Responses to sympathetic ac- tivation). In simplistic terms, activation Lüllmann, Color Atlas of Pharmacology © 2000 Thieme All rights reserved.

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