Thrush - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

HRUSH A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Thrush: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84095-4 1. Thrush-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on thrush. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON THRUSH..................................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Thrush........................................................................................... 4 E-Journals: PubMed Central ......................................................................................................... 8 The National Library of Medicine: PubMed .................................................................................. 8 CHAPTER 2. NUTRITION AND THRUSH ........................................................................................... 17 Overview...................................................................................................................................... 17 Finding Nutrition Studies on Thrush.......................................................................................... 17 Federal Resources on Nutrition ................................................................................................... 18 Additional Web Resources ........................................................................................................... 19 CHAPTER 3. ALTERNATIVE MEDICINE AND THRUSH .................................................................... 21 Overview...................................................................................................................................... 21 National Center for Complementary and Alternative Medicine.................................................. 21 Additional Web Resources ........................................................................................................... 26 General References ....................................................................................................................... 27 CHAPTER 4. CLINICAL TRIALS AND THRUSH ................................................................................. 29 Overview...................................................................................................................................... 29 Recent Trials on Thrush............................................................................................................... 29 Keeping Current on Clinical Trials ............................................................................................. 31 CHAPTER 5. BOOKS ON THRUSH ..................................................................................................... 33 Overview...................................................................................................................................... 33 Book Summaries: Federal Agencies.............................................................................................. 33 Book Summaries: Online Booksellers........................................................................................... 36 Chapters on Thrush...................................................................................................................... 37 CHAPTER 6. MULTIMEDIA ON THRUSH .......................................................................................... 39 Overview...................................................................................................................................... 39 Video Recordings ......................................................................................................................... 39 Audio Recordings......................................................................................................................... 40 CHAPTER 7. PERIODICALS AND NEWS ON THRUSH ....................................................................... 43 Overview...................................................................................................................................... 43 News Services and Press Releases................................................................................................ 43 Newsletter Articles ...................................................................................................................... 45 Academic Periodicals covering Thrush ........................................................................................ 45 CHAPTER 8. RESEARCHING MEDICATIONS .................................................................................... 47 Overview...................................................................................................................................... 47 U.S. Pharmacopeia....................................................................................................................... 47 Commercial Databases ................................................................................................................. 48 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 51 Overview...................................................................................................................................... 51 NIH Guidelines............................................................................................................................ 51 NIH Databases............................................................................................................................. 53 Other Commercial Databases....................................................................................................... 56 APPENDIX B. PATIENT RESOURCES ................................................................................................. 57 Overview...................................................................................................................................... 57 Patient Guideline Sources............................................................................................................ 57 Finding Associations.................................................................................................................... 63 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 67 Overview...................................................................................................................................... 67 Preparation................................................................................................................................... 67

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Finding a Local Medical Library.................................................................................................. 67 Medical Libraries in the U.S. and Canada ................................................................................... 67 ONLINE GLOSSARIES.................................................................................................................. 73 Online Dictionary Directories ..................................................................................................... 73 THRUSH DICTIONARY................................................................................................................ 75 INDEX .............................................................................................................................................. 107

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with thrush is indexed in search engines, such as www.google.com or others, a nonsystematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about thrush, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to thrush, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on thrush. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to thrush, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on thrush. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON THRUSH Overview In this chapter, we will show you how to locate peer-reviewed references and studies on thrush.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and thrush, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “thrush” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Chronic Mucocutaneous Candidiasis Source: Journal of the American Academy of Physician Assistants. JAAPA. 15(4): 6768,70. April 2002. Summary: This journal article uses a case study to provide health professionals with information on chronic mucocutaneous candidiasis (CMC). The case involved a 30 year old woman who presented to an infectious disease clinic for evaluation of chronic oral yeast infections. The woman reported a history of yeast infections since birth. Intermittent treatment with oral ketoconazole beginning at age 9 initially controlled the infections, but they always recurred. Oral fluconazole had no effect on her symptoms. The patient's current medications included an oral contraceptive, norethindrom-ethinyl estradiol; rabeprazole; and itraconazole. Physical examination revealed a generally healthy appearing woman with inflammation of the vermilion border of the lips and

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marked angular cheilitis. Thrush and leukoplakia were found in the oral cavity. There was no evidence of skin rashes or nail changes. Laboratory test results were within normal limits. A fungal culture grew Candida albicans sensitive to amphotericin B but resistant to fluconazole, itraconazole, ketoconazole, and 5-flucytosine. The article discusses protective immunity to Candida and comments on the diagnosis and treatment of chronic mucocutaneous candidiasis (CMC). Diagnostic evaluation of patients with suspected CMC involves identifying Candida with culture and sensitivities and performing a complete blood count with differential, a human immunodeficiency virus antibody test, and serum immunoglobulin G, A, M, and E tests. Endocrine function tests are important to eliminate coexisting disease and establish a baseline for future tests. Current therapy for CMC involves long term use of antifungal agents such as ketoconazole, itraconazole, fluconazole, and amphotericin B. Treatment should be guided by in vitro susceptibility testing. All antifungal therapies do not address the underlying immune defect of CMC, so relapse usually occurs after treatment ends. Treatment with transfer factor focuses on correcting the actual immune defect. Thus, treatment with both antifungals and transfer factor may provide a more definitive treatment for CMC. 2 figures and 12 references.

Federally Funded Research on Thrush The U.S. Government supports a variety of research studies relating to thrush. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to thrush. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore thrush. The following is typical of the type of information found when searching the CRISP database for thrush: •

Project Title: ACTG 323/MSG40--USE OF FLUCONAZOLE AS CHRONIC SUPR THERAPY VS EPISODIC THERAPY Principal Investigator & Institution: Reichman, Richard C.; Professor; University of Rochester Orpa - Rc Box 270140 Rochester, Ny 14627 Timing: Fiscal Year 2001 Summary: The main purpose of the study is to determine whether it is better to give subjects fluconazole to prevent thrush from coming back or to wait and treat each episode of thrush. Also the effect of each strategy on the development of thrush in other places such as esophagus and vagina; conditions that put HIV-infected persons at risk

2 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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for yeast infections; what happens to those who do not respond to treatment; and the effect each strategy will have on the quality of subjects' lives. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ACTG 323--PHASE IV OPEN LABEL COMPARING CHRONIC SUPPRESSIVE THERAPY Principal Investigator & Institution: Bartlett, John G.; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001 Summary: Compare the use of fluconazole as continuous prophylaxis versus episodic therapy in subjects with recurrent oral thrush. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ACTG 349--IMMUNOLOGIC PREDNISONE ON HIV-1 INFECTION

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VIROLOGIC

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Principal Investigator & Institution: Kalayjian, Robert; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2001 Summary: The recognized effects of corticosteroids on immune function suggest that by inhibiting cellular activation, corticosteroids may inhibit HIV expression and reduce the population of potentially infectable cells. Two uncontrolled clinical trials of corticosteroids for HIV infection have suggested a beneficial effect of corticosteroids on p24 antigen levels; one of these studies also suggested a beneficial effect on CD4 cell counts. These and other studies further suggest that the risk of OIs due to prednisone may be avoided by selecting subjects with CD4 cell counts >100/mm3, limiting the dose to <60mg/day and giving preventive therapy for thrush and in selected individuals, HSV. However, these studies have not been confirmed in a randomized, double-blinded clinical study, nor to systematically evaluate immune function in prednisone-treated HIV-infected patients or the immune mechanisms that may facilitate increases in CD4 cell numbers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ANALYTIC METHODS FOR HIV TREATMENT AND CO-FACTOR EFFECTS Principal Investigator & Institution: Robins, James M.; Professor of Epidemiology and Biostatis; Epidemiology; Harvard University (Sch of Public Hlth) Public Health Campus Boston, Ma 02460 Timing: Fiscal Year 2001; Project Start 01-AUG-1992; Project End 31-MAY-2005 Summary: The principal aim of this proposal is further development of new methods for analyzing observational studies and randomized trials of HIV-infected persons. The proposed approaches are based either on (i) the estimation of new classes of causal models, or (ii) new methods for analyzing semi- or non- parametric models in the presence of both informative and non- informative missing data. The new classes of causal models include structural nested models, marginal structural models, direct effect structural nested models, and continuous time structural nested models. Many of the new methods are fundamentally "epidemiologic" in that they require data on timedependent confounding factors, that is, risk factors for outcomes that also predict subsequent treatment with the drug or co-factor under study. The proposed methods of

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analysis will improve upon previous methods in the following ways. First, the new methods are the best methods available to estimate the overall (net) or direct effect of a treatment (e.g., HAART) or a co-factor (e.g., marijuana) on an outcome of interest (e.g., time to AIDS or HIV RNA levels) from observational data, when symptoms of HIV disease (e.g., thrush, fever) are simultaneously confounders and intermediate variables. We shall use the new methods to estimate treatment and co-factor effects of the evolution of CD4-counts and on time to progression of HIV-disease among subjects in the Multicenter AIDS Cohort Study (MACS), transmission between discordant partners in the California Partners' Study, and the effect of protease inhibitors on the growth and development of HIV-infected children in pediatric ACTG Trial 219. Results will be compared with results obtained using standard methods. Second, the new methods are the best methods available to adjust for dependent censoring, non-random noncompliance, treatment cross-over or termination, and the concurrent effect of additional non-randomized treatments in randomized clinical trials. For example, in ACTG trial 002 of the effect of high- dose versus low-dose AZT on the survival of AIDS patients, patients in the low-dose arm took more aerosolized pentamidine (a non-randomized treatment). The new methods are the best methods available to efficiently incorporate information on surrogate markers (e.g., HIV RNA) in order to stop, at the earliest possible moment, randomized trials of the effect of a treatment on a survival time outcome (e.g., time to AIDS), while preseving a valid alpha-level test of the null hypothesis of no effect of treatment on survival. We shall use our new methods to analyze a subset of ACTG trials 002, 021, 175, A5057 rollover, 343, 371, and 384. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CANDIDA ALBICANS ORAL BIOFILM Principal Investigator & Institution: Chaffin, Welda L.; Professor; Microbiology and Immunology; Texas Tech University Health Scis Center Health Sciences Center Lubbock, Tx 79430 Timing: Fiscal Year 2001; Project Start 01-SEP-2001; Project End 31-AUG-2005 Summary: (provided by applicant): Candida albicans is a commensal that colonizes skin and mucosal surfaces including the oral cavity. The organism is also an agent of opportunistic disease of these surfaces as well as internal disseminated disease. Oral candidiasis is associated with derangements of the oral flora related with the acquisition of microbes by neonates and anti-bacterial therapy, oral prostheses, and host factors such as diabetes mellitus and HIV infection. Oral manifestations include pseudomembraneous candidiasis (thrush) and denture stomatitis. Oropharyngeal infection is virtually an inescapable consequence of AIDS (96 percent patients) and frequently reoccurs. Denture stomatitis may affect 50 percent of complete denture wearers. The organism forms biofilms on mucosa, teeth and oral devices such as dentures, generally in association with oral bacteria. Compared to planktonic cells, organisms in biofilms have characteristics such as reduced susceptibility to antifungal drugs and the presence of an extracellular matrix. This study will test the hypothesis that unique characteristics associated with C. albicans biofilms are the result of altered gene expression in general cellular metabolism as well as bioflim specific gene expression. A model of saliva-coated denture acrylic established in this laboratory will be used. About 230 alterations in general cellular metabolism have been identified in biofilm compared to planktonic cells by exploiting the high homology between Saccharomyces cerevisiae and C. albicans and the commercial availability of gene arrays for S. cerevisiae. In Aim 1 this approach will be applied to examine expression temporally during biofilm formation and to other conditions of biofilm development

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using C. albicans DNA chips. In Aim 2, expression in in vitro biodiverse models will also be examined to identify genes inherently associated with biofilms as differentiated from those influenced by the biofilm environment. Expression of selected genes from the inherent biofilm expression class will be determined in vivo in organisms recovered from human saliva. Aim 3 will examine the role of biofilm-regulated genes such as TUP1and EFG1 using genetically modified strains. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FLUCONAZOLE VS EPISODIC IN HIV+ PTS WITH CANDIDIASIS Principal Investigator & Institution: Flexner, Charles W.; Associate Professor; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001 Summary: Compare the use of fluconazole as continuous prophylaxis versus episodic therapy in subjects with recurrent oral thrush. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: IDENTIFYING CANDIDA GENE IN THRUSH USING IVIAT Principal Investigator & Institution: Nguyen, M H.; Medicine; University of Florida Gainesville, Fl 32611 Timing: Fiscal Year 2001; Project Start 29-SEP-2000; Project End 31-JUL-2004 Summary: (abstract verbatim) The applicants have used a novel in vivo microbial expression technology called In Vivo Induced Antigen Technology (IVIAT) to study the pathogenesis of oropharyngeal candidiasis (OPC) in HIV-infected patients. IVIAT uses anti-Candida albicans antibodies in the sera of HIV-infected patients to identify antigens that are expressed in vivo by C. albicans but are not expressed during routine in vitro growth. In preliminary studies, they have confirmed that IVIAT can identify virulence factors for C. albicans. In this proposal, they propose to modify IVIAT to identify antigens expressed by C. albicans during OPC but not expressed during either colonization of the oral mucosa by C. albicans or during in vitro growth. They hypothesize that some of the antigens expressed by C. albicans exclusively during OPC are important virulence factors, and identifying these antigens will provide insight into the mechanisms by which C. albicans is transformed from a harmless commensal organism into an invasive pathogen. This application has five specific aims. In the first specific aim, two separate pooled batches of sera, one from HIV-infected patients with OPC and the other from HIV-infected patients with colonization, will be exhaustively adsorbed with in vitro grown clinical C. albicans isolates to remove all antibodies that react with antigens expressed in vitro. The adsorbed sera will be used for differential screening of a C. albicans genomic expression library. In specific aim 2, the plasmid DNA will be purified from clones that are reactive with the OPC sera but not with the colonization sera and the open reading frames (ORFs) responsible for the serum reactivity will be determined. In specific aim 3, they will confirm that the IVIAT antigens are not expressed by C. albicans in vitro. In specific aim 4, they will clone C. albicans genes encoding IVIAT antigens and purify the proteins expressed by these genes. Lastly, in specific aim 5, they will confirm that the IVIAT antigens are present within thrush samples recovered from HIV-infected patients by light microscopic immunohistochemistry using antibody raised against the purified proteins. They hope that this study will identify new C. albicans virulence factors, increase our understanding of the humoral response to OPC, and lead to potential applications for drug, vaccine or diagnostic test development. With the experience from this project,

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IVIAT should be readily adaptable to study other candidal infections and other fungal pathogens. Potential advantages of IVIAT over existing technologies include the use of the human immune response to identify in vivo expressed genes rather than animal models, its relative technical simplicity, and its ability to study differential gene expression in different types of C. albicans infections in humans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “thrush” (or synonyms) into the search box. This search gives you access to fulltext articles. The following is a sample of items found for thrush in the PubMed Central database: •

Adverse effects of acid rain on the distribution of the Wood Thrush Hylocichla mustelina in North America. by Hames RS, Rosenberg KV, Lowe JD, Barker SE, Dhondt AA.; 2002 Aug 20; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=123239

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Elevated Phenotypic Switching and Drug Resistance of Candida albicans from Human Immunodeficiency Virus-Positive Individuals prior to First Thrush Episode. by Vargas K, Messer SA, Pfaller M, Lockhart SR, Stapleton JT, Hellstein J, Soll DR.; 2000 Oct; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=87443

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals.

