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Ammi visnaga

Botanical Name: Ammi visnaga
Family:Apiaceae
Genus:Ammi
Species:A. visnaga
Kingdom: Plantae
Order:Apiales

Synonyms : Ammi dilatatum. Apium visnaga. Carum visnaga. Daucus visnaga.

Common names : Bisnaga, Toothpickweed, and Khella.

Habitat: Ammi visnaga is native to Europe, Asia, and North Africa, but it can be found throughout the world as an introduced species.It grows in fields and sandy places.
Description:
Ammi visnaga is an annual or biennial herb growing from a taproot erect to a maximum height near 80 centimeters. Leaves are up to 20 centimeters long and generally oval to triangular in shape but dissected into many small linear to lance-shaped segments. The inflorescence is a compound umbel of white flowers similar to those of other Apiaceae species. The fruit is a compressed oval-shaped body less than 3 millimeters long. This and other Ammi species are sources of khellin, a diuretic extract.

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It is in flower from Jul to September. The flowers are hermaphrodite (have both male and female organs) and are pollinated by Insects.The plant is self-fertile.

Cultivation:
Prefers a well-drained soil in a sunny position, succeeding in ordinary garden soil. Tolerates a pH in the range 6.8 to 8.3. This species is not fully winter-hardy in the colder areas of Britain, though it should be possible to grow it as a spring-sown annual. This plant is sold as toothpicks in Egyptian markets.

Propagation: Seed – sow spring in situ. ( Sow under cover Feb-March in a seed tray, module or guttering. Sow direct March-May and/or August-September.)
Edible Uses: Leaves are chewed raw for their pleasant aromatic flavour

Chemical constituents:
Khellin, a chemical obtained from Ammi visnaga gives rose red color with KOH (solid) or NaOH & 2-3 drops of water, was used at one time as a smooth muscle relaxant, but its use is limited due to adverse side effects. Amiodarone and cromoglycate are derivates of khellin that are frequently used in modern medicine.

The chemical visnagin, which is found in A. visnaga, has biological activity in animal models as a vasodilator and reduces blood pressure by inhibiting calcium influx into the cell.
Medicinal Uses:
Antiarrhythmic; Antiasthmatic; Antispasmodic; Diuretic; Lithontripic; Vasodilator.

Visnaga is an effective muscle relaxant and has been used for centuries to alleviate the excruciating pain of kidney stones. Modern research has confirmed the validity of this traditional use. Visnagin contains khellin, from which particularly safe pharmaceutical drugs for the treatment of asthma have been made. The seeds are diuretic and lithontripic. They contain a fatty oil that includes the substance ‘khellin’. This has been shown to be of benefit in the treatment of asthma. Taken internally, the seeds have a strongly antispasmodic action on the smaller bronchial muscles, they also dilate the bronchial, urinary and blood vessels without affecting blood pressure. The affect last for about 6 hours and the plant has practically no side effects. The seeds are used in the treatment of asthma, angina, coronary arteriosclerosis and kidney stones. By relaxing the muscles of the urethra, visnaga reduces the pain caused by trapped kidney stones and helps ease the stone down into the bladder. The seeds are harvested in late summer before they have fully ripened and are dried for later use.
In Egypt, a tea made from the fruit of this species has been used as an herbal remedy for kidney stones. Laborarory rat studies show that the extract slows the buildup of calcium oxalate crystals in the kidneys and acts as a diuretic.
This plant and its components have shown effects in dilating the coronary arteries. Its mechanism of action may be very similar to the calcium channel-blocking drugs. The New England Journal of Medicine writes “The high proportion of favorable results, together with the striking degree of improvement frequently observed, has led us to the conclusion that Khellin, properly used, is a safe and effective drug for the treatment of angina pectoris.” As little as 30 milligrams of Khellin per day appear to offer as good a result, with fewer side effects. Rather than use the isolated compound “Khellin,” Khella extracts standardized for khellin content (typically 12 percent) are the preferred form.

A daily dose of such an extract would be 250 to 300 milligrams. Khella appears to work very well with hawthorn extracts. An aromatic herb which dilates the bronchial, urinary and blood vessels without affecting blood pressure.

Visnaga is a traditional Egyptian remedy for kidney stones. By relaxing the muscles of the ureter, visnaga reduces the pain caused by the trapped stone and helps ease the stone down into the bladder. Following research into its antispasmodic properties, visnaga is now given for asthma and is safe even for children to take. Although it does not always relieve acute asthma attacks, it do3es help to prevent their recurrence. It is an effective remedy for various respiratory problems, including bronchitis, emphysema, and whooping cough. In Andalusia in Spain, the largest and best quality visnaga were employed to clean the teeth. Khella is the source of amiodarone one of the key anti-arrhythmia medications. The usual recommendation calls for pouring boiling water over about a quarter-teaspoon of powdered khella fruits. Steep for five minutes and drink the tea after straining.

Its active constituent is khellin, a bronchiodilator and antispasmodic that makes it useful for asthma sufferers It’s best used to prevent asthma rather than to counter an attack and can be taken on a daily basis with no contraindications. Because khella builds up in the blood, its use can be decreased after a period of time. Khella is safer than ma huang (ephedra) for asthma sufferers because it’s nonstimulating and nonenervating. Unlike ma huang, it doesn’t rob the body, especially the adrenals, of energy.

Spasmolytic action of khellin and visnagin (both furanochromones) is indicated for treatment of asthma and coronary arteriosclerosis.
An extract from khella (Ammi visnaga) is so far the only herb found to be useful in vitili. Khellin, the active constituent, appears to work like psoralen drugs?it stimulates repigmentation of the skin by increasing sensitivity of remaining pigment-containing cells (melanocytes) to sunlight. Studies have used 120-160 mg of khellin per day. Khellin must be used with caution, as it can cause side effects such as nausea and insomnia.

