MYOCARDIAL INFARCTION-HEART ATTACK

HEART ATTACK(M.I.)

When the heart muscle cells dies with necrosis there is complete blockade of coronary blood supply to heart with prolonged ischemia,and complete occlution of the coronary artery the ultimate result is Myocardial Infarction or Heart Attack.During and after the attack the left ventricle become enlarged and hypertrophied due to the outside pressure.

Etiology:The most common cause is acute thrombus (clot) formation following fissuring and rupture of the lipid rich atherosclerosis plaque and platelet aggregation in the already congested coronary artery. Rare association of the coronary arterial spasm may also contribute to the cause.
Heart Attack is one of the morbid result of prolonged ischemia followed by angina pectoris.
The long time Ischemic Heart Desease caused by decreased blood flow to the heart muscle due to obstruction of the blood flow by the clots,the diffused plaque from the atherosclerosis,followed by platlet aggregation,would certainly leads to MI if left untreated.
Because these condion may kill the heart muscle cells by depriving of oxygen which leads to necrosis and ischemia which will eventually lead to MI.

Sudden death is caused by MI which can trigger the abrupt onset of ventricular fibrillation,the most disorganized and lethal arrhythmia,which can suddenly stop the cardiac output.If this emergency situation is not medically intervened immediately by cordial thump,or defibrillation by counter shock the result is death. 
Generally if there is uncontrolled ventricular fibrillation followed by recusciation occur the situaion is emergency and is known as Sudden Death Syndrom 
In MI a portion of the of the heart muscle suffer prolonged severe supply block of oxygenated blood because of a clot formation,leading to blood vessel damage to form atherosclerosis and platelet aggregations.

Symptoms: 

1.Severe pain radiating from the lower left side to the shoulder.back and neck

2.Shortness of breath

3.Nausea with vomiting or without vomiting;some times stomach pain

4.Hypertention or hypotention

5.Dizziness with headpain,and Fatigue

6.Throat or jawpain

7. Unusual loud snoring with cjocking voice may indicate the presence of sleep apnea,a warning signal to heart attack

8.Sweating

9.Non stopable coughing

10.Diaphoresis (Excretion or oozing of moisture through sweating)

11.Heart murmurs,with tachyarrythmias or bradyarrythmias

25% of the heart attacks are not showing the above symptoms and are silent in eldely patiens,patients with Diabetes and Hypertension

MI can be cassified as 1.Anterior;2.Lateral and 3. Inferior.

But more conveniently and medically classified by ECG as 1.Q-wave MI

2.Non Q-wave MI

What is a Q-wave:-

A Q-wave in an ECG represent any down ward left to right depolarization of the interventricular septum during which ventricles dilates to get filled by blood.See the figure down

In the above ECG look at small downward graphic dip indicated by the arrows and circle.

If there is a problem in the normal depolarizing effects of inter ventricular muscle the Q-wave will be elongated

If this is the condition then there is much chances to get an Q-wave mediated MI.But a problem in Q-wave may not always result to an MI.The presence and elongated  Q-wave indicates there are necrosis.This can be corrected by Coronory bypass surgery if done within a few hours of the post MI.
Generally Q-wave syndroms accounts for 40 to 70% of MI events when compared with non Q-wave MIs.In Q-wave mediated MI there is usually an elevated ST segment.In non Q-wave MIs there is depression in ST-segments.
The most serious warning is a sudden ventricular arrythmia with fibrillation occur without any warnings.

Therapy

 Goals:1.Elimination of clot formations by using Thrombolytics

            2.Releiving Pain

            3.To Prevent arrhythmias

            4.To reduce cardiac workload and stabilize rhythm.

            5.Limiting the affected area and preserving the pump function.

            6.Solving the other complications like nausea,vomiting,stomach aches,arrythmias,blood pressure variations etc.etc.

If not contra indicated four groups of medications can be used in MIs

1.Thrombolytics

2.Beta blockers

3.Nitrates

4.Aspirin

Apart from these Morphine,Lidocaine,Heparine and Warfarine can also be used at times.