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Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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To generate your own bibliography of studies dealing with thrush, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “thrush” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for thrush (hyperlinks lead to article summaries): •

“Hanseniaspora uvarum” the ultrastructural morphology of a rare ascomycete, isolated from oral thrush. Author(s): Emmanouil-Nikoloussi E, Kanellaki-Kyparissi M, Papavassiliou P, Koliakos K, Dermentzopoulou M, Foroglou C. Source: Bull Group Int Rech Sci Stomatol Odontol. 1994 March-June; 37(1-2): 13-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7994154&dopt=Abstract

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“Not thrush again!” Women's experience of post-antibiotic vulvovaginitis. Author(s): Pirotta MV, Gunn JM, Chondros P. Source: The Medical Journal of Australia. 2003 July 7; 179(1): 43-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12831384&dopt=Abstract

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A 1-month-old boy with jaundice, thrush, and respiratory distress. Author(s): Barone MA, Lederman HM. Source: Current Opinion in Pediatrics. 1994 December; 6(6): 682-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7849814&dopt=Abstract

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A comparison between fluconazole tablets and clotrimazole troches for the treatment of thrush in HIV infection. Author(s): Redding SW, Farinacci GC, Smith JA, Fothergill AW, Rinaldi MG. Source: Spec Care Dentist. 1992 January-February; 12(1): 24-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10895736&dopt=Abstract

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A simple clinical staging system that predicts progression to AIDS using CD4 count, oral thrush, and night sweats. Author(s): Rabeneck L, Crane MM, Risser JM, Lacke CE, Wray NP. Source: Journal of General Internal Medicine : Official Journal of the Society for Research and Education in Primary Care Internal Medicine. 1993 January; 8(1): 5-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8093485&dopt=Abstract

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All that itches is not thrush. Author(s): Carr-Brown L. Source: Aust Fam Physician. 1992 May; 21(5): 695. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1520143&dopt=Abstract

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Antigliadin antibodies associated with chronic mucocutaneous candidiasis. Author(s): Garcia YH, Diez SG, Aizpun LT, Oliva NP. Source: Pediatric Dermatology. 2002 September-October; 19(5): 415-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12383098&dopt=Abstract

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Childhood oral candidiasis (oral thrush). Author(s): Janniger CK, Kihiczak TC. Source: Cutis; Cutaneous Medicine for the Practitioner. 1994 January; 53(1): 30-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8119075&dopt=Abstract

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Chronic mucocutaneous candidiasis with deficient CD2 (E receptor) but normal CD3 mononuclear cells. Author(s): Noh LM, Hussein SH, Sukumaran KD, Rose I, Abdullah N. Source: J Clin Lab Immunol. 1991 June; 35(2): 89-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1688166&dopt=Abstract

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Clonal production of tea tree oil high in terpinen-4-ol for use in formulations for the treatment of thrush. Author(s): Williams LR. Source: Complementary Therapies in Nursing & Midwifery. 1998 October; 4(5): 133-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9830943&dopt=Abstract

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Community pharmacists' views and beliefs about the treatment of symptoms suggestive of vaginal thrush in community pharmacies. Author(s): Watson MC, Walker AE, Bond CM. Source: Pharmacy World & Science : Pws. 2000 August; 22(4): 130-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11103382&dopt=Abstract

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Competence of a migratory bird, red-bellied thrush (Turdus chrysolaus), as an avian reservoir for the Lyme disease spirochetes in Japan. Author(s): Miyamoto K, Sato Y, Okada K, Fukunaga M, Sato F. Source: Acta Tropica. 1997 April 30; 65(1): 43-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9140513&dopt=Abstract

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Effective management of vaginal thrush. Author(s): White D. Source: The Practitioner. 1995 October; 239(1555): 612-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7494791&dopt=Abstract

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Efficacy of oral amphotericin B in AIDS patients with thrush clinically resistant to fluconazole. Author(s): Dewsnup DH, Stevens DA. Source: Journal of Medical and Veterinary Mycology : Bi-Monthly Publication of the International Society for Human and Animal Mycology. 1994; 32(5): 389-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7844704&dopt=Abstract

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Elevated phenotypic switching and drug resistance of Candida albicans from human immunodeficiency virus-positive individuals prior to first thrush episode. Author(s): Vargas K, Messer SA, Pfaller M, Lockhart SR, Stapleton JT, Hellstein J, Soll DR. Source: Journal of Clinical Microbiology. 2000 October; 38(10): 3595-607. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11015370&dopt=Abstract

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Fluconazole for postpartum candidal mastitis and infant thrush. Author(s): Chetwynd EM, Ives TJ, Payne PM, Edens-Bartholomew N. Source: Journal of Human Lactation : Official Journal of International Lactation Consultant Association. 2002 May; 18(2): 168-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12033079&dopt=Abstract

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Genital thrush in women: the attitudes and practice patterns of General Practitioners in Teesside and north Yorkshire. Author(s): Opaneye AA. Source: J R Soc Health. 1999 September; 119(3): 163-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10518354&dopt=Abstract

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Gentian violet and thrush. Author(s): Utter AR. Source: Journal of Human Lactation : Official Journal of International Lactation Consultant Association. 1992 March; 8(1): 6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1558661&dopt=Abstract

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Gentian violet treatment for thrush: can its use cause breastfeeding problems? Author(s): Utter AR. Source: Journal of Human Lactation : Official Journal of International Lactation Consultant Association. 1990 December; 6(4): 178-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2271112&dopt=Abstract

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Is endometrial infection with Candida albicans a cause of recurrent vaginal thrush? Author(s): Smith JR, Wells C, Jolly M, Shah P, Savage M, Reginald P, Kitchen VS. Source: Genitourinary Medicine. 1993 August; 69(4): 295-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7721292&dopt=Abstract

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Management of genital candidiasis. Review omitted issues on recurrent thrush. Author(s): White DJ, Drake SM. Source: Bmj (Clinical Research Ed.). 1995 September 2; 311(7005): 629. Erratum In: Bmj 1995 October 14; 311(7011): 1028. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7663268&dopt=Abstract

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More on thrush and the use of gentian violet. Author(s): Wilson-Clay B. Source: Journal of Human Lactation : Official Journal of International Lactation Consultant Association. 1991 June; 7(2): 58. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1822987&dopt=Abstract

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Myeloperoxidase deficiency as a predisposing factor for deep mucocutaneous candidiasis: a case report. Author(s): Okuda T, Yasuoka T, Oka N. Source: Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons. 1991 February; 49(2): 183-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1846651&dopt=Abstract

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NAPWA sends thrush alert. National Association of People with AIDS. Author(s): Vazquez E. Source: Posit Aware. 1998 January-February; 9(1): 15-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11364992&dopt=Abstract

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Nipple thrush. Author(s): Dennerstein G. Source: Aust Fam Physician. 2003 June; 32(6): 392; Author Reply 392. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12833757&dopt=Abstract

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Non-African Burkitt lymphoma presenting with oral thrush and an orbital mass in a child. Author(s): Edelstein C, Shields JA, Shields CL, De Potter P, Eagle RC Jr, Turtel L, Hagstrom N. Source: American Journal of Ophthalmology. 1997 December; 124(6): 859-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9402843&dopt=Abstract

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Oral thrush and HIV protease inhibitors. Author(s): Stricker RB, Goldberg B. Source: Journal of Acquired Immune Deficiency Syndromes (1999). 1999 September 1; 22(1): 105-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10534155&dopt=Abstract

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Oral versus intra-vaginal imidazole and triazole anti-fungal agents for the treatment of uncomplicated vulvovaginal candidiasis (thrush): a systematic review. Author(s): Watson MC, Grimshaw JM, Bond CM, Mollison J, Ludbrook A. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 January; 109(1): 85-95. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11843377&dopt=Abstract

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Oral versus intra-vaginal imidazole and triazole anti-fungal treatment of uncomplicated vulvovaginal candidiasis (thrush). Author(s): Watson MC, Grimshaw JM, Bond CM, Mollison J, Ludbrook A. Source: Cochrane Database Syst Rev. 2001; (4): Cd002845. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11687165&dopt=Abstract

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Oral versus intra-vaginal imidazole and triazole anti-fungal treatment of uncomplicated vulvovaginal candidiasis (thrush). Author(s): Watson MC, Grimshaw JM, Bond CM, Mollison J, Ludbrook A. Source: Cochrane Database Syst Rev. 2001; (1): Cd002845. Review. Update In: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11279767&dopt=Abstract

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Post-monilial extensive esophageal stricture. Author(s): Ismail A, Abdulla S. Source: Pediatric Hematology and Oncology. 1993 January-March; 10(1): 111-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8443046&dopt=Abstract

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Randomized comparison of two nystatin oral gels with miconazole oral gel for treatment of oral thrush in infants. Antimycotics Study Group. Author(s): Hoppe JE, Hahn H. Source: Infection. 1996 March-April; 24(2): 136-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8740106&dopt=Abstract

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Recurrent vaginal thrush and soreness. Author(s): Matthews P, Drew SV, Low L. Source: The Practitioner. 1999 September; 243(1602): 633-6, 639, 642. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10715860&dopt=Abstract

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Sex, thrush and bacterial vaginosis. Author(s): Hay PE, Ugwumadu A, Chowns J. Source: International Journal of Std & Aids. 1997 October; 8(10): 603-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9310218&dopt=Abstract

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Should we be treating oral thrush? Author(s): Raucher HS. Source: The Pediatric Infectious Disease Journal. 1998 March; 17(3): 267. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9535267&dopt=Abstract

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Tattoos, body piercing and thrush: a lesson on the harmful effects of lost objectivity. Author(s): Kraytem A, Uldry PY, Lopez-Liuchi JV. Source: Mayo Clinic Proceedings. 1999 August; 74(8): 844. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10473366&dopt=Abstract

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The successful treatment of oral candidiasis (thrush) in a pediatric patient using itraconazole. Author(s): Crutchfield CE 3rd, Lewis EJ. Source: Pediatric Dermatology. 1997 May-June; 14(3): 246. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9192426&dopt=Abstract

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The use of the term “thrush”. Author(s): Pindborg JJ. Source: Journal of Acquired Immune Deficiency Syndromes (1999). 1994 January; 7(1): 98. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8263759&dopt=Abstract

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Thrush and breastfeeding. Author(s): Shepherd J. Source: Pract Midwife. 2002 December; 5(11): 24-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12520814&dopt=Abstract

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Thrush and fever as markers of immune competence in the era of highly active antiretroviral therapy. Author(s): Skolasky RL, Phair J, Detels R, Riddler S, Margolick J, Jacobson LP. Source: Aids Research and Human Retroviruses. 2001 September 20; 17(14): 1311-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11602040&dopt=Abstract

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Thrush and fever as measures of immunocompetence in HIV-1-infected men. Author(s): Kirby AJ, Munoz A, Detels R, Armstrong JA, Saah A, Phair JP. Source: Journal of Acquired Immune Deficiency Syndromes (1999). 1994 December; 7(12): 1242-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7965635&dopt=Abstract

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Thrush and septic shock in a two-month-old. Author(s): Fogarty L. Source: The Pediatric Infectious Disease Journal. 1996 June; 15(6): 553-4, 559-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8783361&dopt=Abstract

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Thrush can be prevented in patients with acquired immunodeficiency syndrome and the acquired immunodeficiency syndrome-related complex. Randomized, doubleblind, placebo-controlled study of 100-mg oral fluconazole daily. Author(s): Stevens DA, Greene SI, Lang OS. Source: Archives of Internal Medicine. 1991 December; 151(12): 2458-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1747004&dopt=Abstract

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Thrush during lactation. Author(s): Pakula S. Source: Aust Fam Physician. 1998 August; 27(8): 672. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9735482&dopt=Abstract

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Thrush in the breastfeeding dyad: results of a survey on diagnosis and treatment. Author(s): Brent NB. Source: Clinical Pediatrics. 2001 September; 40(9): 503-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11583049&dopt=Abstract

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Thrush in the ducts? Author(s): Noble R. Source: The Medical Journal of Australia. 1991 July 15; 155(2): 131. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1857296&dopt=Abstract

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Topical treatment for vaginal candidiasis (thrush) in pregnancy. Author(s): Young GL, Jewell D. Source: Cochrane Database Syst Rev. 2001; (4): Cd000225. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11687074&dopt=Abstract

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Treatment of thrush with itraconazole solution: evidence for topical effect. Author(s): Mascarenas CA, Hardin TC, Pennick GJ, Rinaldi MG, Graybill JR. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1998 May; 26(5): 1242-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9597271&dopt=Abstract

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Vaginal thrush and its management in pregnancy. Author(s): Kukner S, Kuscu E, Ergin T, Gokmen O. Source: J Pak Med Assoc. 1995 January; 45(1): 15-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7731079&dopt=Abstract

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Vaginal thrush: diagnosis and treatment options. Author(s): Greer P. Source: Nurs Times. 1998 January 28-February 3; 94(4): 50-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9510809&dopt=Abstract

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Vaginal thrush: how can we help our clients? Author(s): Everett S. Source: Prof Care Mother Child. 1995; 5(2): 47-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8680221&dopt=Abstract

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Vaginal thrush: perceptions and experiences of women of south Asian descent. Author(s): Chapple A. Source: Health Education Research. 2001 February; 16(1): 9-19. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11252288&dopt=Abstract

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Weekly fluconazole for the suppression of recurrent thrush in HIV-seropositive patients: impact on the incidence of disseminated cryptococcal infection. Author(s): Newton JA Jr, Tasker SA, Bone WD, Oldfield EC 3rd, Olson PE, Nguyen MT, Wallace MR. Source: Aids (London, England). 1995 November; 9(11): 1286-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8561984&dopt=Abstract

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What is the best treatment for treating thrush? Author(s): Romm AJ. Source: The Birth Gazette. 1995 Summer; 11(3): 39-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7795430&dopt=Abstract

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What is thrush, and how is it treated? Author(s): Rosen DS. Source: Health News. 2002 October; 8(10): 12. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12416493&dopt=Abstract

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Withdrawal of fluconazole suppressive therapy for thrush in patients responding to combination antiviral therapy including protease inhibitors. Author(s): Gripshover BM, Valdez H, Salata RA, Lederman MM. Source: Aids (London, England). 1998 December 24; 12(18): 2513-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9875599&dopt=Abstract

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CHAPTER 2. NUTRITION AND THRUSH Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and thrush.

Finding Nutrition Studies on Thrush The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “thrush” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “thrush” (or a synonym): •

Clonal production of tea tree oil high in terpinen-4-ol for use in formulations for the treatment of thrush. Author(s): School of Chemistry, Macquarie University, Sydney, NSW, Australia. Source: Williams, L R Complement-Ther-Nurs-Midwifery. 1998 October; 4(5): 133-6 1353-6117

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Composition of fuel stores and digestive limitations to fuel deposition rate in the long-distance migratory thrush nightingale, Luscinia luscinia. Author(s): Max-Planck-Institut fur Verhaltensphysiologie, Andechs, Germany. Source: Klaassen, M Lindstrom, A Zijlstra, R Physiol-Zool. 1997 Jan-February; 70(1): 12533 0031-935X

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Vaginal thrush: diagnosis and treatment options. Author(s): Praed Street Project, St Mary's Hospital, London. Source: Greer, P Nurs-Times. 1998 January 28-February 3; 94(4): 50-2 0954-7762

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What is the best treatment for treating thrush? Source: Romm, A J Birth-Gaz. 1995 Summer; 11(3): 39-40 0890-3255

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

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Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

The following is a specific Web list relating to thrush; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Minerals Nystatin Oral Source: Healthnotes, Inc.; www.healthnotes.com

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Food and Diet Cinnamon Alternative names: Cinnamomum zeylanicum Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. ALTERNATIVE MEDICINE AND THRUSH Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to thrush. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to thrush and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “thrush” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to thrush: •

“Not thrush again!” Women's experience of post-antibiotic vulvovaginitis. Author(s): Pirotta MV, Gunn JM, Chondros P. Source: The Medical Journal of Australia. 2003 July 7; 179(1): 43-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12831384&dopt=Abstract

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A comparison of fluconazole and ketoconazole in the treatment of rat palatal candidosis. Author(s): Martin MV. Source: Journal of Medical and Veterinary Mycology : Bi-Monthly Publication of the International Society for Human and Animal Mycology. 1989; 27(2): 63-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2545852&dopt=Abstract

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An essential and ancient oil. Author(s): Mennie A.

