Variations on a Theme - Words from ced, cede, ceed, cess

The basic meaning – ‘go, yield, give way’ – are clear in cede. One country may cede, or yield or give up, land to another after a defeat in a war.
Ante- in antecedent means ‘before’. Antecedents are therefore things or people that went before (or preceded) something. Stephenson’s Rocket was the antecedent of today’s railway locomotives.
The con- in concede means ‘thoroughly, utterly’. So conceding to an opponent means yielding or giving up completely. You can also concede defeat. To concede also means ‘to grant, admit, acknowledge as being true’. You will surely concede that this is so. It is only a small concession.
Ex- means ‘beyond’, so something that exceeds your expectations ‘goes beyond’ them or surpasses them. Something that is exceedingly good is good beyond what you expect – that is, very good. The noun from exceed is excess – an immoderate amount, a surplus. You should always avoid excess in all things. Excess fat is too much fat, as when you are overweight.
If you proceed, you ‘go forward’. This might be down the road, or it might means that you begin to.
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Origins – Say, Do, And Wish

Benediction and malediction derive from dico, dictus, to say, tell, Dictate, dictator, dictation, dictatorial – words that signify telling others what to do (‘Do as I say!’) – are built on dico, as is predict, to tell beforehand, i.e., to say that something will occur before it actually does (pre-, before, as in prescient).
The brand name Dictaphone combines dico with phone, sound; contradict, to say against, or to make an opposite statement (‘Don’t contradict me!’; ‘That contradicts what I know’) combines dico with contra-, against, opposite; and addiction, etymologically ‘a saying to or towards’, or the compulsion to say ‘yes’ to a habit, combines dico with ad-, to, towards.
Facio, factus, to do or make (as in malefactor, benefactor), has, as noted, variant spellings in English words: fec-, fic-, or, as a verb ending, -fy.
Thus factory is a place where things are made (-ory, place where); a fact is something done (i.e., something that occurs, or exists, or is; therefore, true); fiction, something made up or invented; manufacture, to make by hand (manus, hand, as in manuscript, manual), a word coined before the invention of machinery; artificial, made by human art rather than occurring in nature, as artificial flowers, etc.; and clarify, simplify, liquefy (to make clear, simple, liquid), and magnify (magnus, large) among hundreds of other –fy verbs.
Volo, to wish, to will, to be willing (as in malevolent, benevolent), occurs in voluntary, involuntary, volunteer, words too familiar to need definition, and each quite obviously expressing wish or willingness. Less common, and from the same root, is volition, the act or power of willing or wishing, as in ‘of her own volition’, i.e., voluntarily, or ‘against her volition’.
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Intelligent Learning – The Right Word In Right Place

Hitting the right ‘register’ – the appropriate level of language for a particular situation – is also important. You might complain to your friends about the fuzz or old Bill, but if you come up before the magistrate for speeding, you would be wise to refer to these people as police officers.
Information about register is often indicated in dictionaries, by means of the labels formal, informal, slang, old-fashioned, obsolete. Also included are regional labels (U.S., Aust.) and usage labels (literary, poetic, humorous).
It is not that one word is simple better than another. It is more a matter of picking the one that suits the occasion. You do not put on climbing boots to go dancing. Few people, if any, speak to their boss, their drinking companions, their wife, and their children in exactly the same way – and there is no reason why they shoud.
Mixing registers will produce curious-sounding results. How incongruous it would sound if the boss told a subordinate at work: ‘kindly endeavour to get cracking’. Not that incongruity necessary means that a construction is wrong.You can achieve humorous and satirical effects by such means.
But if you are not in control of the effects you are trying to create, the attempt may well backfire on you.
Think before choosing a word. Ask yourself: ‘Is this the right time and place?’ If it is not, choose a different word.
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Origins – First The Bad News