The first choice is using thrombolytics such as streptokinase,Urokinase,and Alteplase.as thrombus and embols are the major causes of coronary atherosclerosis plaque apart from LDL and Triglycerides.ACE inhibitors and Calcium channel blockers can also be tried but their efficacy is yet to be proved.

If in case thrombolytics are contraindicated then Percutaneous Transluminal Coronory Angioplasty(PTCA) is proved efficaceous.

Thrombolytic agents were used in patients with suspected MI with prolonged chest pain.

But any benifits that attained by Thrombolytic may seen not immediate but occur as late as 12 hrs.after the pain starts.

Administration of streptokinase IV should be started within 12 hrs and optimally 6 hrs of the pain starts.

Aspirin can be used along with a thrombolytic agent to regulate the circulation in the dosage of 160 mg to 325 mg.for life after the first attack.Get a physicians advice for dosage.

Heparin can be used along with a thrombolytic agent to prevent reocclusion of the coronary artery even heparin is proved in reducing mortality even if it is used without a thrombolytic agent after the first attack.

An IV bolus of 5000 units followed by a continous infusion of 1000 units/hr is its usual dosage.The goal is to maintain the Activated Partial Thromboplastin Time (APTT) between 1 & 1/2 or 2 & 1/2 times normal.

Warfarin can be used in patients with mural thrombus.

Beta Adrenergic blockers propranolo,metoprolol,atenolol,and timolol are commonly used with success.

Nitrates Nitroglycerin is in the most common usage.It should be administered sublingually at the onset of the pain.

 

ACNE TREATMENTS

ACNE VULGARIS

Acne is a big problem experienced especially at the time of puberty by some adolescents.Male children when they attained puberty the matured male sex organs starts to produce the acne cause male sex hormone known as Testosterone in various amounts depending on their genetic nature.However there are so many other factors can cause acne to get at any age. 

Acne vulgaris is defined as a disorder of the pilosebaceous units mainly of the neck,back, and face.The pilosebaceous glands are the hair producing glands located in the skin throught our body except the palms of the hands and the soles of the feet.There are non hair producing sebaceous glands are also exits along side and equally distributed throughout our body similar to the pilosebaceous glands.

Due to some conditions such as excess production of testosteron or blocks at the sebum secretions these pilosebaceous units produce lesions,which starts open or closed comedones and evolve into inflammatory popules.These popules either resolve into macules or develop into pyoderma.

Fortunately acne vulgaris is self limiting and need no physician to treat and can be controlled by self medications available at OTC with some pharmacy councillings.But exceptions are there if the acne becomes a tumor by some mismedications like over use of benzoyl peroxides at high concentration.

Pathology

A.The incidence of acne involves three sequences

a.Excess sebum secretions due to some reasons like over stimulation of the glands by androgens at puberty in both male and female adolescents.

b. When testosterone is converted to dihydrotesterone which stimulates the sebum secretions.

c.Development and stimulation of sebum glands by DHT.

Normally the keratinized horney cells are sloughed off from the epithelial linings of the pilosebaceous duct in the hair follicle and are carried out to the surface of the skin as sebum.

But in case of over stimulation the horney cells fails to sloughed of and block the passage which leads to the formation of bumps at the surface of the skin.

Causative Bacterium: The presence Propionibacterium acne is  significant in the sebum of those who are having acne which is not present in normal people.The reason is unknown as still it is hard to conclude that acne is from purely infectious origin as mostly it is not contageous.Yet the micro organism is contributing to the formation of acne by digesting sebum triglycerides and produces various irritating fatty acids which causes comedones and inflammations.

Stages of Acne

1.Blockade of the pilosebaceous duct by the horney epithelial keratinised cells to form comedon as white head either closed or opened

2.The closed comedon develops into either a popule as black head.The black colour is attributed either by melanin or oxidized lipid.

3.The lesion may enlarge and filled with pus and is know as a pustule.

4.In bad pathological conditions the papule may develop into more painfull cysts or nodules,with unknown causes.

5.The term pimple can be refered to whiteheads,blackheads,papules and pustules.

Clinically acnes are either symptomatic or asymptomatic.Cysts and nodules are usually painfull and can form scars and to be refered to a skin specialist.