Another use is for vitiligo (an extract from ammi visnaga appears to stimulate repigmentation of the skin by increasing sensitivity of remaining pigment containing cells, melanocytes to sunlight)

Other Uses: The fruiting pedicel is used as a toothpick whilst the seeds have been used as a tooth cleaner

Known Hazards : Skin contact with the sap is said to cause photo-sensitivity and/or dermatitis in some people. Avoid during pregnancy and lactation. Avoid if on warfarin or other blood thinning medication. Prolonged use may lead to: constipation, appetite loss, headaches, vertigo, nausea and vomiting.

Disclaimer : The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplement, it is always advisable to consult with your own health care provider.
Resources:
http://en.wikipedia.org/wiki/Ammi_visnaga
http://www.pfaf.org/user/Plant.aspx?LatinName=Ammi+visnaga
http://www.sarahraven.com/flowers/plants/cut_flower_seedlings/ammi_visnaga.htm

http://www.herbnet.com/Herb%20Uses_IJK.htm

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Cognitive Behavioural Therapy (CBT)

Definition:
Cognitive behavior therapy (CBT) is a type of psychotherapeutic treatment that helps patients understand the thoughts and feelings that influence behaviors. CBT is commonly used to treat a wide range of disorders including phobias, addictions, depression, and anxiety.

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Cognitive behavioral therapy (CBT) is a short-term psychotherapy originally designed to treat depression, but is now used for a number of mental illnesses. It works to solve current problems and change unhelpful thinking and behavior.  The name refers to behavior therapy, cognitive therapy, and therapy based upon a combination of basic behavioral and cognitive principles.  Most therapists working with patients dealing with anxiety and depression use a blend of cognitive and behavioral therapy. This technique acknowledges that there may be behaviors that cannot be controlled through rational thought, but rather emerge based on prior conditioning from the environment and other external and/or internal stimuli. CBT is “problem focused” (undertaken for specific problems) and “action oriented” (therapist tries to assist the client in selecting specific strategies to help address those problems),  or directive in its therapeutic approach.

CBT has been demonstrated to be effective for the treatment of a variety of conditions, including mood, anxiety, personality, eating, substance abuse, tic, and psychotic disorders. Many CBT treatment programs for specific disorders have been evaluated for efficacy; the health-care trend of evidence-based treatment, where specific treatments for symptom-based diagnoses are recommended, has favored CBT over other approaches such as psychodynamic treatments.  However, other researchers have questioned the validity of such claims to superiority over other treatments.

Description:
Mainstream cognitive behavioral therapy assumes that changing maladaptive thinking leads to change in affect and behavior,[8] but recent variants emphasize changes in one’s relationship to maladaptive thinking rather than changes in thinking itself.  Therapists or computer-based programs use CBT techniques to help individuals challenge their patterns and beliefs and replace “errors in thinking such as overgeneralizing, magnifying negatives, minimizing positives and catastrophizing” with “more realistic and effective thoughts, thus decreasing emotional distress and self-defeating behavior.”  These errors in thinking are known as cognitive distortions. Cognitive distortions can be either a pseudo- discrimination belief or an over-generalization of something.  CBT techniques may also be used to help individuals take a more open, mindful, and aware posture toward them so as to diminish their impact. Mainstream CBT helps individuals replace “maladaptive… coping skills, cognitions, emotions and behaviors with more adaptive ones”,  by challenging an individual’s way of thinking and the way that they react to certain habits or behaviors,  but there is still controversy about the degree to which these traditional cognitive elements account for the effects seen with CBT over and above the earlier behavioral elements such as exposure and skills training.

Modern forms of CBT include a number of diverse but related techniques such as exposure therapy, stress inoculation training, cognitive processing therapy, cognitive therapy, relaxation training, dialectical behavior therapy, and acceptance and commitment therapy.  Some practitioners promote a form of mindful cognitive therapy which includes a greater emphasis on self-awareness as part of the therapeutic process.

CBT has six phases:
1.Assessment or psychological assessment;
2.Reconceptualization;
3.Skills acquisition;
4.Skills consolidation and application training;
5.Generalization and maintenance;
6.Post-treatment assessment follow-up.

The reconceptualization phase makes up much of the “cognitive” portion of CBT.   A summary of modern CBT approaches is given by Hofmann.

There are different protocols for delivering cognitive behavioral therapy, with important similarities among them.  Use of the term CBT may refer to different interventions, including “self-instructions (e.g. distraction, imagery, motivational self-talk), relaxation and/or biofeedback, development of adaptive coping strategies (e.g. minimizing negative or self-defeating thoughts), changing maladaptive beliefs about pain, and goal setting”. Treatment is sometimes manualized, with brief, direct, and time-limited treatments for individual psychological disorders that are specific technique-driven. CBT is used in both individual and group settings, and the techniques are often adapted for self-help applications. Some clinicians and researchers are cognitively oriented (e.g. cognitive restructuring), while others are more behaviorally oriented (e.g. in vivo exposure therapy). Interventions such as imaginal exposure therapy combine both approaches.

Types of Cognitive Behavior Therapy:
There are a number of different approaches to CBT that are regularly used by mental health professionals. These types include:
•Rational Emotive Behavior Therapy (REBT)
•Cognitive Therapy
•Multimodal Therapy

Medical uses of CBT:
In adults, CBT has been shown to have effectiveness and a role in the treatment plans for anxiety disorders,  depressioneating disorders chronic low back painpersonality disorderspsychosis,  schizophrenia,  substance use disorders,  in the adjustment, depression, and anxiety associated with fibromyalgia,  and with post-spinal cord injuries.  Evidence has shown CBT is effective in helping treat schizophrenia, and it is now offered in most treatment guidelines.

