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There are two main applications of jamu: • To maintain physical fitness order viagra super active 50mg with amex, health and sexual performance • To cure various kinds of illness buy 100 mg viagra super active visa. Other cosmetics are for topical application such as bedak dingin (cool powder) and lulur (scrubbing powder) 100 mg viagra super active visa. An examination on the microbiological quality of seven kinds of jamu and their raw materials was conducted according to the requirements of microbial contamination in traditional medicine cheap viagra super active 25 mg without a prescription, issued by the Department of Health of Indonesia viagra super active 50 mg mastercard. It was suggested that certain plants be scanned for antibacterial and antifungal activity. Whole genome expression and biochemical correlates of extreme constitutional types defined in Ayurveda. Introduction: Evaluating the safety of comple- mentary and alternative products and practices. Utilization of Ayurveda in health care: an approach for prevention, health promotion, and treatment of disease. Effects of Boswellia serrata gum resin in patients with bronchial asthma: results of a double-blind, placebo- controlled, 6-week clinical study. Safety and efficacy of Hartone in stable angina pectoris – an open comparative trial. From ancient medicine to modern medicine: ayurvedic concepts of health and their role in inflammation and cancer. Jamu Gendong, a kind of traditional medicine in Indonesia: the microbial contamination of its raw materials and end product. The name is derived from the Japanese symbols kan, which means China and po, which means medicine. Koteidaikei described the theory of yin–yang and the five elements, featured in the original philosophies of China. Shinnohonzokyo described the effects of medicinal herbs, and was composed of 365 medicinal herbs comprising animal, plant and mineral origins, and classified into three different (upper, middle and lower) grades depending on their safeties and efficacies. Shokanron and Kinkiyouryaku are both most important classic textbooks for the treatment by the decoction of traditional Chinese medicines. Shokanron has instructions on the diagnosis and treatment of typhoid-like acute febrile diseases, called Shokan. The symptoms of this 226 | Traditional medicine disease are categorised in six stages according to the progress of the disease, and the pathological observation and corresponding suitable kampo formulae are described. In contrast to Shokanron, Kinkiyoryaku has been described various chronic diseases and the formulae for the treatment. Many popular kampo formulae appear in both classic textbooks as the major sources. Chinese medicine underwent numerous modifications to make it better suited to the Japanese situation and kampo medicine was established in the Edo era during the eighteenth century. Except for limited trade with China and the Netherlands, Japan was a closed country during this time. Although Dutch medicine was introduced to Japan in the sixteenth century and admin- istered alongside traditional medicine, its usage did not surpass that of the traditional medicine until end of the nineteenth century. When Japan opened its door to western countries in 1867, the government would license only medical doctors for the practice of western medicine. Despite this unfavourable aspect of the period, kampo medicine continued to thrive through the efforts of a few medical leaders who recog- nised its benefits. With the progress of modern science and technology, modern medicine has greatly improved. Although incidences of numerous globally rampant infections had been reduced by the development of antibi- otics, the latter half of the twentieth century saw a marked increase in chronic, endogenous, metabolic disorders. There has also been an increase in non-specific, constitutional or psychosomatic diseases. Some severe adverse effects associated with some natural and synthetic compounds have also resulted in occasional disillusionment with modern medicine. Against these social backgrounds, use of kampo medicines in Japan emerged as an alternative. Consequently, kampo medicine now plays an important role in medical treatment in Japan. In 2001, The Ministry of Culture, Sports and Education of Japan confirmed the new core curriculum of the medical schools, and the education of kampo medicine was introduced into this new curriculum. Principles of kampo medicine Kampo medicine attempts to harness a state of harmony or equilibrium from the disturbed digestive, immune, endocrine and cardiovascular systems in the whole body to relieve or abolish symptoms related to the diseases. It is based on a number of criteria that are used to assess each patient’s overall condition of the whole body:1 • yin and yang for patient’s constitution • hypofunction and hyperfunction for the level of energy Japanese kampo medicine | 227 • heat and cold for the character of the disease based on subjective feelings of heat (fever) and cold (chills) • exterior or interior for the body area showing symptoms • ki (vital energy), ketsu (blood) and sui (water) for the body’s overall homoeostatic balance • the theory of the pathogenesis of visceral disease • the six stages in the progress of disease.

