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By: K. Narkam, MD

Associate Professor, Icahn School of Medicine at Mount Sinai

History: It is a native of Africa hypertension young living generic 10mg ramipril visa, the Middle East and India blood pressure chart by who ramipril 5mg otc, and it was first brought into medicinal use by the ninth-century Arabian physicians arteria auditiva buy generic ramipril on line, Serapion and Sesue arrhythmia vs pvc cheap ramipril, who gave it its Arabic name and employed it as a purgative. The Cassia acutifolia plant (also called Senna alexandrina or Cassia Senna) was exported from Egypt, via Cairo and the Red Sea, and Cassia angustifolia from India, via Madras; and by 1640, Senna was cultivated and being utilized in England for its cathartic properties. The herb was officially listed in both the British Pharmacopoeia and the United States Pharmacopoeia, and the herb is one of the few herbal medicines approved by the United States Food and Drug Administration for over-the-counter use and may be one of the most widely used herbal medicines in the United States. In the United States, Senna leaf, fruit and extract are used in over-the-counter laxatives. In Germany, Senna leaf, Alexandrian Senna pod and Tinnevelly Senna pod are licensed as standard medicinal teas available only in a pharmacy, official in the German Pharmacopoeia and approved in the Commission E monographs. They are used alone and in more than 110 prepared drugs, mostly laxatives and biliary remedies. The plant is well distributed throughout the world as an annual or perennial, depending upon its geographic location, and the herb encompasses many species within the genus Cassia. Some of the constituents in Senna leaves include anthraquinone compounds, including dianthrone glycosides, sennosides (aloe-emodin derivatives), flavonoids, naphthalene glycosides, mucilage, tannin, resin and beta-sitosterol. Medical Uses: Senna is an effective and potent purgative with its action being chiefly on the lower bowel. The anthraquinone stimulate the bowel and increase the peristaltic movements of the colon by its local action upon the intestinal wall, leading to evacuation in approximately ten hours. The herb has been recommended for people who require a soft, easily passed stool, especially when following rectal surgery or preparing for a colonoscopy). By cleansing the colon, Senna may have positive results in improving skin afflictions (pimples, etc. Treatments: Senna is an ingredient that is primarily used to help with constipation. Senna is not known to treat constipation, but can be associated with alleviating this problem for a short period. A natural herb that comes from a plant that is grown and cultivated in places like India, Sudan, Egypt and Pakistan, Senna is also used in many over the counter laxatives and may be found in pharmaceutical products. Pregnant, nursing or menstruating women should not use Senna, and it is not appropriate for children under six years of age. People with intestinal blockage, inflammatory bowel disease, intestinal ulcers, and undiagnosed stomach pain or appendicitis Symptoms must avoid Senna. Senna can cause cramping, nausea and diarrhea, and the urine may take on a reddish hue (which is harmless). Long-term use is not recommended, since it may cause dependence and a weakened colon, aggravate constipation and result in a loss of potassium and other vital minerals, which is particularly dangerous to people with heart rhythm irregularities. Chronic constipation is usually indicative of another condition and should always be discussed with a physician. Dosages: Take two (2) capsules, two (2) times each day approximately thirty (30) minutes before mealtimes. Try Skull Cap as a natural way to ease frayed nerves, relax, and get a restful sleep. Skull Cap is also considered very useful for alleviating the difficulties of barbiturate and drug withdrawal. Plant Description: Skull Cap (also spelled Scullcap) is a small, herbaceous perennial, indigenous to North America, with an erect and branching square stem and flowers that may grow to a height of three feet. It is abundant throughout the land and thrives in damp places, meadows, ditches and waste places from Canada to Florida. Different varieties of this herb grow throughout the world in temperate regions (most notably in China and Russia) with some similar medicinal applications as the "American Scullcap," but they are not generally used interchangeably. History: the name, Skull Cap, is derived from the helmet-shaped flower that resembles a helmet with the visor raised, and a "Skullcap" was the word for a type of military helmet that was familiar to early colonists. In the nineteenth century, Skull Cap was a popular medicinal treatment for nervous disorders and was used to subdue undue sexual desires without damage. Some of the constituents included in Skull Cap include essential oil, albumen, tannins, a bitter principle (scutellaine), flavonoids (scutellarein, isoscutellarein, wogonin, and baicalin), acids, beta carotene, lignin, tannins, chloride of soda, salts of iron, silica, calcium, magnesium, manganese, phosphorus, potassium, selenium, zinc, beta-carotene, B-vitamins and Vitamin C.

