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For example buy slimex 10 mg with mastercard, establishment of captive plantations using clon- ally multiplied material from high-yielding lines could greatly contribute to the 210 R effective slimex 15 mg. In fact, towards this end, as mentioned elsewhere in this chapter, efforts are being made to identify high-yielding lines and populations from the distributional range of the species in India. Extraction of renewable plant parts such as leaves and fruits instead of bark could be one of the possible approaches to sustain the extraction. For example, stabilization of cell cultures from high- yielding individuals could help develop in vitro production systems. It is estimated that even today, 11 of the top 20 best-selling drugs are being derived from plants. In most cases, and particularly in the biodiversity rich regions of the world, the plants are nearly entirely sourced from the wild. For example, in India, of about 880 medicinal plants that are traded for various uses, 538 (61 %) are sourced from the wild only [46]. Indiscriminate harvesting of these species has already led to a serious threat to these species. It is esti- mated that about 100 species (58 of which are globally threatened) of medicinal plants in the Western Ghats, a mega-biodiversity center in south India, might already be highly threatened due to excessive harvesting [28]. Thus, unless al- ternative approaches are developed, the extraction of most of the medicinal plants to meet global demands will be unsustainable. As mentioned elsewhere, due to increasing harvesting pressures from the wild, this species is already listed as endangered [28]. Toward this end, as described in this chapter, several initia- tives could be taken that explore all possibilities to meet the global demand sus- tainably. These “elite” trees could also be focused toward deriving tissue material for in vitro production systems, as was done for several other systems, for example taxane from Taxus wallichiana [47, 48] and for podophyllotoxin from Podophyllum peltatum [49, 50]. Acknowledgments The authors wish to thank the Department of Biotechnology, Government of India for supporting the program and the Forest Departments of the states of Karnataka, Kerala and the Maharastra for facilitating the feldwork in the Western Ghats. International Potato Center and International Plant Genetic Resources Institute, Lima, Peru 43. Ashoka Trust for Research in Ecology and Environment, Bangalore and Forestry Research support Program for Asia and the Pacifc, Food and Agriculture Organisation, Bangkok 47. Poupat C, Ingrid H, Francoise G, Alain A, Daniel G, Pierre P (2000) Planta Med 66:580 49. Wiedenfeld H, Furmanowa M, Roeder E, Guzewska J, Gustowski W (1997) Plant Cell Tiss Org Cult 49:213 54. Saito K, Sudo H, Yamazaki M, Koseki-Nakamura M, Kitajima M, Yamazaki M, Takayama H, Aimi N (2001) Plant Cell Rep 20:267 55. Aiyama R, Nagai H, Nokata K, Shinohara C, Sawada S (1988) Phytochemistry 27:3663 58. Yamazaki Y, Urano A, Sudo H, Kitajima M, Takayama H, Yamazaki M, Aimi N, Saito K (2003) Phytochemistry 62:461 Chapter 11 Colchicine – an Overview for Plant Biotechnologists S. Jha () Centre of Advanced Study in Cell and Chromosome Research, Department of Botany, University of Calcutta, 35 Ballygunge Circular Road, Calcutta, 700019, India, e-mail: sjbot@caluniv. Besides the importance for the plant itself, several secondary metabolites are commercially available as fne chemicals, such as drugs, dyes, favors, fragrances, and insecticides. Due to their extensive biological activities, plant secondary metabolites have been used for centuries in traditional med- icine. Alkaloids are an important group of secondary metabolites, of which colchicine is a useful agent in the treatment of acute attacks of gout. Apart from inhibiting the assembly of microtubules, the major biological effects of colchicine include leukocyte diapedesis, lysosomal degranulation, and inhibi- tion of proliferation of fbroblasts as well as collagen transport to the extracel- lular space. In this way it relieves the pain associated with acute gout, decreases interleukin-l production in patients with primary biliary cirrhosis, and is used in the prevention or treatment of amyloidosis, scleroderma, and chronic cuta- neous leukocytoclastic vasculitis. Colchicine is sold under different brand/trade names in different countries as a medicine for gout. The increased demand for colchicine has stimulated great interest in known plant sources of colchicine, new sources, and the route by which the alkaloid could be synthesized. Colchi- cine and related compounds have been found in several genera such as Colchi- cum, Merendera, Androcymbium, Gloriosa, and Littonia. Plant secondary prod- ucts are vulnerable to fuctuations in value, depending on the effects of climate, pests, and diseases on the producing crops, or political changes in the producing countries. This has raised interest in developing biotechnological processes for the industrial production of such fne chemicals. However, very few reports are available on biotechnological approaches toward the biological production of such an important alkaloid.