Built on Latin malus, bad, evil, to malign is to speak evil about, to defame, to slander. Malign is also an adjective meaning bad, harmful, evil, hateful, as in ‘the malign influence of his unconscious will to fail’. Another adjective form is malignant, as in ‘a malignant glance’, i.e., one showing deep hatred, or ‘a malignan growth’, i.e., one that is cancerous (bad).
The noun of malignant is malignancy, which medically, is a cancerous growth, or, generally, the condition, state, or attitude of harmfulness, hatefulness, evil intent, etc. The noun form of the adjective malign is malignity.
Observe how we can construct English words by combining malus with other Latin roots.
Add the root dico, dictus, to say or tell, to form malediction, a curse, i.e., an evil saying. Adjective is maledictory.
Add the root volo, to wish, to will, or to be willing, and we can construct the adjective malevolent, wishing evil or harm – a malevolent glance, attitude, feeling, etc. The noun is malevolence.
Add the root facio, factus, to do or make (also spelled, in English words, fec-, fic-, factus, or, as a verb ending, -fy), to form the adjective maleficent, doing harm or evil, or causing hurt – maleficent acts, deeds, behaviour.
A malefactor is a wrongdoer, an evildoer, a criminal – a malefactor commits a malefaction, a crime, an evil deed.
French is a ‘Romance’ language, that is, a language based on Roman or Latin (as are, also, Spanish, Portuguese, Italian, and Romanian), and so Latin malus became French mal, bad, the source of maladroit, clumsy, bungling, awkward, unskillful, etymologically, having a ‘bad right hand’. The noun is maladroitness. Also from French malmalaise (ma-LAYZ’), an indefinite feeling of bodily discomfort, as in a mild illness, or as a symptom preceding an illness; etymologically, ‘bad ease’, just as disease (dis-ease) is ‘lack of ease’.
Other common words that you are familier with also spring from Latin malus: malicious, malice, malady; and the same malus functions as a prefix in words like maladjusted, malcontent, malpractice, malnutrition, etc., all with the connotation of badness.
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Pidgins And Creoles

English has also been the basis for a number of distinctive pidgin or creole languages, particularly in West Africa, the Caribbean region, and in the former pacific colonies. A pidgin is a simplified language (usually based on that of a trading nation – in this case English) which aries from the need for people with no languages in common to communicate. The word itself may come from a Chinese pronunciation of business. Creoles are pidgins that have been adopted as the mother language of a community. Perhaps 60 million people around the world use pidgins or creoles for everyday purposes.
An English-based pidgin or creole lies at the very limits of what you might call English. Though founded on English, it includes admixtures from local languages, such as the names of products, foods, plants, and animals.
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New Zealand English

Much of what has been said of Australia applies also to New Zealand. Like the accents, the dialects of the two countries are similar. (To distinguish the accents, listen for the pronunciation of words like big and widow. Australians pronounce the vowel as a short version of the vowel sound in keep; New Zealanders use a short sound more akin to that in hut).
The strongest influence on the English of New Zealand has been that of Australia, which is where many of the earliest settlers came from. New Zealand shares with Australia usages that differ from those in Standard English, such as station and theatre. It also shares much of its colloquial vocabulary: buldger, crook, lolly, and to rubbish. But cobber and fair dinkum would sound like deliberate Australianisms in New Zealand.
A number of Maori and Polynesian words have come into Standard English through New Zealand. Maori itself comes from a word meaning ‘ordinary’. The word Pakeha (pronounced/ Paaki-haa/), used for white population, appears to be of Maori origin. Maori loans include the names of local birds (kiwi, moa, takahe) and plants (kauri, rata, tutu).
The word mana was used in Melanesian, Polynesian, and Maori, and meant the mysterious power inherent in any god or sacred object. It was adopted by historians of religion to describe this kind of aura wherever it occurs. People now use it more generally to mean any kind of authority, charisma, prestige, or influence.
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Origins – Ways Of Writing

Proscribe, to forbid, is commonly used for medical, religious, or legal prohibitions.
A doctor proscribes a food, drug, or activity that might prove harmful to the patient. The church proscribes, or announces a proscription against, such activities as may harm its parishioners. The law proscribes behaviour detrimental to the public welfare.
The derivation is the prefix pro-, before, plus scribe, scriptus, to write. In ancient Roman times, a man’s name was written on a public bulletin board if he had committed some crime for which his property or life was to be forfeited; Roman citizens in Good standing would thereby know to avoid him. In a similar sense, the doctor writes down those foods or activities that are likely to commit crimes against the patient’s health – in that way the patient knows to avoid them.
Scribo, scriptus is the building block of scores of common English words: scribe, scribble, prescribe, describe, subscribe, script, the Scriptures, manuscript, typescript, etc. Describe uses the prefix de-, down – to describe is, etymologically, ‘to write down’ about. Manuscript, combining manus, hand (as in manual labour), with scriptus, is something handwritten – the word was coined before the invention of the typewriter. The Scriptures are holy writings. To subscribe (as to a magazine) is to write one’s name under an order or contract (sub, under, as in subway, subsurface, etc.); to subscribe to a philosophy or a principle is figuratively to write one’s name under the statement of such philosophy or principle.
To inscribe is to write in or into (a book, for example, or metal or stone). A postscript is something written after (Latin post, after) the main part is finished.
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British Vs American – IS the Word or Sense Different?