These materials are slowly re sorbed blood pressure xls purchase ramipril 5 mg amex, taking up to blood pressure xanax buy ramipril online pills 4 weeks before they are resorbed blood pressure medication range buy discount ramipril line. Such long-lasting resorbable sutures are rarely indicated in the oral cavity for basic oral surgery blood pressure dizziness 10mg ramipril for sale. Monofilament sutures are sutures such as plain and chromic gut, nylon, and stainless steel. Polyfilament sutures are braided sutures such as silk, polyglycolic acid, and polylactic acid. The cut ends are usually soft and nonirritating to the tongue and surrounding soft tissues. Monofilament sutures do not cause this wicking action but can be more difficult to tie and tend to come untied. Also, the cut ends are stiffer, being more irritating to the tongue and soft tissue. The color makes the suture easy to see when the patient returns for suture removal. Sutures that are holding mucosa together are usually left in place no longer than 5 to 7 days, so the wicking action is of little clinical importance. The outer package of the suture peeled open to allow the surgeon or assistant to grasp it in a sterile 1 manner. The use of the needle holder and the technique necessary to pass the curved needle through tissue are difficult to master. The following discussion presents the technique used in suturing; practice is necessary before suturing can be performed with skill and finesse. Just as with all such skills, hands-on learning while under the watchful eye of an instructor is critical to becoming able to suture with skill and finesse. If the needle passes through the tissue obliquely, the suture will tear through the surface layers of the fiap when the suture knot is tied, which results in greater injury to soft tissue. When passing the needle through the tissue, the surgeon must ensure that an adequate amount of tissue is taken, to prevent the needle or suture from pulling through the soft tissue. Because the tissue being sutured is a muco periosteum, it should not be tied too tightly. The minimal amount of tissue between the suture and the edge of the fiap should be 3 mm. In most situations, the suture needle should pass through the tissue following the curvature of the needle with rotation of the wrist or forearm. However, the surgeon must consciously consider how deep to guide the needle so that too much or too little tissue is not engaged. In most circum stances in oral surgery, the same amount of tissue should be engaged on each side of the wound being repaired. This means that the distance from the wound edge the needle enters on the first side should equal the distance from the wound edge when the needle emerges on the other side. Similarly, the depth at which the suture needle leaves the subepithelial tissue on the first side should be equal to the depth the needle enters the subepithelial tissue on the other side. A, When passing through the mucosa, the needle should enter the surface of tissue at a 60 to 90 angle. The angle the needle enters is dictated by how deep the suture is intended to run. B, the needle hold er should be turned such that the needle passes easily through the tissue. C, If the needle enters the soft tissue at too acute an angle and is pushed (rather than turned) through the tissue, tearing of the mucosa with the needle or with the suture is likely to occur and too little tissue will be engaged. D, In most cases, the same amount of tissue should be engaged on both sides of the wound. The technique for placing and knotting a routine interrupted suture will be presented first, followed by a discussion of other suturing techniques used for dentoal veolar surgery.

