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By: H. Akascha, M.A., M.D.
Clinical Director, Sam Houston State University College of Osteopathic Medicine
Bates have shewn18 that the females of some other species are extremely variable can you get arthritis in the knee buy generic pentoxifylline 400 mg on-line, the males being nearly constant arthritis in balls of feet safe pentoxifylline 400mg. A striking case of a rare variety rheumatoid arthritis natural treatment discount 400 mg pentoxifylline amex, strictly intermediate between two other well-marked female varieties rheumatoid arthritis charity order pentoxifylline 400 mg line, is given by Mr. In a future chapter I shall have occasion to shew that the beautiful eye-like spots or ocelli, so common on the wings of many Lepidoptera, are eminently variable. On the whole, although many serious objections may be urged, it seems probable that most of the species of Lepidoptera which are brilliantly coloured, owe their colours to sexual selection, excepting in certain cases, presently to be mentioned, in which conspicuous colours are beneficial as a protection. From the ardour of the male throughout the animal kingdom, he is generally willing to accept any female; and it is the female which usually exerts a choice. Hence if sexual selection has here acted, the male, when the sexes differ, ought to be the most brilliantly coloured; and this undoubtedly is the ordinary rule. When the sexes are brilliantly coloured and resemble each other, the characters acquired by the males appear to have been transmitted to both sexes. But will this explanation of the similarity and dissimilarity in colour between the sexes suffice The males and females of the same species of butterfly are known20 in several cases to inhabit different stations, the former commonly basking in the sunshine, the latter haunting gloomy forests. On the contrary it seems to me more probable that the males alone, in the large majority of cases, have acquired their bright colours through sexual selection, the females having been but little modified. Consequently the females of distinct but allied species ought to resemble each other much more closely than do the males of the same species; and this is the general rule. The females thus approximately show us the primordial colouring of the parent-species of the group to which they belong. They have, however, almost always been modified to a certain extent by some of the successive steps of variation, through the accumulation of which the males were rendered beautiful, having been transferred to them. The males and females of allied though distinct species will also generally have been exposed during their prolonged larval state to different conditions, and may have been thus indirectly affected; though with the males any slight change of colour thus caused will often have been completely masked by the brilliant tints gained through sexual selection. When we treat of Birds, I shall have to discuss the whole question whether the differences in colour between the males and females have been in part specially gained by the latter as a protection; so that I will here only give unavoidable details. In all cases when the more common form of equal inheritance by both sexes has prevailed, the selection of bright-coloured males would tend to make the females bright-coloured; and the selection of dull-coloured females would tend to make the males dull. If both processes were carried on simultaneously, they would tend to neutralise each other. But by the selection of successive variations, which were from the first sexually limited in their transmission, there would not be the slightest difficulty in giving bright colours to the males alone, and at the same time or subsequently, dull colours to the females alone. In this latter manner female butterflies and moths may, as I fully admit, have been rendered inconspicuous for the sake of protection, and widely different from their males. Mr, Wallace22 has argued with much force in favour of Ms view that when the sexes differ, the female has been specially modified for the sake of protection; and that this has been effected by one form of inheritance, namely, the transmission of characters to both sexes, having been changed through the agency of natural selection into the other form, namely, transmission to one sex. I was at first strongly inclined to accept this view; but the more I have studied the various classes throughout the animal kingdom, the less probable it has appeared. This supposed difference in the " need of protection by the " two sexes " is rather deceptive, and requires some discussion. It is obvious that brightly-coloured individuals, whether males or females, would equally attract, and obscurely-coloured individuals equally escape, the 22 A. But we are concerned with, the effects of the destruction or preservation of certain individuals of either sex, on the character of the race. With insects, after the male has fertilised the female, and after the latter has laid her eggs, the greater or less immunity from danger of either sex could not possibly have any effect on the offspring. Before the sexes have performed their proper functions, if they existed in equal numbers and if they strictly paired (all other circumstances being the same), thepreservation of the males and females would be equally important for the existence of the species and for the character of the offspring. But with most animals, as is known to be the case with the domestic silk-moth, the male can fertilise two or three females; so that the destruction of the males would not be so injurious to the species as that of the females. Wallace believes that with moths the progeny from a second or third fertilisation is apt to be weakly, and therefore would not have so good chance of surviving.