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Source: Nurs Times. 1997 November 19-25; 93(47): 31-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9418507&dopt=Abstract •

Antifungal activity of volatile constituents of Eugenia dysenterica leaf oil. Author(s): Costa TR, Fernandes OF, Santos SC, Oliveira CM, Liao LM, Ferri PH, Paula JR, Ferreira HD, Sales BH, Silva M do R. Source: Journal of Ethnopharmacology. 2000 September; 72(1-2): 111-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10967461&dopt=Abstract

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Betel chewer's perleche. Author(s): Singh G. Source: The British Journal of Dermatology. 1973 July; 89(1): 98. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4788326&dopt=Abstract

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Cannabis abuse and oral health care: review and suggestions for management. Author(s): Darling MR. Source: Sadj. 2003 June; 58(5): 189-90. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14596260&dopt=Abstract

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Changes in the oral microflora during cytotoxic chemotherapy in children being treated for acute leukemia. Author(s): O'Sullivan EA, Duggal MS, Bailey CC, Curzon ME, Hart P. Source: Oral Surg Oral Med Oral Pathol. 1993 August; 76(2): 161-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8361725&dopt=Abstract

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Clinical and lymphocyte responses to beta-carotene supplementation in 11 HIVpositive patients with chronic oral candidiasis. Author(s): Silverman S Jr, Kaugars GE, Gallo J, Thompson JS, Stites DP, Riley WT, Brandt RB. Source: Oral Surg Oral Med Oral Pathol. 1994 October; 78(4): 442-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7800374&dopt=Abstract

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Clonal production of tea tree oil high in terpinen-4-ol for use in formulations for the treatment of thrush. Author(s): Williams LR. Source: Complementary Therapies in Nursing & Midwifery. 1998 October; 4(5): 133-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9830943&dopt=Abstract

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Cyclic, low-dose total body irradiation for metastatic neuroblastoma. Author(s): DAngio GJ, Evans AE.

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Source: International Journal of Radiation Oncology, Biology, Physics. 1983 December; 9(12): 1961-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9463100&dopt=Abstract •

Diabetes insipidus in a patient with a highly malignant B-cell lymphoma and stomatitis. Author(s): Breidert M, Schimmelpfennig C, Kittner T, Helwig A, Ehninger G. Source: Experimental and Clinical Endocrinology & Diabetes : Official Journal, German Society of Endocrinology [and] German Diabetes Association. 2000; 108(1): 54-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10768833&dopt=Abstract

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Effect of commercial ethanol propolis extract on the in vitro growth of Candida albicans collected from HIV-seropositive and HIV-seronegative Brazilian patients with oral candidiasis. Author(s): Martins RS, Pereira ES Jr, Lima SM, Senna MI, Mesquita RA, Santos VR. Source: J Oral Sci. 2002 March; 44(1): 41-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12058869&dopt=Abstract

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Effect of fluconazole on the growth and adhesion of Candida albicans in the presence of antineoplastic agents. Author(s): Fekete-Forgacs K, Kis B, Nagy G, Lenkey B. Source: Journal of Basic Microbiology. 1999; 39(5-6): 305-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10629971&dopt=Abstract

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Efficacy of alcohol-based and alcohol-free melaleuca oral solution for the treatment of fluconazole-refractory oropharyngeal candidiasis in patients with AIDS. Author(s): Vazquez JA, Zawawi AA. Source: Hiv Clinical Trials. 2002 September-October; 3(5): 379-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12407487&dopt=Abstract

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Helping carers to cope. Author(s): Moss V. Source: Aids Action. 1998 June-August; (41): 4-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12294383&dopt=Abstract

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HIV infection: clinical features and treatment of thirty-three homosexual men with Kaposi's sarcoma. Author(s): Epstein JB, Scully C. Source: Oral Surg Oral Med Oral Pathol. 1991 January; 71(1): 38-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1704495&dopt=Abstract

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In vitro activity of Cinnamomum zeylanicum against azole resistant and sensitive Candida species and a pilot study of cinnamon for oral candidiasis. Author(s): Quale JM, Landman D, Zaman MM, Burney S, Sathe SS. Source: The American Journal of Chinese Medicine. 1996; 24(2): 103-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8874667&dopt=Abstract

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Nhova (the myths and the facts). Author(s): Mamvura CB. Source: Cent Afr J Med. 1982 April; 28(4): 95-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7127447&dopt=Abstract

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Novel oral combination chemotherapy in the treatment of intermediate-grade and high-grade AIDS-related non-Hodgkin's lymphoma. Author(s): Remick SC, McSharry JJ, Wolf BC, Blanchard CG, Eastman AY, Wagner H, Portuese E, Wighton T, Powell D, Pearce T, et al. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 1993 September; 11(9): 1691-702. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8355036&dopt=Abstract

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Ocular involvement in the acquired immune deficiency syndrome (AIDS). Author(s): McCluskey PJ, Wakefield D. Source: Australian and New Zealand Journal of Ophthalmology. 1985 August; 13(3): 293-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4074557&dopt=Abstract

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Oral fungal colonization and oral candidiasis in renal transplant patients: the relationship to Miswak use. Author(s): Al-Mohaya MA, Darwazeh A, Al-Khudair W. Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 2002 April; 93(4): 455-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12029285&dopt=Abstract

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Oral lesions and dental caries status in perinatally HIV-infected children in Northern Thailand. Author(s): Pongsiriwet S, Iamaroon A, Kanjanavanit S, Pattanaporn K, Krisanaprakornkit S. Source: International Journal of Paediatric Dentistry / the British Paedodontic Society [and] the International Association of Dentistry for Children. 2003 May; 13(3): 180-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12752917&dopt=Abstract

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Oral manifestations of drug therapy. Author(s): Guggenheimer J.

Alternative Medicine 25

Source: Dent Clin North Am. 2002 October; 46(4): 857-68. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12436836&dopt=Abstract •

Orofacial complications of chemotherapy for breast cancer. Author(s): McCarthy GM, Skillings JR. Source: Oral Surg Oral Med Oral Pathol. 1992 August; 74(2): 172-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1324459&dopt=Abstract

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Prevalence study of oral mucosal lesions in a selected Cambodian population. Author(s): Ikeda N, Handa Y, Khim SP, Durward C, Axell T, Mizuno T, Fukano H, Kawai T. Source: Community Dentistry and Oral Epidemiology. 1995 February; 23(1): 49-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7774177&dopt=Abstract

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Proliferation of intracellular structure corresponding to reduced affinity of fluconazole for cytochrome P-450 in two low-susceptibility strains of Candida albicans isolated from a Japanese AIDS patient. Author(s): Maebashi K, Kudoh M, Nishiyama Y, Makimura K, Kamai Y, Uchida K, Yamaguchi H. Source: Microbiology and Immunology. 2003; 47(2): 117-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12680714&dopt=Abstract

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Proteome analysis of oral pathogens. Author(s): Macarthur DJ, Jacques NA. Source: Journal of Dental Research. 2003 November; 82(11): 870-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14578497&dopt=Abstract

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Taboos of childbearing and child-rearing in Bendel state of Nigeria. Author(s): Iweze FA. Source: Journal of Nurse-Midwifery. 1983 May-June; 28(3): 31-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6552278&dopt=Abstract

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The effects of vitamin A supplementation on the morbidity of children born to HIVinfected women. Author(s): Coutsoudis A, Bobat RA, Coovadia HM, Kuhn L, Tsai WY, Stein ZA. Source: American Journal of Public Health. 1995 August; 85(8 Pt 1): 1076-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7625499&dopt=Abstract

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The therapy of oral lichen planus. Author(s): Eisen D.

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Source: Critical Reviews in Oral Biology and Medicine : an Official Publication of the American Association of Oral Biologists. 1993; 4(2): 141-58. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8435463&dopt=Abstract •

Transient neonatal zinc deficiency. Author(s): Krieger I, Alpern BE, Cunnane SC. Source: The American Journal of Clinical Nutrition. 1986 June; 43(6): 955-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3717070&dopt=Abstract

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Vaginal thrush: diagnosis and treatment options. Author(s): Greer P. Source: Nurs Times. 1998 January 28-February 3; 94(4): 50-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9510809&dopt=Abstract

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What is the best treatment for treating thrush? Author(s): Romm AJ. Source: The Birth Gazette. 1995 Summer; 11(3): 39-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7795430&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

Alternative Medicine 27

The following is a specific Web list relating to thrush; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Allergies and Sensitivities Source: Healthnotes, Inc.; www.healthnotes.com Asthma Source: Integrative Medicine Communications; www.drkoop.com Candida/Yeast Hypersensitivity Syndrome Source: Prima Communications, Inc.www.personalhealthzone.com Canker Sores Source: Healthnotes, Inc.; www.healthnotes.com Chronic Candidiasis Source: Healthnotes, Inc.; www.healthnotes.com HIV and AIDS Support Source: Healthnotes, Inc.; www.healthnotes.com Infection Source: Healthnotes, Inc.; www.healthnotes.com Vitiligo Source: Healthnotes, Inc.; www.healthnotes.com Yeast Infection Source: Healthnotes, Inc.; www.healthnotes.com

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Herbs and Supplements L. Acidophilus Source: Integrative Medicine Communications; www.drkoop.com Lactobacillus Acidophilus Source: Integrative Medicine Communications; www.drkoop.com Tea Tree Alternative names: Melaleuca alternifolia Source: Healthnotes, Inc.; www.healthnotes.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the

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MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. CLINICAL TRIALS AND THRUSH Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning thrush.

Recent Trials on Thrush The following is a list of recent trials dedicated to thrush.8 Further information on a trial is available at the Web site indicated. •

A Study to Compare the Use of Fluconazole as Continuous Therapy Versus Periodic Therapy in HIV-Positive Patients with Recurrent Thrush Condition(s): Candidiasis, Oral; HIV Infections Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID) Purpose - Excerpt: The purpose of this study is to determine whether it is better to treat patients with fluconazole on a continuous basis to prevent thrush (yeast infection in the mouth) from coming back or to wait and treat each episode of thrush. Fluconazole is one of the most commonly prescribed drugs to treat thrush and other yeast infections. However, the number of patients with fluconazole-resistant thrush is increasing, and it is not known whether continuous or intermittent use of fluconazole leads to greater resistance. Therefore, it is important to determine the most effective treatment strategy. Phase(s): Phase IV Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000951

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Fluconazole Prophylaxis of Thrush in AIDS Condition(s): Acquired Immunodeficiency Syndrome; Candidiasis; Oral Candidiasis

8

These are listed at www.ClinicalTrials.gov.

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Study Status: This study is completed. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID) Purpose - Excerpt: This is a placebo-controlled trial of intermittent fluconazole prophylaxis (200 mg orally three times a week) in the prevention of thrush. Phase(s): Phase IV Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001542 •

Safety and Effectiveness of Fluconazole Versus SCH 56592 to Treat Thrush in HIVPositive Patients Condition(s): Candidiasis, Oral; HIV Infections Study Status: This study is completed. Sponsor(s): Schering-Plough Purpose - Excerpt: The purpose of this study is to compare the safety and effectiveness of 2 treatments for thrush (a fungal infection of the mouth and throat) in HIV-positive patients. Fluconazole is a drug that is commonly used to treat thrush. SCH 56592 is a new drug that will be compared to fluconazole. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00002446

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Safety and Effectiveness of Giving L-743,872 to Patients with Thrush That Has Not Been Cured With Fluconazole Condition(s): Candidiasis, Oral; HIV Infections Study Status: This study is terminated. Sponsor(s): Merck Research Laboratories Purpose - Excerpt: The purpose of this study is to see if it is safe and effective to give L743,872 to patients with thrush, an AIDS-related yeast infection of the mouth, that has not been cured with fluconazole treatment. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00005920

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Safety and Effectiveness of Giving Lamisil to HIV-Positive Subjects With Thrush Who Have Not Responded to Fluconazole Treatment Condition(s): Candidiasis, Oral; HIV Infections Study Status: This study is completed. Sponsor(s): Novartis Pharmaceuticals

Clinical Trials 31

Purpose - Excerpt: The purpose of this study is to see if it is safe and effective to give Lamisil to HIV-positive patients with thrush (a fungal infection) that has not responded to fluconazole. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00002394

Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “thrush” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

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For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

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CHAPTER 5. BOOKS ON THRUSH Overview This chapter provides bibliographic book references relating to thrush. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on thrush include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “thrush” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on thrush: •

Instructions for Patients. 5th ed Source: Orlando, FL: W.B. Saunders Company. 1994. 598 p. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887-4430. (800) 545-2522 (individuals) or (800) 782-4479 (schools); Fax (800) 874-6418 or (407) 352-3445; http://www.wbsaunders.com. PRICE: $52.00 (English); $49.95 (Spanish); plus shipping and handling. ISBN: 0721649300 (English); 0721669972 (Spanish).

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Summary: This book is a compilation of instructions for patients, published in paperback format. The fact sheets each provide information in three sections: basic information, including a description of the condition, frequent signs and symptoms, causes, risk factors, preventive measures, expected outcome, and possible complications; treatment, including general measures, medication, activity guidelines, and diet; and when to contact one's health care provider. Fact sheets are available on oral health topics including: herpangina, leukoplakia, lichen planus, salivary gland infection, benign mouth or tongue tumors, oral cancer, periodontitis, salivary gland tumors, Sjogren's syndrome, stomatitis, teething, temporomandibular joint syndrome (TMJ), oral candidiasis (thrush), thumbsucking, glossitis (tongue inflammation), bruxism (tooth grinding), necrotizing ulcerative gingivitis (trench mouth), and trigeminal neuralgia (tic douloureux). The fact sheets are designed to be photocopied and distributed to patients as a reinforcement of oral instructions and as a teaching tool. •

AIDS and Its Treatment by Traditional Chinese Medicine Contact: Blue Poppy Press, 1775 Linden Ave, Boulder, CO, 80304, (303) 447-8372. Summary: This book of treatments for AIDS, compiled at the Heilongjiang College of Traditional Chinese Medicine (TCM), describes the causes, disease mechanisms, pattern discrimination, and treatment of the most commonly encountered conditions associated with AIDS including Kaposi's sarcoma, loss of appetite, diarrhea, herpes, thrush, and dementia. It was written as a clinical manual for TCM practioners, staying as close to the original Chinese version as possible. It offers information on the etiology and pathology of AIDS; the BianZheng treatment of various stages of AIDS and its main "pathoconditions;" commonly used formulas and herbs in the treatment of AIDS; and the treatment of AIDS with combined Chinese-Western medicine.

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Tongue Complaints Source: in Scully, C. Handbook of Oral Disease: Diagnosis and Management. New York, NY: Thieme New York. 2001. p.356-384. Contact: Available from Thieme New York. 333 Seventh Avenue, New York, NY 10001. (212) 760-0888, ext 110. PRICE: $35.00 plus shipping and handling. ISBN: 1841840874. Summary: This chapter on tongue complaints is from a handbook of oral disease that is intended to be used by all members of the dental team who need a ready office reference. The handbook covers the more common and important soft tissue orofacial disorders and gives clinically relevant aspects of the etiology, diagnosis, treatment, and prevention. This chapter covers amyloidosis, ankyloglossia (tongue tie), black hairy tongue, candidal glossitis (associated with fungal infection, thrush), coated tongue (white hairy tongue), deficiency glossitis, eosinophilic ulcer, erythema migrans (geographic tongue), fissured tongue, foliate papillitis, granular cell tumor, hairy leukoplakia, lingual thyroid, median rhomboid glossitis, oral-facial-digital syndrome, sublingual (under the tongue) keratosis, swelling, and syphilitic leukoplakia. For each condition, the authors note etiology (cause), diagnosis, symptoms, epidemiology, risk factors, treatment, and prevention (where possible). Much of the information is provided in table or outline format for ease of reference. Full color photographs illustrate some conditions. 39 figures. 9 references.