Some words that exist in both dialects do not always mean the same thing – words like faggot (American: a homosexual; British: a bundle of sticks) and vest (American: waistcoat; British: undershirt). Similarly, if you take someone for a ride in Britain you are stringing him along in order to deceive him. In America, you are liquidating him or bumping him off. With words or expressions like these an explanation is even more in order. Using them without one could lead to serious – and embarrassing – misunderstandings.
Another, parallel, complication arises with words such as lift and elevator. It is not really true to say that a lift in British is an elevator in American. You would be nearer the truth if you said that one of the meanings of lift in British corresponds to one of the meanings of elevator in America. In America you can still give a hitchhiker a lift; in Britain grain might be unloaded using an elevator.
Again be careful if your readers or listeners include people from the other side of the Atlantic.
Explain your meaning of the word – or use an alternative, unambiguous one.
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Origins – Hear Voices

Equivocal, you will recall, combines aequus with vox, vocis, voice; and vox, vocis combines with fero, to bear or carry, to form vociferous, etymologically ‘carrying (much) voice ‘, hence loud, noisy, clamorous, as vociferous demands (not at all quiet or subtle), or the vociferous play of young children (‘please! Try to be quiet so Dad can get his work done!’), though unfortunately TV addiction has abnormally eliminated child noises.
If you are vocal, you express yourself readily and freely by voice; vocal sounds are voiced; vocal music is sung; and you know what your vocal cords are for.
To vocalize is to give voice to (‘vocalize your anger, don’t’’ hold it in!’), or to sing the vocals (or voice parts) of music . A vocalist is a singer.
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Welsh English

Welsh English differs less from Standard English than Scots or Irish. Until this century the Celtic Welsh language was dominant through most of the principality. Words from Celtic that have survived in Welsh English include bach (little one; man, as in Ress bach), del (pretty one), and tollut (a hayloft).
Welsh English has also given fewer words than the Scots or Irish varieties to the standard vocabulary.
Of words not especially associated with Welsh culture (eisteddfod, for example), only flannel and the pudding flummery are at all common. Both of these words can also mean ‘insincere flattery, waffle’. If you also consider the verb to welsh (meaning, ‘to avoid paying a debt’), you can see that the Welsh have suffered from decided linguistic discrimination at the hands of the English.
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Origins – Statements Of Various Kinds

Do not confuse equivocal with ambiguous. An equivocal statement is purposely, deliberately (and with malice aforethought) couched in language that will be deceptive; an ambiguous statement is accidentally couched in such language. Equivocal is, in short, purposely ambiguous.
You will recall that ambi-, which we last met in ambivert and ambidextrous, is a root meaning both; anything ambiguous may have both one meaning and another meaning. If you say, ‘That sentence is the height of ambiguity’, you mean that you find it vague because it admits of both affirmative and negative interpretation, or because it may mean two different things. Ambiguity is pronounced am’-bi-GYOO-i-ti.
Another type of statement or word contains the possibility of two interpretation – one of them suggestive, risqué, or sexy. Such a statement or word is double entendre. This is from the French and translates literally as double meaning.
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The Root Of English – English In The Middle Ages