In children or adolescents, CBT is an effective part of treatment plans for anxiety disorders,  body dysmorphic disorder,  depression and suicidality,  eating disorders and obesity,  obsessive–compulsive disorder,  and posttraumatic stress disorder,  as well as tic disorders, trichotillomania, and other repetitive behavior disorders.

Cochrane reviews have found no evidence that CBT is effective for tinnitus, although there appears to be an effect on management of associated depression and quality of life in this condition.   Other recent Cochrane Reviews found no convincing evidence that CBT training helps foster care providers manage difficult behaviors in the youth under their care,  nor was it helpful in treating men who abuse their intimate partners.

According to a 2004 review by INSERM of three methods, cognitive behavioral therapy was either “proven” or “presumed” to be an effective therapy on several specific mental disorders.  According to the study, CBT was effective at treating schizophrenia, depression, bipolar disorder, panic disorder, post-traumatic stress, anxiety disorders, bulimia, anorexia, personality disorders and alcohol dependency.

Some meta-analyses find CBT more effective than psychodynamic therapy and equal to other therapies in treating anxiety and depression.  However, psychodynamic therapy may provide better long-term outcomes.

Computerized CBT (CCBT) has been proven to be effective by randomized controlled and other trials in treating depression and anxiety disorders, including children,  as well as insomnia.  Some research has found similar effectiveness to an intervention of informational websites and weekly telephone calls.  CCBT was found to be equally effective as face-to-face CBT in adolescent anxiety  and insomnia.

Criticism of CBT sometimes focuses on implementations (such as the UK IAPT) which may result initially in low quality therapy being offered by poorly trained practitioners.  However evidence supports the effectiveness of CBT for anxiety and depression.

Mounting evidence suggests that the addition of hypnotherapy as an adjunct to CBT improves treatment efficacy for a variety of clinical issues.

CBT has been applied in both clinical and non-clinical environments to treat disorders such as personality conditions and behavioral problems.  A systematic review of CBT in depression and anxiety disorders concluded that “CBT delivered in primary care, especially including computer- or Internet-based self-help programs, is potentially more effective than usual care and could be delivered effectively by primary care therapists.”

Emerging evidence suggests a possible role for CBT in the treatment of attention deficit hyperactivity disorder (ADHD);  hypochondriasis;  coping with the impact of multiple sclerosis;  sleep disturbances related to aging; dysmenorrhea;  and bipolar disorder,  but more study is needed and results should be interpreted with caution. CBT has been studied as an aid in the treatment of anxiety associated with stuttering. Initial studies have shown CBT to be effective in reducing social anxiety in adults who stutter,  but not in reducing stuttering frequency.

Martinez-Devesa et al. (2010) found no evidence that CBT is effective for tinnitus, although there appears to be an effect on management of associated depression and quality of life in this condition. Turner et al. (2007) found no convincing evidence that CBT training helps foster care providers manage difficult behaviors in the youth under their care,[39] and Smedslund et al. (2007) found that it was not helpful in treating men who abuse their intimate partners.

In the case of metastatic breast cancer, Edwards et al. (2008) maintained that the current body of evidence is not sufficient to rule out the possibility that psychological interventions may cause harm to women with this advanced neoplasm.

In adults, CBT has been shown to have a role in the treatment plans for anxiety disorders; depression;  eating disorders;  chronic low back pain;  personality disorders;  psychosis; schizophrenia;  substance use disorders;  in the adjustment, depression, and anxiety associated with fibromyalgia;  and with post-spinal cord injuries.  There is some evidence that CBT is superior in the long-term to benzodiazepines and the nonbenzodiazepines in the treatment and management of insomnia.  CBT has been shown to be moderately effective for treating chronic fatigue syndrome.

In children or adolescents, CBT is an effective part of treatment plans for anxiety disorders;  body dysmorphic disorder;  depression and suicidality;  eating disorders and obesity;  obsessive–compulsive disorder;  and posttraumatic stress disorder;  as well as tic disorders, trichotillomania, and other repetitive behavior disorders. CBT-SP, an adaptation of CBT for suicide prevention (SP), was specifically designed for treating youth who are severely depressed and who have recently attempted suicide within the past 90 days, and was found to be effective, feasible, and acceptable. Sparx is a video game to help young persons, using the CBT method to teach them how to resolve their own issues. That’s a new way of therapy, which is quite effective for child and teenager. CBT has also been shown to be effective for posttraumatic stress disorder in very young children (3 to 6 years of age).  Cognitive Behavior Therapy has also been applied to a variety of childhood disorders,  including depressive disorders and various anxiety disorders.

In the United Kingdom, the National Institute for Health and Care Excellence (NICE) recommends CBT in the treatment plans for a number of mental health difficulties, including posttraumatic stress disorder, obsessive–compulsive disorder (OCD), bulimia nervosa, and clinical depression

Use of CBT  in other different ways:
With older adults:
CBT is used to help people of all ages, but the therapy should be adjusted based on the age of the patient with whom the therapist is dealing. Older individuals in particular have certain characteristics that need to be acknowledged and the therapy altered to account for these differences thanks to age.   Some of the challenges to CBT because of age include the following:
The Cohort effect The times that each generation lives through partially shape its thought processes as well as values, so a 70-year-old may react to the therapy very differently from a 30-year-old, because of the different culture in which they were brought up. A tie-in to this effect is that each generation has to interact with one another, and the differing values clashing with one another may make the therapy more difficult.  Established role By the time one reaches old age, the person has a definitive idea of her or his role in life and is invested in that role. This social role can dominate who the person thinks he or she is and may make it difficult to adapt to the changes required in CBT. Mentality toward aging If the older individual sees aging itself as a negative this can exacerbate whatever malady the therapy is trying to help (depression and anxiety for example).  Negative stereotypes and prejudice against the elderly cause depression as the stereotypes become self-relevant.[88]Processing speed decreasesAs we age, we take longer to learn new information, and as a result may take more time to learn and retain the cognitive therapy. Therefore, therapists should slow down the pacing of the therapy and use any tools both written and verbal that will improve the retention of the cognitive behavioral therapy.