Asymptomatic acnes can be treated on OTC with pharmacist's advices 
Complicating Factors There are many drugs which are comedogenic and may make the acne to get worsen.They are,
1.Topical and systemic Bromides and Iodides
2.Topical coal tar products
3.Topical and systemic Androgens and Progestins
4.Phenytoin
5.Lithium
6.Topical and systemic corticosteroids
7.Stress
8.Oily and fatty diets and chocholates are not acne producing.
9.Physical trauma and irritations,this includes agressive scrubbing of face,wearing headphones,cradling the chin with the hand,and picking the pimples can contribute to worst sequences.Gentle face wash with mild soap is better
10.Some cosmetics are comedogenic such as lanolin,petrolatum jelly,cocoa butter and avoid them.
11.Some women can experience acne at premenstural cycle.
12.High humidity and sweating can contribute to the formation of acne.

Treatments

Generally most patients can be treated successfully with either topical or systemic medications or both.Acne often improves when the patients reaches early twenties.

Acne can be Mild to Moderate to Severe

In mild cases there are a few papules and pustules without any single cysts or nodules.Daily a gentle face wash with a mild soap is beneficial.Fatty and oily diets should be avoided.High humidity and sweating also to be avoided.Keep the stress at the bay.Chocholate and nuts can be used without any harm.

In moderate cases there are many papules and pustules with a few cysts and nodules.Treatment options include salicylic acid,sulphur and resorcinol approved by FDA.There are scruffs such as Clearacil Adultcare,Clearasil Clearstick and Benzoyl peroxide 5 and 10 can be used.But while using Benzoylperoxide take an advice from a doctor and be carefull that high usage of this madicine may cause skin cancer,but not yet to be concluded. Before apply the product should be tested for allergy as follows
Wash the area with a mild soap and dry it.apply a small quantity and leave it for 20 minutes.
1.Benzoyl peroxide is available as alcoholic gel,cream and lotion.The gel preparation is more effective
There is no much difference in clinical effect between the preparations 2.5 %,5 % and 10%
This product discolour hair and cloth.Beware of that.
Benzoyl peroxide is thrown from first to third category by the FDA on safety concerns
 2.Salicylic acid The first category medicines available in 0.5% to 2%.This is an irritant keratolytic agent increase epithelial cell turnover and safer than B.P.
3.Sulphur The first category medicine available in strength as 3 % to 8 %.It is keratolytic and antibacterial.But sulphur on prolonged use may be acnegenic.
4.Resorcinol This medicine comes under second category as a single agent but jump into the first category when combined with sulphur in a proper proportion as the effect and safety are increased.
In severe cases there are numerous number of papules and pustules with many cysts and nodules.These cases should avoid self treatments and to be refered to a skin specialist as there is a need for antibiotic therapies.

CONTACT DERMATITIS-SOLUTIONS

CONTACT DERMATITIS

Contact Dermatitis is one of the most common dermatological problems with irritating and annoying consequences in social life.While at office,at home and at social events with friends these consequences are the most disturbing one and produce uneasiness to scratch the irritating area in front of others.
Usually a foreign body touches your skin and enter into our body may produce antibodies to fight the invader.Mast cells are triggered to release various inflammatory chemical such as histamine and ecosanoids to express the body its inconvenience by its own languages such as itching edema infammations etcetc.

There are wo type of contact dermatitis as follows:-
A.Irritant Contact Dermatitis is caused by direct contact with a primary irritant and the primary irritants are of the types as follows:-
1.Absolute Primary Irritants These are corrosively skin damaging substances such as strong acids,alkalis and similar industrial chemicals
2.Relative Primary Irritants These are the most common cases of contact dermatitisseen in clinical practices.These irritants are less toxic than absolute primary irritants and they require repeated frequent contacts to establish a dermatitis.(e.g)soaps,detergents benzoylperoxide and some plants

