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A stimulatory effect by guggulsterone on the thyroid gland has been re- ported cheap 100 mg azithromycin amex, which is also considered as a possible mechanism for its lipid-lower- ing activity [61 discount 250 mg azithromycin overnight delivery, 62]. However, side effects like skin rashes and diarrhea have been reported with therapeutic doses, and which differ in individuals. Therefore, formulations should be prepared as per the ancient Ayurvedic literature (e. Presence of resin on the surface and bacteria in the resin canals make the sterilization of the explants (stem, leaf, or petioles) diffcult. Although zygotic embryos give satisfactory results, low seed set, diffculty in dissecting hard fruits (drupe) to obtain the ovule, and the low frequency of embryonic response of the zygotic embryos makes it a diffcult material [5]. Micropropogation is the most widely used application of plant tissue culture in general and medicinal plants in particular [72, 73]. Clonal propagation as a biotechnological approach is commonly applied for the vegetative propagation 114 K. However, micropropagation through axillary shoots using nodal explants [74] and seedling explants [75] have been described (Table 5. A lim- ited number of shoot formations from these explants and plantlets transferred into pots showed feasibility but not technology development for the plant to- ward its micropropagation. Immature ovule explants produced several embryos in cultures very rapidly [50] because of the presence of polyembryony in the fruits [2]. Morphactin enhances guggulsterones Chapter 5 Guggulsterone from Commiphora wightii 115 ing 2,4,5-trichlorophenoxyacetic acid and kinetin to a medium devoid of any growth regulator. This was the only way to achieve somatic embryogenesis in callus cultures initiated from immature zygotic embryos; treatments with other plant growth regulators did not produce any embryogenesis [5]. Although the frequency of explants producing embryonic culture was low, immature zygotic embryos were the only suitable explants to produce an embryonic callus as ma- ture explants did not produce any type of organogenesis on any of the treat- ments tested. Asynchronously growing embryos formed plantlets regularly, which were successfully transferred to feld conditions [5]. The de- velopment of technology through somatic embryogenesis using callus and cell cultures has been a major focus of our laboratory for last 7 years. Several prob- lems associated with this plant system remain to be resolved before it can be used for mass propagation, namely, asynchronous development of embryos, the low conversion rate, and the survival of plantlets. Although laticifer formation and their regulation in callus cultures is known [79, 80], no single report describes resin canal formation in callus cultures. Resin canal formation was not recorded in callus cultures, but its formation was observed during somatic embryogenesis. Resin canals formed in somatic embryos were comparable with those formed in the stem [81]. Because of resin canal development, somatic embryos accumulated a threefold higher level of guggulsterones. This provides large quantities of aseptic resin canals of somatic origin, which can be used for guggulsterone production through biotechnologi- cal methods, thus relieving pressure on natural resources [78]. The cultures were grown for three passages on medium containing an antibiotic (tetracycline 250 mg/l) to eliminate contamination of explant origin. Undifferentiated cultures contained the lowest amount of gug- gulsterones as compared to embryonic cultures and plant parts. Among the various treatments of plant growth regulators, morphactin and 2-isopente- nyl adenine (2iP) interacted signifcantly to enhance callus growth and gug- gulsterone production by about eightfold in 1-year-old cultures. However, the effect of morphactin on callus growth and guggulsterone production was not uniform over the levels of 2iP tested [21]. Although it was clear that cytodif- ferentiation might be a prerequisite for high production of guggulsterones, cell cultures were initiated to look into the possibility of guggulsterone production. Of all the permu- tations and combinations used for enhancing the guggulsterone contents of the cells, the maximum guggulsterone content and yield per litre were recorded in cells grown in the medium containing a sucrose:glucose combination at the 4 % level. This concentration and combination of sugars enhanced the yield of gug- gulsterones two- to threefold as compared to similar concentrations of sucrose or maltose. Biomass generation using cells grown in growth medium in vessels of different sizes (250 ml to 2 l) and a stirred tank (2 l) bioreactor has been achieved [84]. Guggulsterone accumula- tion increased about fourfold during somatic embryogenesis (Fig. Currently, conditions for the growth of these cells in production medium using elicitors and immobilization, and histochemical localization of guggulsterones are in process. The continuous research efforts during the last three de- cades has resulted in some success in establishment of cell suspension cultures grown up to bioreactor level, developing somatic embryogenesis in callus cul- tures, micropropagation systems and feasibility of guggulsterones production in cell cultures. However, there are several problems that remain to be resolved before guggulsterones are produced by alternative technology, like somatic em- bryogenesis in cell suspension cultures, assessment of genetic variability in na- ture and in the regenerants, regulation of somatic embryogenesis, high yields of guggulsterones through immobilization and elicitation of suitably selected so- matic embryos, histochemical localization of producer cells, and identifcation of stem cells for better embryogenesis. A better understanding of biosynthetic pathways and the use of precursors hold promise toward developing this tech- nology-achieving target of high guggulsterone production. Ubrich C, Basch E, Szapary, P, Hammerness P, Axentsev S, Boon H, Kroll D, Gar- raway L, Vora M, Woods J (2005) Comp Ther Med 13:270 32.