Prevention of mental illness:
For anxiety disorders, use of CBT with people at risk has significantly reduced the number of episodes of generalized anxiety disorder and other anxiety symptoms, and also given significant improvements in explanatory style, hopelessness, and dysfunctional attitudes.  In another study, 3% of the group receiving the CBT intervention developed generalized anxiety disorder by 12 months post intervention compared with 14% in the control group.  Subthreshold panic disorder sufferers were found to significantly benefit from use of CBT.  Use of CBT was found to significantly reduce social anxiety prevalence.

For depressive disorders, a stepped-care intervention (watchful waiting, CBT and medication if appropriate) achieved a 50% lower incidence rate in a patient group aged 75 or older.  Another depression study found a neutral effect compared to personal, social, and health education, and usual school provision, and included a comment on potential for increased depression scores from people who have received CBT due to greater self recognition and acknowledgement of existing symptoms of depression and negative thinking styles.[99] A further study also saw a neutral result. A meta-study of the Coping with Depression course, a cognitive behavioural intervention delivered by a psychoeducational method, saw a 38% reduction in risk of major depression.

For schizophrenia, one study of preventative CBT showed a positive effect   and another showed neutral effect.

Criticisms of Cognitive Behavior Therapy:
The research conducted for CBT has been a topic of sustained controversy. While some researchers write that CBT is more effective than other treatments,[148] many other researchers  and practitioners  have questioned the validity of such claims. For example, one study  determined CBT to be superior to other treatments in treating anxiety and depression. However, researchers responding directly to that study conducted a re-analysis and found no evidence of CBT being superior to other bona fide treatments, and conducted an analysis of thirteen other CBT clinical trials and determined that they failed to provide evidence of CBT superiority.

Furthermore, other researchers  write that CBT studies have high drop-out rates compared to other treatments. At times, the CBT drop-out rates can be more than five times higher than other treatments groups. For example, the researchers provided statistics of 28 participants in a group receiving CBT therapy dropping out, compared to 5 participants in a group receiving problem-solving therapy dropping out, or 11 participants in a group receiving psychodynamic therapy dropping out.

Other researchers  conducting an analysis of treatments for youth who self-injure found similar drop-out rates in CBT and DBT groups. In this study, the researchers analyzed several clinical trials that measured the efficacy of CBT administered to youth who self-injure. The researchers concluded that none of them were found to be efficacious. These conclusions  were made using the APA Division 12 Task Force on the Promotion and Dissemination of Psychological Procedures to determine intervention potency.

However, the research methods employed in CBT research have not been the only criticisms identified. Others have called CBT theory and therapy into question. For example, Fancher  writes the CBT has failed to provide a framework for clear and correct thinking. He states that it is strange for CBT theorists to develop a framework for determining distorted thinking without ever developing a framework for “cognitive clarity” or what would count as “healthy, normal thinking.” Additionally, he writes that irrational thinking cannot be a source of mental and emotional distress when there is no evidence of rational thinking causing psychological well-being. Or, that social psychology has proven the normal cognitive processes of the average person to be irrational, even those who are psychologically well. Fancher also says that the theory of CBT is inconsistent with basic principles and research of rationality, and even ignores many rules of logic. He argues that CBT makes something of thinking that is far less exciting and true than thinking probably is. Among his other arguments are the maintaining of the status quo promoted in CBT, the self-deception encouraged within clients and patients engaged in CBT, how poorly the research is conducted, and some of its basic tenets and norms: “The basic norm of cognitive therapy is this: except for how the patient thinks, everything is ok”.

Meanwhile, Slife and Williams  write that one of the hidden assumptions in CBT is that of determinism, or the absence of free will. They argue that CBT invokes a type of cause-and-effect relationship with cognition. They state that CBT holds that external stimuli from the environment enter the mind, causing different thoughts that cause emotional states. Nowhere in CBT theory is agency, or free will, accounted for. At its most basic foundational assumptions, CBT holds that human beings have no free will and are just determined by the cognitive processes invoked by external stimuli.

Another criticism of CBT theory, especially as applied to Major Depressive Disorder (MDD), is that it confounds the symptoms of the disorder with its causes.

A major criticism has been that clinical studies of CBT efficacy (or any psychotherapy) are not double-blind (i.e., neither subjects nor therapists in psychotherapy studies are blind to the type of treatment). They may be single-blinded, i.e. the rater may not know the treatment the patient received, but neither the patients nor the therapists are blinded to the type of therapy given (two out of three of the persons involved in the trial, i.e., all of the persons involved in the treatment, are unblinded). The patient is an active participant in correcting negative distorted thoughts, thus quite aware of the treatment group they are in.

The importance of double-blinding was shown in a meta-analysis that examined the effectiveness of CBT when placebo control and blindedness were factored in.[156] Pooled data from published trials of CBT in schizophrenia, MDD, and bipolar disorder that used controls for non-specific effects of intervention were analyzed. This study concluded that CBT is no better than non-specific control interventions in the treatment of schizophrenia and does not reduce relapse rates, treatment effects are small in treatment studies of MDD, and it is not an effective treatment strategy for prevention of relapse in bipolar disorder. For MDD, the authors note that the pooled effect size was very low. Nevertheless, the methodological processes used to select the studies in the previously mentioned meta-analysis and the worth of its findings have been called into question.