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Oral Complications of Diabetes Source: Torrance, CA: Homestead Schools, Inc. 2000. 73 p.

Books

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Contact: Available from Homestead Schools, Inc. 23844 Hawthorne Boulevard, Suite 200, Torrance, CA 90505. (310) 791-9975. Fax (310) 791-0135. E-mail: [email protected]. Website: www.homesteadschools.com. PRICE: $36.00 plus shipping and handling. Course No. 6620. Summary: This continuing education program for dentists focuses on the oral complications of diabetes. Topics include the epidemiology of diabetes mellitus in the United States, particularly in minority populations; the morbidity and mortality of diabetes; the importance of glycemic control in a patient with diabetes; the etiology and pathogenesis of type 1 and type 2 diabetes; the long term complications of diabetes; the genetics of diabetes; the interrelationship between glycemic control and periodontitis; the genetic connection between the increased risk for periodontitis and diabetes; the pathophysiological mechanism involved in the destruction of collagen, accelerated alveolar bone loss and diabetes; diabetes as a risk factor for periodontal health; the effect of mechanical periodontal treatment and systemic antibiotics therapy in improving periodontal status as well as glycemic control; the connection between diabetes and oral health in older adults; patient education; the connection between bacterial infections and diabetes; risk factors for periodontitis; the natural history of oral infections in diabetes; the periodontal manifestations of diabetes and the signs and symptoms that may help a dentist detect and monitor the presence of this disease; patient education principles and strategies; the role of saliva in fighting plaque and gum disease; the importance of maintaining natural dentition in patients with diabetes; the link between periodontal disease and diabetes, including the impact of diabetes control, blood vessel changes, bacteria, and smoking; treatment options for periodontal disease; and other oral problems linked to diabetes, including dental cavities, thrush, and dry mouth. The document concludes with a posttest with which readers can qualify for continuing education credit. The document is illustrated with numerous black and white photographs. 13 figures. 3 tables. 65 references. •

Nutrition: Your Ammunition for AIDS Contact: University of California San Diego, Medical Center, Department of Clinical Nutrition, 225 Dickinson St H-802, San Diego, CA, 92103-1990, (619) 543-3783. Summary: This monograph addresses nutritional needs, especially for persons with HIV/AIDS. It states that the best nutritional status is maintained with a well-balanced diet and an ample amount of calories to prevent weight loss. It explains that symptoms of AIDS, such as fevers, nausea, vomiting, diarrhea, candidiasis (thrush), infection, and herpetic and Kaposi's sarcoma lesions have a direct effect on specific nutritional needs and lists ways to reduce such symptoms. Eating a variety of food from the basic food groups in frequent but small amounts is also recommended. It encourages taking vitamins, minerals, protein, and calorie supplements. Difficulties with chewing, swallowing, nausea, vomiting, diarrhea, are also addressed. It offers suggestions for eliminating loss of appetite, feeling full too soon, and being too tired to cook food. It also includes intake guidelines for males, females, and vegetarians with HIV/AIDS, highcalorie recipes, and foods that can be stored for days when a person with HIV/AIDS may be too tired to cook.

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Surviving and Thriving With AIDS: Collected Wisdom. Vol. II Contact: People With AIDS Coalition of New York, 50 W 17th St 8th Fl, New York, NY, 10011-1607, (212) 647-1415.

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Summary: This monograph consists of articles written by Persons with AIDS (PWA's) about their personal experiences and opinions. Topics covered include emotional responses to diagnosis, AIDS-related complex and HIV-antibody testing, treatment options, insurance benefits, sexual behavior, family, friends, Acquired immunodeficiency syndrome (AIDS) in prison, women, minorities, Intravenous drug users (IVDU's), and children with AIDS. The articles on treatment modalities encompass a wide range of approaches: Azothymidine (AZT) and transfusions, lipids, total parenteral nutrition, Hickman catheters, gancyclovir (DHPG), skin problem ointments, and holistic health care. In addition, several articles dispute the myth that all PWA's die shortly after becoming infected with Human immunodeficiency virus (HIV) and discuss how difficult it is to live with AIDS in the United States. The monograph also presents articles on political responses to AIDS, on the PWA's self-empowerment movement, and on non-PWA's who are involved in the fight against AIDS. It also provides helpful hints on Kaposis sarcoma lesions, thrush, and hairy leukoplakia, as well as disability guidelines regarding Social Security. It contains resource listings for the National Association for PWA's, according to regions in the United States.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “thrush” at online booksellers’ Web sites, you may discover nonmedical books that use the generic term “thrush” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “thrush” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

A Self-Help Guide to Thrush; ISBN: 0903652668; http://www.amazon.com/exec/obidos/ASIN/0903652668/icongroupinterna

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Coping With Thrush by Caroline Clayton (1994); ISBN: 0859696979; http://www.amazon.com/exec/obidos/ASIN/0859696979/icongroupinterna

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Thrush: How to Prevent and Treat Yeast Infection (Thorsons Health Series) by Jane Butterworth; ISBN: 0722536224; http://www.amazon.com/exec/obidos/ASIN/0722536224/icongroupinterna

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Thrush: What It Is and What to Do About It by Ros Asquith (Illustrator); ISBN: 1854484893; http://www.amazon.com/exec/obidos/ASIN/1854484893/icongroupinterna

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Understanding Thrush, Cystitis and Women's Genital Symptoms by Caroline Bradbeer; ISBN: 1903474000; http://www.amazon.com/exec/obidos/ASIN/1903474000/icongroupinterna

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Victims of Thrush and Cystitis by Angela Kilmartin; ISBN: 0099406608; http://www.amazon.com/exec/obidos/ASIN/0099406608/icongroupinterna

Books

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Chapters on Thrush In order to find chapters that specifically relate to thrush, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and thrush using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “thrush” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on thrush: •

Oral Thrush Source: in World Health Organization (WHO) Global Programme on AIDS. Guidelines for the Clinical Management of HIV Infection in Adults. Geneva, Switzerland: World Health Organization. 1991. p. 4:1-4:10. Contact: Available from WHO Publications Center USA. 49 Sheridan Avenue, Albany, NY 12210. Fax (518) 436-7433. E-mail: [email protected]. PRICE: $11.70 plus shipping and handling. Summary: This chapter provides a patient care algorithm for managing patients with HIV-infection who have oral thrush. The chapter is from a set of guidelines, published by the World Health Organization, on the clinical management of HIV infection in adults. The guidelines address the wide variations in the presentation of HIV-related diseases, availability of resources, and health infrastructures in various countries around the world. The algorithm for oral thrush begins with instructions for diagnosis, the describes recommended treatment options, including treatment for chronic or recurrent thrush problems. The author notes that candidiasis may extend into the esophagus and cause difficulty (dysphagia) and pain (odynophagia) on swallowing. Hairy leukoplakia may mimic thrush. Therapies discussed include ketoconazole, clotrimazole, miconazole, and amphotericin B. In the presence of oral candidiasis, gastroscopy is usually only performed after failure of adequate antifungal chemotherapy and in the presence of esophageal symptoms. A biopsy is important to confirm tissue invasion by Candida albicans or to identify other causes. 1 figure. (AA-M).

39

CHAPTER 6. MULTIMEDIA ON THRUSH Overview In this chapter, we show you how to keep current on multimedia sources of information on thrush. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on thrush is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “thrush” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “thrush” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on thrush: •

Nutrition Strategies in HIV Management Teleconference Contact: TKN - TV, 2000 5th Ave R-101, River Grove, IL, 60171. Summary: This videorecording documents a teleconference on the subject of nutrition and Human immunodeficiency virus (HIV) infection. Hosted by Novella Dudley, it features a panel of four experts from various areas of the field who discuss aspects of HIV and nutrition; they then field questions from both the studio audience and over the telephone. Short video segments introduce each new topic. The panel includes Dr. Donald Kotler, of St. Luke's - Roosevelt Hospital; Joyce Fitzpatrick, a nursing consultant; Frank San Miguel, coordinator of HIV services for travelers and immigrants in Chicago; and Annette Smerko of Caremark. The teleconference opens by considering nutrition as part of the psychosocial needs of a Person with AIDS (PWA). The symptoms of malnutrition are discussed, such as weight loss, anorexia, diarrhea, fever, and painful chewing or swallowing. It addresses financial issues of the cost of medication being so great that some patients cannot afford food. It looks at the different nutritional needs of PWA's, who must avoid weight loss by eating extra calories. The panel addresses the

40

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philosophy behind providing nutritional care for someone who is dying, and looks at the effect of alcohol use on nutrition. Case studies are examined; they say that the lack of ability to eat may be due to neurologic disease, drugs, or local pathology. PWA's are encouraged to consult with a dietitian, a physican, and a social worker. The connection between depression and malnutrition is established. The panel looks at specific opportunistic infections that may affect the appetite, such as hepatitis, thrush, and candida. A demonstration is given on safe handling of food to prevent salmonella and other foodborne diseases. The videorecording examines the devastating effects of weight loss on a patient, and looks at the barriers to motivating a patient to eat. It studies ethical concerns in treatment and legal issues involved in refusal to treat. The concluding segment studies the diagnosis and management of gastrointestinal disorders. It touches on steroid use and the use of nutritional supplements. At the end of the videorecording, viewers are urged to complete an evaluation. •

AIDS: A Matter of Life Contact: Philadelphia Department of Public Health, AIDS Activities Coordinating Office, 1101 Market 9th Fl, Philadelphia, PA, 19107, (215) 685-5600, http://www.phila.gov/departments/health/AIDS/AIDS.html. Summary: Through interviews with Persons with AIDS (PWA's) from diverse backgrounds, this videorecording presents a macroview of Human immunodeficiency virus (HIV) transmission. It examines the physical, emotional, and psychological implications of the disease for patients and family. The videorecording addresses modes of contagion involving needle sharing, bisexual and multiple sex partners, and blood transfusions. It also stresses methods of prevention including safer sexual conduct and use of condoms. It mentions symptoms and illnesses that arise from the Acquired immunodeficiency syndrome (AIDS), such as nausea and fatigue, often followed by brain damage, pneumonia, and thrush. The role of the church as a support system is also examined.

Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Sound Recordings.” Type “thrush” (or synonyms) into the “For these words:” box. The following is a typical result when searching for sound recordings on thrush: •

AIDS: Disease, Patient, Internist Contact: California Medical Association, Audio Digest Foundation, 1577 E Chevy Chase Dr, Glendale, CA, 91206, (213) 245-8505. Summary: This sound recording, along with accompanying pre-test and post-test questions, comprises part of an ongoing series of educational activities. The first speaker, Michael S. Gottlieb, of Allergy and Immunology Associates in Santa Monica, CA, discusses real and perceived risks of Human immunodeficiency virus (HIV) transmission. He points out that there are three important routes of transmission: Sexual, parenteral, and perinatal. The likelihood of transmission through insect bites or casual contact is dismissed; the risks in the health-care setting are assessed. Following

Multimedia 41

his speech is a dramatization of a doctor-patient interchange presented by the Los Angeles County Medical Association. The dramatization covers awareness of the patient's sexual behavior; symptoms; asymptomatic carriers; high-risk sexual behavior, possibly risky behavior, and low-risk behavior; and other considerations. Early diagnosis and treatment is the subject of a presentation by Lowell S. Young, clinical professor of medicine at the University of California, San Francisco, School of Medicine; Chief, Division of Infectious Diseases, Pacific Presbyterian Medical Center; and Director, Kuzell Institute for Arthritis and Infectious Diseases, San Francisco. He outlines the various opportunistic infections that may afflict Persons with AIDS (PWA's), including Pneumocystis carinii pneumonia (PCP), leukopenia, cryptosporidiosis, toxoplasmosis, thrush, CMV infection, mycobacterium avium infection, and Kaposi's sarcoma. He also looks at antiviral therapy and bolstering immunity as methods of treatment.

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CHAPTER 7. PERIODICALS AND NEWS ON THRUSH Overview In this chapter, we suggest a number of news sources and present various periodicals that cover thrush.

News Services and Press Releases One of the simplest ways of tracking press releases on thrush is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “thrush” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to thrush. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “thrush” (or synonyms). The following was recently listed in this archive for thrush: •

Prolonged antifungal course may be warranted for recurrent vaginal thrush Source: Reuters Medical News Date: June 15, 2001

•

FDA grants Demegen request to launch phase I/II trial of thrush treatment Source: Reuters Industry Breifing Date: April 19, 2001

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•

Cavities Link To Oral Thrush In HIV Patients Source: Reuters Health eLine Date: February 17, 1998

•

Oral Solution Of Itraconazole Suppresses Oral Thrush In HIV Cases Source: Reuters Medical News Date: February 12, 1998

•

Bread Yeast Linked to Thrush Source: Reuters Health eLine Date: May 23, 1997

•

Fluconazole Superior To Nystatin For the Treatment Of Children With Thrush Source: Reuters Medical News Date: August 25, 1995 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “thrush” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “thrush” (or synonyms). If you know the name of a company that is relevant to thrush, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the

Periodicals and News

45

company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “thrush” (or synonyms).

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “thrush” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on thrush: •

Seek Organic Causes in Burning Tongue Syndrome Source: Skin and Allergy News. 31(8): 28. August 2000. Contact: Available from Skin and Allergy News. 12230 Wilkins Avenue, Rockville, MD 20852. (301) 816-8796. Summary: This news report reminds readers that burning tongue syndrome (glossodynia) is common during menopause. Patients with the condition complain of severe burning, stinging, or soreness of the mouth and tongue; there are no obvious lesions. Some studies have suggested that the majority of cases of this condition are psychosomatic, but this article contends that most cases have one or more treatable, organic cause. The condition occurs most commonly in menopausal patients, with about one in four menopausal women complaining of such symptoms. In addition, about 1 in 10 patients with diabetes are affected, and about 1 in 20 patients in a general dental practice may complain of glossodynia symptoms. Other causes may include candidiasis (thrush), nutritional deficiencies (especially B vitamin deficiencies), drugs, xerostomia (dry mouth), and trauma (particularly from dentures). The article reviews diagnostic strategies, including the identification of any psychological disorders that may be associated with the condition. The author concludes that treatment of these patients tends to be very time consuming, but it can also be very successful. 1 figure.

Academic Periodicals covering Thrush Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to thrush. In addition to these sources, you can search for articles covering thrush that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to

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http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 8. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for thrush. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with thrush. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to thrush: Ciclopirox •

Topical - U.S. Brands: Loprox http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202140.html

Econazole •

Topical - U.S. Brands: Spectazole http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202211.html

Nystatin and Triamcinolone •

Topical - U.S. Brands: Dermacomb; Mykacet; Mytrex http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202420.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

51

APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute9: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

9

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

Physician Resources

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.10 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:11 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

10 Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 11 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html The Combined Health Information Database

A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “thrush” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “thrush” (or synonyms) into the “For these words:” box. The following is a sample result: •

Comprehensive Maternal - Child HIV Management and Research Center Contact: Los Angeles County University of Southern California, Medical Center, Comprehensive Maternal - Child HIV Management and, Research Center, 1640 Marengo St 2nd Fl, Los Angeles, CA, 90089-9260, (323) 226-2200. Summary: This handbook describes the services and schedule of the Maternal and Child HIV Clinic of the Comprehensive Maternal- Child HIV Management & Research Center in Los Angeles, CA. It also provides general information on care of children who are HIV positive. It discusses what HIV is, how children and adolescents may get infected, testing, and prevention. Problems associated with HIV infection in children are listed, including cytomegalovirus, thrush, ear or sinus infections, and hepatitis. Guidelines are presented for immunizations, when to call the doctor, and dental care. A section on medical care for HIV-positive children discusses measles and chicken pox, and specifies treatments for fever, vomiting, diarrhea, and constipation.

