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By H. Sulfock. Morehouse College. 2018.

For this reason order arcoxia 90 mg, CP It might be possible to group the causes of CP into is also referred to as static (nonprogressive) encephalopa- those that are genetic and those that are non-genetic order 60mg arcoxia, but thy (disease of the brain). Grouping causes disorders of muscle control that arise in the muscles into those that occur during pregnancy (prenatal), those themselves and/or in the peripheral nervous system that happen around the time of birth (perinatal), and those (nerves outside the brain and spinal cord). CP related CP is not a specific diagnosis, but is more accurately to premature birth and multiple birth pregnancies considered a description of a broad but defined group of (twins, triplets, etc. Those with CP may have only minor difficulty with fine motor skills, such as grasping and manipulating Although much has been learned about human items with their hands. A severe form of CP could embryology in the last couple of decades, a great deal involve significant muscle problems in all four limbs, remains unknown. Studying prenatal human develop- mental retardation, seizures, and difficulties with vision, ment is difficult because the embryo and fetus develop in speech, and hearing. However, the relatively recent development of a number of prenatal Muscles that receive abnormal messages from the tests has opened a window on the process. Add to that brain may be constantly contracted and tight (spastic), more accurate and complete evaluations of newborns, exhibit involuntary writhing movements (athetosis), or especially those with problems, and a clearer picture of have difficulty with voluntary movement (dyskinesia). There can also be a lack of balance and coordination with unsteady movements (ataxia). A combination of any of The complicated process of brain development these problems may also occur. Spastic CP and mixed CP before birth is susceptible to many chance errors that can constitute the majority of cases. Some of these can range from mild weakness or partial paralysis (pare- errors will result in structural anomalies of the brain, sis), to complete loss of voluntary control of a muscle or while others may cause undetectable, but significant, group of muscles (plegia). For instance, affected muscles abnormality in structure or wiring is sometimes heredi- in one limb is monoplegia, both arms or both legs is tary, but is most often due to chance, or a cause unknown diplegia, both limbs on one side of the body is hemiple- at this time. Whether and how much genetics played a role gia, and in all four limbs is quadriplegia. Muscles of the in a particular brain abnormality depends to some degree trunk, neck, and head may be affected as well. CP can be caused by a number of different mecha- Several maternal-fetal infections are known to nisms at various times—from several weeks after concep- increase the risk for CP, including rubella (German tion, through birth, to early childhood. For many years, it measles, now rare in the United States), cytomegalovirus was accepted that most cases of CP were due to brain (CMV), and toxoplasmosis. Each of these infections is injuries received during a traumatic birth, known as birth considered a risk to the fetus only if the mother contracts asphyxia. However, extensive research in the 1980s it for the first time during that pregnancy. Even in those GALE ENCYCLOPEDIA OF GENETIC DISORDERS 213 cases, though, most babies will be born normal. Most injuries to the mother could compromise the availability women are immune to all three infections by the time of nutrients and oxygen to the developing fetal brain. A lapsed cord (cord delivered before the baby) are possible burst blood vessel in the brain followed by uncontrolled causes of birth asphyxia, as are bleeding and other com- bleeding (coagulopathy), known as intracerebral hemor- plications associated with placental abruption and pla- rhage, could cause a fetal stroke, or a cerebral blood ves- centa previa (placenta lying over the cervix). Infants who Infection in the mother is sometimes not passed to later develop CP, along with their mothers, are more likely the fetus through the placenta, but is transmitted to the than other mother-infant pairs to test positive for factors baby during delivery. Any such infection that results in that put them at increased risk for bleeding episodes or serious illness in the newborn has the potential to pro- blood clots. A teratogen is any substance to which a woman is Postnatal causes exposed that has the potential to harm the embryo or The remaining 15% of CP is due to neurologic injury fetus. CP that has a postnatal cause is during pregnancy and a risk for CP are difficult to prove. Furthermore, any substance that increases the mother and child (mother Rh negative, baby Rh positive) risk for premature delivery and low birth weight, such as can result in severe anemia in the baby (erythroblastosis alcohol, tobacco, or cocaine, among others, might indi- fetalis). Rh disease in the The fetus receives all nutrients and oxygen from newborn is now rare in developed countries due to routine blood that circulates through the placenta. Therefore, screening of maternal blood type and treatment of preg- anything that interferes with normal placental function nancies at risk. The routine, effective treatment of jaundice might adversely affect development of the fetus, includ- due to other causes has also made it an infrequent cause of ing the brain, or might increase the risk for premature CP in developed countries.

GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 1227 Lomatium and other herbal remedies are not regu- lated by the United States Food and Drug Administration KEY TERMS (FDA) in the same way that prescription drugs are regu- cheap 90 mg arcoxia. This difference means that the effectiveness of lo- Coumarins—A group of crystalline compounds matium has not been scientifically tested best 60 mg arcoxia. In addition, found in lomatium that may be useful in treating supplements are not standard in their ingredients or HIV infection. Women who are pregnant or nursing should not Infusion—A liquid extract of a herb prepared by use lomatium, because its safety for these conditions has steeping or soaking plant parts in water or another not been determined. Potentiate—To intensify the effects of another Side effects herb or prescription medication. Although lomatium is generally believed to be safe, Tincture—A method of preserving herbs with al- the herb has been reported to cause a skin rash. Wildcrafting—The art of gathering or harvesting herbs or other plants from their native wild envi- ronment for human use. Interactions Lomatium has been reported to potentiate (intensify the effects of) two groups of drugs, anticoagulants OTHER (blood thinners) and immunostimulants (drugs given to Cabrera, Chancel. Lomilomi literally means “to break up into small PERIODICALS pieces with the fingers. Anti-HIV Principle from Lomatium suksdorfii, Its Struc- ture-Activity Correlation with Related Coumarins, and Origins Synergistic Effects with Anti-AIDS Nucleosides. ORGANIZATIONS When Captain Cook and other European explorers American Botanical Council. Box 201660, Austin, TX disembarked on the islands of Polynesia, the indigenous 78720. One member of the Kahuna—A traditional Hawaiian village leader re- family would be trained by a village kahuna. Kahunas not only trained practitioners in the physical as- pects of massage, they also taught that an important as- pect of the healing process was the transfer of positive Preparations thoughts from the lomilomi practitioner to the client in a In traditional lomilomi, the client may drink herbal way that channels energy, called “mana” or life force, teas to cleanse the body internally prior to the massage. The body is also cleansed externally with red clay or The best known school for training lomilomi practi- salt. Sometimes time is alternated between a steam hut tioners is run by Margaret Machado, known to her stu- and plunges in cold water to increase circulation prior to dents as Aunty Margaret, on the island of Hawaii. Much of this preparation is dis- Machado was born in the early 1900s and learned tradi- pensed with by modern practitioners. Unlike traditional lomilomi practitioners, most modern practi- Precautions tioners tend to concentrate more strongly on the physical There are no particular precautions to be observed rather than the spiritual aspects of this therapy. Like many therapies, lomilomi is most effective when the client is in a recep- Benefits tive frame of mind to accept healing. Lomilomi cleanses and relaxes the body, both physical- ly and spiritually in order to achieve internal harmony. It in- Side effects creases circulation, relaxes tension spots, and relieves pain. Most clients report feeling a reduction in stress and a general feeling of well being. Others report specific re- Description lief of pains such as headaches and backaches. A lomilomi massage generally begins with clients re- laxing on a table and opening themselves to a healing state Research & general acceptance of mind. Some practitioners begin by using heated lomi There are relatively few practitioners of lomilomi, stones to increase blood flow to certain areas of the body. Un- like Swedish massage, however, lomilomi practitioners use Training & certification their elbows and forearms and incorporate some vigorous The Hawaiian Lomilomi Association offers certifica- deep tissue techniques. The forearm movement is typically tion to practitioners who have received training from any applied across the grain of the long muscles of the back. These sion or when deeper massage is needed in a specific part certification levels are Certified Lomilomi Therapist, Li- of the body.