English was like a river that suddenly vanishes underground and seems to be lost for ever – until, with a great roar, its waters burst out of the ground in some far-off place.
Even in the early days of the Norman domination, the ordinary people of England had stuck doggedly to the language of their fathers, making little attempt to speak like their masters. Rievaulx Abbey, in North Yorkshire, was founded by Cistercian monks in 1131, and is usually pronounced today in the French fashion / reevo /. But there are still local people who insist that the proper pronunciation is the one their ancestors used.
Then, in the latter half of the 14th century, English came into its own once more. The now Anglicised aristocracy started using English in preference to French on all occasions, and English again became the all-purpose language – though in the courts Norman French Persisted for longer. Modern legal English retains such expressions as feme sole (an unmarried woman).
The newly invigorated language found its greuatest exponent in the poet Chaucer, writing an English that was exuberant, vigorous , as full of colour as a stained-glass window. But Chaucer’s English had changed almost beyond recognition from Old English. Most of the Old English symbols had gone, and the vocabulary had changed even more. French and Latin influence was all-pervasive – Chaucer’s writing teem with words borrowed or adapted from French or Latin sources.
English between about 1150 and 1450 is called Middle English. Here is a passage from Chaucer’s Canterbury Tales. It describes a parson unspoilt by the clerical abuses of his day.
A good man was ther of religioun,
And was a povre person of a toun,
But riche he was of hooly thought and werk.
He was also a lerned man, a clerk,
That Cristes gospel trewely wolde preche;
His parisshens devoutly wolde he teche.
Benygne he was, and wonder diligent,
And in adversitee ful pacient.
This looks fairly straightforward to the modern reader. But there are some qualifications.
First, the pronunciation has changed considerably since Chaucer’s time, though in fact his spelling is closer to his way of speaking than modern spelling is to modern pronunciation. When Chaucer writes night it ought to be read in the Scottish manner, / nikht /, as if in a Burns poem. Where he has line you ought to pronounce it rather like leaner. Wolde in the passage rhymes with the modern English solder rather than with good.
Secondly, some of the words may look familiar but their meaning has changed in the last 600 years. One obvious example here is clerk, which in Chaucerian English still has its original meaning of a ‘cleric’. Another of Chaucer’s characters was a verray parfit gentil knight – this does not mean that he was ‘very perfect and gentle’, but ‘truly perfect and well-born’.
Bear in mind that Chaucer, writing in cosmopolitan London, was using the most up-to-date dialect of his age, and the one from which modern Standard English descends.
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Origins – The ego

Egoist and egotist are built on the same Latin root – the pronoun ego, meaning I. I is the greatest concern in the egoist’s mind, the most overused word in the egotist’s vocabulary. (keep the words differentiated in your own mind by thinking of the t in talk, and the additional t in egotist). Ego itself has been taken over from Latin as an important English word and is commonly used to denote one’s concept of oneself, as in, ‘What do you think your constant criticisms do to my ego?’ Ego has also a special meaning in psychology – but for the moment you have enough problems without going into that.
If you are an egocentric, you consider yourself the centre of the universe – you are an extreme form of egoist. And if you are an egomaniac, you carry egoism to such an extreme that your needs, desires, and interests have become a morbid obsession, a mania. The egoist or egotist is obnoxious, the egocentric is intolerable, and the egomaniac is dangerous and slightly mad.

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The Roots of English

There has been a language called ‘English’ for at least 1300 years. It descends from a form of Germanic brought to Britain by the Anglo-Saxons, whose homelands lay along the eastern shores of the North Sea. The Romans settled some of these fierce, fair-haired warriors in Britain as mercenaries, and more came as invaders as the Roman Empire began to collapse and the legions were withdrawn to protect Rome itself.

The Indo-European Heritage

English and the Germanic languages, as a whole are part of a much larger family of languages, including most of those of modern Europe and southwest Asia. The common ancestor of this family was the language known to scholars as Proto-Indo-European. Of modern European tongues only a handful – notably Hungarian, Finnish, and Basque – have a different ancestry.
Family likenesses can be traced in many of the words these languages use today. The Hindi word maharajah, for instance, derives from the Indo-European root reg-, meaning ‘to put straight’ and, from that, ‘to rule’. This same root turns up in Latin in words like rex, regis (a king) and rego, return (to rule). Form these were formed the English words regal, rector,correct, and direct. Also from Latin, but this time changed by centuries in early French, come royal and adroit.

The Germanic form of the same Indo-European root has given English right and rich (which originally meant ‘powerful’, and owes its form to French influence). There is also the German Reich (originally ‘a kingdom’), as well as the Romany (Gypsy) term for a man of authority, rye. The Gypsies carried their language from their original homelands in northern India on their journeys west.

Language experts have pieced together a reasonably clear picture of the vocabulary of Proto-Indo-European – which, in turn, reveals much about the people who spoke it, as well as about where and how they lived.

For example, the Indo-Europeans seem to have had words for winter and snow, but not far sea. This suggests that they lived not too far to the south, but away from oceans. They had words for oak, beech, pine, bear, wolf, and deer, but none for donkey, chicken, bamboo, palm, camel, lion, or monkey. Their homeland would thus seem to have been a region of temperate woodland with cold winters.

The Indo-Europeans also had words for pig, horse, cow, dog, and plough, and so must have known something about agriculture.