Resources:
http://en.wikipedia.org/wiki/Cognitive_behavioral_therapy
http://psychology.about.com/od/psychotherapy/a/cbt.htm

Lupus Nephritis

 

Alternative Names: Nephritis – lupus; Lupus glomerular disease

Definition:
Lupus nephritis is an inflammation of the kidney caused by systemic lupus erythematosus (SLE), a disease of the immune system. Apart from the kidneys, SLE can also damage the skin, joints, nervous system and virtually any organ or system in the body.

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Symptoms:
General symptoms of lupus include malar rash, discoid rash, photosensitivity, oral ulcers, nonerosive arthritis, pleuropericarditis, renal disease, neurological manifestations, and haematological disorders.

Clinically, SLE usually presents with fever, weight loss (100%), arthralgias, synovitis, arthritis (95%), pleuritis, pericarditis (80%), malar facial rash, photodermatosis, alopecia (75%), anaemia, leukopaenia, thrombocytopaenia, and thromboses (50%).

About half of cases of SLE demonstrate signs of lupus nephritis at one time or another. Renal-specific signs include proteinuria (100%), nephrotic syndrome (55%), granular casts (30%), red cell casts (10%), microhematuria (80%), macrohematuria (2%), reduced renal function (60%), RPGN (30%), ARF (2%), hypertension (35%), hyperkalemia (15%) and tubular abnormalities (70%).

The World Health Organization (WHO) developed a system to classify the six different stages of lupus nephritis:

Stage 1: no evidence of lupus nephritis:
In histology, Stage I (minimal mesangial) disease has a normal appearance under light microscopy, but mesangial deposits are visible under electron microscopy. At this stage urinalysis is typically normal.
Stage 2: mildest form, easily treated with corticosteroids:
Stage 2 disease (mesangial proliferative) is noted by mesangial hypercellularity and matrix expansion. Microscopic haematuria with or without proteinuria may be seen. Hypertension, nephrotic syndrome, and acute renal insufficiency are rare at this stage.
Stage 3: earliest stage of advanced lupus. Treatment requires high amounts of corticosteroids. The outlook remains favorable.

Stage 3 disease (focal lupus nephritis) is indicated by sclerotic lesions involving less than 50% of the glomeruli, which can be segmental or global, and active or chronic, with endocapillary or extracapillary proliferative lesions. Under electron microscopy, subendothelial deposits are noted, and some mesangial changes may be present. Immunofluorescence reveals the so-called “Full House” stain, staining positively for IgG, IgA, IgM, C3, and C1q. Clinically, haematuria and proteinuria is present, with or without nephrotic syndrome, hypertension, and elevated serum creatinine.
Diffuse proliferative lupus nephritis; photo shows the classic “flea-bitten” appearance of the cortical surface in the diffuse proliferative glomerulonephritides

Stage 4: advanced stage of lupus.

Stage 4 lupus nephritis (diffuse proliferative) is both the most severe, and the most common subtype. More than 50% of glomeruli are involved. Lesions can be segmental or global, and active or chronic, with endocapillary or extracapillary proliferative lesions. Under electron microscopy, subendothelial deposits are noted, and some mesangial changes may be present. Immunofluorescence reveals the so-called “Full House” stain, staining positively for IgG, IgA, IgM, C3, and C1q. Clinically, haematuria and proteinuria are present, frequently with nephrotic syndrome, hypertension, hypocomplementemia, elevated anti-dsDNA titres and elevated serum creatinine. There is the risk of kidney failure. Patients require high amounts of corticosteroids and immune suppression medications.
A wire-loop lesion may be present in stage III and IV. This is a glomerular capillary loop with subendothelial immune complex deposition that is circumferential around the loop. Stage V is denoted by a uniformly thickened, eosinophilic basement membrane. Stage III and IV are differentiated only by the number of glomeruli involved (which is subject to inherent sample bias), but clinically the presentation and prognosis are both expected to be more severe in stage 4 versus stage 3.
Stage 5:
Stage 5 (membranous lupus nephritis) is characterized by diffuse thickening of the glomerular capillary wall (segmentally or globally), with diffuse membrane thickening, and subepithelial deposits seen under electron microscopy. Clinically, stage V presents with signs of nephrotic syndrome. Microscopic haematuria and hypertension may also been seen. Plasma creatinine is usually normal or slightly elevated, and stage V may not present with any other clinical/serological manifestations of SLE (complement levels may be normal; anti-DNA Ab may not be detectable). Stage 5 also predisposes the affected individual to thrombotic complications such as renal vein thromboses or pulmonary emboli.Excessive protein loss and swelling. Doctors will treat with high amounts of corticosteroids. Doctors may or may not give immune-suppressing drugs.
A final stage is usually included by most practitioners, stage VI, or advanced sclerosing lupus nephritis. It is represented by Global sclerosis involving more than 90% of glomeruli, and represents healing of prior inflammatory injury. Active glomerulonephritis is usually not present. This stage is characterised by slowly progressive renal dysfunction, with relatively bland urine sediment. Response to immunotherapy is usually poor.

A tubuloreticular inclusion is also characteristic of lupus nephritis, and can be seen under electron microscopy in all stages. It is not diagnostic however, as it exists in other conditions. It is thought to be due to chronic interferon exposure.
Causes:
Systemic lupus erythematosus (SLE, or lupus) is an autoimmune disease. This means there is a problem with the body’s immune system.