•

AIDS - Related Fungal Illnesses Contact: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Allergy and Infectious Diseases, 31 Center Dr MSC 2520, Bethesda, MD, 20892-2520, (301) 496-5717, http://www.niaid.nih.gov. Summary: This report discusses the common fungal infections associated with Acquired immunodeficiency syndrome (AIDS). Thrush, or candidiasis, caused by the organism Candida Albicans, is the most commonly seen fungal infection. It is often considered a predictor of progression from Human immunodeficiency virus (HIV) infection to AIDS. Women may experience candidiasis in the vagina, and infants, as diaper rash. A more serious manifestation is esophageal candidiasis, which causes pain in swallowing. It is not considered life-threatening. Other, more serious, fungal infections include cryptococcal meningitis and histoplasmosis. Few therapies have proven effective against these infections. Although fungal infections often respond initially to standard treatment, they require maintenance treatment with drugs that cause severe side effects. Drugs used to treat fungal infections include clotrimazole, mycostatin, ketoconazole, amphotericin B, fluconazole, intraconazole, and SCH 39304. The National Institute of

Physician Resources

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Allergy and Infectious Diseases (NIAID) presently has seven drug studies underway on the treatment of fungal infections.

The NLM Gateway12 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.13 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “thrush” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 3367 23 365 520 0 4275

HSTAT14 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.15 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.16 Simply search by “thrush” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

12

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

13

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 14 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 15 16

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists17 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.18 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.19 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

17 Adapted 18

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 19 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on thrush can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to thrush. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to thrush. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “thrush”:

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•

Guides on thrush Candidiasis http://www.nlm.nih.gov/medlineplus/candidiasis.html

•

Other guides AIDS http://www.nlm.nih.gov/medlineplus/aids.html AIDS and Infections http://www.nlm.nih.gov/medlineplus/aidsandinfections.html Fungal Infections http://www.nlm.nih.gov/medlineplus/fungalinfections.html Immune System and Disorders http://www.nlm.nih.gov/medlineplus/immunesystemanddisorders.html Infant and Newborn Care http://www.nlm.nih.gov/medlineplus/infantandnewborncare.html Mouth Disorders http://www.nlm.nih.gov/medlineplus/mouthdisorders.html Throat Disorders http://www.nlm.nih.gov/medlineplus/throatdisorders.html Vaginal Diseases http://www.nlm.nih.gov/medlineplus/vaginaldiseases.html

Within the health topic page dedicated to thrush, the following was listed: •

General/Overviews Candidiasis: Diaper Rash, Oral Thrush, Vaginal Yeast Infection Source: Nemours Foundation http://kidshealth.org/parent/infections/common/candidiasis.html

•

Diagnosis/Symptoms Genital Problems in Men: Self-Care Flowcharts Source: American Academy of Family Physicians http://familydoctor.org/539.xml Genital Problems in Women: Self-Care Flowcharts Source: American Academy of Family Physicians http://familydoctor.org/537.xml Mouth Problems: Self-Care Flowcharts Source: American Academy of Family Physicians http://familydoctor.org/509.xml Yeast Infection? Are You Sure? Source: Interstitial Cystitis Association http://www.ichelp.org/FeatureArticles/YeastInfectionAreYouSure.html

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Treatment FDA Updates Safety Information for Miconazole Vaginal Cream and Suppositories Source: Food and Drug Administration http://www.fda.gov/bbs/topics/ANSWERS/2001/ANS01071.html Yogurt: Can It Cure Yeast Infections? Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=AN00608

•

Specific Conditions/Aspects Dubious “Yeast Allergies” Source: Quackwatch, Inc. http://www.quackwatch.org/01QuackeryRelatedTopics/candida.html Frequently Asked Questions about Yeast Infections http://www.4woman.gov/faq/yeast.pdf Genital Candidiasis (Vulvovaginal Candidiasis (VVC), Vaginal Yeast Infections) Source: National Center for Infectious Diseases http://www.cdc.gov/ncidod/dbmd/diseaseinfo/candidiasis_gen_g.htm Invasive Candidiasis Source: National Center for Infectious Diseases http://www.cdc.gov/ncidod/dbmd/diseaseinfo/candidiasis_inv_g.htm Oral Thrush Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DS00408 Oropharyngeal Candidiasis (OPC, Thrush) Source: National Center for Infectious Diseases http://www.cdc.gov/ncidod/dbmd/diseaseinfo/candidiasis_opc_g.htm Vaginal Yeast Infections Source: American Academy of Family Physicians http://familydoctor.org/206.xml

•

Latest News Non-genital Areas May Fuel Repeat Yeast Infections Source: 11/14/2003, Reuters Health http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_14681 .html

•

Men Yeast Infection in Men Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HO00172

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•

Organizations National Center for Infectious Diseases, Division of Bacterial and Mycotic Diseases http://www.cdc.gov/ncidod/dbmd/ National Institute of Allergy and Infectious Diseases http://www.niaid.nih.gov/

•

Research Identification of Yeast Mating Habits Opens New Doors to Candida Research Source: National Institute of Allergy and Infectious Diseases http://www.niaid.nih.gov/newsroom/releases/candida.htm

•

Teenagers Yeast Infections Source: Nemours Foundation http://kidshealth.org/teen/infections/fungal/yeast_infections.html

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on thrush. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

What Patients With HIV or AIDS Should Know About Oral Thrush (Oropharnygeal Candidiasis) : Answers to Important Questions Contact: Pfizer Pharmaceuticals, 235 E 42nd St, New York, NY, 10017-5755, (212) 5732323, http://www.pfizer.com. Summary: This brochure discusses oral thrush (oropharyngeal candidiasis), how it is treated, and how to prevent it. The brochure describes oral thrush's appearance and how it develops; people with suppressed or depressed immune systems are particularly vulnerable. Oral thrush treatment (with antifungals) is described and the fact that the condition is not serious if treated correctly. The brochure includes information about how to reduce the risk of developing oral thrush.

•

Symptoms, Treatment, and Oral Thrush Prevention: Your Guide to Control Source: Mountain View, CA: Alza Pharmaceuticals. 1998. 10 p.

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Contact: Available from Alza Pharmaceuticals. 1550 Plymouth Avenue, Mountain View, CA 94043. (800) 634-8977. PRICE: Single copy free; bulk orders available. Order Numbers: 0008291 or 0008485. Summary: This brochure helps readers to prevent oral thrush (candidiasis). Oral thrush is an infection of the mouth by a yeast called Candida. Normally, the body's immune system keeps Candida in check. However, when the immune system is weakened (from chemotherapy, steroid therapy, HIV infection, or diabetes, for example), the person may be at risk for oral thrush. Written in a question and answer format, the brochure describes the symptoms of oral thrush, topical and systemic medications used to treat oral thrush, ways to lessen the discomfort of oral thrush, medications that can be used to prevent future infections, and daily self care steps to help control oral thrush. The brochure recommends that readers should check for symptoms daily, take all medications as prescribed, practice good oral hygiene (including regular dental checkups), avoid alcohol and foods that can aggravate oral thrush, and follow their physician's instructions. Two full color photographs show examples of Candida infections. 2 figures. •

Oropharyngeal Candidiasis (Oral Thrush) Contact: Pfizer Pharmaceuticals, 235 E 42nd St, New York, NY, 10017-5755, (212) 5732323, http://www.pfizer.com. Summary: This brochure uses a question-and-answer format to discuss oropharyngeal candidiasis (oral thrush). It details what the disease is, how it is transmitted, and methods of treatment. The brochure informs the reader that oral thrush is not a serious condition when treated, and suggests things to do to reduce the risk of reinfection.

•

Thrush: GMHC Treatment Issues Fact Sheet. Translated title Contact: Gay Mens Health Crisis, 119 W 24th St Tisch Bldg, New York, NY, 10011-1995, (212) 367-1205, http://www.gmhc.org. Summary: This English and Spanish fact sheet defines thrush (candidiasis) and its symptoms. Treatment and prevention are also outlined. A list of medicines is provided including localized and systemic drugs for prevention; or for persistent, life-threatening or drug-resistant infections.

•

Thrush (Oral Candidiasis) Source: in Griffith, H.W. Instruction for Patients. 5th ed. Orlando, FL: W.B. Saunders Company. 1994. p. 462. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887-4430. (800) 545-2522 (individuals) or (800) 782-4479 (schools); Fax (800) 874-6418 or (407) 352-3445; http://www.wbsaunders.com. PRICE: $52.00 (English); $49.95 (Spanish); plus shipping and handling. ISBN: 0721649300 (English); 0721669972 (Spanish). Summary: This fact sheet on oral candidiasis (thrush) is from a compilation of instructions for patients, published in book format. The fact sheet provides information in three sections: basic information, including a description of the condition, frequent signs and symptoms, causes, risk factors, preventive measures, expected outcome, and possible complications; treatment, including general measures, medication, activity guidelines, and diet; and when to contact one's health care provider. The fact sheet is

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designed to be photocopied and distributed to patients as a reinforcement of oral instructions and as a teaching tool. •

Candidiasis: Diaper Rash, Oral Thrush, Vaginal Yeast Infection Source: KidsHealth. June 2001. 3 p. Contact: Nemours Foundation. Website: www.kidshealth.org. Summary: This fact sheet provides an overview of different types of candidiasis that can affect children. Diaper rash is the most common form of candidiasis, appearing in healthy newborns and older babies, and is characterized by red, tender skin, especially in skin folds and creases. Diaper rash can be prevented by changing cloth diapers as soon as they get wet or soiled and thoroughly rinsing soaps and other irritants from the diapers. Zinc oxide and other nonprescription ointments can be applied. Oral thrush is candidiasis of the mouth and appears in healthy newborns or older children. The fungus causes cracks in the corners of the mouth and yellow or white patches on the lips, tongue, palate and inside the cheeks. In healthy children, thrush requires no treatment. In children with cancer or HIV, treatment is necessary to prevent infection spreading to other organs. Another common ailment is Candida paronychia, which infects the skin around the nails. The cuticles around the nails become red, swollen, and painful. Antifungal medications are prescribed to treat this disorder. Candida vulvovaginitis, or yeast infections, affect older girls and women and are characterized by vaginal itching, redness, and thick white discharge. To prevent vaginal candidiasis, keep the vagina area clean, avoid vaginal sprays and douches, wear cotton underpants, and change into dry clothing after swimming.

•

Thrush Contact: Community AIDS Treatment Information Exchange, PO Box 1104, Toronto, (416) 203-7122, http://www.catie.ca. Summary: This fact sheet, for individuals with the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), provides information on candidiasis (thrush). It discusses candidasis and identifies those individuals who are at risk for this opportunistic infection; it lists the symptoms of candidiasis and describes the tests used to diagnose thrush; it examines how HIV-positive individuals can help to prevent candidiasis; and it discusses some of the medical treatments used for HIVpositive individuals co-infected with thrush.

•

Candidiasis (Thrush) Contact: University of New Mexico School of Medicine, New Mexico AIDS Education and Training Center, New Mexico AIDS InfoNet, PO Box 810, Arroyo Seco, NM, 87514, (505) 776-8032, http://www.aidsinfonet.org. Summary: This information sheet discusses candidiasis (thrush), a fungal infection caused by common yeast and the most common opportunistic infection (OI) in people whose immune systems have been damaged by the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). Candidiasis can infect the mouth, throat, or vagina. In the mouth, the infection is called thrush and looks like white patches similar to cottage cheese or red spots. It can cause sore throat, pain when swallowing, nausea, and loss of appetite. There is no way to prevent exposure to this fungus, and there is no way to prevent an outbreak of it. Treatments for candidiasis can

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be local or systemic. The fact sheet lists the local anti-fungal treatments for candidiasis, and describes systemic and natural treatments for this infection. •

Oral Candidiasis (Thrush) Contact: Project Inform, National HIV/AIDS Treatment Hotline, 205 13th St Ste 2001, San Francisco, CA, 94103, (415) 558-8669, http://www.projectinform.org. Summary: This information sheet, for individuals with the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), discusses oral candidiasis, otherwise know as thrush. The information sheet describes the causes of oral candidiasis; diagnosis; treatment which includes topical therapy and systemic therapy with anti-fungals; side effects; drug interactions; and prevention methods such as smoking cessation, good oral hygiene; and avoidance of unnecessary antibiotics, alcohol, sugars, and steroids. In addition, the information sheet discusses diet changes for treating and preventing fungal infections naturally. The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to thrush. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to thrush. By consulting all of associations listed in this

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chapter, you will have nearly exhausted all sources for patient associations concerned with thrush. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about thrush. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “thrush” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “thrush”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “thrush” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “thrush” (or a synonym) into the search box, and click “Submit Query.”

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67

APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.20

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

20

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)21: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

21

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

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MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

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Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

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On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

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Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

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Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

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MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

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Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

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Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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THRUSH DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Acid Rain: Acidic water usually pH 2.5 to 4.5, which poisons the ecosystem and adversely affects plants, fishes, and mammals. It is caused by industrial pollutants, mainly sulfur oxides and nitrogen oxides, emitted into the atmosphere and returning to earth in the form of acidic rain water. [NIH] Acquired Immunodeficiency Syndrome: An acquired defect of cellular immunity associated with infection by the human immunodeficiency virus (HIV), a CD4-positive Tlymphocyte count under 200 cells/microliter or less than 14% of total lymphocytes, and increased susceptibility to opportunistic infections and malignant neoplasms. Clinical manifestations also include emaciation (wasting) and dementia. These elements reflect criteria for AIDS as defined by the CDC in 1993. [NIH] Acute leukemia: A rapidly progressing cancer of the blood-forming tissue (bone marrow). [NIH]

Adrenal Glands: Paired glands situated in the retroperitoneal tissues at the superior pole of each kidney. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH]

Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and

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herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Alveolar Bone Loss: The resorption of bone in the supporting structures of the maxilla or mandible as a result of periodontal disease. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amyloidosis: A group of diseases in which protein is deposited in specific organs (localized amyloidosis) or throughout the body (systemic amyloidosis). Amyloidosis may be either primary (with no known cause) or secondary (caused by another disease, including some types of cancer). Generally, primary amyloidosis affects the nerves, skin, tongue, joints, heart, and liver; secondary amyloidosis often affects the spleen, kidneys, liver, and adrenal glands. [NIH] Anaerobic: 1. Lacking molecular oxygen. 2. Growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antifungal: Destructive to fungi, or suppressing their reproduction or growth; effective against fungal infections. [EU] Antifungal Agents: Substances that destroy fungi by suppressing their ability to grow or reproduce. They differ from fungicides, industrial because they defend against fungi present in human or animal tissues. [NIH]

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Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-infective: An agent that so acts. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antimycotic: Suppressing the growth of fungi. [EU] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antineoplastic Agents: Substances that inhibit or prevent the proliferation of neoplasms. [NIH]

Antiviral: Destroying viruses or suppressing their replication. [EU] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Aspergillosis: Infections with fungi of the genus Aspergillus. [NIH] Asymptomatic: Having no signs or symptoms of disease. [NIH] Avian: A plasmodial infection in birds. [NIH] Bacteremia: The presence of viable bacteria circulating in the blood. Fever, chills, tachycardia, and tachypnea are common acute manifestations of bacteremia. The majority of cases are seen in already hospitalized patients, most of whom have underlying diseases or procedures which render their bloodstreams susceptible to invasion. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Infections: Infections by bacteria, general or unspecified. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its