This ridge extends out laterally arthritis in neck and back purchase pentoxifylline 400 mg amex, where it forms the bony tip of the shoulder and joins with the lateral end of the clavicle arthritis pain remedies discount 400mg pentoxifylline with mastercard. By following along the clavicle arthritis in neck sleeping generic 400mg pentoxifylline with mastercard, you can palpate out to the bony tip of the shoulder arthritis in neck pinched nerve buy pentoxifylline 400 mg otc, and from there, you can move back across your posterior shoulder to follow the ridge of the scapula. Both of these bones serve as important attachment sites for muscles that aid with movements of the shoulder and arm. The right and left pectoral girdles are not joined to each other, allowing each to operate independently. In addition, the clavicle of each pectoral girdle is anchored to the axial skeleton by a single, highly mobile joint. This allows for the extensive mobility of the entire pectoral girdle, which in turn enhances movements of the shoulder and upper limb. Clavicle the clavicle is the only long bone that lies in a horizontal position in the body (see Figure 8. First, anchored by muscles from above, it serves as a strut that extends laterally to support the scapula. This in turn holds the shoulder joint superiorly and laterally from the body trunk, allowing for maximal freedom of motion this content is available for free at cnx. This forms the sternoclavicular joint, which is the only bony articulation between the pectoral girdle of the upper limb and the axial skeleton. This joint allows considerable mobility, enabling the clavicle and scapula to move in upward/downward and anterior/posterior directions during shoulder movements. The sternoclavicular joint is indirectly supported by the costoclavicular ligament (costo- = "rib"), which spans the sternal end of the clavicle and the underlying first rib. The lateral or acromial end of the clavicle articulates with the acromion of the scapula, the portion of the scapula that forms the bony tip of the shoulder. In men, the clavicle is heavier and longer, and has a greater curvature and rougher surfaces where muscles attach, features that are more pronounced in manual workers. Such breaks often occur because of the force exerted on the clavicle when a person falls onto his or her outstretched arms, or when the lateral shoulder receives a strong blow. Because the sternoclavicular joint is strong and rarely dislocated, excessive force results in the breaking of the clavicle, usually between the middle and lateral portions of the bone. Muscles acting across the shoulder will also pull the shoulder and lateral clavicle anteriorly and medially, causing the clavicle fragments to override. The clavicle overlies many important blood vessels and nerves for the upper limb, but fortunately, due to the anterior displacement of a broken clavicle, these structures are rarely affected when the clavicle is fractured. Scapula the scapula is also part of the pectoral girdle and thus plays an important role in anchoring the upper limb to the body. The three margins or borders of the scapula, named for their positions within the body, are the superior border of the scapula, the medial border of the scapula, and the lateral border of the scapula. The suprascapular notch is located lateral to the midpoint of the superior border. The corners of the triangular scapula, at either end of the medial border, are the superior angle of the scapula, located between the medial and superior borders, and the inferior angle of the scapula, located between the medial and lateral borders. The inferior angle is the most inferior portion of the scapula, and is particularly important because it serves as the attachment point for several powerful muscles involved in shoulder and upper limb movements. This shallow depression articulates with the humerus bone of the arm to form the glenohumeral joint (shoulder joint). At the shoulder, the coracoid process is located inferior to the lateral end of the clavicle. It is anchored to the clavicle by a strong ligament, and serves as the attachment site for muscles of the anterior chest and arm. Extending laterally from the spine is a flattened and expanded region called the acromion or acromial process. The acromion forms the bony tip of the superior shoulder region and articulates with the lateral end of the clavicle, forming the acromioclavicular joint (see Figure 8. Together, the clavicle, acromion, and spine of the scapula form a V-shaped bony line that provides for the attachment of neck and back muscles that act on the shoulder, as well as muscles that pass across the shoulder joint to act on the arm. Two of these are found on the posterior scapula, above and below the scapular spine. Superior to the spine is the narrow supraspinous fossa, and inferior to the spine is the broad infraspinous fossa. All of these fossae provide large surface areas for the attachment of muscles that cross the shoulder joint to act on the humerus.