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Between the epithelial zones of the anal canal and the rectum is the anal transitional zone buy cheap viagra super active 25 mg, which is usually located in the region of the anal columns and is purple (177) generic viagra super active 100 mg line. The anal canal generic 50 mg viagra super active with mastercard, as previously defined purchase 100mg viagra super active fast delivery, is lined by nonkeratinized squa- mous epithelium and is salmon pink in the living (174) buy generic viagra super active 25mg. It is sensitive to touch, pain, heat, and cold to just above the dentate line (175). The anus and lumen of the anal canal usually appear as an asymmetric Y-shaped slit when viewed via a proctoscope (anoscope). The folds of mucosa and subcutane- ous tissue (containing small convulated blood vessels surrounded by con- nective tissue) between the indentations of the Y are referred to as the anal cushions. Although this appearance is usually obscured externally by the folds of skin on the perianal area, it may become apparent if the patient is anesthetized or as the anus dilates. Rectum The rectum extends from the anal transitionary zone to the sigmoid colon and is 8–15 cm long. Anal Sphincters and Fecal Incontinence Although numerous muscles encircle the anal canal, the two that are forensically significant are the internal and the external anal sphincters. Internal Anal Sphincter This sphincter is a continuation of the circular muscle coat of the rectum and extends 8–12 mm below the dentate line. In the normal living subject, the internal anal sphincter is tonically contracted so that the anal canal is closed. The internal sphincter is supplied by autonomic nerve fibers and is not consid- ered to be under voluntary control (3). Thus, although it appears to contract 104 Rogers and Newton during a digital assessment of voluntary anal contraction, it is presumed to result from its compression by the surrounding external sphincter fibers (177). External Anal Sphincter This sphincter encircles the internal sphincter but extends below it, end- ing subcutaneously. The lower edges of the external and internal sphincters can be distinguished on digital palpation. Although this sphincter is tonically contracted in the resting state, this contraction can be overcome with firm pressure (177). If the patient is asked to contract the anus during a digital assessment, the external sphincter can be felt to ensure contraction and clos- ing of the anus tightly. However, because the muscle fibers are predominantly the slow-twitch type, a maximum contraction of the external sphincter can only be maintained for approx 1 minute(178). Fecal continence is maintained by several factors, the relative impor- tance of which has not been fully elucidated. Currently, the most important factor is the angulation between the rectum and the anal canal, which is main- tained at a mean of 92° by continuous contraction of the puborectalis muscles, located above the external sphincter. Both sphincters have supportive roles in maintaining fecal continence (175), and their disruption can result in inconti- nence (see Subheading 10. Forensic Evidence The presence of semen in the anus or rectum of a male complainant can be corroborative evidence of alleged anal intercourse in conjunction with the presented history and possible physical findings. The same is only true for a female complainant if no semen is detected in the vagina, because semen has been found on rectal and anal swabs taken from women who described vaginal intercourse only. It is postulated that the presence of semen in these cases results from vaginal drainage (49,179). Swabs should also be taken if a condom or lubricant was used during the sexual assault and if anilingus is alleged (see Subheading 7. Just as when sampling the skin elsewhere, if the perianal skin is moist, the stain should be retrieved on dry swabs. If there is no visible staining or the stain is dry, the double-swab technique should be used (28). The forensic practitioner should use as many swabs as are necessary to remove any visible stain (repeating moistened swab followed by dry swab). Although not specifically defined for forensic pur- Sexual Assualt Examination 105 poses, the perianal area should be considered as an area with a radius of 3 cm from the anus. Even though traditionally these swabs have been labeled “external anal swab,” they should be labeled as “perianal swab” to clearly indicate the site of sam- pling. The anal canal is then sampled by passing a wet swab and then a dry swab, sequentially, up to 3 cm through the anus. The proctoscope (anoscope) is then passed 2–3 cm into the anal canal, and the lower rectum is sampled using a dry swab.

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Persons at Risk During Interviews in Police Custody: The Identifica- tion of Vulnerabilities cheap 50mg viagra super active with mastercard. There is a constant need for information as new organisms emerge purchase 50 mg viagra super active with amex, existing ones develop resistance to current drugs or vaccines viagra super active 50 mg mastercard, and changes in epidemiology and prevalence occur 100mg viagra super active otc. Population migration and the relatively low cost of flying means that unfamiliar infectious diseases may be brought into industrialized countries order viagra super active 25 mg with mastercard. Despite modern technology and a huge input of money, it took months for the agent to be identified, a diagnostic test to be produced, and a strategy for disease reporting and isolation to be established. There is no doubt that other new and fascinating diseases will continue to emerge. The first problem is managing detainees or police personnel who have contracted a disease and may be infectious or unwell. The second prob- lem is handling assault victims, including police officers, who have poten- tially been exposed to an infectious disease. The latter can be distressing for those involved, compounded, in part, from an inconsistency of management guidelines, if indeed they exist. There- fore, it is prudent to preempt such situations before the consultation begins by obtaining either written or verbal consent from the detainee to allow certain pieces of information to be disclosed. If the detainee does not agree, then the doctor must decide whether withholding relevant details will endanger the lives or health of those working within custody or others with whom they may have had close contact (whether or not deliberate). Adopting a universal approach with all detainees will decrease the risk to staff of acquiring such diseases and will help to stop unnecessary overreac- tion and unjustified disclosure of sensitive information. For violent or sexual assault victims, a more open-minded approach is needed (see also Chapter 3). If the assailant is known, then it may be possible to make an informed assess- ment of the risk of certain diseases by ascertaining his or her lifestyle. This chapter highlights the most common infections encountered by the forensic physician. It dispels “urban myths” and provides a sensible approach for achiev- ing effective management. Forensic physicians or other health care professionals should wash their hands before and after contact with each detainee or victim. Police officers should be encouraged to wash their hands after exposure to body fluids or excreta. All staff should wear gloves when exposure to body fluids, mucous membranes, or nonintact skin is likely. Gloves should also be worn when clean- ing up body fluids or handling clinical waste, including contaminated laun- dry. Single-use gloves should only be used and must conform to the requirements of European Standard 455 or equivalent (1–3). A synthetic alter- native conforming to the same standards should also be available for those who are allergic to latex. All staff should cover any fresh wounds (<24 hours old), open skin le- sions, or breaks in exposed skin with a waterproof dressing. Gloves cannot prevent percutaneous injury but may reduce the chance of acquiring a blood- borne viral infection by limiting the volume of blood inoculated. Gloves should only be worn when taking blood, providing this does not reduce manual dex- terity and therefore increase the risk of accidental percutaneous injury. Infectious Diseases 237 Ideally, a designated person should be allocated to ensure that the clini- cal room is kept clean and that Sharps containers and clinical waste bags are removed regularly. After use, the clinical waste should be double- bagged and sealed with hazard tape. The bags should be placed in a desig- nated waste disposal (preferably outside the building) and removed by a professional company. When cells are contaminated with body fluids, a professional cleaning company should be called to attend as soon as possible. Sharps Awareness There is a legal requirement in the United Kingdom under the Environ- mental Protection Act (1990) and the Control of Substances Hazardous to Health Regulations 1994 to dispose of sharps in an approved container. In cus- tody, where Sharps containers are transported off site, they must be of an approved type. In the United Kingdom, such a requirement is contained within the Carriage of Dangerous Goods (Classification, Packaging and Labelling) and Use of Transportable Pressure Receptacles Regulations 1996.

