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Following a polio epidemic in Scandinavia cheap citalopram 10 mg line anxiety 30000 diagnosis, the first pediatric critical care unit was established in Sweden in the late 1950s buy generic citalopram 10 mg depression symptoms hygiene. As the discipline became more established discount citalopram 10mg without a prescription mood disorder psychopathology, provision of services became more structured buy 10 mg citalopram overnight delivery depression definition dsm 5, leading to a concentration of expertise and resources within regional lead centers. Furthermore, advances in critical care medicine has resulted in improved survival rates, particularly among premature infants and children with complex medical conditions. Consequently, the need to transport critically ill children to appropriate institutions has risen. The military have a long history of transporting the critically ill, initially on foot with stretcher- bearers moving wounded soldiers from the frontline. Aero medical transport of injured soldiers began in World War I and became a prominent feature of subsequent conflicts, particularly the Korean and Vietnam wars. The military followed a strategy of ‘scoop-and-run’, whereby the casualty was very quickly transported to hospital facilities with little pre-transport stabilization. Advances in critical care medicine has resulted in improved survival rates, particularly among premature infants and children with complex medical conditions. Consequently, the need to transport critically ill children to appropriate institutions had risen. Initially the attending team used to transfer patients to these institutions but it was soon realized that transport of these sick and unstable patients require expert services which could be provided by specialized pediatric retrieval teams. Subsequent studies indicated that morbidity and mortality of critically ill patients were much reduced if specially trained teams conducted transport and delivered life-sustaining treatments. The second consequence was the development of the ‘stay-and-play’ concept, where the patient received maximum stabilization at the referring hospital before transport. This highlights the limits and the potential destabilising influence of transport on the patient. Scene run - from a non-medical site to the nearest available or designated hospital. In this chapter we will be concentrating on inter-hospital transport of critically sick children though whether the child is being transported to critical care facilities from outside the hospital or within the same hospital the principles of medical management remains the same. There may be may various situations when transferring a critically ill child to another facility is considered. Such a situation may arise due to non availability of pediatric subspecialty ( neurology, nephrology) or specific investigation (e. Or it may be simply due to non availability of continuous monitoring in the referring hospital. The need for transport may also arise out of request from patients relatives due to variety of reasons. Once a patient who has been treated in tertiary hospital is stable, he might be needed to be transported back to the referring hospital for further on going care. The goals of an effective transport system should be: • To reach persons in need as quickly as possible with trained personnel • To stabilize the patient’s condition preventing further deterioration • To move the patient to a facility capable of providing more extensive care or additional services that will enhance patient outcome • To offer the level of care equal to the receiving institution recognizing the limits inherent in traveling. If ambulances are readily available, teams can use them to travel to the referring hospital as well as the to the receiving unit. However, they can be uncomfortable and may induce travel sickness, particularly over long journeys. For long journeys, urgent transports, and when ambulances are not available, rapid response vehicles may be preferable. On the return journey, if there is insufficient room in the ambulance to allow a parent to escort the patient and team, rapid response vehicles can also be used to transport the family to the receiving unit. Generally, decisions to transport by air will depend on a number of factors including severity of illness and distance involved. Adult studies have indicated that if travel is predicted to be above 80 kilometers or 90 minutes’ duration, then air transport is preferred. Other factors including availability of aircraft, crew, weather conditions, cost, and mobilization times will also influence the decision. It is also preferable to have knowledge of “charge structure”, mandatory deposit required prior to admission if any. The reason for transport, option of institute, and the financial implication should be discussed with them. The clinical condition of the patient should be thoroughly discussed with physician at the tertiary care centre and any advice about patient management sought. It is strongly recommended that critical care transport be performed by a minimum of two trained individuals. Team members