B.Allergic Contact Dermatitis These are the worst annoying and irritating skin conditions.Almost most of the things which are allergic to the skin can produce this dermatitis.Some plants,many chemicals,can cause allergic contact dermatitis.The best example is the contact dermatitis produced by poison ivy plant.The plant produces on contact with our skin a peculiar type of reaction mediated by T-Cells(T-lymphocytes) a type of WBC circulating in our blood through the lymphatic system and need the following sequence of events must occur to provoke it.

a)The skin epidermis must come in contact with the allergen (the hapten)
b)Thereby a hapten-epidermal protein complex must form as the antigen
c) The antigen must enter into the lymphatic system
d)Immunologically competent lymphatic cells must be formed which are selectively active against the invading antigen
e) In this condition if a second contact between the skin epidermis and a hapten occurs then the incidence of contact dermatitis starts. 
f)The duration between the first contact and the second contact is known as the induction period and it may last for 4 to several weeks.Once the induction period completed a minute second contact will produce a severe eczema with an onset of 12 hrs and attain the peak at 48 hrs to 72 hrs after exposure.
Once the sensitivity is fully developed it will last for life
Most contact allergens produce sensitization only to a small populations except the poison ivy which produces sensitization to almost 99% of the populations,who come in contact with it.
PHASES OF CONTACT DERMATITIS

1.Acute Stage Wet lesions such as leaking blisters,weaping skin,erythema,edema, vesicles and oozing.

2.Sub Acute Stage Crusts and scabs form over the already wet lesions.Allergic contact dermatitis and irritant contact dermatitis caused by absolute primary irritants such as strong chemical can produce both acute and sub acute stages.

3.In this stage initially the lesions become dry and thickend to form fissures.Later erythema,lichenification,and excoriations appear.This stage occurs mostly with irritant contact dermatitis caused by relative primary irritants.

Allergen Producing Plants 1.Poison ivy;2.Poison oak 3.Poison sumac
In all the above plants a previous contact must be necessary to produce swensitization to form dermatitis by the second one.
In most of these poisonous plants the main sensitizing agent is an oleo resin known as urushiol oil 
The plants must be bruised or crushed inorder to contact with the oleoresin which is presen in the roots,stems,leaves and fruits.
The oleoresin can remain in tools, toys, cloths,pets and fingernails for longer time if these items comes in contact with the bruised poison plants.
urushiol oil is not volatile if a person sits simply nearby the plant without touching it will not get contact dermatitis
But in a burning plant the oleoresin droplets may be carried by the smokes and get deposited in our skin to produce the dermatitis.
 
For further detailed study of treatments please click here and download it

SUN PROTECTION

OTC TREATMENTS FOR SUN RADIATION PROBLEMS-1

The scotching summer is ahead.In tropical countries like Middle East the summer would roast the sands continously for eight months.In other parts of the world like Europe,Eastern Asia,Central Australia,and the Americas there are frequent attacks of heat waves with the raises in mercurily level as high as 45 Degree Celcius.
Our skin is more vulnerable to the attacks of heat waves especially by the Ultra Violet region of the EMR radiating from the SUN.Generally over exposure to the scotching sunlight will damage our skin
SUNTAN  is a skin response to injury by sunlight.Only UV over exposure of the skin would produce SUNTAN and SUNBURN

THE ULTRA VIOLET SPECTRUM:-

UV-B in mild exposure by evening sunlight is responsible for the preparation of Vitamin-D3 by our body from skin cholesterol
UV-B radiation is erythrogenic and long time exposure to it at peak hours like 10 a.m to 2 p.m it can cause severe erythema and skin cancers.