The commonest theory among scholars is that the original Indo-Europeans lived, at least at times, in settled villages somewhere in eastern Europe or the steppes of western Asia, and that their period as a fairly unified group was probably around 5000-3000 BC. After that they spread out over much of Europe and Asia, leaving as their heritage a bond of shared word roots among the languages of what became widely diverging cultures.

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The Last Hundred Years – Science

The great Changes in the world over the last century or so have brought a further flood of new words into English. Many of these are associated with new fields of human activity and knowledge.
Science: A large proportion of scientific coinings are based on greek word elements.
X . Medicine and Life Science: allergy, anaemia, anaesthetic, antitoxin, appendicitis, aspirin, bronchitis, carbohydrate, cholesterol, clinic, DNA, endocrine, enzyme, homeopathy, hormone, immunology, insulin, metabolism, natural selection, orthodontist, penicillin, protein, sclerosis, stethoscope, tonsilitis.
X . Psychology: egocentric, extrovert, inhibition, introvert, psychoanalysis.
X . Physics and Electronics: alternating current, are light, atomic energy, calorie, dynamo, electron, ion, quantum, radioactive, relativity, ultra violet.
X . Chemistry: benzine, biochemistry, creosote, cyanide, nitroglycerine, ozone, radium.
X . Space Science: astronaut, cosmonaut, countdown, launch pad, lunar module, moon shot, space shuttle, spacecraft, stratosphere.
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Topical calcipotriol

Vitamin D3( cholecalciferol) is produced naturally by epidermal keratinocytes and metabolized to the to the biologically active form 1,25(OH)2D3.The therapeutic effect of 1,25(OH)2D3 is limited by its hypercalcimic action . The synthetic analogue of vitamine D3 produced by the modification of the side chain is Calcipotriol which is about 200 times less potent in hypercacemia and hypercalciuria than 1,25(OH)2D3. The calcipotriol is most important synthetic analog of vitamin D3, as it quickly transformed into the inactive metabolites there by reducing the side effects like hypercalcemia and hypercalciuria. which act through antiproliferative and anti-inflammatory effects and stimulates terminal differentiation of keratinocytes by acting through immunologic mechanism and regulating intracellular calcium concentration. In India its available as 50 µg/g ointment.
Mechanism of action
It acts on vitamin D receptor (VDR) which belong to the group of steroid receptor. The biologic actions of the ligands-receptor complex are mediated by binding to DNA sequence within the vitamin D responsive genes. It has inhibitory action on cell proliferation and normalizes cell differentiation in the epidermal layer of skin. It also exerts immunologic effect by acting on the monocytes , macrophages, B & T lymphocytes that expresses the VDR. It also inhibits the thymocyte proliferation induced by IL-1 and the release of IL-6 and interferon-y from activated mononuclear cells. In the psoriatic lesion when its applied it causes progressive reduction in the dermal cellular infiltrate with change in the cell type CD4+ helper cells to CD8+ suppressor cells in the lesion and reducing infiltration of neutrophils.
Indications
It is currently used in psoriasis, vitiligo, morphoea, pityriasis rubra pilaris, ichthyoses and palmoplantar keratodermas
Contraindications
Calcipotriol is contraindicated in hypercalcemia, hypercalciuria, urolithiasis, parathyroid disease, disorders of calcium metabolism, photosensitivity, pregnancy, lactation and concomitant use of vitamin D or calcium or any other drug that affect calcium homeostasis.
Combination of calcipotriol with psoralen UVA
The combination therapy in vitiligo is found to be more effective than PUVA alone. It is advised to apply calcipotriol after UVA exposure because there is a significant decrease in the calcipotriol concentration ranging from 2% to 75% with a mean reduction of 28% if applied before hand.

Mode of application
The Calcipotriol ointment is applied twice daily and application amount should not exceed 100g in adult and 50g in children in a week.
Side effects
Commonly noted side effects noted during the topical application are skin irritation, burning sensation, erythema ,scaling, & stinging sensation. In systemic side effects are hypercalcimia, which is observed, when its application exceeds 100g/week, however the serum level of calcium comes down to normal after discontinuing the drug for a week.