should be trained and competent in pediatric critical care and transport medicine, be expected to provide advanced pediatric resuscitation and recognize limitations and physiologic effects of transport on the patient Inter-hospital transfer of critically ill children by specialist retrieval teams tend to be associated with a lower incidence of major complications than those transported by a non-trained personnel. It states “Team members should be chosen for both their medical skills and their ability to behave responsibly when interacting with personnel at the referring and receiving hospital, parent/patient and one another. From personal experience, this is only successful if the team can replicate conventional nursing roles including operating pumps and preparing drug infusions. While there may be many individual factors, the decision to transport a patient will ultimately depend on if the severity of the child’s condition necessitates treatment in excess of local capabilities and if the benefits of transfer outweigh the risks. The child will only be transferred if the referring and receiving institutions and the transport team agree that these two criteria are met. Therefore it is generally agreed that children should be stabilized before transport. After clinical evaluation, we should check the position of the endotracheal tube on X-ray, re-position it if required and secure it using elastoplast. We as a protocol make an airway bag containing endotracheal tubes, intubation equipment, intubation drugs, ambu bag, appropriate sized masks, suction catheters, elastoplast, scissors. In case there is an accidental extubation or tube blockage, everything is at hand and patient can be easily stabilized without running the risk of last minute confusion of looking for things and avoiding prolonged hypoxemia. If the transport team can afford, inhaled nitric oxide could be a valuable adjunct to this mobile intensive care unit. All pneumothoraces should be drained, the thoracostomy tubes should have underwater seal or even better still is Hemlich valve (fluttering valve ). Ideally, the team should be able to access the site without removing safety restraints. Arrest drugs are kept ready along with the de-fibrillator and infusions are run on infusion pumps. Once the transport team has stabilized the child and is ready to move, it has to ensure that the patient is safely moved in and out of the vehicle. Appropriate precautions to immobilize the patient including cervical spine immobilization should be taken, whenever appropriate. All infusion pumps and intravenous lines should be secured so that they do not harm the patient or accompanying personnel in case of sudden deceleration of transport vehicle.

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In addition to the specific antidotes (atropine and pralidoxime) buy citalopram 10mg overnight delivery depression symptoms rating scale, the main stay of treatment is supportive cheap citalopram 40 mg on line depression symptoms home remedy. Atropine is an antidote for muscarinic symptoms but does not reverse nicotinic symptoms such as muscle weakness and respiratory failure purchase citalopram 40 mg with visa mood disorder 29699 diagnosis code. Frequent suctioning and ventilation should be provided until the patient regains respiratory strength purchase citalopram 20mg on-line bipolar depression or manic depression. The most common symptoms include weakness, poor suck and feed, decreased tone and reflexes, weakness in descending pattern, constipation and autonomic symptoms (tachycardia, hypotension, urinary retention, decreased tears). The management of patients with botulism is supportive until axonal sprouting reestablishes at the neuromuscular junction. In respiratory compromise, mechanical ventilation should be instituted until the patient regains protective reflexes and respiratory strength. If the patients are unable to tolerate oral feeds, nasogastric/ nasojejunal feeds should be initiated. The resolution of symptoms occurs in the reverse pattern of presentation with return of head control appearing to be a reliable measure of improving muscle function. Most metabolic or toxic neuropathies preferentially attack axons and are usually chronic, sensory more than motor with a distal predilection more than proximal. Heavy metal poisoning from lead, arsenic or thallium and organic compounds have been reported to cause axonal damage. Rapid progression of weakness leads to a flaccid involvement of all four extremities and respiratory compromise. Recommended treatment modalities include carbohydrate loading and administration of heme. Prophylaxis consists of adequate nutritional intake, avoidance of drugs known to exacerbate porphyria and prompt treatment of intercurrent diseases or infections. Tick Paralysis Toxin of tick inhibits the release of acetylcholine at the presynaptic terminal and causes ascending paralysis which progresses rapidly to the bulbar area and rapid improvement occurs with removal of the tick. Diseases of Muscle These conditions present for intensive management in specialized situations of neonatal and infantile onset, requiring both diagnosis and management, or