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Clearance of intravenous midazolam may be modestly increased in patients taking echinacea arthritis pain over the counter buy pentoxifylline 400 mg with amex. In another study in 12 healthy subjects given Echinacea purpurea 800 mg twice daily for 28 days with a single 8-mg oral dose of midazolam arthritis fingers mucous cysts discount pentoxifylline 400 mg mastercard, there Eclipta Eclipta alba Hassk (Asteraceae) Synonym(s) and related species Trailing eclipta rheumatoid arthritis edema discount generic pentoxifylline canada. Constituents Eclipta contains terthienyl derivatives anti arthritis diet osteoarthritis purchase 400 mg pentoxifylline amex, including -formylterthienyl and a number of esterified 5-hydroxyterthienyl derivatives. The leaves and stem contain the flavonoids apigenin and luteolin, and the isoflavone orobol; wedelolactone and desmethylwedelolactone, as well as their glucosides, are present throughout the herb. Oleanane-type triterpenoids known as the ecliptasaponins, eclalbatin and the eclalbasaponins (based on echinocystic acid), and several steroidal alkaloids based on verazine and ecliptalbine, are also found in eclipta. Pharmacological studies support these uses to some extent, but clinical data are lacking. It has also been used for alopecia, as an antiseptic and as an analgesic; its analgesic effects have been attributed to the alkaloid content. For information on the pharmacokinetics of individual flavonoids and isoflavones present in eclipta, see under flavonoids, page 186 and isoflavones, page 258, respectively. For information on the interactions of individual flavonoids and isoflavones present in eclipta, see under flavonoids, page 186 and isoflavones, page 258, respectively. Use and indications Eclipta is traditionally used for blood-related diseases, 171 Elder Sambucus nigra L. Several in vitro studies have shown that elder berry constituents have antidiabetic, antiviral and immune-modulating effects, enhance cytokine production and activate phagocytes, but clinical data are lacking. The flowers contain: triterpenes based on oleanolic and ursolic acids; the flavonoids rutin, quercetin, hyperoside, kaempferol, nicotoflorin and others; and linolenic and linoleic acids. The berries contain: anthocyanins cyanidin-3-sambubioside and cyanidin-3-glucoside; the flavonoids quercetin and rutin; cyanogenic glycosides including sambunigrin; and vitamins. The unripe berries of elder contain toxic constituents, but these are lost on drying and/or heating, and are not present in the medicinal product. For information on the pharmacokinetics of individual flavonoids found in elder, see under flavonoids, page 186. Interactions overview There is some very weak experimental evidence to suggest that elder extracts may have additive effects with antidiabetic drugs and phenobarbital, and may antagonise the effects of morphine. For information on the interactions of individual flavonoids found in elder, see under flavonoids, page 186. Experimental evidence In an in vitro study, it was found that an aqueous elder flower extract enhanced glucose uptake by 70%, but had no additional effect on glucose uptake when insulin was also given. This study supports this suggestion as it found that diazoxide inhibited the effects of elder. Importance and management the in vitro study provides limited evidence of a possible bloodglucose-lowering effect of an aqueous elder flower extract. Because of the nature of the evidence, applying these results in a clinical setting is extremely difficult, and the effect of elder flower extracts given with conventional antidiabetic medication is unknown. However, if patients taking antidiabetic drugs want to take elder it may be prudent to discuss the potential for additive effects, and advise an increase in blood-glucose monitoring, should an interaction be suspected. The traditional plant treatment, Sambucus nigra (elder), exhibits insulin-like and insulin-releasing actions in vitro. Experimental evidence In a study in rats aqueous extracts of elder flower and elder berry were found to modestly decrease the analgesic effects of morphine 90 minutes after dosing. The elder extracts had no effect on the analgesic response to morphine at a subsequent time point (150 minutes), and had tended to increase the effects of morphine 10 minutes after dosing. Importance and management Evidence for an interaction between extracts of elder flower and elder berry and morphine appears to be limited to this study in rats, which found only a modest decrease in analgesic effects at just one time point. It is unknown if this effect would occur in humans, but, even if it does, it seems unlikely to be of much clinical relevance. E Elder + Phenobarbital the interaction between elder and phenobarbital is based on experimental evidence only. Experimental evidence In a study in rats aqueous extracts of elder flower and elder berry were found to approximately halve the time to the onset of sleep and increase the sleeping time in response to phenobarbital (from about 190 minutes to 200 minutes). Importance and management Evidence for an interaction between extracts of elder flower and elder berry and phenobarbital appears to be limited to this study in rats, which found only a very modest increase in sleeping time. It is unknown if this effect would occur in humans, but, even if it does, it seems unlikely to be clinically relevant. Interaction of Sambucus nigra flower and berry decoctions with the actions of centrally acting drugs in rats.