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However buy 15 mg slimex with mastercard, when bronchiectasis is localized and the morbidity is substantial despite ade- should be dictated by a careful assessment of the clinical quate medical therapy discount slimex 15 mg mastercard, surgical resection of the involved scenario. In a patient with focal bronchiectasis, for exam- region of lung should be considered. Although resec- tion may be successful if the disease is localized, embolization is preferable with widespread disease. Aspiration is the most common cause; tions characterized by an increase in quantity and puru- factors that portend an increased risk of aspiration include lence of the sputum, antibiotics are used only during esophageal dysmotility, seizure disorders, and neurologic acute episodes. Other predispos- be guided by Gram’s stain and culture of sputum, ing conditions for lung abscess include periodontal disease empiric coverage (e. In an immunocompromised host, aerobic bacte- ria and opportunistic pathogens may predominate. The differential diagnosis includes mycobacterial infection, pulmonary sequestration, malig- The symptoms of lung abscess are typical of pul- nancy, pulmonary infarction, and an infected bulla. Blood, sputum cultures, and (when course may evolve over an extended period of time, appropriate) pleural fluid cultures should be obtained and some patients may be asymptomatic. The role of fiberoptic presentations are typical of infection with aerobic bronchoscopy with bronchoalveolar lavage or protected- bacteria. The relatively low yield, especially with evidence of consolidation may be present. Fetid breath anaerobic lung abscess, should be balanced against the and poor dentition may be diagnostic clues. Clubbing or risk of rupture of the abscess cavity with spillage into hypertrophic pulmonary osteoarthropathy may occur in the airways. Other less commonly used methods for thick-walled cavities in dependent areas of the lung, par- microbiologic sampling are transtracheal or transthoracic ticularly the upper lobes and posterior segments of the aspiration. Because of the emergence of β-lactamase–producing organisms, clindamycin (150–300 mg q6 h) is now standard ther- apy. Other agents, such as carbapenems and β-lactam/ β-lactamase inhibitor combinations, may be useful in selected cases. When possible, the choice of antibiotics should be guided by microbiologic results. Four to 6 weeks of antibiotic therapy is typically used, although a more extended course is favored by some experts. Although surgery has had a limited role in treatment in the antibiotic era, indications include refractory hemoptysis, inadequate response to medical therapy, or the need for a tissue diagnosis when there is concern for a noninfectious etiology. Of note, Class I mutations typically occur in childhood, but about 5% of patients in that encode for premature stop codons are important to the United States are diagnosed as adults. Because of identify because they may in the future be treated with improvements in therapy, >41% of patients are now adults agents that promote “read-through” of the stop codon (≥18 years old) and 13% are past the age of 30 years. This disease is characterized by chronic bacterial America and northern Europe, one in 17,000 live infection of the airways that ultimately leads to bronchiec- births of African Americans, and one in 90,000 live tasis and bronchiolectasis, exocrine pancreatic insuffi- births of the Asian population of Hawaii. However, the unifying concept is that all affected tissues express abnormal ion transport function. Both Na+ dysfunctions lead to desiccated intraluminal contents Na+ 2Cl– A + and obstruction of both the small and large intestine. Indeed, both mucus stasis and mucus hypoxia may contribute to the propensity for Upper respiratory tract disease is almost universal in Pseudomonas spp. The occurrence of nasal polyps approaches 25% and often requires treatment with topical steroids, surgery, or both. Patient-to-patient spread of and symptoms of malabsorption of fat-soluble vitamins, certain strains of this organism mandates strict infection including vitamins E and K, are also noted. The irreversible component reflects chronic destruction of the airway wall and bronchiolitis. Oral agents used clearance of secretions and control infection in the lung, to treat Staphylococcus infection include a semisynthetic provide adequate nutrition, and prevent intestinal penicillin or a cephalosporin. Regular use of these maneuvers is effective in dosage should be monitored so that levels for gentamicin preserving lung function. A major advance has been the or tobramycin peak at ranges of ∼10 μg/mL and demonstrated efficacy of inhaled hypertonic saline (7%) exhibit troughs of <2 μg/mL. Antibiotics directed at in restoring mucus clearance and pulmonary function in Staphylococcus, H. Hypertonic saline Inhaled β-adrenergic agonists can be useful to con- is safe but can produce bronchoconstriction in some trol airways constriction, but long-term benefit has not patients, which can be prevented with coadministered been shown. Pharmacologic agents for increasing mucus clearance The chronic damage to airway walls partly reflects are in use and in development. Atelectasis requires treatment with inhaled imental drugs aimed at restoring salt and water content hypertonic saline, chest physiotherapy, and antibiotics. It should requires treatment of lung infection and assessment of be noted, however, that because routine hospital micro- coagulation and vitamin K status. For massive hemopty- biologic cultures are performed under conditions that sis, bronchial artery embolization should be performed. J Clin (3 x normal), but this treatment has not been shown to Invest 109:317, 2002 influence the course of hepatic disease.