in the situation where the diagnosis is known but natural history or iatrogenic complications supervene. In the neonatal period the presentation of muscle disease is usually either respiratory compromise or poor feeding. The common disorders are infantile myotonic dystrophy and congenital muscular dystrophy. Periodic Paralysis Rare illness that results in episodes of severe weakness associated with an abnormality of circulating potassium during attacks. Two major forms are described: Hypokalemic Periodic Paralysis It is the most common form of periodic paralysis. The weakness may progress to flaccid paralysis of all limbs with areflexia and normal sensation. It does not cause respiratory compromise despite the presence of dramatic limb paralysis. Light exercise can prevent an attack and an acute attack can be relieved by intake of glucose. Erythema and edema of periorbital area and extensor surfaces may be seen in dermatomyositis. These include critical illness polyneuropathy, acute myopathy or both and manifest as prolonged ventilatory dependency. Critical illness polyneuropathy is characterized by development of neuropathy during a severe illness requiring intensive care. Acute necrotizing myopathy in sepsis or trauma presents as a sudden onset of generalized muscle weakness, high blood creatinine kinase and myoglobinuria. The management strategies in neuromuscular respiratory failure include: Respiratory Management Careful assessment of the upper airway and the patients ability to protect his/her airway is essential. None of these can replace clinical observation and judgment in this cohort of patients. More important is a clinical and constant watch on the patients effort, air entry, pattern of breathing- abdomino-thoracic, loss of diaphragmatic movement etc; use of accessory muscles, diaphoresis, restlessness or drowsiness. Administration of O2 to keep up a falling saturation is foolhardy as it only saves to mask hypoventilation and delay proper intervention. As the lungs are usually normal, a small amount of O2 will cause a quick and steep rise in SpO2 and PaO2 and this will give a false sense of security. Peak flow meters and single breath counts are good bed side tools in the co-operative patient. Although ventilatory support is clearly indicated in the setting of frank respiratory failure, particularly when there is cardiovascular instability, ideally it should be initiated in the setting of emerging respiratory failure when there has been a clear downward trend in respiratory function. The options for ventilatory support include endotracheal intubation, noninvasive positive pressure ventilation and tracheostomy, which are discussed below. It has generally been initiated when the underlying disease process is new or uncontrolled and the patient manifests evidence of emerging respiratory failure. Noninvasive positive pressure ventilation —An alternative to elective intubation in selected patients involves the use of noninvasive positive pressure ventilation. This modality may be tried in patients who present with early acute respiratory failure, are cooperative, can protect their airway with intact brain stem and lower cranial nerve function, have adequate upper airway function, have minimal secretions, and remain hemodynamically stable. This modality is more suited to the chronic patient such as the Duchenne or spinal muscular atrophy patient and not for the acute patient whose disease progression is unknown. Once the child has been intubated and is comfortable, minimal analgesia and sedation is usually needed. Patient triggered modes can be used and the trigger should be carefully adjusted to the level of strength/weakness of the patient’s respiratory muscles. Every effort should be made to keep the wave form, cycle times and pressures as physiological as possible. Tracheostomy — In patients with acute neuromuscular respiratory failure, tracheostomy is an important decision when the need for mechanical ventilation appears prolonged in order to minimize the well described problems associated with prolonged nasotracheal or orotracheal intubation. However, the indications for tracheostomy and the timing will vary with the individual patient and the underlying disease process. Discontinuation of ventilatory support —Although the initial strategy for weaning depends on the individual patient, weaning is often initiated in the pressure support mode. As the patient would be on a trigger, it is easy to see the effort that the muscles are capable off producing. As the patient gets stronger, the levels of support are reduced and the tidal volumes generated are closely watched. In older children who have had a long recovery period on the ventilator, there is often a great deal of anxiety associated with extubation and psychological dependence on the ventilator. Daily counseling and encouragement is needed and the child should never be forced as excessive anxiety will cause failure of extubation. As the recovery of the upper airway protective muscles might lag behind the recovery of the ventilatory musculature, the integrity and function of the upper airway musculature should be closely monitored following extubation.