Influence of spices and spice principles on hepatic mixed function oxygenase system in rats arthritis in neck bone spurs pentoxifylline 400 mg with visa. Experimental evidence In a study in rats arthritis pain during sleep purchase discount pentoxifylline line, asafoetida gum extract significantly reduced mean arterial blood pressure arthritis relief at your fingertips pentoxifylline 400mg without a prescription. Importance and management Because of the nature of the evidence arthritis immediate relief discount 400 mg pentoxifylline fast delivery, applying these results in a clinical setting is extremely difficult and, until more is known, it would be unwise to advise anything other than general caution. Asafoetida + Warfarin and related drugs the interaction between asafoetida and warfarin and related drugs is a prediction only. Experimental evidence Some reviews1 and monographs list asafoetida as having the potential to increase the risk of bleeding or potentiate the effects of warfarin. Mechanism this appears to be based on the fact that asafoetida contains natural coumarins, but these are not thought to have the structural requirements for anticoagulant activity. Importance and management There appears to be no evidence to support the prediction of an interaction between warfarin and asafoetida, and some data do suggest that an interaction is unlikely to occur. No special precautions therefore appear to be needed if patients taking warfarin or related anticoagulants also wish to take asafoetida. Note that ashwagandha has also been known as Indian ginseng, which should not be confused with the common ginsengs, page 219. It has sedative and anti-inflammatory effects and is used for a wide range of conditions including hypercholesterolaemia. The extract also contains phytosterols and alkaloids such as ashwagandhine, ashwagandhinine, anahygrine, withasomnine, withaninine and others. Interactions overview Although ashwagandha may have blood-glucose-lowering effects, these seem to be mild, and would not generally be expected to affect the control of diabetes with conventional medicines. Ashwagandha may affect the reliability of digoxin assays, and interfere with the control of hypo- and hyperthyroidism. Use and indications Use of ashwagandha root originates in Ayurvedic medicine, 41 42 Ashwagandha phenobarbital, procainamide, salicylate, theophylline, tobramycin or valproic acid. Experimental evidence (a) Digoxin In a study, mice fed two ashwagandha extracts (in quantities that equated to human doses) developed apparent serum digoxin levels of 0. Effect of Indian Ayurvedic medicine ashwagandha on measurement of serum digoxin and 11 commonly monitored drugs using immunoassays: study of protein binding and interaction with Digibind. Interference of Asian, American, and Indian (Ashwagandha) ginsengs in serum digoxin measurements by a fluorescence polarization immunoassay can be minimized by using a new enzyme-linked chemiluminescent immunosorbent or turbidimetric assay. A Ashwagandha + Antidiabetics Limited evidence suggests that ashwagandha has blood-glucoselowering effects, which may be additive with conventional antidiabetics. Clinical evidence In 6 subjects with mild type 2 diabetes, giving powdered root of ashwagandha 1 g three times daily after meals for 30 days reduced blood-glucose levels by 12% (from 11. Importance and management the limited evidence suggests that ashwagandha might have bloodglucose-lowering effects. Until further information is available, if a patient taking antidiabetic drugs wants to take ashwagandha it may be prudent to discuss these potential additive effects, and advise an increase in blood-glucose monitoring should an interaction be suspected. However, bear in mind that, although ashwagandha has been used for a wide number of complaints, it does not appear to be used for diabetes, suggesting that any effects are mild, and probably not clinically relevant. Hypoglycemic, diuretic and hypocholesterolemic effect of winter cherry (Withania somnifera, Dunal) root. Ashwagandha + Digoxin Ashwagandha has been shown to interfere with some methods of measuring serum digoxin levels; see Ashwagandha + Laboratory tests below. Ashwagandha + Thyroid and Antithyroid drugs Limited evidence suggests that ashwagandha increases thyroid hormone levels and therefore interferes with the control of hypoand hyperthyroidism. Clinical evidence A 32-year-old healthy woman developed clinical symptoms of thyrotoxicosis, and was found to have elevated levels of thyroid hormones when she increased the dose of capsules containing ashwagandha herbal extract that she had been taking for chronic fatigue. Ashwagandha does not interfere with in vitro assays for carbamazepine, gentamicin, paracetamol, phenytoin, Ashwagandha Experimental evidence In a study in mice, ashwagandha root extract 1.