The sunburn is more likely to occur in high altitudes as UV-B intensity increases by every 4 % with an increased altitude height by every 250 meters. Our solar radiation contains electrical (vertical) and as well as corrospondig magnetic (horizontal) oscillating waves.Hence this is generally known as Electro-Magnetic Radiations or simply by the term EMR.
This EMR contains three portions as Ultra-viotet,Visible and Infra-red regions.Out of these three regions the Ultra-Violet or the UV region is having the heat waves with more frequent and congestive waves with shortest lenghths with the highest skin penetrating power.
The UV spectrum ranges from 200 to 400 nanometers(nm).A nanometer is one thousandth of a millimeter.Imagine the shortest lenghth of one UV wave to another.Therefore the waves are highly frequent with high penetrating power and the most dangerous.
Further the UV radiation is devided into A,B,and C. and each differ from the other by the wavelengths with corrosponding frequencies as follows:-
UV-A :-The smallest sizes of photon radiation with shortest wavelenghths ranges from 320-400 nm.UVA is having more penetrating power and can pass the ozone layer to reach the earth 10 to 100 times more than UV-B.As these are very small photons hence they are less likely causes erythema but these UV-A deeply penetrating into the dermis and make the skin more vulnarable to the effect of UV-B which is carcinogenic.Also UV-A can produce photoaging and photodermatoses on prolonged exposure.
Becareful when you go for a walking when the season is cloudy and pleasant,and on a fullmoon out walk as these seasons are the one with maximum UV-A radiations.
Further UV-A can be divided into two as 1,and 2.UV-A-1 is less likely erythrogenic and melanogenic than UV-A-2 and the UV-A-2 is more likely to UV-B.
UV-A is often tanning boths and is often entertained in the psoralen plus UV-A(PUVA) treatment of psoriasis.
UV-B they are radiations of little bit bigger photonic particles than UV-A particles with the wave lengths of 290nm to 320nm.As these are bigger particles and having less penerating power than the UV-A particles but still they can pass the ozone layer and reaches the earth,and produces more serious effects to the skin like skin erythemas,and skin cancers.
These radiations causes sunburn and suntan more effectively.A proper exposure to this radiation during sunbath with a fixed and calculated time by your skin doctor,you can get a good protective suntan at your skin.
SUNTAN is natural way of tanning or blackening your skin by calculative exposure to the sulight to protect your skin from further damages by the sun.UV-B radiation is good skin tanner because it is melonogenic.But a doctor should advice.Also a small exposure to this radiati
UV-C:-It is bigger particles than the other two radiation the least penetrating power because they have long wavelength with less frequencies and hence most of them are retained by the ozone layer from not reacing the earth.

OTHER SKIN REACTIONS TO SUNLIGHT

1.Actinic keratosis it is a precancerous condition may happen after long time sun exposure.It is typically araising at the middle or later age,with the manifestations of sharp demarcated,roughened hardened growth,which may be fltened or raise leads to squamous cell carcinoma.
2.Skin cancers
A.Squamous cell carcinoma Leasions apperaed mostly as thickened rough particles which can bleed.Among the skin cancers it accounts for 15%
B.Basel cell carcinoma It appears as pearly transluscent bumps and originates in the basal cell.It accounts for 80% of the skin cancers.
C.Malignant melanoma originates from the melanocytes and is the most dangerous form of skin cancers.It is charectorised by the changes in the appearances of moles such as colour fading,dissappearing,shape and borders of the mole becomes irregular,asymmetrical,and diameter over 6 m.m.
3.Drugs Induced Skinreactions
A.Photo-Allergic Reactions occur when light makes a drug into an antigen or a photoallergen (Hapten) if the drug is repeatedly used as skin creams.For example some creams or ointments if repeatedly uses may suddenly produce skin rashes as they become allergents due to light.
B.Phototoxic reactions occurs when light transfer a drug into a toxic form,which result into a tissue damage.
C.Implicated Drugs Many drugs are implicated in causing photo allergy or photo toxic reactions.(e.g)1.thiazides;2.tetracyclines;3.Phenothiazines;4.Sulphonamides;and sunscreens.Some drugs are producing both photo toxic and photo allergic reactions.
4.Photodermatoses They are photo reactions caused by light of specific wavelenghths.(e.g)1.Polymorphous light erruptions;2.Lupus erythematous;and solar urticaria.
5.Photoaging It is the aged appearence of skin by sun exposure and not by real aging.Dry,scaly,yellow skin with deep wrinkles,thin and more fragile.
SUNSCREEN AGENTS
People can protect their skin from violent UV radiations by avoiding exposure,by wearing protective clothings and by applying sunscreen agents.
The sunscreens should be applied evenly throughout all the exposed parts of our skin,30 minutes to 2 hrs (for PABA and PABA esters),before sun exposure to allow proper penetration,and binding to the skin.
Persipiration,swimming,bathing,clothing,sand baths,towel bath may remove the sunscreen and needed to be reapplied.
Hence we must by the products after seeing the labels for the how for the products substand inspite of persipiration and swimming.
If a product is labelled as water proof that means it can adhere on the skin upto a maximum period of 80 minutes swimming
If a product is labelled as water resistant means it can withstand with our skin upto a maximum period of 40 minutes swimming.
Sunscreens should be noted in the label for their Sun Protection Factor (SPF).Baby oils,mineral oil,olive oil,and cocoa butter are not sunscreens but can be used to produce a Tan.
SPF of 30 is enough to give 97% protection from the UV radiation.The American FDA is recommending the upper limitation of SPF is 30 only any benifits getting by increasing this limit is interestingly negligible.An SPF of 15% is the upper limitation set by Skin Cancer Foundation.Hence products with SPF mor than 30 as SPF 50 ,SPF 100 etc.etc on the labels are merely for business attractions and of no use.
SPF can be calculated by Minimal Erythema Dose (MED) of the protected skin devided by that of the unprotected skin
MED is defined as the amount of sun radiation needed to produce minimal skin redness.
For example a man who gets minimal skin redness by the exposure of his skin 20minutes to the sun and want to stay in the sun for 120 minutes can use a sunscreen with the SPF of 6 as (120/20=6).When he use the sun screen of SPF-6 should its substantivity so that it must not be femoved by swimming or clothing.
An SPF of 15 can give 93% protection from the UV-B radiation.
Some people may get allergic reactions to some sunscreen cream beware of that.