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The Root Of English – The Norman Conquest

The Normans, too, were of Viking stock, but they had been settled in Normandy for over a century when Duke William led his invasion of England in 1066. By then they had become completely ‘Frenchified, in customs, culture, and language.
Just as the Norman knights conquered England, so their language, at least for a time, conquered that of the defeated Anglo-Saxons. The new aristocracy in England spoke French, and writing in English on official, cultural, religious, or literary matters all but ceased – through some records, such as the Anglo-Saxon Chronicle kept at the Abbey of Peterborough, were still being made in English until the 1150s. Now the languages in use became Latin, for church and intellectual writing, and the Anglo-Norman form of French for law and literary works. English, Much basic English Vocabulary arose from the Viking in vasion.
However, survived among the ordinary people to re-emerge as the common language of England in the 14th century.
Anglo-Norman differed from standard French in several respects, and English would borrow words from each dialect. From Anglo-Norman would come hostel, reward, and warranty; the related words hotel, regard, and guarantee came from standard French a little later.
English people of recent times have given the Anglo-Normans little credit for their achievements. During the 12th century, in particular, a great deal of the finest literature in Europe was produced in this country, but in French. For instance, the oldest surviving version of the story of Tristan and Iseult is the poem (written in Norman French) by Thomas d’ Angleterre – Thomas of England.
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Photochemotherapy

Photochemotherapy is the therapeutic use of ultra violet A (UVA) in the range of 320-400nm with photosensitizing agent psoralen. The action spectrum of psoralens is around 330nm. The first use of photochemotherapy dates back to over 2000 years ago, when Egyptians used Ammi majus plant seed extracts for treating skin condition. Subsequently many psoralens are used in treating the different kinds of skin conditions. The three most commonly used psoralens are 8-methoxypsoralen(8-MOP),5-methoxypsoralen (5-MOP) and 4,5,8-trimethylpsoralen(TMP). Among these most commonly used psoralen is 8- methoxypsoralen. After the oral intake of the crystalline form of the drug, the drug reaches the pick level in the skin in 2 hours, while intake of liquid form takes about 1 hour to reach the peak level in the skin. The absorption rate of 5-methoxypsoralen is only 25%,while the absorption of 8-methoypsoralen can be compensated by increasing dose by 1.2-1.5mg/kg. TMP is used as a topical or as PUVA bath as its poorly absorbed.
Psoralens act by the direct effect on the DNA. The two type of effects are well known; the first one is oxygen dependent DNA photo adduction associated with therapeutic effect. Second one is by oxygen dependent photodynamic reaction, which has some immunosuppressive action on the body

Indication
Psoralen is indicated in Psoriasis, Vitiligo, Hyper keratotic eczema, Morphea, Alopecia areata, Cutaneous T cell lymphoma, PLC, Prurigo nodularis etc.

Contraindication
The drug is contra indicated in pregnancy, lactating mother, children below 12 years, photosensitive diseases and collagen vascular diseases. However, when the drug is to be used for short duration it may be considered for use.
Minimal Phototoxic Dose(MPD)
Before starting PUVA therapy the patients Minimal phototoxic dose (MPD) or minimal erythema dose (MED) is determined to avoid phototoxic reaction. It is determined by irradiating UVA ray on the patients re-presented sites (about1cm) and such 6-8 sites are selected, either on the buttock or cover part of the body to be irradiated with UVA ray in a gradual increasing dose of UVA, after administering oral psoralen at the dose 0.4mg/kg. The UVA ray irradiation is carried out after 2 hour of psoralen intake. And these areas are read after 72 hour to look for the minimal erythema (pink erythema) induced by the lowest dose of UVA. The minimal dose of UVA required to induce erythema is regarded as the Minimal eythema dose for that particular individual.


Oral PUVA
Psoralen when used with UVA ray of artificial source is regarded as PUVA therapy; when the UVA ray of solar system is used it’s regarded as PUVA Sol.

Generally two protocol are followed while using PUVA/PUVA Sol as the mode for treatment for any photochemotherapy responsive condition.
In the American protocol the PUVA is given either twice a week or thrice a week. The UVA radiation is given 2 hours after the oral administration of psoralen, at the dose of 70-80% of the determined MPD to start with, then it’s dose is increased by 30% of the initial dose. In the European protocol the treatment is given 4days a week.

When UVA from solar source is used its called PUVA sol and the sun exposure is started by 5 minutes then it’s increased by 5 minutes every week until 30 minute is reached. The UVA ray reaches earth between 9am-3pm, and the best time for sun exposure to have maximum UVA is between 11.30-01.30 pm.

Patients eye and genitalia is protected during UVA exposure by using UVA blocking glasses and guards.