Normally, the immune system helps protect the body from infection or harmful substances. But in patients with an autoimmune disease, the immune system cannot tell the difference between harmful substances and healthy ones. As a result, the immune system attacks otherwise healthy cells and tissue.

SLE may damage different parts of the kidney, leading to interstitial nephritis, nephrotic syndrome, and membranous GN. It may rapidly worsen to kidney failure.

Lupus nephritis affects approximately 3 out of every 10,000 people. In children with SLE, about half will have some form or degree of kidney involvement.

More than half of patients have not had other symptoms of SLE when they are diagnosed with lupus nephritis.

SLE is most common in women ages 20 – 40.
Diagnosis:
The diagnosis of lupus nephritis depends on blood tests, urinalysis, X-rays, ultrasound scans of the kidneys, and a kidney biopsy. On urinalysis, a nephritic picture is found and RBC casts, RBCs and proteinuria is found.

The World Health Organization has divided lupus nephritis into five stages based on the biopsy. This classification was defined in 1982 and revised in 1995.

* Class I is minimal mesangial glomerulonephritis which is histologically normal on light microscopy but with mesangial deposits on electron microscopy. It constitutes about 5% of cases of lupus nephritis. Renal failure is very rare in this form.[2]

*Class II is based on a finding of mesangial proliferative lupus nephritis. This form typically responds completely to treatment with corticosteroids. It constitutes about 20% of cases.[2] Renal failure is rare in this form.[2]

* Class III is focal proliferative nephritis and often successfully responds to treatment with high doses of corticosteroids. It constitutes about 25% of cases. Renal failure is uncommon in this form.

*Class IV is diffuse proliferative nephritis. This form is mainly treated with corticosteroids and immunosuppressant drugs. It constitutes about 40% of cases. Renal failure is common in this form.

* Class V is membranous nephritis and is characterized by extreme edema and protein loss. It constitutes about 10% of cases.[2] Renal failure is uncommon in this form.

Medicines are prescribed that decrease swelling, lower blood pressure, and decrease inflammation by suppressing the immune system: Patients may need to monitor intake of protein, sodium, and potassium. Patients with severe disease should restrict their sodium intake to 2 grams per day and limit fluid as well. Depending on the histology, renal function and degree of proteinuria, patients may require steroid therapy or chemotherapy regimens such as cyclophosphamide, azathioprine, mycophenolate mofetil, or cyclosporine.
Possible Complications:

*Acute renal failure
*Chronic renal failure
*End-stage renal disease
*Nephrotic syndrome
Treatment:

There is no cure for lupus nephritis. The goal of treatment is to keep the problem from getting worse. Stopping kidney damage early can prevent the need for a kidney transplant.

Treatment can also provide relief from lupus symptoms.

Common treatments include:

*minimizing intake of protein and salt
*taking blood pressure medication
*using steroids to reduce swelling and inflammation
*taking immune-suppression medicines like prednisone to reduce immune system damage to the kidneys

Extensive kidney damage may require additional treatment.

Drug regimens prescribed for lupus nephritis include mycophenolate mofetil (MMF), intravenous cyclophosphamide with corticosteroids, and the immune suppressant azathioprine with corticosteroids. MMF and cyclophosphamide with corticosteroids are equally effective in achieving remission of the disease. MMF is safer than cyclophosphamide with corticosteroids, with less chance of causing ovarian failure, immune problems or hair loss. It also works better than azathioprine with corticosteroids for maintenance therapy.

Prognosis:  How well you do depends on the specific form of lupus nephritis. You may have flare-ups, and then times when you do not have any symptoms.

Some people with this condition develop chronic kidney failure.

Although lupus nephritis may return in a transplanted kidney, it rarely leads to end-stage kidney disease.
Prevention: There is no known prevention for lupus nephritis.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
Resources:
http://en.wikipedia.org/wiki/Lupus_nephritis
http://www.nlm.nih.gov/medlineplus/ency/article/000481.htm
http://www.healthline.com/health/lupus-nephritis#Diagnosis3

Goldenseal (Hydrastis canadensis)

Botanical Name :Hydrastis canadensis
Family: Ranunculaceae
Genus: Hydrastis
Species: H. canadensis
Kingdom: Plantae
Order: Ranunculales

Common Names:Goldenseal , orangeroot or yellow puccoon

Habitat :Hydrastis canadensis is native to southeastern Canada and the northeastern United States.  Eastern N. America – Connecticut to Minnesota, Missouri and Kansas.It grows in rich shady woods and moist areas on woodland edges. Mesic, deciduous forests, often on clay soils at elevations of 50 – 1200 metres.

Description:

Hydrastis canadensis  is a perennial herb. It may be distinguished by its thick, yellow knotted rootstock. The stem is purplish and hairy above ground and yellow below ground where it connects to the yellow rhizome. The plant bears two palmate, hairy leaves with 5–7 double-toothed lobes and single, small, inconspicuous flowers with greenish white stamens in the late spring and the seeds ripen from July to August. The flowers are hermaphrodite (have both male and female organs) It bears a single berry like a large raspberry with 10–30 seeds in the summer.

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It is hardy to zone 3.

Cultivation:
Goldenseal is somewhat difficult of cultivation, it prefers a good rich moist loamy leafy soil in shade or partial shade. Prefers a sandy, acid to neutral humus-rich soil. Grows best in a pH range from 6 to 7. Plants are hardy to at least -15°c. Goldenseal is grown commercially as a medicinal plant, but it is not easy to establish the plants[4, 200]. Another report says that all goldenseal root that is used medicinally comes from wild plants. Since the plant is becoming increasingly rare in many parts of its range, it is probably wise to try and find alternatives to this species for medicinal use unless you can be sure that your supply comes from cultivated plants.