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Depending on the size of the bags viagra super active 25 mg with visa, three to fve tubes can be placed in a single bag order 50mg viagra super active fast delivery. First discount 100mg viagra super active with amex, if leakage occurs from a tube cheap 50mg viagra super active with amex, it limits the potentially contaminating exposure to a limited number of other samples best viagra super active 25 mg, and it also reduces the likelihood that numerous labels will become smudged or illegible. Second, when working with very large numbers of samples, the plastic bag simplifes the moving of evidence to and from the laboratory or in and out of storage. If precoordinated with the laboratory, collection teams can even use the bags to batch samples according to their priority. Te 16-quart size or larger allows ample room for bags of ice or reusable ice packs to keep samples cold during transportation. If samples cannot be transferred to the laboratory immediately, they should be kept in a cool, dark, dry environment, preferably at –20°C. Samples may be shipped using a commercial courier, but a courier rotating directly and only between the morgue and laboratory, maintaining wireless communication with both sites, and possessing security clearances at both sites is highly desirable. Tis arrangement will overcome the business hour restrictions that hamper some delivery services and also will facilitate an unbroken chain of custody. But neither is more com- plex than the need to assemble all of the data that are generated, review them, and compare these unknown profles with the available references, including interpreting the results and assigning a statistical weight to the conclusions. Tis activity becomes far more challenging depend- ing on the number of diferent laboratories that are processing samples and the degree of commonality between their procedures. Te variation in capa- bility from one management system to another is quite extreme, and very few laboratories have systems that are developed specifcally to handle mass fatality scenarios. Cases that may require this approach are those that involve remains of unique cultural value or museum specimens where the destruction of the material must be minimized. Examples are investigations into the remains of Tzar Nicholas and his family, analysis of dental evidence representing members of George Washington’s extended family, and attempts to identify the putative skulls of Mozart and Fredric Schiller (unpublished data). Studies by Krzyżańska use a microfuidic pump to fush cells from the tooth by rinsing the pulp system from the apical orifces through small holes in the occlusal surface. Tis decision should be made in concert with the forensic odontologist using his knowledge of dental histology and taking into account the presence of any identifable morphological or restorative traits of the tooth. Te forensic odontologist may also be approached with questions regarding the buccal swab. Saliva is composed chiefy of water but also contains electrolytes, bufers, glycoproteins, antibodies, and enzymes. Some are very specifc and are based on monoclonal antibody activity that focuses on human salivary α-amylase, whereas others are more general in relying on the detection of amylase activity to release a colored dye suggesting the presence of saliva. If used, consideration should be given to selecting the most informative product that requires the least volume of sample. Alternative light sources, such as lasers and high-intensity lights that can be fltered to provide a single wavelength, are probably the best for screening evidence, including skin, for the presence of saliva. Tese cells are not secreted by the salivary glands but are incorporated into saliva as part of the shared oral environment. Specifcally, oral mucosal cells are sloughed into the salivary mix through normal epithelial turnover and the activity of mastication. Additionally, white blood cells, most commonly the acute infammatory polymorphonuclear leukocytes, arise from the crevicular fuid secondary to gingivitis. Te technique requires two sterile cotton swabs and 3 ml of sterile, distilled water. Roll the head of this swab over the area of the saliva stain while using moderate pressure and a continuous circular motion. Allow this frst swab to air dry in a contamination-free environment for at least thirty minutes. Within ten seconds of completing the frst swab, roll the tip of the second, dry swab across the now moist area of the stain. Use a circular motion and light pressure to absorb the moisture from the skin into the second swab. Allow the second swab to air dry in a contamination-free environ- ment for at least thirty minutes.

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