TYPES OF SUNSCREENS

Physical sun blocks are opaque preparations that can block from UV to visible portions (290 nm to 700 nm) of the sunlight.These products often contains concenterated Titanium Di Oxide,and Zinc Oxide.These products are not attractive for greater area use but can be used in smaller areas like upper nose.Newer products with diluted titanium dioxides are available and are more cosmetic and attractive.Red Petrolatum covers a spectrum of 290 nm to 365 nm.
Chemical sun screens acts by absorbing a specific portion of the UV radiation inorder to prevent to reach the skin.These are of 5 groups as followsl:-
1.PARA AMINO BENZOIC ACID (PABA) and its esters primarily absorbs UV-B radiations (e,g) p-amino benzoic acid,glyceryl PABA,padimate-O.
Cinnamates primarily absorb UV-B rays.(e.g) cinoxate,octyl methoxycinnate.
Salicylate primarily absorb UV-B rays.(e.g) ethyl hexyl salicylate and homosalate.
Benzophenones absorb UV-B and a portion of UV-A rays.(e.g) oxybenzone,dioxybenzone.Because of their extensive coverage these can be used for photosensitivity reactions.
Miscellaneous the newer product butylmethoxydibenzoylmethane prvides full coverage UV-A and UV-B .This product with the combination of oxybenzone,and octyl methoxycinnamate offers the greatest protection in both UV-A and UV-B
Special agents of interests
Dihydroxyacetone (DHA) it offer an artificial suntan by reacting with keratin in the stratum corneum
It is not offering protection from UV rays and it is not producing natural looking tan.It's can withstand for a limited period and would peel off automatically.Also it will discolour hair and clothing.
Beta carotene a vitamin-A precursor can produce discolouration when taken orally.It is protective against some forms of abnormal photosensitivity like erythropoietic protoporphyria.But it is not protective against sunburn in normal individuals.
Tyrosine As tyrosine is a precursor in the synthesis of tan producing pigment melanin it is also used as an tanning agent but it is not a proved agent.

ARTHRITIS-A REVIEW

ANTI- ARTHRITIS

Arthritis is a painful episodes that mostly happened in our joints,muscles surrounding joints and less likely in all other parts of our body.It is of various types such as Osteo arthritis Rheumatic arthritis and Gout.

Arthritis is mainly due to the inflammation of the affected area.These inflammations are due to the release of various inflammatory agents especially the prostaglandins.Prostaglandins are hormone like secretions by the muscular tissues in response to various stimuli by some events such as injury and acid secretions to express the body language.mostly inflammation

In general inflammation is the reaction of vascularised living tissue to injury.