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Ingestion of and infection with this organism may result in a spec- trum of illnesses cheap slimex 15 mg mastercard, including mild diarrhea slimex 10mg amex, hemorrhagic colitis with bloody diarrhea, acute renal failure, and death. Infection has been associated with ingestion of contaminated beef (in particular ground beef), ingestion of raw milk, and contamination via the fecal-oral route. Cooking ground beef so that it is no longer pink is an effective means of preventing infection, as are hand washing and pasteurization of milk. As the ability to more rapidly diagnose some of these diseases increases, their likelihood of causing undi- agnosed persistent fever lessens. Self-limited infections such as influenza should not cause fever that persists for many weeks. Since conditions such as systemic lupus erythematosus are more easily diagnosed today, they are less frequent causes of this syndrome. Factitious fever is most com- mon among young adults employed in health-related positions. A prior psychiatric history or multiple hospitalizations at other institutions may be clues to this condition. Such patients may induce infections by self- injection of nonsterile material, with resultant multiple abscesses or polymicrobial infections. In these cases, a discrepancy between temperature and pulse or between oral temperature and witnessed rectal temperature will be observed. Following cardiac catheterization, blood cultures obtained from a distal vein are rarely positive. Thus, prophylactic antibiotics are not currently recommended for cardiac catheterization. Bacteremia commonly occurs following other procedures such as periodontal surgery, tonsillectomy, and prostate surgery. The animals that present the most danger are wild skunks and bats; foxes are also possible carriers. Raccoons are responsible for an increasing num- ber of cases in the mid-Atlantic states. The incubation period ranges from 4 days to many years, but is usually between 20 and 90 days. The incuba- tion period is usually shorter with a bite to the head than with one to an extremity. In humans, only four definite recoveries from established infec- tion have been reported. Nonimmunized animals that have been bitten should be killed and their brains submitted for virus by immunofluores- cent antibody examination. A negative fluorescent test removes the need to treat the bite victim either actively or passively. This disease most com- monly affects children between the ages of 5 and 14 years, but it can also occur in adults. The disease is characterized by a slapped-cheek rash, which may follow a prodrome of low-grade fever. Complications in adults include arthralgias, arthritis, aplastic crisis in patients with chronic hemolytic anemia, spontaneous abortion, and hydrops fetalis. Desquamation of the skin usually occurs during or after recovery from toxic shock syndrome (associated with a toxin produced by S. Peeling of the skin is also seen in Kawasaki disease, scarlet fever, and some severe drug reactions. Infectious mononucleosis is the usual manifestation of infec- tion with Epstein-Barr virus. A diffuse maculopapular rash has been observed in over 90% of patients with infectious mononucleosis who are given ampicillin. Males who develop mumps after puberty have a 20 to 35% chance of developing a painful orchitis. Myocarditis, thrombocytopenic purpura, and polyarthritis may also occur as complications of this disease. An inflamma- tory change in the pancreas is a potentially serious problem; symptoms consist of abdominal discomfort and a gastroenteritis-like illness. While chickenpox is usually a benign illness in chil- dren, other complications such as myocarditis, iritis, nephritis, orchitis, and hepatitis may occur. Infectious Disease Answers 23 It can be difficult to distinguish between the vesicular lesions of small- pox and chickenpox. Classically, however, a history of rash with vesicles that develop over a few hours would be typical of a chickenpox infection; vesiculation that develops over a period of days is the rule in smallpox. While fever is characteristic of the prodrome of smallpox, it subsides prior to focal eruptions.

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