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subdivisions is the basal (basement) lamina. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Pigments: Pigments that give a characteristic color to bile including: bilirubin, biliverdine, and bilicyanin. [NIH] Biofilms: Films of bacteria or other microbial organisms, usually embedded in extracellular polymers such as implanted medical devices, which adhere to surfaces submerged in, or subjected to, aquatic environments (From Singleton & Sainsbury, Dictionary of Microbiology and Molecular Biology, 2d ed). Biofilms consist of multilayers of microbial cells glued together to form microbial communities which are highly resistant to both phagocytes and antibiotics. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Blastomycosis: A fungal infection that may appear in two forms: 1) a primary lesion characterized by the formation of a small cutaneous nodule and small nodules along the lymphatics that may heal within several months; and 2) chronic granulomatous lesions characterized by thick crusts, warty growths, and unusual vascularity and infection in the middle or upper lobes of the lung. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood transfusion: The administration of blood or blood products into a blood vessel. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or

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within a natural body cavity or implanted directly into the tissues. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Bruxism: A disorder characterized by grinding and clenching of the teeth. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Callus: A callosity or hard, thick skin; the bone-like reparative substance that is formed round the edges and fragments of broken bone. [NIH] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Candidosis: An infection caused by an opportunistic yeasts that tends to proliferate and become pathologic when the environment is favorable and the host resistance is weakened. [NIH]

Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Catheters: A small, flexible tube that may be inserted into various parts of the body to inject or remove liquids. [NIH] Causal: Pertaining to a cause; directed against a cause. [EU] Caustic: An escharotic or corrosive agent. Called also cauterant. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Count: A count of the number of cells of a specific kind, usually measured per unit volume of sample. [NIH]

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Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cellular metabolism: The sum of all chemical changes that take place in a cell through which energy and basic components are provided for essential processes, including the synthesis of new molecules and the breakdown and removal of others. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cheilitis: Inflammation of the lips. It is of various etiologies and degrees of pathology. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chlorophyll: Porphyrin derivatives containing magnesium that act to convert light energy in photosynthetic organisms. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Clone: The term "clone" has acquired a new meaning. It is applied specifically to the bits of inserted foreign DNA in the hybrid molecules of the population. Each inserted segment originally resided in the DNA of a complex genome amid millions of other DNA segment. [NIH]

Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Clotrimazole: An imidazole derivative with a broad spectrum of antimycotic activity. It inhibits biosynthesis of the sterol ergostol, an important component of fungal cell membranes. Its action leads to increased membrane permeability and apparent disruption of enzyme systems bound to the membrane. [NIH] Codons: Any triplet of nucleotides (coding unit) in DNA or RNA (if RNA is the carrier of primary genetic information as in some viruses) that codes for particular amino acid or signals the beginning or end of the message. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic

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substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Combination chemotherapy: Treatment using more than one anticancer drug. [NIH] Commensal: 1. Living on or within another organism, and deriving benefit without injuring or benefiting the other individual. 2. An organism living on or within another, but not causing injury to the host. [EU] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Condoms: A sheath that is worn over the penis during sexual behavior in order to prevent

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pregnancy or spread of sexually transmitted disease. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Conjugated: Acting or operating as if joined; simultaneous. [EU] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contraceptive: An agent that diminishes the likelihood of or prevents conception. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corticosteroid: Any of the steroids elaborated by the adrenal cortex (excluding the sex hormones of adrenal origin) in response to the release of corticotrophin (adrenocorticotropic hormone) by the pituitary gland, to any of the synthetic equivalents of these steroids, or to angiotensin II. They are divided, according to their predominant biological activity, into three major groups: glucocorticoids, chiefly influencing carbohydrate, fat, and protein metabolism; mineralocorticoids, affecting the regulation of electrolyte and water balance; and C19 androgens. Some corticosteroids exhibit both types of activity in varying degrees, and others exert only one type of effect. The corticosteroids are used clinically for hormonal replacement therapy, for suppression of ACTH secretion by the anterior pituitary, as antineoplastic, antiallergic, and anti-inflammatory agents, and to suppress the immune response. Called also adrenocortical hormone and corticoid. [EU] Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Crowns: A prosthetic restoration that reproduces the entire surface anatomy of the visible natural crown of a tooth. It may be partial (covering three or more surfaces of a tooth) or complete (covering all surfaces). It is made of gold or other metal, porcelain, or resin. [NIH] Cryptosporidiosis: Parasitic intestinal infection with severe diarrhea caused by a protozoan, Cryptosporidium. It occurs in both animals and humans. [NIH] Curative: Tending to overcome disease and promote recovery. [EU]

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Cutaneous: Having to do with the skin. [NIH] Cytochrome: Any electron transfer hemoprotein having a mode of action in which the transfer of a single electron is effected by a reversible valence change of the central iron atom of the heme prosthetic group between the +2 and +3 oxidation states; classified as cytochromes a in which the heme contains a formyl side chain, cytochromes b, which contain protoheme or a closely similar heme that is not covalently bound to the protein, cytochromes c in which protoheme or other heme is covalently bound to the protein, and cytochromes d in which the iron-tetrapyrrole has fewer conjugated double bonds than the hemes have. Well-known cytochromes have been numbered consecutively within groups and are designated by subscripts (beginning with no subscript), e.g. cytochromes c, c1, C2, . New cytochromes are named according to the wavelength in nanometres of the absorption maximum of the a-band of the iron (II) form in pyridine, e.g., c-555. [EU] Cytomegalovirus: A genus of the family Herpesviridae, subfamily Betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Cytosine: A pyrimidine base that is a fundamental unit of nucleic acids. [NIH] Cytotoxic: Cell-killing. [NIH] Cytotoxic chemotherapy: Anticancer drugs that kill cells, especially cancer cells. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Dental Abutments: Natural teeth or teeth roots used as anchorage for a fixed or removable denture or other prosthesis (such as an implant) serving the same purpose. [NIH] Dental Care: The total of dental diagnostic, preventive, and restorative services provided to meet the needs of a patient (from Illustrated Dictionary of Dentistry, 1982). [NIH] Dental Caries: Localized destruction of the tooth surface initiated by decalcification of the enamel followed by enzymatic lysis of organic structures and leading to cavity formation. If left unchecked, the cavity may penetrate the enamel and dentin and reach the pulp. The three most prominent theories used to explain the etiology of the disase are that acids produced by bacteria lead to decalcification; that micro-organisms destroy the enamel protein; or that keratolytic micro-organisms produce chelates that lead to decalcification. [NIH]

Dentists: Individuals licensed to practice dentistry. [NIH] Dentition: The teeth in the dental arch; ordinarily used to designate the natural teeth in position in their alveoli. [EU] Dentures: An appliance used as an artificial or prosthetic replacement for missing teeth and adjacent tissues. It does not include crowns, dental abutments, nor artificial teeth. [NIH]

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Dermal: Pertaining to or coming from the skin. [NIH] Dermatitis: Any inflammation of the skin. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diaper Rash: A type of irritant dermatitis localized to the area in contact with a diaper and occurring most often as a reaction to prolonged contact with urine, feces, or retained soap or detergent. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Dietitian: An expert in nutrition who helps people plan what and how much food to eat. [NIH]

Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Double-blinded: A clinical trial in which neither the medical staff nor the person knows which of several possible therapies the person is receiving. [NIH] Dross: Residue remaining in an opium pipe which has been smoked; contains 50 % of the morphine present in the original drug. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Resistance: Diminished or failed response of an organism, disease or tissue to the intended effectiveness of a chemical or drug. It should be differentiated from drug tolerance which is the progressive diminution of the susceptibility of a human or animal to the effects of a drug, as a result of continued administration. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duct: A tube through which body fluids pass. [NIH]

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Dura mater: The outermost, toughest, and most fibrous of the three membranes (meninges) covering the brain and spinal cord; called also pachymeninx. [EU] Dysphagia: Difficulty in swallowing. [EU] Ecosystem: A dynamic complex of plant, animal and micro-organism communities and their non-living environment interacting as a functional unit. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Emaciation: Clinical manifestation of excessive leanness usually caused by disease or a lack of nutrition. [NIH] Emollient: Softening or soothing; called also malactic. [EU] Enamel: A very hard whitish substance which covers the dentine of the anatomical crown of a tooth. [NIH] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]

Endometrium: The layer of tissue that lines the uterus. [NIH] Endopeptidases: A subclass of peptide hydrolases. They are classified primarily by their catalytic mechanism. Specificity is used only for identification of individual enzymes. They comprise the serine endopeptidases, EC 3.4.21; cysteine endopeptidases, EC 3.4.22; aspartic endopeptidases, EC 3.4.23, metalloendopeptidases, EC 3.4.24; and a group of enzymes yet to be assigned to any of the above sub-classes, EC 3.4.99. EC 3.4.-. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophilic: A condition found primarily in grinding workers caused by a reaction of the pulmonary tissue, in particular the eosinophilic cells, to dust that has entered the lung. [NIH] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Erythema: Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of causes. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophageal Stricture: A narrowing of the esophagus often caused by acid flowing back from the stomach. This condition may require surgery. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estrogen: One of the two female sex hormones. [NIH]

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Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Ethinyl Estradiol: A semisynthetic estrogen with high oral estrogenic potency. It is often used as the estrogenic component in oral contraceptives. [NIH] Evacuation: An emptying, as of the bowels. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Facial: Of or pertaining to the face. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fermentation: An enzyme-induced chemical change in organic compounds that takes place in the absence of oxygen. The change usually results in the production of ethanol or lactic acid, and the production of energy. [NIH] Flexor: Muscles which flex a joint. [NIH] Fluconazole: Triazole antifungal agent that is used to treat oropharyngeal candidiasis and cryptococcal meningitis in AIDS. [NIH] Flucytosine: A fluorinated cytosine analog that is used as an antifungal agent. [NIH] Fungi: A kingdom of eukaryotic, heterotrophic organisms that live as saprobes or parasites, including mushrooms, yeasts, smuts, molds, etc. They reproduce either sexually or asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to those that grow as multicelluar colonies (mushrooms and molds). [NIH] Fungicides, Industrial: Chemicals that kill or inhibit the growth of fungi in agricultural applications, on wood, plastics, or other materials, in swimming pools, etc. [NIH] Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some

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reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gastroscopy: Endoscopic examination, therapy, or surgery of the interior of the stomach. [NIH]

Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Gentian Violet: A dye that is a mixture of violet rosanilinis with antibacterial, antifungal, and anthelmentic properties. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glossalgia: Painful sensations in the tongue, including a sensation of burning. [NIH] Glossitis: Inflammation of the tongue. [NIH] Glossodynia: Pain in the tongue; glossalgia. [EU] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen

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frequently in diabetes mellitus but also occurs with other diseases. [NIH] Gonadal: Pertaining to a gonad. [EU] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] Gram-positive: Retaining the stain or resisting decolorization by alcohol in Gram's method of staining, a primary characteristic of bacteria whose cell wall is composed of a thick layer of peptidologlycan with attached teichoic acids. [EU] Granular Cell Tumor: Unusual tumor affecting any site of the body, but most often encountered in the head and neck. Considerable debate has surrounded the histogenesis of this neoplasm; however, it is considered to be a myoblastoma of, usually, a benign nature. It affects women more often than men. When it develops beneath the epidermis or mucous membrane, it can lead to proliferation of the squamous cells and mimic squamous cell carcinoma. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Habitat: An area considered in terms of its environment, particularly as this determines the type and quality of the vegetation the area can carry. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpes Zoster: Acute vesicular inflammation. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Holistic Health: Health as viewed from the perspective that man and other organisms function as complete, integrated units rather than as aggregates of separate parts. [NIH]

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Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Humoral: Of, relating to, proceeding from, or involving a bodily humour - now often used of endocrine factors as opposed to neural or somatic. [EU] Humour: 1. A normal functioning fluid or semifluid of the body (as the blood, lymph or bile) especially of vertebrates. 2. A secretion that is itself an excitant of activity (as certain hormones). [EU] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Imidazole: C3H4N2. The ring is present in polybenzimidazoles. [NIH] Immune function: Production and action of cells that fight disease or infection. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]

effects

of

foreign

Immunocompetence: The ability of lymphoid cells to mount a humoral or cellular immune response when challenged by antigen. [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunodeficiency syndrome: The inability of the body to produce an immune response. [NIH]

Immunoglobulin: A protein that acts as an antibody. [NIH] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Immunology: The study of the body's immune system. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH]

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In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insurance Benefits: Payments or services provided under stated circumstances under the terms of an insurance policy. In prepayment programs, benefits are the services the programs will provide at defined locations and to the extent needed. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Having to do with the intestines. [NIH] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intracellular: Inside a cell. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques.

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[EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Irradiation: The use of high-energy radiation from x-rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Irradiation is also called radiation therapy, radiotherapy, and x-ray therapy. [NIH] Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce inflammation; those that cause redness due to hyperemia are rubefacients; those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH] Itraconazole: An antifungal agent that has been used in the treatment of histoplasmosis, blastomycosis, cryptococcal meningitis, and aspergillosis. [NIH] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH]

Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keratolytic: An agent that promotes keratolysis. [EU] Keratosis: Any horny growth such as a wart or callus. [NIH] Ketoconazole: Broad spectrum antifungal agent used for long periods at high doses, especially in immunosuppressed patients. [NIH] Lactation: The period of the secretion of milk. [EU] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Leishmaniasis: A disease caused by any of a number of species of protozoa in the genus Leishmania. There are four major clinical types of this infection: cutaneous (Old and New World), diffuse cutaneous, mucocutaneous, and visceral leishmaniasis. [NIH] Lesion: An area of abnormal tissue change. [NIH] Leukemia: Cancer of blood-forming tissue. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukopenia: A condition in which the number of leukocytes (white blood cells) in the blood is reduced. [NIH] Leukoplakia: A white patch that may develop on mucous membranes such as the cheek, gums, or tongue and may become cancerous. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Lichen Planus: An inflammatory, pruritic disease of the skin and mucous membranes,

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which can be either generalized or localized. It is characterized by distinctive purplish, flattopped papules having a predilection for the trunk and flexor surfaces. The lesions may be discrete or coalesce to form plaques. Histologically, there is a "saw-tooth" pattern of epidermal hyperplasia and vacuolar alteration of the basal layer of the epidermis along with an intense upper dermal inflammatory infiltrate composed predominantly of T-cells. Etiology is unknown. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphocyte Count: A count of the number of lymphocytes in the blood. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lymphoma: A general term for various neoplastic diseases of the lymphoid tissue. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mammary: Pertaining to the mamma, or breast. [EU] Mandible: The largest and strongest bone of the face constituting the lower jaw. It supports the lower teeth. [NIH] Mannans: Polysaccharides consisting of mannose units. [NIH] Mastication: The act and process of chewing and grinding food in the mouth. [NIH] Mastitis: Inflammatory disease of the breast, or mammary gland. [NIH] Medical Staff: Professional medical personnel who provide care to patients in an organized facility, institution or agency. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Menopause: Permanent cessation of menstruation. [NIH]

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Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Miconazole: An imidazole antifungal agent that is used topically and by intravenous infusion. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Micro-organism: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Migrans: Infestation of the dermis by various larvae, characterized by bizarre red irregular lines which are broad at one end and fade at the other, produced by burrowing larvae. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Mononuclear: A cell with one nucleus. [NIH] Morphological: Relating to the configuration or the structure of live organs. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucocutaneous: Pertaining to or affecting the mucous membrane and the skin. [EU] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mustard Gas: Severe irritant and vesicant of skin, eyes, and lungs. It may cause blindness and lethal lung edema and was formerly used as a war gas. The substance has been proposed as a cytostatic and for treatment of psoriasis. It has been listed as a known

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carcinogen in the Fourth Annual Report on Carcinogens (NTP-85-002, 1985) (Merck, 11th ed). [NIH] Mycobacterium: A genus of gram-positive, aerobic bacteria. Most species are free-living in soil and water, but the major habitat for some is the diseased tissue of warm-blooded hosts. [NIH]