The main body chemical mediators to initialize the inflammation are known as Prostaglandins.Prostaglandins are localised tissue secretions and are not circulating in the blood.

Prostaglandins are belonging to a group of body chemicals known as ecosanoids as they are mostly prepared by our body from an omega three fatty acid known as ecosatetranoic acid or arachidonic acid.Arachidonic acid is a part of phospholipids present in our body tissues and is released by phospholipase A2.

There are other ecosanoids such as prostacyclines,leucotrienes and thromboxane and evch contribute to form different events of inflammation.A few examples has been given below:-

Prostaglandin E2 (PGE2):- Erythema

Prostaglandin I2 (PGI2) :- Vasodilation

Leucotriene C2  :- edema

Leucotriene D4 :- vasodilation

All of the above :-pain,tenderness
Arthritis of any type has no permanent cure.But the best we can hope is temporary relief.All NSAIDs may give good releif for the inflammatory pains with the excemption of Aspirin during the episodes of Gout due to hyperuricemia as Aspirin is an Anti Uricosuric that means it would block uric acid excretion.Aspirin can be used for any other episodes of Arthritis with caution for GI distress ,bleeding and Ulcers.Not only Aspirin all other  NSAIDs have these disadvantages.
Paracetamol can be tried for mild arthritic pains because it is not a perfect anti inflammatory drug but would not disturb the digestive system.Paracetamol in high doses cannot be used as it may harm the liver.
Careless use of NSAIDs can be fatal as in one occation the American FDA released figures of NSAID deaths per year in USA alone was 10000 to 20000 and interestingly these figures were more than the yearly death figures due to illicit drugs like,cocain,marijuana,opium etc.etc.This is mostly because people think that only prescription drugs are harmfull for long time use and not the OTC drugs.This is utter wrong.Even a OTC medicine can be fatal if we use it carelessly.A woman used 15 tablets of Brufen by ignoring the manufacturers warning of not exceed 6 tablets per day.An exhamination for a heavy stomach pain she experienced shown that she damaged her stomach's inner protective linings.Then she pushed back to 10 tablets per day as she thought the manufacture's warning was over cautious.This is utter wrong.

NSAIDs

(NON STEROIDAL ANTI INFLAMMATORY DRUGs):-

-AN OVER VIEW:-

These drugs belongs to a class of dissimilar agents that act by inhibiting the cycloxygenase enzyme and subsquently the synthesis of Prostaglandins.

SALICYLATES

Aspirin 

Salsalate

PYRAZOLINES

Phenylbutazone-Extremely toxic can damage blood WBC to produce Agranulocytosis

ACETIC ACIDS

Indomethacin(Indocid)-Can be used in Gout attacks-Cautious to kidneys

Sulindac

Etodolac

Ketorolac-An excellent analgesic

PROPIONIC ACIDS

Ibuprofen (Brufen)

Naproxen

Ketoprofen

OXICAMS

Piroxicam (Feldene)-Longer halflife and hence once daily dose is enough.

FENAMATES

Mefenamic Acid

Meclofenamic Acid 

USES

Aspirin differ from other NSAIDs by irriversibly inhibiting cyclooxigenase while others are riversibly inhibiting it.Also Aspirin has antiplatelet activity which last for longer time atleast for 7 days the lifespan of a platelet Aspirin can be very usefull in preventing Myocardial Heart Attacks.

In general NSAIDs are used as an anti inflammatory,Antipyretic,Analgesic and antiplatelet activities.

SLOW ACTING ANTI RHEUMATIC DRUGS (SARDS)

1.Methotrexate

2.Gold salts

3.Penicillamine

4.Hydrochloroquine

These drugs are acting very slowly may take several months for the effects to become real.But it should be warned that a prolonged use may result in serious side effects including a remission of the rheumatic attack.Hence these medicines should be used under doctor's strict supervisions.These medicines should be tried only if the other therapies fail.These are not first line agents.