Eclampsia must also be considered in pregnant women as a potential etiology of seizures buy azithromycin 250mg overnight delivery. Diagnosis History: History is essential in the evaluation of a seizure patient discount azithromycin 250 mg on line, especially in a first-time seizure. It is important to ask the patient and/or witnesses the circum- stances leading up to the seizure, including a description of the ictal movements and the postictal period. Any symptoms associated with the seizure should also be addressed to help direct work-up and management. For example, a headache prior to the seizure is concerning for intracranial hemorrhage, while a fever and/or general malaise in a patient who presents with a seizure is worrisome for infectious causes. Patients with a known seizure disorder should be questioned about the type and frequency of their seizures as well as medication compliance. Focal deficits may be a critical clue to the ultimate diagnosis or may rep- resent a common transient postictal neurologic insult referred to as a Todd paralysis. The head and neck examination should include the tongue to look for lacerations, head or facial trauma, and signs of meningismus. Cardiopulmonary examination should include auscultation for heart murmurs or an irregular rhythm suggesting an embolic or syncopal event. Although rare, extremity fractures or dislocations are commonly missed when they do occur and should be ruled out by a thorough musculoskeletal examination. Diagnostic Workup: Appropriate laboratory studies in patients with first-time seizures include glucose, serum electrolytes such as sodium, calcium, and magne- sium, assessment of renal function, hematology studies such as a complete blood cell count, and drug or toxicology screen. Neuroimaging studies should be performed when a clear etiology to the seizure is not identified or whenever an acute intracranial process is suspected. A lumbar puncture is an essential part of the workup if clinical presentation is suggestive of an infectious process. Aggressive airway protection is critical as seizure patients have decreased gag reflexes and are at risk for aspiration. Positioning the patient on their side with frequent suctioning, if necessary, will lower the risk for aspiration. Patients who continue to seize despite therapy or those unable to protect their airway with con- servative measures require intubation. If a benzodiazepine does not terminate seizure activity, second-line agents for abortive therapy include phenytoin or fosphenytoin. Phenytoin does not directly suppress electrical activity at the seizure focus but rather slows recovery of volt- age-activated sodium channels and thus suppresses neuronal recruitment. Thus, concurrent benzodiazepine administration is necessary when treating active sei- zures. The total oral dose of phenytoin is about 20 mg/kg with a maximum of 400 mg every 2 hours. The rate can be no greater than 50 mg/min to avoid hypotension and cardiac dysrhythmias associated with its propylene glycol diluent. Fosphenytoin is the prodrug of phenytoin, is water soluble, and can be administered at 150 mg/min without significant toxicity. Cerebellar findings, such as nystagmus and ataxia, are the most common neurological side effects associated with phenytoin. While parenteral loading is most common, oral loading is appropriate in patients who report medication noncompliance or are found to have a subtherapeutic phe- nytoin level. The onset of intravenous phenobarbital is 15 to 30 minutes with a long duration of action of up to 48 to 96 hours. Adverse effects of phenobarbital include profound respiratory depression and hypotension, limiting its use as abortive seizure therapy to third-line therapy. Parenteral valproic acid has shown some recent promise as abortive seizure therapy, and is considered an alternative in cases where benzodiazepine or phenytoin use is limited by hypotension or hypersensitivity. Recommended loading dose for valproic acid is 15 to 20 mg/kg at a rate of 3 to 6 mg/kg/min, although more rapid bolus infusions have been safely administered. Additional agents to be considered for abortive seizure therapy include pro- pofol, barbiturates (other than phenobarbital), and inhaled anesthetics such as isoflurane. If the patient requires paralysis for management purposes, it cannot be assumed that the patient’s seizure has been ter- minated. There are no clear evidence-based guidelines for the management of drug- related seizures and usually require therapy that is specific to the etiological agent. Seizures caused by cocaine are a result of a combination of a lowered seizure threshold and hyper- sympathetic state. These seizures are usually self-limited, but in cases of status epilepticus, should be treated with high doses of benzodiazepines. Tricyclic antidepressants cause seizures as a consequence of their anti- cholinergic properties. In addition to standard seizure therapy, patients with status epilepticus secondary to tricyclic overdose should be treated with sodium bicarbon- ate in an effort to obtain a blood pH of approximately 7.