Generally generic 60 mg arcoxia visa, for every affected female discount arcoxia 60 mg with visa, ily treated and generally does not affect vision, develops there are 2-3 affected males. Rarely, the disease may GALE ENCYCLOPEDIA OF GENETIC DISORDERS 95 affect the heart or aorta. Kidney failure is a rare compli- diagnosing a person with AS prior to the development cation. Lung function can be affected due to bone of signs seen on x ray or MRI will continue to be very changes that affect the mechanics of breathing. Therefore, individuals with AS should refrain from smoking to avoid early respiratory failure. Ninety percent Treatment and management of affected individuals experience the first symptoms before age 45. Males are more commonly affected than Phyical therapy plays a major role in maintaining females, who tend to be diagnosed later partly due to flexibility, range-of motion, posture, and ultimately milder symptoms. Surgery can improve joint function, as well as minimize associated pain, which may be treated with nonsteroidal anti-inflammatory medications. Other med- Diagnosis ications—sulfasalazine and methotrexate—can provide Diagnostic criteria were established by the European some relief for peripheral arthritis. A ications that paralyze the ciliary muscle of the eye) and clinical diagnosis of AS requires the presence of spinal local steroids are effective at treating anterior uveitis. Avoidance of smoking is encouraged to maintain asymmetric or involving primarily the lower limbs. Vision can be affected in some individuals with anterior uveitis that is not responsive to treatment, • Psoriasis (a scaly skin disease) but this is rare. The rare complication of kidney failure • Urethritis (inflammation of the urethra) can limit life-expectancy, as can respiratory failure that • Cervicitis (inflammation of the cervix) may result from smoking. New will not be identified as having the disease based on this York: Churchill Livingston, 1997, pp. The description has a specificity that is also PERIODICALS approximately 87%, meaning that 87% of the time a per- Benjamin, R. Either the fluid itself or cells from medical and surgical treatment of eye disorders. Cleft palate—A congenital malformation in which Otolaryngologist—Physician who specializes in the there is an abnormal opening in the roof of the care of the ear, nose, and throat and their associated mouth that allows the nasal passages and the mouth structures. Psychologist—An individual who specializes in the Craniofacial—Relating to or involving both the science of the mind. Sleep apnea—Temporary cessation of breathing Dermatologist—A physician that specializes in dis- while sleeping. Speech therapist—Person who specializes in teach- Fontanelle—One of several “soft spots” on the skull ing simple exercises to improve speech. Syndactyly—Webbing or fusion between the fingers Hypoplasia—Incomplete or underdevelopment of a or toes. Anxiety neurosis see Panic disorder Genetic profile Apert syndrome (AS) is an autosomal dominant dis- order, meaning a person only has to inherit one non- working copy of the gene to manifest the condition. In most cases, AS is sporadic, meaning that the parents are IApert syndrome usually unaffected but a fresh mutation or gene change occurring in the egg or sperm was passed onto the Definition affected child. For these families the chance to have Premature closure of the skull bones leading to facial another affected child is very low. An affected parent has distortion with an usually tall skull and fusion of the fin- a 50% chance of passing on the abnormal gene to their gers and toes, known as syndactyly, are the major fea- child, who will then also have Apert syndrome. Another name for this Two unique mutations in the fibroblast growth factor disorder is acrocephalysyndactyly. When parental studies were per- formed, genetic researchers determined that the father A French physician, E. Apert, first reported in 1906 passed on the gene causing AS and was usually older the syndrome that bears his name.