Topical PUVA
Here the psoralen is given in the form of bath(PUVA Bath) or bathing suit PUVA, psoralen soak and UVA exposure, direct psoralen application and PUVA, and PUVA comb are used to limit the side effect of psoralen.

Trioxalen bath solution is prepares by adding 100ml(0.05% solution) to 150L of water at room temperature. While, 8-Methoxlen bath is prepared by adding 50ml, 0.75% 8 MOP(commercially available at Indian market) to 100ml water, making the final solution 3.75mg/L.
The patient is soaked in the solution for about 15 minutes, dries off and irradiated with UVA in a conventional phototherapy unit.
For localized lesion we have been using topical psoralen in modified form (one drop of psoralen with 10-20 drops of water) applied on the lesion and after 20-30 minutes the area is exposed to sun for one minute and it’s washed off. In some centers in India instead of PUVA suit, Dermatologist are using trousers soaked in diluted solution of psoralen, worn for 15-20 minutes and then UVA ray is irradiated and soap bath is given to remove psoralen from the skin.

Side effects of oral psoralen are anorexia, nausea, vomiting, headache, dizziness, light headness, insomnia, depression, redness on skin, blister formation, dryness, pain on the skin, exacerbation of asthma, drug fever, maculopapular lesions on skin, urticaria, hypertrichosis, cataract, cutaneous aging, malignancy
Side effect of topical PUVA are redness, tenderness, blister formation, and hyperpigmentatio
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Origins – The Whole Tooth

Orthodontist is built on orthos, straight, correct, plus odontos, tooth.
A periodontist is a gum specialist – the term combines odontos with the prefix peri-, around, surrounding. (As a quick glance in the mirror will tell you, the gums surround the teeth, more or less.) The speciality: periodontics (Per’- i-o-DON’-tiks); the adjective: periodontic (Per’-i-o-DON’-tik).
An endodontist (en’-do-DON’-tist) specializes in work on the pulp of the tooth and in root-canal therapy – the prefix in this term is endo-, from Greek endon, inner, within.
The prefix ex-, out, combines with odontos to form exodontist (eks’-o-DON’-tist).
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Origins – The Nervous System

Neurologist derives from Greek neuron, nerve, plus logos, science.
Neuralgia is acute pain along the nerves and their branches; the word comes from neuron plus algos, pain.
Neuritis is inflammation of the nerves.
Neurosis, combining neuron with -osis, a suffix meaning abnormal or diseased condition, is not, despite its etymology, a disorder of the nerves, but rather, as described by the late Eric Berne, a psychiatrist, ‘. . . an illness characterized by excessive use of energy for unproductive purposes so that personality development is hindered or stopped. A man who spends most of his time worrying about his health, counting his money, plotting revenge, or washing his hands, can hope for little emotional growth’. .
Neurotic is both the adjectival form and the term for a person suffering from neurosis.
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How Children increase their Vocabularies

The typical ten-year-old, you will recall, has a recognition vocabulary of over twenty thousand words – and has been learning many hundreds of new words every year since the age of four.
You were once that typical child.
You were once an accomplished virtuoso of vocabulary building.
What was your secret?
Did you spend hours every day poring over a dictionary?
Did you keep notebooks full of all the new words you ever heard or read?
Did you immediately look up the meaning of any new word that your parents or older members of your family used?
Such procedures would have struck you as absurd then, as absurd as they would be for your today.
You had a much better, much more effective, and considerably less self-conscious method.
Your method was the essence of simplicity: day in and day out you kept learning; you kept squeezing every possible ounce of learning out of every waking moment; you were an eternal question box, for you had a constant and insatiable desire to know and understand.
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How To Start Building Your Vocabulary

For if you systematically increase your vocabulary, you will also sharpen and enrich your thinking; push back your intellectual horizons; build your self-assurance; improve your facility in handling the English language and thereby your ability to express your thoughts effectively; and acquire a deeper understanding of the world in general and of yourself in particular.
Increasing your vocabulary does not mean merely learning the definitions of large numbers of obscure words; it does not mean memorizing scores of unrelated terms. What it means – what it can only mean - is becoming acquainted with the multitudinous and fascinating phenomena of human existence for which words are, obviously, only the verbal descriptions.
Increasing your vocabulary – properly, intelligently, and systematically – means treating yourself to an all-round, liberal education.
And surely you cannot deny that such an experience will change you intellectually –
Will have a discernible effect on your methods of thinking – on your store of information – on your ability to express your ideas – on your understanding of human problems.