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Many biotin molecules can be coupled to a protein order citalopram 20 mg visa anxiety 10 weeks pregnant, enabling the biotiny- lated protein to bind more than one molecule of avidin trusted 40mg citalopram depression explained. If biotinylation is performed under gentle conditions 40mg citalopram otc anxiety or panic attacks, the bio- logical activity of the protein can be preserved citalopram 20mg line depression test self harm. This system has proven particularly useful in the brown granular deposit depending upon the chromogenic hydrogen donor used. Pancreatic islet cell hormones: Immunoperoxidase stain- area of reddish-brown pigment. Tissues may be counterstained ing of islet cell adenomas with antibodies to insulin, gluca- with hematoxylin. A chromogenic substrate is a colorless substance that is transformed into a colored product by an enzymatic Autoradiography is a method employed to localize radio- reaction. Proof that the probe has hybridized to its comple- cent labeled anticytokine antibodies to “stain” permeabilized mentary strand in the tissue or cell under study must be by cells that synthesize the cytokine in question. If antibody is being sought in the test sample, then antigen should be attached the enzyme-multiplied immunoassay technique is an to the plastic surface. Following antigen–antibody interac- immunoassay used to monitor therapeutic drugs such as tion, the enzyme–antiimmunoglobulin conjugate is added. It is a one-phase, appropriate substrate to yield a colored product that is mea- competitive enzyme-labeled immunoassay. Alkaline phosphatase and horseradish peroxidase are enzymes that are often employed. Collagen disease/lupus erythematosus diagnostic panel Protein blotting: See immunoblotting. Southwestern blotting is helpful in delineat- to identify antibodies against proteins of precise molecular ing nuclear transcription-related proteins. This pro- to a nitrocellulose or nylon membrane followed by exposure to duces a characteristic peptide fragment pattern that is typical biotinylated or radioisotope-labeled antibody. Molecular hybridization probe is a molecule of nucleic Northern blotting (Figure 28. This is detected by autoradiography of the Reverse transcriptase polymerase chain reaction radiolabeled probe. Because of this multiplicity of alleles, there is only a remote possibility that two unrelated persons Taq polymerase or Thermus aquaticus polymerase. The specifcity of this probe, known as the Jeffries probe, renders it applicable to Determine best parentage testing, human genome mapping, and forensic sci- concentrations ence. A characteristic pat- Dot varying amounts tern for that molecule is produced and aids in identifying it. Immunological Methods and Molecular Techniques 845 each chromosome, one from the mother and the other from the father. A separate technique detects amplifed product points where they recognize a very specifc oligonucleotide by color fuorescence. There are several modifca- will identify, as each cell of the body will have two copies of tions of this assay, as some antibodies other than IgM may fx 846 Atlas of Immunology, Third Edition this method have been used to identify cells producing anti- bodies against a variety of antigens or haptens conjugated to the sheep red cells, it can also be used to ascertain the immu- Plaque- noglobulin class being secreted. An assay Hemolytic plaque of plaques that develop in the hemolytic plaque assay and related techniques. The antibody-forming cells are suspended in aga- rose and incubated at 37°C in Petri plates with sheep red cells complement less effciently. Anti-Ig and complement are also pres- an antiglobulin antibody called developing antiserum is ent. The the hemolytic plaque assay in which an erythrocyte mono- reaction bears some resemblance to β hemolysis produced by layer between a glass slide and cover slip is used without agar streptococci on a blood agar plate. B cells are then eluted from spleen cells from a mouse immunized against sheep red blood the column. Magnetic beads have replaced nylon wool for lym- suspension is distributed into Petri plates where it gels. After appropriate wash- sheep erythrocytes can be identifed by adding anti-IgG anti- ing, these purifed lymphocyte preparations are counted and body to aid lysis by complement. Whereas modifcations of aliquots dispensed into microtiter plate wells containing predispensed quantities of antibody. After incu- cell bation of the cells and antisera, rabbit complement is added Spleen and the plates are again incubated. The extent of cytotoxicity induced is determined by incubating the cells with trypan blue, which enters dead cells staining them blue but leaves Sheep live cells unstained. When purifed, B cell preparations and