Mycobacterium avium: A bacterium causing tuberculosis in domestic fowl and other birds. In pigs, it may cause localized and sometimes disseminated disease. The organism occurs occasionally in sheep and cattle. It should be distinguished from the M. avium complex, which infects primarily humans. [NIH] Mycostatin: A drug that treats infections caused by fungi. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Needle Sharing: Usage of a single needle among two or more people for injecting drugs. Needle sharing is a high-risk behavior for contracting infectious disease. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasm: A new growth of benign or malignant tissue. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neuralgia: Intense or aching pain that occurs along the course or distribution of a peripheral or cranial nerve. [NIH] Neuroblastoma: Cancer that arises in immature nerve cells and affects mostly infants and children. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier

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nuclei during their decay. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nitrogen Oxides: Inorganic oxides that contain nitrogen. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nutritional Status: State of the body in relation to the consumption and utilization of nutrients. [NIH] Nystatin: Macrolide antifungal antibiotic complex produced by Streptomyces noursei, S. aureus, and other Streptomyces species. The biologically active components of the complex are nystatin A1, A2, and A3. [NIH] Odynophagia: A painful condition of the esophagus. [NIH] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Open Reading Frames: Reading frames where successive nucleotide triplets can be read as codons specifying amino acids and where the sequence of these triplets is not interrupted by stop codons. [NIH] Opportunistic Infections: An infection caused by an organism which becomes pathogenic under certain conditions, e.g., during immunosuppression. [NIH] Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Oral Hygiene: The practice of personal hygiene of the mouth. It includes the maintenance of oral cleanliness, tissue tone, and general preservation of oral health. [NIH] Orbit: One of the two cavities in the skull which contains an eyeball. Each eye is located in a bony socket or orbit. [NIH] Orbital: Pertaining to the orbit (= the bony cavity that contains the eyeball). [EU] Orofacial: Of or relating to the mouth and face. [EU] Ossification: The formation of bone or of a bony substance; the conversion of fibrous tissue or of cartilage into bone or a bony substance. [EU] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Pachymeningitis: Inflammation of the dura mater of the brain, the spinal cord or the optic nerve. [NIH] Palate: The structure that forms the roof of the mouth. It consists of the anterior hard palate and the posterior soft palate. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar

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gland that secretes digestive enzymes. [NIH] Parathyroid: 1. Situated beside the thyroid gland. 2. One of the parathyroid glands. 3. A sterile preparation of the water-soluble principle(s) of the parathyroid glands, ad-ministered parenterally as an antihypocalcaemic, especially in the treatment of acute hypoparathyroidism with tetany. [EU] Parathyroid Glands: Two small paired endocrine glands in the region of the thyroid gland. They secrete parathyroid hormone and are concerned with the metabolism of calcium and phosphorus. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Parenteral Nutrition: The administering of nutrients for assimilation and utilization by a patient who cannot maintain adequate nutrition by enteral feeding alone. Nutrients are administered by a route other than the alimentary canal (e.g., intravenously, subcutaneously). [NIH] Paronychia: Inflammation involving the folds of tissue surrounding the nail. Called also perionychia. [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogen: Any disease-producing microorganism. [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra. [NIH] Pentamidine: Antiprotozoal agent effective in trypanosomiasis, leishmaniasis, and some fungal infections; used in treatment of Pneumocystis carinii pneumonia in HIV-infected patients. It may cause diabetes mellitus, central nervous system damage, and other toxic effects. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perceived risk: Estimate or evaluation of risk as observed through personal experience or personal study, and personal evaluation of consequences. [NIH] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontitis: Inflammation of the periodontal membrane; also called periodontitis simplex. [NIH]

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Pharmacists: Those persons legally qualified by education and training to engage in the practice of pharmacy. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Pigments: Any normal or abnormal coloring matter in plants, animals, or micro-organisms. [NIH]

Pilot study: The initial study examining a new method or treatment. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasmid: An autonomously replicating, extra-chromosomal DNA molecule found in many bacteria. Plasmids are widely used as carriers of cloned genes. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polymers: Compounds formed by the joining of smaller, usually repeating, units linked by covalent bonds. These compounds often form large macromolecules (e.g., polypeptides, proteins, plastics). [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU]

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Prednisolone: A glucocorticoid with the general properties of the corticosteroids. It is the drug of choice for all conditions in which routine systemic corticosteroid therapy is indicated, except adrenal deficiency states. [NIH] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Propolis: Resinous substance obtained from beehives; contains many different substances which may have antimicrobial or antimycotic activity topically; its extracts are called propolis resin or balsam. Synonyms: bee bread; hive dross; bee glue. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protease Inhibitors: Compounds which inhibit or antagonize biosynthesis or actions of proteases (endopeptidases). [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Pruritic: Pertaining to or characterized by pruritus. [EU] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a

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machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refractory: Not readily yielding to treatment. [EU] Refusal to Treat: Refusal of the health professional to initiate or continue treatment of a patient or group of patients. The refusal can be based on any reason. The concept is differentiated from patient refusal of treatment see treatment refusal which originates with the patient and not the health professional. [NIH] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Rickets: A condition caused by deficiency of vitamin D, especially in infancy and childhood, with disturbance of normal ossification. The disease is marked by bending and distortion of the bones under muscular action, by the formation of nodular enlargements on the ends and sides of the bones, by delayed closure of the fontanelles, pain in the muscles, and sweating of the head. Vitamin D and sunlight together with an adequate diet are curative, provided that the parathyroid glands are functioning properly. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH]

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Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Salmonella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that utilizes citrate as a sole carbon source. It is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia. Food poisoning is the most common clinical manifestation. Organisms within this genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Sarcoma: A connective tissue neoplasm formed by proliferation of mesodermal cells; it is usually highly malignant. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Sebaceous: Gland that secretes sebum. [NIH] Sebaceous gland: Gland that secretes sebum. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Small-pox: A generalized virus infection with a vesicular rash. [NIH] Soaps: Sodium or potassium salts of long chain fatty acids. These detergent substances are obtained by boiling natural oils or fats with caustic alkali. Sodium soaps are harder and are used as topical anti-infectives and vehicles in pills and liniments; potassium soaps are soft, used as vehicles for ointments and also as topical antimicrobials. [NIH]

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Social Work: The use of community resources, individual case work, or group work to promote the adaptive capacities of individuals in relation to their social and economic environments. It includes social service agencies. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Squamous: Scaly, or platelike. [EU] Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma. [NIH] Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma. [NIH] Squamous cells: Flat cells that look like fish scales under a microscope. These cells cover internal and external surfaces of the body. [NIH] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Steroid therapy: Treatment with corticosteroid drugs to reduce swelling, pain, and other symptoms of inflammation. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between

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the termination of the esophagus and the beginning of the duodenum. [NIH] Stomatitis: Inflammation of the oral mucosa, due to local or systemic factors which may involve the buccal and labial mucosa, palate, tongue, floor of the mouth, and the gingivae. [EU]

Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Sublingual: Located beneath the tongue. [EU] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Sulfur Oxides: Inorganic oxides of sulfur. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Suppressive: Tending to suppress : effecting suppression; specifically : serving to suppress activity, function, symptoms. [EU] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Systemic: Affecting the entire body. [NIH] Systemic therapy: Treatment that uses substances that travel through the bloodstream, reaching and affecting cells all over the body. [NIH] Tea Tree Oil: Essential oil extracted from Melaleuca alternifolia (tea tree). It is used as a topical antimicrobial due to the presence of terpineol. [NIH] Tear Gases: Gases that irritate the eyes, throat, or skin. Severe lacrimation develops upon irritation of the eyes. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Tic: An involuntary compulsive, repetitive, stereotyped movement, resembling a purposeful movement because it is coordinated and involves muscles in their normal synergistic relationships; tics usually involve the face and shoulders. [EU] Tissue: A group or layer of cells that are alike in type and work together to perform a

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specific function. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Toxoplasmosis: The acquired form of infection by Toxoplasma gondii in animals and man. [NIH]

Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfer Factor: Factor derived from leukocyte lysates of immune donors which can transfer both local and systemic cellular immunity to nonimmune recipients. [NIH] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trigeminal: Cranial nerve V. It is sensory for the eyeball, the conjunctiva, the eyebrow, the skin of face and scalp, the teeth, the mucous membranes in the mouth and nose, and is motor to the muscles of mastication. [NIH] Trypanosomiasis: Infection with protozoa of the genus Trypanosoma. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH]

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Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vaginitis: Inflammation of the vagina characterized by pain and a purulent discharge. [NIH] Vaginosis: A condition caused by the overgrowth of anaerobic bacteria (e. g., Gardnerella vaginalis), resulting in vaginal irritation and discharge. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Veins: The vessels carrying blood toward the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vesicular: 1. Composed of or relating to small, saclike bodies. 2. Pertaining to or made up of vesicles on the skin. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Vitamin D: The vitamin that mediates intestinal calcium absorption, bone calcium metabolism, and probably muscle activity. It usually acts as a hormone precursor, requiring 2 stages of metabolism before reaching actual hormonal form. It is isolated from fish liver oils and used in the treatment and prevention of rickets. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Vulva: The external female genital organs, including the clitoris, vaginal lips, and the opening to the vagina. [NIH] Vulvovaginitis: Inflammation of the vulva and vagina, or of the vulvovaginal glands. [EU] Wart: A raised growth on the surface of the skin or other organ. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] Xerostomia: Decreased salivary flow. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] X-ray therapy: The use of high-energy radiation from x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation

Dictionary 105

therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. X-ray therapy is also called radiation therapy, radiotherapy, and irradiation. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH]

107

INDEX A Acid Rain, 8, 75 Acquired Immunodeficiency Syndrome, 14, 29, 75 Acute leukemia, 22, 75 Adrenal Glands, 75, 76 Adverse Effect, 75, 100 Aerobic, 75, 94 Affinity, 25, 75 Agar, 75, 97 Age of Onset, 75, 103 Algorithms, 75, 78 Alimentary, 75, 90, 96 Alternative medicine, 44, 75 Alveolar Bone Loss, 35, 76 Alveoli, 76, 83 Amino Acid Sequence, 76 Amino Acids, 76, 95, 96, 97, 98, 102 Amyloidosis, 34, 76 Anaerobic, 76, 100, 104 Analog, 76, 86 Animal model, 8, 76 Anorexia, 39, 76, 87 Antibacterial, 76, 87, 101 Antibiotic, 9, 21, 76, 95, 101 Antibodies, 7, 9, 76, 88, 89, 92, 97 Antibody, 4, 7, 36, 75, 76, 77, 81, 88, 89, 90, 91, 93, 99, 101, 105 Antifungal, 4, 6, 22, 37, 43, 62, 76, 86, 87, 91, 93, 95 Antifungal Agents, 4, 76 Antigen, 5, 7, 75, 76, 77, 81, 89, 90 Anti-infective, 77, 100 Anti-inflammatory, 77, 82, 87, 98 Antimicrobial, 77, 98, 102 Antimycotic, 77, 80, 98 Antineoplastic, 23, 77, 82 Antineoplastic Agents, 23, 77 Antiviral, 16, 41, 77 Arterial, 77, 98 Arteries, 77, 78, 82, 93 Arterioles, 77, 78 Aspergillosis, 77, 91 Asymptomatic, 41, 77 Avian, 10, 77 B Bacteremia, 77, 100

Bacteria, 6, 35, 76, 77, 78, 83, 86, 88, 93, 94, 97, 100, 101, 103, 104 Bacterial Infections, 35, 77 Bactericidal, 77, 86 Bacteriophage, 77, 97, 100 Bacterium, 77, 94 Base, 77, 83, 91 Basement Membrane, 77, 86 Benign, 34, 78, 88, 94, 99 Bile, 78, 87, 89, 91, 92, 101 Bile Pigments, 78, 91 Biofilms, 6, 78 Biopsy, 37, 78 Biosynthesis, 78, 80, 98 Biotechnology, 8, 44, 53, 78 Blastomycosis, 78, 91 Blood pressure, 78, 93 Blood transfusion, 40, 78 Blood vessel, 35, 78, 101, 102, 104 Bone Marrow, 75, 78, 92 Bowel, 78, 84 Bowel Movement, 78, 84 Brachytherapy, 78, 90, 91, 99, 105 Branch, 71, 79, 96, 101, 102 Breakdown, 79, 80 Bruxism, 34, 79 Buccal, 79, 102 C Calcium, 79, 81, 96, 104 Callus, 79, 91 Candidosis, 21, 79 Carcinogenic, 79, 101 Cardiac, 79, 85, 94, 101 Carotene, 22, 79 Case report, 12, 79, 80 Case series, 79, 80 Catheters, 36, 79, 89, 90 Causal, 5, 79 Caustic, 79, 100 Cell, 5, 23, 77, 78, 79, 80, 81, 83, 86, 88, 90, 93, 94, 97, 99, 104 Cell Count, 5, 79 Cell Division, 77, 80, 97 Cell membrane, 80 Cellular metabolism, 6, 80 Cellulose, 80, 86, 97 Central Nervous System, 80, 96 Cheilitis, 4, 80

108 Thrush

Chemotherapy, 25, 37, 61, 80 Chlorophyll, 80, 86 Cholesterol, 78, 80, 101 Chromosomal, 80, 97 Chronic, 3, 9, 10, 22, 27, 37, 78, 80, 90, 102 Clinical study, 5, 80 Clinical trial, 4, 5, 29, 31, 53, 80, 82, 84, 99 Clone, 7, 80 Cloning, 78, 80 Clotrimazole, 9, 37, 54, 80 Codons, 80, 95 Cofactor, 80, 98 Collagen, 35, 77, 80, 98 Combination chemotherapy, 24, 81 Commensal, 6, 7, 81 Complement, 18, 81 Complementary and alternative medicine, 21, 27, 81 Complementary medicine, 21, 81 Computational Biology, 53, 81 Conception, 81, 82 Condoms, 40, 81 Confounding, 5, 82 Congestion, 82, 85 Conjugated, 82, 83 Conjunctiva, 82, 103 Connective Tissue, 78, 80, 82, 100 Consciousness, 82, 83, 84 Constipation, 54, 82 Consumption, 82, 87, 95, 99 Contraceptive, 3, 82 Contraindications, ii, 82 Controlled study, 14, 82 Coronary, 82, 93 Coronary Thrombosis, 82, 93 Corticosteroid, 82, 98, 101 Cortisone, 82, 98 Cranial, 82, 94, 103 Crowns, 82, 83 Cryptosporidiosis, 41, 82 Curative, 82, 99, 102 Cutaneous, 10, 78, 79, 83, 91 Cytochrome, 25, 83 Cytomegalovirus, 54, 83 Cytosine, 83, 86 Cytotoxic, 22, 83, 99 Cytotoxic chemotherapy, 22, 83 D Databases, Bibliographic, 53, 83 Degenerative, 83, 88 Dementia, 34, 75, 83 Dental Abutments, 83