Propagation:
Seed – sow autumn or early spring in a moist sandy loam in a shady part of the cold frame or greenhouse. The seed is slow to germinate. Prick out the seedlings into individual pots when they are large enough to handle and grow them on in light shade in the greenhouse for the first year or two. Plant out into their permanent positions when the plants are dormant. Division of the roots in autumn. The roots can be divided into quite small pieces and can also be transplanted at almost any time of the year. Larger clumps can be replanted direct into their permanent positions, though it is best to pot up smaller clumps and grow them on in a cold frame until they are rooting well. Plant them out in the spring.

Constituents:
Goldenseal contains the isoquinoline alkaloids: hydrastine, berberine, berberastine, hydrastinine, tetrahydroberberastine, canadine, and canalidine. A related compound, 8-oxotetrahydrothalifendine was identified in one study. One study analyzed the hydrastine and berberine contents of twenty commercial goldenseal and goldenseal-containing products and found they contained variously 0%-2.93% hydrastine and 0.82%-5.86% berberine. Berberine and hydrastine act as quaternary bases and are poorly soluble in water but freely soluble in alcohol. The herb seems to have synergistic antibacterial activity over berberine in vitro, possibly due to efflux pump inhibitory activity.

Multiple bacteria and fungi, along with selected protozoa and chlamydia are susceptible to berberine in vitro. Berberine alone has weak antibiotic activity in vitro since many microorganisms actively export it from the cell (although a whole herb is likely to work on the immune system as well as on attacking the microbes and hence have a stronger clinical effect than the antibiotic activity alone would suggest).[citation needed] Interestingly, there is some evidence for other berberine-containing species synthesizing an efflux pump inhibitor that tends to prevent antibiotic resistance, a case of solid scientific evidence that the herb is superior to the isolated active principle. However, it is not yet known whether goldenseal contains a drug resistance efflux pump inhibitor, although many antimicrobial herbs do

Medicinal Uses
Antibacterial; Antiperiodic; Antiseptic; Antispasmodic; Astringent; Cholagogue; Diuretic; Laxative; Sedative; Stomachic; Tonic.

Goldenseal is a traditional medicine of the North American Indians and is still widely used in Western herbal medicine. In the Nineteenth century it acquired a reputation as a heal-all and was grossly over-collected from the wild and has become rare in the east of its range. It is now being cultivated on a small scale. It is especially valued in treating disorders of the digestive system and mucous membranes and is also extremely useful in the treatment of habitual constipation.   The root is the active part of the plant, it is harvested in the autumn after the plant has died down and is dried for later use. It is said to be antiperiodic, antiseptic, astringent, cholagogue, diuretic, laxative, stomachic, tonic. It is used mainly in the treatment of disorders affecting the ears, eyes, throat, nose, stomach, intestines and vagina. The root contains the alkaloids hydrastine, berberine and canadine. Berberine is antibacterial (effective against broad-spectrum bacteria and protozoa), it increases bile secretions, acts as an anticonvulsant, a mild sedative and lowers blood pressure. Use of this plant destroys beneficial intestinal organisms as well as pathogens, so it should only be prescribed for limited periods (a maximum of three months). The plant should be used with caution, and not at all during pregnancy or by people with high blood pressure. An infusion of the root is used externally as a wash for skin diseases, vaginal infections, gum diseases etc.

Traditional Uses:
At the time of the European colonization of the Americas, goldenseal was in extensive use among certain Native American tribes of North America, both as a medicine and as a coloring material. Prof. Benjamin Smith Barton in his first edition of Collections for an Essay Toward a Materia Medica of the United States (1798), refers to the Cherokee use of goldenseal as a cancer treatment. Later, he calls attention to its properties as a bitter tonic, and as a local wash for ophthalmia. It became a favorite of the Eclectics from the time of Constantine Raffinesque in the 1830s.

The Eclectics used goldenseal extensively for cancers and swellings of the breasts, although they did not consider it sufficient for cancer alone.[citation needed] Hale recommended its use in hard swellings of the breast, while conium was used for smaller painless lumps. The two herbs alone or with phytoplankton Americana were used for cancers, along with alternatives like red clover.

Herbalists today consider goldenseal an alterative, anti-catarrhal, anti-inflammatory, antiseptic, astringent, bitter tonic, laxative, anti-diabetic and muscular stimulant. They discuss the astringent effect it has[citation needed] on mucous membranes of the upper respiratory tract, the gastrointestinal tract, the bladder, and rectum (applied topically), and the skin. Goldenseal is very bitter, which stimulates the appetite and aids digestion, and often stimulates bile secretion

Efficacy:
There is currently insufficient evidence to determine whether goldenseal is effective for any conditions

Other Uses
Dye and Repellent.
A yellow dye is obtained from the whole plant. It is obtained from the root. The pounded root is smeared on the body to act as an insect repellent.

Known Hazards:The whole plant is poisonous

Cautions:
Goldenseal has an affinity for mucosa, and is cooling so should not be used if an infection is at an early stage or there are more chills than fever.   Goldenseal should be used with caution only while sick with illnesses that respond to hydrastine and berberine. It should generally not be taken for an early stage Upper Respiratory Infection (URI), but reserved for illnesses in which there is yellow or green phlegm.[citation needed] Generally a two-week maximum dosage is suggested.[citation needed] Taking goldenseal over a long period of time can reduce absorption of B vitamins. Avoid goldenseal during pregnancy and lactation, with gastrointestinal inflammation, and with proinflammatory disorders.A recent study (2011) found rats fed with Goldenseal constantly for two years had a greater tendency towards tumor formation.