specifc tor to target cell ratios can be employed for quantifcation. Each of these lymphoid cells has the (effector) lymphocytes are cytotoxic for donor (target) lym- ability to respond by proliferating following stimulation by phocytes after the two are combined in culture (Figure 28. In the one-way reaction, the donor Target cells are labeled by incubation with 51Cr at 37°C for cells are treated with mitomycin or irradiation to render them 60 min. Thus, the donor antigens stimulate tissue culture, the release of 51Cr from target cells injured by the untreated responder cells. The mixed-lymphocyte reaction usually Syringe measures a proliferative response and not an effector-cell- Nylon wool killing response. The test is important in bone marrow and organ transplantation to evaluate the degree of histoincom- patibility between donor and recipient. The transformed cell increases in size and amount of T and B lymphocytes cytoplasm. Nucleoli develop in the nucleus, which becomes (T cells pass through) lighter staining as the cell becomes a blast. The lymphocyte transformation include immunoglobulins, cytokines, and growth factors. Antiimmunoglobulin, bacterial lypopolysaccharides, and staphycoccal protein A activate B lymphocytes. The lymphocyte transformation assay is a broadly used in vitro test to evaluate lymphocyte function in patients. Strain A Strain B the lymphocyte antigen stimulation test is an assay for the in vitro assessment of impaired cell-mediated immu- nity. This test is useful to evaluate patients with genetic or Responder Stimulator acquired immunodefciencies, bacterial and viral infections, lymphocytes lymphocytes from cancer, autoimmune disorders, transplantation-related dis- from the spleen the spleen treat with X-rays or mitomycin C orders, antisperm antbodies, or previous exposure to a vari- ety of antigens, allergens, pathogens, and metals/chemicals. Lymphocytes from an animal or human sensitized used for the in vitro assessment of cell-mediated immunity to the antigen release a lymphokine called migration inhibi- in patients with immunodefciency, autoimmunity, infec- tory factor that will block migration of macrophages from tious diseases, cancer, and chemical-induced hypersensitiv- the end of the tube where the cells form an aggregated mass. Lymphocytes respond to these mitogens that stimulate large numbers of lymphocytes, without prior sen- Macrophage functional assays are tests of macrophage sitization. Mitogens may stimulate both B and T cells, of a Boyden chamber and a chemoattractant is added to the and the inability of lymphocytes to respond to mitogens sug- other end.

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Hydroxytyrosol from olives and olive oil is vides protection against oxidative modifcation of a potent antioxidant order 10mg citalopram free shipping depression symptoms on the body. The soy isofavones/d increased plasma nitrite and nitrate most famous lignan is podophyllotoxin 40 mg citalopram for sale depression self help, which has concentrations and improved endothelium-independent potent anticancer activity and its derivatives have been vasodilatation in healthy postmenopausal women [17] cheap citalopram 40 mg online anxiety attack symptoms. Clinical stud- ies have associated the imbalanced dietary intake of Plant terpenoids are an important group of phytonutri- essential fatty acids including alpha-linolenic acid (an ents trusted 20mg citalopram depression symptoms period, including pre-vitamin A carotenoid, zeaxanthin, omega-3 fatty acid) and linoleic acid (an omega-6 fatty and vitamin E, Coenzyme Q10, and bioactive monoter- acid) with impaired brain development, performance, pene, sesquiterpenes, diterpenoids. They are essential for human body lipid-soluble antioxidant and a very popular food supple- to make many important molecules affecting neuro- ment. Epidemiological studies function, cellular function, infammation, mood, and have clearly shown the great benefts of consumption of behavior. Dietary long-chain polyunsaturated fatty tomato to human health due to tomato carotenoids, acids, such as arachidonic acid, eicosapentaenoic acid mainly lycopene, b-carotene, and lutein [18]. People now take extra omega-3 fatty acids from and inhibiting tumor cell growth in animals [18]. Plant foods activity by neutralizing free radicals, which are regarded such as faxseed, soya oil, canola oil, Oliver oil, pump- as one of the major causes of aging and various cancers. M onoterpenes in citrus plenty of scientifc evidence shows that substitution of fruits, cherries, peppermint, and herbs have anticarci- dietary saturated fat by oleic acid and/or polyunsatu- nogenic actions, as well as cardioprotective effects in rated omega-3 fatty acids beneft cardiovascular health experimental models. The unique monoterpene