Dental Care, 54, 83 Dental Caries, 24, 83 Dentists, 35, 83 Dentition, 35, 83 Dentures, 6, 45, 83 Dermal, 84, 92 Dermatitis, 84 Diabetes Mellitus, 6, 35, 84, 88, 90, 96 Diagnostic procedure, 44, 84 Diaper Rash, 54, 58, 62, 84 Diarrhea, 34, 35, 39, 54, 82, 84 Dietitian, 40, 84 Digestive system, 32, 84 Direct, iii, 5, 35, 47, 84, 99 Discrimination, 34, 84 Disinfectant, 84, 86 Dissociation, 75, 84 Double-blinded, 5, 84 Dross, 84, 98 Drug Interactions, 48, 63, 84 Drug Resistance, 8, 11, 84 Drug Tolerance, 84 Duct, 84, 100 Dura mater, 85, 92, 95 Dysphagia, 37, 85 E Ecosystem, 75, 85 Elastin, 81, 85 Emaciation, 75, 85 Emollient, 85, 95 Enamel, 83, 85 Endocarditis, 79, 85 Endometrial, 11, 85 Endometrium, 85 Endopeptidases, 85, 98 Environmental Health, 52, 54, 85 Enzymatic, 79, 81, 83, 85 Enzyme, 80, 85, 86, 98, 104 Eosinophilic, 34, 85 Epidermal, 85, 92 Epidermis, 85, 88, 92 Erythema, 34, 85 Esophageal, 13, 37, 54, 85 Esophageal Stricture, 13, 85 Esophagus, 4, 37, 84, 85, 95, 102 Estrogen, 85, 86 Ethanol, 23, 86 Ethinyl Estradiol, 3, 86 Evacuation, 82, 86 Exogenous, 86, 103 External-beam radiation, 86, 91, 99, 104 Extracellular, 6, 78, 82, 86

Index 109

Extracellular Matrix, 6, 82, 86 Extracellular Space, 86 F Facial, 34, 86 Family Planning, 53, 86 Fat, 78, 79, 82, 86, 101 Fatigue, 40, 86 Fatty acids, 86, 100 Feces, 82, 84, 86 Fermentation, 86, 100 Flexor, 86, 92 Fluconazole, 3, 4, 5, 7, 9, 10, 11, 14, 16, 21, 23, 25, 29, 30, 31, 44, 54, 86 Flucytosine, 4, 86 Fungi, 76, 77, 86, 87, 93, 94, 105 Fungicides, Industrial, 76, 86 Fungus, 62, 79, 86 G Gallbladder, 84, 87 Gastroenteritis, 87, 100 Gastrointestinal, 40, 86, 87 Gastrointestinal tract, 86, 87 Gastroscopy, 37, 87 Gels, 13, 87 Gene, 6, 8, 78, 87 Gene Expression, 6, 8, 87 Genetics, 35, 87 Genital, 11, 36, 58, 59, 87, 104 Gentian Violet, 12, 87 Gestation, 87, 96 Gland, 34, 82, 87, 92, 95, 96, 100, 102 Glossalgia, 87 Glossitis, 34, 87 Glossodynia, 45, 87 Glucocorticoid, 87, 98 Glucose, 80, 84, 87, 90, 100 Glucose Intolerance, 84, 87 Gonadal, 88, 101 Governing Board, 88, 97 Grade, 24, 88 Graft, 88, 89 Gram-negative, 88, 100 Gram-positive, 88, 94 Granular Cell Tumor, 34, 88 Growth, 6, 7, 23, 76, 77, 86, 88, 91, 92, 94, 97, 102, 103, 104 H Habitat, 88, 94 Haptens, 75, 88 Heme, 83, 88 Hemorrhage, 88, 102 Hepatitis, 40, 54, 88

Hepatocytes, 88 Heredity, 87, 88 Herpes, 34, 88 Herpes Zoster, 88 Heterogeneity, 75, 88 Holistic Health, 36, 88 Hormonal, 82, 89, 104 Hormone, 82, 89, 90, 96, 98, 102, 104 Host, 6, 77, 79, 81, 89, 104 Humoral, 7, 89 Humour, 89 Hybrid, 80, 89 Hydroxylysine, 81, 89 Hydroxyproline, 81, 89 Hyperbilirubinemia, 89, 91 Hyperplasia, 89, 92 I Id, 19, 26, 59, 63, 70, 72, 89 Imidazole, 12, 13, 80, 89, 93 Immune function, 5, 89 Immune response, 8, 77, 82, 88, 89, 104 Immune system, 60, 61, 62, 89, 92, 103, 104 Immunity, 4, 41, 75, 89, 103 Immunocompetence, 14, 89 Immunodeficiency, 4, 8, 11, 14, 36, 39, 40, 54, 62, 63, 75, 89 Immunodeficiency syndrome, 14, 36, 40, 54, 89 Immunoglobulin, 4, 76, 89, 93 Immunohistochemistry, 7, 89 Immunology, 6, 25, 40, 75, 89 Impairment, 89, 93 Implant radiation, 89, 90, 91, 99, 105 In vitro, 4, 7, 23, 24, 90 In vivo, 7, 90 Incision, 90 Indicative, 36, 90, 96, 104 Infancy, 90, 99 Infarction, 82, 90, 93 Inflammation, 3, 34, 77, 80, 84, 87, 88, 90, 91, 92, 95, 96, 101, 102, 104 Infusion, 90, 93, 103 Insight, 7, 90 Insulin, 90, 103 Insurance Benefits, 36, 90 Intermittent, 3, 29, 30, 90 Internal radiation, 90, 91, 99, 105 Interstitial, 58, 78, 86, 90, 91, 105 Intestinal, 79, 82, 90, 104 Intestines, 86, 87, 90 Intracellular, 25, 90, 97 Intramuscular, 90, 96

110 Thrush

Intravenous, 36, 90, 93, 96 Intrinsic, 75, 77, 90 Invasive, 7, 59, 89, 90 Involuntary, 91, 94, 102 Irradiation, 22, 91, 105 Irritants, 62, 91 Itraconazole, 3, 14, 15, 44, 91 J Jaundice, 9, 89, 91 Joint, 34, 86, 91 K Kb, 52, 91 Keratolytic, 83, 91 Keratosis, 34, 91 Ketoconazole, 3, 21, 37, 54, 91 L Lactation, 11, 12, 15, 91 Large Intestine, 84, 90, 91, 99 Leishmaniasis, 91, 96 Lesion, 78, 91, 92, 103 Leukemia, 91 Leukocytes, 78, 91 Leukopenia, 41, 91 Leukoplakia, 4, 34, 36, 37, 91 Library Services, 70, 91 Lichen Planus, 25, 34, 91 Liver, 76, 78, 83, 84, 86, 87, 88, 92, 98, 104 Localization, 89, 92 Localized, 61, 76, 83, 84, 90, 92, 94, 97, 103 Lymphatic, 90, 92, 101 Lymphocyte, 22, 75, 77, 92 Lymphocyte Count, 75, 92 Lymphoid, 76, 89, 92 Lymphoma, 12, 23, 24, 92 M Malignant, 23, 75, 77, 92, 94, 99, 100 Malnutrition, 39, 92 Mammary, 92 Mandible, 76, 92, 99 Mannans, 86, 92 Mastication, 92, 103 Mastitis, 11, 92 Medical Staff, 84, 92 MEDLINE, 53, 92 Membrane, 80, 81, 82, 88, 92, 93, 96 Memory, 76, 83, 92 Meninges, 80, 85, 92 Meningitis, 54, 86, 91, 92 Menopause, 45, 92 Menstruation, 92, 93 Mental Disorders, 32, 93 Metastasis, 93

Metastatic, 22, 93 MI, 23, 73, 93 Miconazole, 13, 37, 59, 93 Microorganism, 80, 93, 96, 104 Micro-organism, 83, 85, 93, 97 Migrans, 34, 93 Molecular, 53, 56, 76, 78, 81, 93 Molecule, 77, 81, 84, 93, 95, 97, 99 Monitor, 35, 93 Monoclonal, 91, 93, 99, 105 Mononuclear, 10, 93 Morphological, 86, 93 Morphology, 9, 93 Motion Sickness, 93, 94 Mucins, 93, 100 Mucocutaneous, 3, 9, 10, 12, 91, 93 Mucosa, 6, 7, 93, 102 Mustard Gas, 91, 93 Mycobacterium, 41, 94, 103 Mycobacterium avium, 41, 94 Mycostatin, 54, 94 Myocardium, 93, 94 N Nausea, 35, 40, 62, 87, 94 NCI, 1, 31, 51, 94 Necrosis, 90, 93, 94 Need, 3, 33, 34, 37, 39, 45, 54, 64, 75, 94 Needle Sharing, 40, 94 Neonatal, 26, 94 Neoplasm, 88, 94, 100 Neoplastic, 92, 94 Nerve, 94, 95, 103 Nervous System, 80, 94 Neural, 89, 94 Neuralgia, 34, 94 Neuroblastoma, 22, 94 Neurologic, 40, 94 Neutrons, 91, 94, 98 Nitrogen, 75, 95, 103 Nitrogen Oxides, 75, 95 Nucleus, 93, 94, 95 Nutritional Status, 35, 95 Nystatin, 13, 19, 44, 48, 95 O Odynophagia, 37, 95 Ointments, 36, 62, 95, 100 Open Reading Frames, 7, 95 Opportunistic Infections, 40, 41, 75, 95 Oral Health, 22, 34, 35, 95 Oral Hygiene, 61, 63, 95 Orbit, 95 Orbital, 12, 95

Index 111

Orofacial, 25, 34, 95 Ossification, 95, 99 Oxidation, 83, 95 P Pachymeningitis, 92, 95 Palate, 62, 95, 102 Palliative, 95, 102 Pancreas, 84, 90, 95 Parathyroid, 96, 99 Parathyroid Glands, 96, 99 Parenteral, 36, 40, 96 Parenteral Nutrition, 36, 96 Paronychia, 62, 96 Patch, 91, 96 Pathogen, 7, 96 Pathogenesis, 7, 35, 96 Pathologic, 78, 79, 82, 89, 96, 99 Patient Education, 35, 60, 68, 70, 73, 96 Penis, 81, 96 Pentamidine, 6, 96 Peptide, 85, 96, 97, 98 Perceived risk, 40, 96 Perinatal, 40, 96 Periodontal disease, 35, 76, 96 Periodontitis, 34, 35, 96 Pharmacists, 10, 97 Pharmacologic, 97, 103 Physiologic, 78, 93, 97, 99 Pigments, 78, 79, 97 Pilot study, 24, 97 Plants, 75, 87, 93, 97, 100, 103 Plaque, 35, 97 Plasma, 76, 80, 87, 97 Plasma cells, 76, 97 Plasmid, 7, 97 Poisoning, 87, 94, 97, 100 Polymers, 78, 97, 98 Polypeptide, 76, 80, 97 Polysaccharide, 77, 80, 97 Posterior, 95, 97 Potassium, 97, 100 Practice Guidelines, 55, 97 Precursor, 85, 97, 103, 104 Prednisolone, 98 Prednisone, 5, 98 Progesterone, 98, 101 Progression, 6, 9, 54, 76, 98 Progressive, 83, 84, 88, 94, 98 Proline, 81, 89, 98 Prophylaxis, 5, 7, 29, 30, 98 Propolis, 23, 98 Protease, 6, 12, 16, 98

Protease Inhibitors, 6, 12, 16, 98 Protein S, 78, 98 Proteins, 7, 76, 77, 80, 81, 93, 95, 96, 97, 98, 100, 103 Pruritic, 91, 98 Psychic, 98 Psychosomatic, 45, 98 Public Policy, 53, 98 Publishing, 8, 98 Pulmonary, 78, 82, 85, 98 Pulse, 93, 98 R Radiation, 23, 86, 90, 91, 98, 99, 104 Radiation therapy, 86, 90, 91, 98, 105 Radioactive, 89, 90, 91, 99, 105 Radiolabeled, 91, 99, 105 Radiotherapy, 78, 91, 99, 105 Randomized, 5, 13, 14, 99 Randomized clinical trial, 6, 99 Receptor, 10, 77, 99 Rectum, 78, 84, 91, 99 Refer, 1, 79, 81, 86, 88, 92, 94, 99 Refractory, 23, 99 Refusal to Treat, 40, 99 Relapse, 4, 99 Resorption, 76, 99 Respiration, 93, 99 Rickets, 99, 104 Risk factor, 5, 34, 35, 61, 99 Rod, 77, 99, 100 S Saliva, 6, 35, 100 Salivary, 34, 83, 84, 100, 104 Salivary glands, 83, 84, 100 Salmonella, 40, 87, 100 Saponins, 100, 101 Sarcoma, 23, 34, 35, 36, 41, 100 Screening, 7, 80, 100 Sebaceous, 91, 100 Sebaceous gland, 91, 100 Secretion, 82, 89, 91, 93, 100 Self Care, 61, 100 Semisynthetic, 86, 100 Septic, 14, 100 Serum, 4, 7, 81, 100 Shock, 14, 100, 103 Side effect, 47, 54, 63, 75, 100, 103 Signs and Symptoms, 34, 35, 61, 99, 100 Skeleton, 91, 100 Small-pox, 100 Soaps, 62, 100 Social Work, 40, 101

112 Thrush

Soft tissue, 34, 78, 100, 101 Solvent, 86, 101 Somatic, 89, 101 Specialist, 64, 101 Species, 24, 87, 89, 91, 93, 94, 95, 101, 102, 103, 104 Specificity, 75, 85, 101 Spectrum, 80, 91, 101 Spleen, 76, 83, 92, 101 Squamous, 88, 101 Squamous cell carcinoma, 88, 101 Squamous cells, 88, 101 Staging, 9, 101 Steroid, 40, 61, 82, 100, 101 Steroid therapy, 61, 101 Stomach, 84, 85, 87, 89, 90, 94, 101 Stomatitis, 6, 23, 34, 102 Stress, 87, 94, 102 Stroke, 32, 52, 102 Subacute, 90, 102 Subclinical, 90, 102 Subcutaneous, 96, 102 Sublingual, 34, 102 Subspecies, 101, 102 Sulfur, 75, 102 Sulfur Oxides, 75, 102 Supplementation, 22, 25, 102 Suppression, 16, 82, 102 Suppressive, 16, 102 Synergistic, 102 Systemic, 35, 61, 63, 76, 78, 79, 90, 91, 98, 99, 102, 103, 105 Systemic therapy, 63, 102 T Tea Tree Oil, 10, 18, 22, 102 Tear Gases, 91, 102 Therapeutics, 48, 102 Thrombosis, 98, 102 Thyroid, 34, 96, 102 Tic, 34, 102 Tissue, 37, 75, 77, 78, 82, 84, 85, 86, 87, 88, 89, 90, 91, 92, 94, 95, 96, 99, 100, 101, 102 Topical, 15, 48, 61, 63, 86, 100, 102, 103 Toxic, iv, 89, 96, 103 Toxicity, 84, 103 Toxicology, 54, 103 Toxins, 77, 90, 103 Toxoplasmosis, 41, 103

Trachea, 102, 103 Transfection, 78, 103 Transfer Factor, 4, 103 Transfusion, 103 Trauma, 45, 94, 103 Trigeminal, 34, 103 Trypanosomiasis, 96, 103 Tryptophan, 81, 103 Tuberculosis, 82, 94, 103 Type 2 diabetes, 35, 103 U Ulcer, 34, 103 Unconscious, 89, 103 Urine, 84, 103 Uterus, 85, 93, 98, 103, 104 V Vaccine, 7, 103 Vagina, 4, 54, 62, 79, 93, 104 Vaginal, 10, 11, 12, 13, 15, 16, 18, 26, 43, 58, 59, 62, 104 Vaginitis, 79, 104 Vaginosis, 13, 104 Vascular, 90, 104 Veins, 78, 104 Venous, 98, 104 Venules, 78, 104 Vesicular, 88, 100, 104 Veterinary Medicine, 53, 104 Virulence, 7, 103, 104 Virus, 4, 8, 11, 36, 39, 40, 54, 62, 63, 75, 77, 97, 100, 104 Vitamin D, 45, 99, 104 Vitro, 7, 104 Vivo, 7, 104 Vulva, 104 Vulvovaginitis, 9, 21, 62, 104 W Wart, 91, 104 White blood cell, 76, 91, 92, 97, 104 Windpipe, 102, 104 X Xenograft, 76, 104 Xerostomia, 45, 104 X-ray, 91, 98, 99, 104 X-ray therapy, 91, 104 Y Yeasts, 79, 86, 105

Index 113

114 Thrush

Index 115

116 Thrush