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Staphylococcal scalded skin syndrome (SSSS)

Staphylococcal scalded skin syndrome is also known as Ritter disease, characterized by erythematous tender macule, which coalesce rapidly to cover large area , skin peels from the effected area in sheet and rarely forms blister due to collection of exudates beneath the involved skin. This disorder is caused by the exotoxin “exfoliative toxins”(ET) released from strains of Staphylococcus aureus.

Histologically there is a separation in the epidermis, just beneath the granular cell layer. Two types of staphylococcal scalded skin syndrome exist: a localized form, in which there is a limited involvement of the epidermis, and the generalized form, in which there is a large area involvement.

Two exfoliative toxins (ET-A and ET-B) are known to cause this syndrome, but the exact mechanism by which they cause exfoliation is not clear. However its believed that the toxins act as proteases, target the desmoglein-1, responsible for cell-to-cell adhesion in the epidermis. SSSS commonly seen in the infants and children because of the immature kidney in children that fails to clear the circulating exotoxins, in the adults it is encountered in persons with renal disease because of the same reason .Other postulated theory is exfoliative toxins possess a superantigenic property which is also is responsible for detachment of the skin.


Initial studies had suggested that phage l group II S aureus (subtypes 3A, 3B, 3C, 55 and 71) were solely responsible for exfoliative toxin production, but it is now known that all phage groups are capable of producing exfoliative toxin and can cause staphylococcal scalded skin syndrome.

Staphylococcal scalded skin syndrome differs from the toxic epidermal necrolysis (TEN), in the cleavage site, in staphylococcal scalded skin syndrome the cleavage is at the granular layer of epidermis, opposed to the TEN, where there is necrosis of the full thickness of epidermal layer. Mucosa is never involved in SSSS, where as mucosa is always involved in TEN. Treatment of SSSS is administration of appropriate antibiotic, where as treatment of TEN is stopping the offending agent, maintenance of nutrition and electrolyte imbalance, in early stage of TEN(drug induced) the suspected drug is stopped, and to arrest the progression of the TEN, suprapharmacological dose of corticosteroid may be considered for a very short duration.

The mortality rate from staphylococcal scalded skin syndrome (SSSS) in children is very low (1-5%), unless associated sepsis, in adult it is higher (as high as 50-60%).

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Reiter's Syndrome

Reiter's syndrome is one of the reactive arthritis , characterized by a triad of arthritis, urethritis, conjunctivitis, and skin or mucosal lesion for more than 4-6 weeks.

It involves the large joints, ligaments and tendons attachment site. Reiter's syndrome usually develops following an intestinal or a genital/urinary tract infection (urethritis, prostatitis, cervicitis, & cystitis), conjectivitis, and skin lesions (keratoderma blenorrheigica). These symptoms may occurs once or recur throughout life. Reiter’s syndrome is more likely to occur in individuals who are genetically predisposed. It usually occurs 1 to 3 weeks following a mild or severe diarrhea or urinary tract infection.

Symptoms

Arthritis :

People with Reiter's syndrome experience swelling and tenderness of the ankle or knee, lower back, heels of the foot, toes and fingers, often called "sausage digits" because of their shape, tenderness at the site of attachment of tendon (enthesiopathy).

Urethritis is commonly described in Reiter's. But in reality eliciting history or demonstrating signs of urethritis have always been difficult.

Conjunctivitis is described with the Reiters syndrome and often found in patients with the Reiter’s syndrome during examination.

Skin lesion of Reiters syndrome are characteristics and they start as erythematous macule to skin colored papule. In the process of evolution it turns pseudo vesiculopustular to erythematous plaque covered with heaped up crust. On the palm and sole often the thick crust falls off leaving a collaret of scaling in the lesion called keratoderma blenorrheagica.In mucosa it present as cercinate lesion on the glans and oral mucosa

Diagnosis

Diagnosis is based upon the findings of the classic triad, evolution of the skin lesion and heaped up crust.

Treatment of Reiter's Syndrome

The objective of treatment is to reduce joint pain and inflammation; prevent or decrease the amount of joint damage; and restore the function of damaged joints. Treatment urethritis, conjunctivitis, and skin lesions. The most common drugs used are non-steroidal anti-inflammatory drugs (NSAIDS) such as indomethacin, diclofenac, or phenylbutazone. In severe cases, folic acid antagonists such as methotrexate is used which relieve joint inflammation and improves skin lesion .

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