Goldenseal has been found to have inhibited cytochrome P450 CYP2D6, CYP3A4, and CYP3A5 activity by approximately 40%, a statistically and clinically significant reduction.  CYP2D6 specifically is a known metabolizer of many commonly used pharmaceuticals, such as antidepressants (including all SSRIs except for fluvoxamine), neuroleptics, and codeine.  Combining Goldenseal with such medications should be done with caution and under the supervision of a doctor as it can lead to serious – perhaps fatal – toxicity. Those with a genetic deficiency in these enzymes are at particular risk.

Use for masking illicit drug use in urine drug tests:
Goldenseal became a part of American folklore associated with chemical testing errors, from pharmacist John Uri Lloyd’s 1900 novel Stringtown on the Pike. In the book, the victim’s habit of taking goldenseal in the form of digestive bitters, causes this herb to appear as the poison strychnine in a chemical test – thus suggesting murder. It has been used on occasions in this century to attempt to mask the use of morphine in race horses (without success).

Two studies have demonstrated no effect of oral goldenseal on urine drug assays over water alone. Subjects who drank large amounts of water had the same urine drug levels as subjects who took goldenseal capsules along with the water.

Endangered status:
Goldenseal is in serious danger due to overharvesting. Goldenseal became popular in the mid-nineteenth century. By 1905, the herb was much less plentiful, partially due to overharvesting and partially to habitat destruction. Wild goldenseal is now so rare that the herb is listed in the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) goldenseal is one of the most overharvested herbs. More than 60 million goldenseal plants are picked each year without being replaced.[36] The process of mountain top removal mining has recently put the wild goldenseal population at major risk due to loss of habitat, illegality of removing goldenseal for transplant without registration while destruction in the process of removing the mountain top is permitted, and increased economic pressure on stands outside of the removal area.

Many herbalists urge caution in choosing products containing goldenseal, as they may have been harvested in an unsustainable manner as opposed to having been organically cultivated.

There are several berberine-containing plants that can serve as useful alternatives, including Chinese coptis, yellowroot, or Oregon grape root.

Disclaimer:
The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplements, it is always advisable to consult with your own health care provider.

Resources:
http://en.wikipedia.org/wiki/Hydrastis_canadensis
http://digedibles.com/database/plants.php?Hydrastis+canadensis

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Asmatica

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Botanical Name : Tylophora asmatica
Family : Apocynaceae
Genus : Tylophora
Species: Asmatica
Common names :  Indian lobelia   asmatica,asmitica
Parts Used : Leaves
Habitat :Grows in tropical countries.Native to the Indian subcontinent, asmatica grows wild on the plains of India.

Description:
The Tylophora is a perennial vine, twining climber with lance-shaped leaves and greenish flowers that produce many flat seeds. The leaves are gathered when the plant is in flower.
The leaves and roots of tylophora have been included in the Bengal Pharmacopoeia since 1884. It is said to have laxative, expectorant, diaphoretic (sweating), and purgative (vomiting) properties. It has been used for the treatment of various respiratory problems besides asthma, including allergies, bronchitis and colds, as well as dysentery and oseteoarthritis pain.

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History:
Asmatica has long been used in Ayurvedic medicine to induce vomiting and expectoration as well as for treating dysentery and rheumatic conditions.

Extensive laboratory research and clinical study has taken place in India and established that asmatica is an effective remedy for asthma. In the 1970s, a number of clinical trials showed that a majority of asthmatics taking the herb for just six days, gained relief for an additional twelve weeks.

It should be noted that the spelling of this plant, asmatica, differs from the asthmatic plant (Euphorbia hirta syn.E. pilulifera) and should not be confused with it although it does have a history of similar usage.

Cultivation
Propagule  Various Pollination method .

Chemical Constituents: Alkaloids (including tylophorine) ,flavonoids ,sterols ,tannins

Medicinal properties: antiasthmatic

Medicinal Uses:
Tylophora asmatica has been traditionally used as an antiasthmatic. Asmatica (sometimes called Indian lobelia) is only to be administered with proper professional knowledge. Herbal remedies are only prepared from the leaves.

Considered a specific remedy for asthma, asmatica may relieve symptoms for up to 3 months.  It is also beneficial in cases of hay fever, and is prescribed for acute allergic problems such as eczema and nettle rash.  The plant holds potential as a treatment for chronic fatigue syndrome and other immune system disorders.  Asmatica may relieve rheumatoid arthritis and may also be of value in the treatment of cancer.  Extensive laboratory and clinical research in India has established that asmatica is an effective remedy for asthma.  In the 1970s, a number of clinical trials showed that a majority of asthmatic patients taking the herb for just 6 days gained relief from asthma for up to a further 12 weeks.  However, the leaves do produce side effects  The plant’s alternative name, Indian lobelia, alludes not only to its value in treating asthma but also to its irritating effect on the digestive tract.
It is also beneficial in cases of hay fever as well as such acute allergic problems as eczema and nettle rash.

The plant holds promise as a treatment for chronic fatigue syndrome and other immune system disorders. It may also relieve rheumatoid arthritis and be of value in the treatment of cancer.

Other Traditional uses :
Parts used  Traditional uses for  Fragrance  intensity. Dye parts  Dye color
Cautions:
*Take only under professional guidance.
*Like its lobelia relatives, the leaves of asmatica do produce side effects and can have an irritating effect on the digestive tract.

Disclaimer:
The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplements, it is always advisable to consult with your own health care provider.

Resources:
http://www.crescentbloom.com/Plants/Specimen/TU/Tylophora%20asmatica.htm
http://www.herbnet.com/Herb%20Uses_AB.htm

http://www.innvista.com/health/herbs/asmatica.htm