derivatives or triglycerides also have benefts to human health thujaplicins from trees are widely used as antifungal [26]. Unlike long- or very-long-chain fatty acids, these medicine in clinic, cosmetic products, and wood preser- fatty acids passively diffuse into the portal system vation [19]. The most well-known sesquiterpenes such without requirements of modifcation and digestion. M etabolic syndromes, such Another important class of terpenoid phytosterols, such as abdominal obesity, dyslipidemia, hypertension and as stigmasterol, sitosterol, campesterol, are natural com- impaired fasting glucose, contribute to increased car- ponents of many plant foods. M edium-chain structures with cholesterols from meats, phytosterols fatty acids and medium-chain triglycerides suppress competitively inhibit human cholesterol absorption by fat deposition through enhanced thermogenesis and fat the gut [21, 22]. Coconut for cancer prevention and successful aging in both oil is composed of approximately 66% medium-chain women and men. Taking up the likely contributory factor to dramatic difference adequate essential amino acids are very important for between Asian women who have signifcantly lower health since they are building blocks of proteins, which levels of breast cancer and women in western countries carried functions of human body [1, 28]. Tryptophan is may be that Asian women take a vegetarian diet with used for synthesis of neurotransmitter serotonin and higher intake of legumes and other plant foods con- relief of depression; faxseeds have high tryptophan lev- taining a variety of lignans, dietary fbers, and isofa- els. Tyrosine is for dopamine, norepinephrine and adren- vonoid phytoestrogens, which act as nature’s sex aline synthesis for normal neurosystem activity and hormone modulators and provide estrogenic effects enhances positive mood. Isoleucine is necessary for the and an anti-estrogenic competitive effect [16, 17, 31]. Leucine has Epidemiological studies demonstrated that l-arginine, benefcial effects for skin, bone and tissue wound heal- chlorogenic acid, fermented milk, garlic, onion, tea, ing, and promotes growth hormone synthesis. Lysine soybean, ginger, hawthorn, and fsh oil have benefcial and valine are essential for muscle proteins, as well as effects on prevention, improvement, or treatment of the synthesis hormones and l-carathine which is essen- patient’s elevated blood pressure [32]. M ethionine is essential for all protein synthesis and helps in breakdown of fats and reduces muscle degeneration. Phenylalanine is benefcial for healthy nervous system and boosts Phytotherapy strategies using herbal drug combinations memory and learning. Phenylalanine may be useful with superior effcacy and lesser side effects in com- against depression and suppressing appetite. In addition, parison with single isolated constituents of plant extracts l-Arginine is a conditional essential amino acid for has been repeatedly assessed clinically as well as phar- infants and growing children, as well as for pregnant macologically [1]. Like other Chinese herbal medicines combined with various herbs containing dif- 6. Except for nutraceuticals such as glucosamine and secondary metabolites with similar structure with hor- chondroitin, many herbs have been tried for treatment mone estradiol and thus with ability to cause estrogenic of osteoarthritis and rheumatoid arthritis diseases [1, or/and antiestrogenic effects. Other degenerative diseases and immunosystem tained in our daily diets, such as soybean and cabbage, problems that could not be effectively treated by cur- nuts, and oilseeds, therefore also called “dietary estro- rent synthetic drugs become targets of herbs, nutraceu- gens. Allergic rhinitis is the most lated favonoids, and isofavones can act as antioxidants, frequently occurring immunological disorder. A tradi- estrogen agonists, and antagonists with multiple effects tional Chinese formulation Aller-7 comprising seven [30]. An optimal “estrogen balance” has implications herbal extracts was shown well tolerated and effcacious 6 Phytonutrient and Phytotherapy for Improving Health 53 in patients with allergic rhinitis without serious adverse the rapidly increasing number of such proof-of-con- effect [36]. Similarly, another formulation was also cept studies strongly support success of some phyto- studied in clinical trial and appears to offer symptom- nutrients and their phytotherapies on improvement atic relief and improvement of quality of life for some of health or even solve health problems. The eff- cacy and safety of the butterbur leaf extract Ze 339 were to be safe and effcacious in the treatment of 6. All these Loss, Facial Aging, and Cosmetic studies clearly suggest that multi-component tradi- Surgery tional herbals can offer a very