  

(To be continued)

AN INTERESTING NEWS FOR DIABETICS

New drugs, treatment make diabetes management easier

TNN | Apr 13, 2016, 01.10 AM IST

Chennai: Many people with diabetes have to suffer several needle pricks a day- they have to get their fingers jabbed for routine blood tests and take insulin shots to keep their sugar level under control.

Scientists are now trying to reduce the daily discomfort and pain for people with diabetes by advising them to use sensors and devices to check their sugar levels. One such solution is the ambulatory glucose profiler, which works on a coin-sized sensor, and gives 1,400 readings. "You stick it on your upper arm for 15 days. The doctor can remove the sensor and pass it through a reader to get the readings and graphs," said diabetologist Dr V Mohan. He said technology was changing healthcare, and an example is how a device like Google Glass can give readings by scanning iris.

It is not just monitoring, even drug delivery can be non-invasive. Insulin pumps, in existence for about three decades as an alternative to multiple daily injections of insulin, are being improved. "Monitoring devices can be attached to these pumps to switch them on and off automatically. Prototypes of pumps that can manage high and low blood sugar levels have been developed," Dr Mohan said.

On Tuesday, a company announced in Chennai an injectible drug that can delay a diabetic's switchover from tablets to insulin shots. Edgard Olaizola, MD, Lilly India, said the drug is the first injectible when a patient is not able to keep the sugar under control with oral medication. "It has a molecule that mimics the effects of GLP-1, a hormone that helps keep the sugar level normal by helping the body release its insulin," he said. India has around 65 million diabetics. A paper published recently in Lancet found that 15.3% of adults with diabetes are from India. The paper, based on data from 751 studies, involving 4.4 million adults from 200 countries, showed that the prevalence of diabetes has increased 80% in women and more than doubled in men in the country.

PAINFULL MENSES PERIODS AND RELIEVES

DYSMENORRHEA

Some women are experiencing painful periods during the end gap of one cycle for a period several days to start another cycle.The condition is known as dysmenorrhea.

Menses  

It is a cyclic periodical discharge of blood and other physiological wastes through the vagina of a non pregnant woman in order clean the system at the end of one period with the duration of some days to start the next period.

Dysmenorrhea is of two types 1.Primary 2.Secondary

Primary Dysmenorrhea is a painfull mensturation with prostaglandin discharge in the absence of any identifiable pelvic disorder

Secondary Dysmenorrhea is associated with any identifyable pelvic disorders.

Symptoms 

Nausea,vomiting,diarrhea,headache,dizziness,and lower abdominal cramping which may some times spread to back and legs.

Treatments

Treatments should be based on the degree of pain experienced by an individual.Usually the pain associated with dysmenorrhea may hardly last for two three days only.If the pain continue for longer periods it must be referred to your physician as it may be due to some underlying causes.

Treatments in the beginning may start with aspirin or paracetamol.Naproxen may be a drug of choice among the NSAIDs followed by Ibuprofen.The dosage recipe can be started one or two days before the menses starts followed by another two to three days to be continued within ihe cycle duration.

The Dosage for Naproxen is mentioned in the PDR is start with 550 mg followed by 275 mg for every 6 to 8 hrs.and not to exceed 1375mg per day.

Naproxen is available on the pharmacy OTC as Aleve,Naprosyn etc with each ablet contain 220 mg of Naprosyn Sodium for women's self treatment.The label comes with the packing reads 1 tablet every 8 to 12 hrs.But a woman can follow the optional regimen of take 2 caplet at the start followed by 1 caplet every  12 hrs if pain persists.Do not exceed 12 tablets per day.

In case of Ibuprove which is also said to be effective in releiving menstural cramps is available with perfect formulation in the pharmacy OTC as Cramp Releiving Midol-IB,Cramp End Tablets,Halran,Midol-200,Pamprin and Trendar.

But a 400 mg Brufen 1 tablets 2 imes daily or a single dosage of 600 mg can solve the problem.

Mensural Migrains are also an another annoying experience during the periods are common to some women

Conclusion

See pains are symptoms of body language to express he underlying serious causes such as ovarian or endometrial disorders.Hence simply aking painkillers for a limitless periods may result into disaster.