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When used externally prehypertension statistics buy ramipril cheap, the herb provides the same soothing effects on mucous membranes that will support the skin and connective tissues arterial network on the dorsum of the foot discount 5mg ramipril. It is thought that Marigold will support good heart health hypertension drug list buy discount ramipril 10mg line, as some recent studies indicate that the herb may reduce blood pressure arteria3d full resource pack purchase ramipril overnight. Precautions: Pregnant women should not take Marigold internally, as it may stimulate the uterus. When taken internally, Marigold/Calendula may increase the sedative effects of medications taken for anxiety and insomnia, and caution should be exercised if using the medications and the herb at the same time, particularly when driving or operating machinery. When using topically, some people may show an allergic reaction, and it is wise to test a patch of skin before widespread use. It eases colic, sour stomach, stomach pains and menstrual cramps and is an effective expectorant that loosens phlegm in the lungs and alleviates sinus headache, bronchitis, dry coughs and the symptoms of colds and flu. Marjoram is also a natural disinfectant, anti inflammatory, antifungal and antioxidant that effectively relieve pains and aches. Plant Description: Sweet Marjoram is a half-hardy annual that is native to southern Europe (probably Portugal) and can be found in North Africa, the Balkans and the Middle East, and has been introduced throughout Europe and into North America. Sweet Marjoram Leaf has a more delicate flavor than its close cousin, Origanum vulgare (oregano or wild marjoram), and possesses very similar medicinal properties, often being used in a similar manner. Marjoram Leaf is a bushy plant with small, dark green leaves and flowers that resemble little knots, hence, one of its common names, Knotted Marjoram, and the plant generally reaches about one foot in height, thriving in well drained-to-dry, and neutral-to-alkaline soil in full sun. History: the Greeks gave us its botanical name, Origanum, which is derived from oros and ganos, meaning "joy of the mountain," and those traveling through Greece will find it (and wild Marjoram) covering the hillsides and scenting the summer air. Legend tells us that sweet Marjoram was created by Aphrodite as a symbol of happiness, and bridal couples in Greece and Rome were crowned with its garlands to ensure a happy marriage. This highly fragrant herb was also placed on tombs to give peace to departed spirits. In ancient Greece Marjoram was used in oils to massage into the skin to relieve pain, and Aristotle recommended it as an antidote for poisoning, claiming that tortoises swallowing a snake would immediately eat wild Marjoram as an antidote to prevent death. The ancient Egyptians also knew of its power to heal, using it to disinfect, preserve and heal wounds, and it is used in that country for the same purposes to this day. In medieval times, herbalists prescribed Marjoram oil for toothache, and sixteenth and seventeenth-century herbalists recommended it as an internal aid to digestion and as a diuretic. Throughout history, Marjoram Leaf has been used in preserving food and in remedies for colds and sore throats, and dried Marjoram Leaf was popular as snuff. Sweet or Knotted Marjoram is considered by many cooks to be far better than wild Marjoram (oregano), and the leaves are highly popular in Italian and Greek cuisine and used to flavor oil and vinegar. It is often infused in healthful teas, and its fragrance is placed on pillows to promote sleep, in moth bags to deter moths, in potpourris for it fragrance, on hair and skin for its sweet scent and added to bathwater to relieve tension and rheumatic pains. Marjoram Leaf is rich in flavonoids and volatile oils, notably carvacrol and the powerful antiseptic, thymol, gallic acid, caffeic acid, saponins and tannin. Medical Uses: Marjoram Leaf is an expectorant that has long been used to loosen and expel phlegm from the lungs. Because of its saponin content, it is a fine decongestant that is very useful for bronchial complaints, especially relieving congestion and mucus in the chest and sinuses. Marjoram Leaf helps to ease asthma, bronchitis, dry coughs, and sinusitis and sinus headaches. As a mild tonic for the nervous system, Marjoram Leaf is thought to be more relaxing than oregano, and it is used to soothe the nerves, reduce tension and mitigate stress, especially environmental stress. The flavonoids possess sedative qualities that help to relieve insomnia, tension headaches and migraines. Marjoram Leaf promotes healthy digestion and treats simple gastrointestinal disorders, such as loss of appetite, indigestion, nausea and flatulence. It is said to act like peppermint in the way it soothes minor digestive upsets and colic. The flavonoids and saponins in Marjoram Leaf are thought to promote healthy arteries and heart. Laboratory experiments claim that it prevents cholesterol buildup, improves blood circulation and may reduce high blood pressure.

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