effcacious and better therapeutic option to patients in many diseases. An increasing prevalence of overweight and obesity However, a lack of information on the phytochemistry has reached global proportions. Overweight and obe- and pharmacological section of phytochemicals, or the sity generate a major risk of chronic diseases such as synergistic effects of phytotherapies may threaten and type 2 diabetes, cardiovascular disease, hypertension, damage the customers and market [39]. Overweight and obesity are diet- Clinical trials and epidemiological studies are related health problems, their patients, however, may commonly used methods to investigate effects of not be simply and easily recovered by reducing diet phytonutrients and herbs on various health targets. Some synthetic drugs have been designs, proper controls, a long time period for feed- developed, yet their side effects and potential risks ing, observation and physiological measurements, are nor ignoble. W ith strong belief on the potential data collection, but also a large population of patients health benefts of phytonutrients people look for herbs willing to cooperatively participate in the study, as and phytonutrients that are effective in weight loss well as fnal systematic analysis. Actually, plants-based foods have because effects of phytonutrients are usually mar- low saturated fats and sugar, high levels of diet fbers, ginal, long-term, and individually differential. Also, and more balanced minerals and vitamins, and be other factors also can signifcantly affect the outcome eaten against many health-problems including weight of clinical trials and epidemiological studies, for and obesity [42]. M oreover, some phytonutrients instance, quality and quantity of herbs or phytonutri- from plant foods or medicinal plants have potent ents, absorption and metabolism of phytonutrient, effects on prevention and treatment of overweight and and drug–herbs or drug–phytonutrient interaction. For example, as one of the widely commer- which is a major risk factor for coronary heart disease cialized example of phytotherapeutics, Saw palmetto [43]. However, high- because of their rich amino acids, vitamins, antioxidants quality clinical trials and epidemiological studies on and other phytonutrients with antibacterial, antifungal, phytonutrients and physiotherapies provide most and anti-infammatory activity that are helpful for the close-to-realty and reliable evaluation of their bio- skin. Nowadays use of phytonutrients or herbs, effective logical effects on human health, and they are essen- cosmetics (many of them also contain phytonutrients), tial and highly needed to evaluate phytonutrients aesthetic plastic and cosmetic surgery, or combinations of and phytotherapies for continuous and healthy devel- them are widespread among people for various levels of opment of natural resources and healing system. Zhao certain herbs or phytonutrients have potent effects on symptoms and benign prostatic hyperplasia, bioactive reduction of weight, obesity, diabetes, facial aging and ingredients fatty acids and phytosterols), arnica M ontana rejuvenation, or other degenerative diseases, and nutri- (used as anti-infammatory and antibiotic regent, active tional defciencies, or improvement of overall health and ingredient: helenalin), St. However, there are also warns of nega- foratum, used for mild and moderate mood disorders or tive effects on uses of herbs and natural products, particu- depression, active ingredient hypericin), bromelain larly perioperative use of herbs and phytonutrient (pineapple stem, anti-infammatory, antibacterial, and supplements regarding aesthetic plastic, and cosmetic proteolytic activity), thunder god vine (Tripterygium surgery because these health problems on patients have a wilfordii, root extracts used to treat rheumatoid arthritis, signifcant impact on surgical outcome and complica- bioactive component: triptolide). Although phytonutrients have benefcial these herbs may have negative effects on surgical effects on some aesthetic plastic and cosmetic surgeries procedure or recovery, such as bleeding (ginger, gin- [47, 49], some raw herbs are more complex due to mul- seng, Ginkgo biloba, and garlic), immunosuppression tiple-components, limited information on their phy- (Echinacea), infammation (garlic, ginkgo), wound tochemical, medical/toxical, or clinical researches; healing (Echinacea and garlic), blood pressure and/or perioperative taking of these herbs by patients who are heart rate (Ephedra, garlic, ginseng, and goldenseal), undergoing surgery may have unexpected infuences on increase anesthesia effects (Kava, St. Valerian) and unexpected hormone-like effects (Saw M any plastic or cosmetic patients are taking herbal palmetto).

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