Primary route of 10–50% renal (unchanged) Larger doses can produce confusion generic 90 mg arcoxia visa, delirium generic 60mg arcoxia free shipping, hallucina- excretion tions, or psychoses. Quinidine can decrease blood glucose Therapeutic serum 2–4 g /mL concentrations, possibly by inducing insulin secretion. For this reason, digitalis should be used before quinidine when one is attempting Drug Interactions to convert atrial flutter or atrial fibrillation to normal si- Quinidine can increase the plasma concentrations of nus rhythm. Gastrointestinal, central nervous system Adverse Effects (CNS), or cardiac toxicity associated with elevated The most common adverse effects associated with digoxin concentrations may occur. Quinidine and digoxin quinidine administration are diarrhea (35%), upper can be administered concurrently; however, a downward gastrointestinal distress (25%), and light-headedness adjustment in the digoxin dose may be required. Cimetidine Procainamide can decrease the occurrence of all inhibits the hepatic metabolism of quinidine. Phenytoin, types of active ventricular dysrhythmias in patients with rifampin, and barbiturates increase the hepatic metabo- acute myocardial infarction who are free from A-V dis- lism of quinidine and reduce its plasma concentrations. About 90% of patients with ventricular prema- Procainamide ture contractions and 80% of patients with ventricular tachycardia respond to procainamide administration. Procainamide (Pronestyl, Procan SR) is a derivative of Although the spectrum of action and electrophysio- the local anesthetic agent procaine. Procainamide has a logical effects of quinidine and procainamide are simi- longer half-life, does not cause CNS toxicity at thera- lar, the relatively short duration of action of pro- peutic plasma concentrations, and is effective orally. Adverse Effects Electrophysiological Actions Acute cardiovascular reactions to procainamide admin- istration include hypotension, A-V block, intraventricu- Table 16. The drug dosage must be reduced or even stopped if severe depression of conduction (severe pro- Hemodynamic Effects longation of the QRS interval) or repolarization (severe prolongation of the QT interval) occurs. The hemodynamic alterations produced by pro- cainamide are similar to those of quinidine but are not Long-term drug use leads to increased antinuclear as intense. Alterations in circulatory dynamics vary ac- antibody titers in more than 80% of patients; more than cording to the cardiovascular state of the individual. The symptoms may disappear within a few days nounced after intramuscular administration and seldom of cessation of procainamide therapy, although the tests occur after oral administration. Pharmacokinetics Procainamide, unlike procaine, has little potential to The pharmacokinetic characteristics of procainamide: produce CNS toxicity. Oral bioavailability 75–95% Onset of action 5–10 minutes Contraindications Peak response 60–90 minutes Duration of action 4–10 hours Contraindications to procainamide are similar to those Plasma half-life 2. Because of its effects on A-V nodal and Primary route of Hepatic; active metabolite His-Purkinje conduction, procainamide should be ad- metabolism ministered with caution to patients with second-degree Primary route of 50–60% renal (unchanged) A-V block and bundle branch block. Procainamide excretion should not be administered to patients who have shown Therapeutic serum 4–10 g /mL procaine or procainamide hypersensitivity and should concentration be used with caution in patients with bronchial asthma. Prolonged administration should be accompanied by Clinical Uses hematological studies, since agranulocytosis may occur. Procainamide is an effective antiarrhythmic agent when Drug Interactions given in sufficient doses at relatively short (3–4 hours) dosage intervals. Procainamide is useful in the treatment The inherent anticholinergic properties of procainamide of premature atrial contractions, paroxysmal atrial tachy- may interfere with the therapeutic effect of cholinergic cardia, and atrial fibrillation of recent onset. Patients receiving cimetidine and procainamide is only moderately effective in converting atrial flutter or may exhibit signs of procainamide toxicity, as cimetidine chronic atrial fibrillation to sinus rhythm, although it has inhibits the metabolism of procainamide. Simultaneous 174 III DRUGS AFFECTING THE CARDIOVASCULAR SYSTEM use of alcohol will increase the hepatic clearance of pro- transmission therefore will be determined by the sum of cainamide. Procainamide may enhance or prolong the its direct depression and indirect facilitation of trans- neuromuscular blocking activity of the aminoglycosides mission. The simultaneous administration of quinidine or amio- His-Purkinje System and Ventricular Muscle darone may increase the plasma concentration of pro- Disopyramide administration reduces membrane cainamide. Action potentials are prolonged after Disopyramide (Norpace) can suppress atrial and ven- disopyramide administration, and this results in an in- tricular arrhythmias and is longer acting than other crease in the ERPs of His-Purkinje and ventricular drugs in its class. Unlike procainamide and quinidine, disopyramide does not produce postrepolarization re- Electrophysiological Actions fractoriness. The effect of disopyramide on conduction velocity The effects of disopyramide on the myocardium and depends on extracellular K concentrations. Electrocardiographic Changes Sinoatrial Node The direct depressant actions of disopyramide on The electrocardiographic changes observed after the sinoatrial node are antagonized by its anticholiner- disopyramide administration are identical to those seen gic properties, so that at therapeutic plasma concentra- with quinidine and procainamide.