Why are Tasmanian Devils dying from oral cancer?

Before we get into this ailment, let us understand what these Tasmanian devils are - a Tasmanian devil is a well-built marsupial with a large head and powerful jaws; they have black fur and they are not found anywhere else in the world except in Tasmania. They are lethargic and slow-moving but aggressive and feed mainly on carrion. The Tasmanian devil is the world’s largest living carnivorous marsupial. It is about the size of a small dog, Tasmanian devils are well known for their piercing nocturnal shrieks and their strong jaws. They are found only on the island of Tasmania, to the south of the mainland of Australia. Being marsupial mammals, Tasmanian devils give birth to tiny and underdeveloped young, completing their development in the mother’s pouch. The Devil Facial Tumour Disease (DFTD) is a distinctive form of transferable cancer which harms its victims by causing tumours to grow around the face. These tumours interfere with their feeding patterns and lead ultimately to starvation. The lack of genetic variation in Tasmanian devil population leaves them particularly vulnerable to mass infection. Hence, the disease has eradicated a large percentage of Tasmanian devils, inflicting havoc in the survival of this already endangered species. Perhaps no animal is better suited to its name than the Tasmanian devil. While it might look cuddly; in reality, this animal is quite the opposite. With the strongest bite of any mammal and a wicked blood-curdling scream, the Tasmanian devil is a ferocious creature which is known to assault animals many times its size. The irony is that even this devil is no match for its supreme enemy - an unusual and contagious face cancer, wrecking the population. The first glimpse of this mysterious disease was given about two decades ago when people sighted large tumours on Tasmanian devils’ faces. They began to grow common. The news channels then started reporting that in the past twenty years; a third of their population had already died from this mysterious illness. The tumours were growing at a rapid and uncontrollable rate until they were noticed. The tumours were slowly covering their mouths and eyes and were giving indication that this could be cancerous. Neither the people living in Tasmania were able to figure nor were the scientists there able to determine the cause of such large tumours that were pervasive and growing fast. Usually, cancer starts as a result of a single mutation or a change to a section of DNA (Deoxyribonucleic Acid). Most mutations are safe but often; they can cause a cell to grow and divide in an uncontrollable manner. This unrestricted enlargement causes the rogue cells to amass, forming the masses that we recognise as cancerous tumors. As cancer cells continually grow and divide, they tend to get more and more mutations in their DNA, resulting in tumors that give birth to a broader landscape of mutations. However, as mutations are considered random events, cancer often looks different in each individual. For example, two people having breast cancer may have tumors with completely different armoury of mutations. This is what makes the case of the Tasmanian devil so puzzling. It is almost impossible for so many of these animals to independently develop similar type of cancer so quickly through the classical mutation technique. Even more intriguing is that every tumor sample has shown the same pattern of alterations in the Tasmanian devils’ chromosomes. This finding was quite odd, especially compared to how cancer has been generally shown to appear through a series of random mutations to DNA. The fact that all Tasmanian devil samples showed the same irregular chromosome patterns made researchers suspect that the devils were not suffering from a typical type of cancer as it would be nearly impossible for so many creatures to grow with the same exact mutations in their DNA. Instead, the lethal cancer spreading through their population might be infectious, spreading from one animal to another through bites to the face during sessions of fighting. Intriguingly, the cancer affecting the Tasmanian devils showed no sign of viral transmission and the similarity among tumors did not support the mutation model. How this is then spreading from one animal to another? The answer may lie in what is called the MHC or Major Histo-compatibility Complex. The immune system has various ways of protecting the body against invasion by viruses, bacteria and parasites and any intrusive or cancerous cells. The first line of defense is built up by an inborn immune response made up of barriers like skin, tears, saliva and mucus. This is followed by defensive mechanisms built up by adaptive immune reactions that are more specific for the intruder. Adaptive immunity includes both a humoral response (macro-molecules) produced by antibodies and a cell-mediated reaction produced by T-cells that have the ability to destroy other cells. The cell-mediated adaptive immune reaction is synchronised by the Major Histo-compatibility Complex (MHC). It is called that because it is responsible for the rejection of graft or tissue compatibility. As per reports, compared with the figures of Tasmanian devils in the past decade, almost sixty percent of their population has been destroyed by this disease. From the time of the initial discovery of DFT1, a second mutation has arisen as a variation in the form of DFT2 and has been devastating their population. There is a very fine article written by Sharon Guynup in Mongabay magazine, which will help throw up better light on this issue facing the Tasmanian devils. Here is the link: https://news.mongabay.com/2021/10/in-harms-way-our-actions-put-people-and-wildlife-at-risk-of-disease/. This article elaborates on facts like how infectious diseases such as these pose a grave threat to not only Tasmanian devils but also chimpanzees, tigers, African wild dogs and Ethiopian wolves. Some viral diseases are being spread by humans, other domestic animals and livestock and this can culminate in giving a knockout punch to already endangered species that are bordering on extinction’s edge. Not many people realize that a collection of humans, pigs, cows, dogs or chickens into wild areas can bring in further risk of the already endangered species. Somewhere along the line, man has had a broken relationship with nature in its wild patches. Corporate greed has also proved that the rich are quite separate from the rest of the species on earth. Activity of rich corporate thinkers has altered natural systems on earth in a rapid way. It has been so dramatic in the last few decades that it has brought in a new geological eon. These changes include deforestation which has gone out of control, farming, ranching, international travel, global commerce and wildlife trade with the help of poachers has affected climate change and has also helped spread diseases. Why does this happen? It is because such activities bring livestock, people and wildlife into contact, exposing all concerned to viruses and bacteria. Often, the ones suffering lack immunity in a rapidly warming world. Ticks, mosquitoes and several other parasitic carriers of diseases have an expanded range now, bringing debilitating ailments along with them. These changes have also helped new diseases to appear and spread to newer areas. This may lead perhaps to outbreaks soaring in the future. We have already seen recently how a pandemic could impact the whole ecosystem of this planet. Paradoxically, the ecosystem benefits when the dark satanic mills run to less than their optimal range and people are not polluting the atmosphere with carbon monoxide. Here is the ominous part! Roughly around seventy per cent of all the growing and re-emerging pathogens are becoming zoonotic diseases that are transmitted from animals to humans. We have no idea when the next threat or the next Disease X will strike and when. This is also the sentiment shared by the Director of the World Health Organisation, Tedros Adhanom Ghebreyesus when he voiced the same at a meeting concerned with global animal health. Most infectious viruses are emerging from tropical areas which are also home to a rich variety of species and the volume of pathogens they can host and these areas are China, parts of Southeast Asia, Africa and India. We simply have to face the fact that we have to live with diseases as they have become a part of this natural world. Bacteria and viruses have become interwoven into our ecosystems in a varied environment where indigenous residents have now evolved immune systems which prevent high rates of infection and subsequent deaths. Ecosystems have become intact and they maintain equilibrium. For example, as per Rick Ostfeld, a disease ecologist at Cary Institute of Ecosystem Studies in Millbrook, New York, USA, the web of life is thriving in tropical forests and also keeping hosts of diseases like rodents in decent check. Coming back to our main focus, the Tasmanian devil facial tumour disease involves a couple of independent transmissible cancerous cells which have killed a majority of these species. These cells are originating from Schwann cells and spread between them as they bite each other as that is a common kind of behaviour during their mating season. DFT1 and DFT2 spread as a result of direct contact between them in situations involving fights over food and mates. It is a point to be noted that like most other cancer remedial care, there is no satisfactory treatment procedures for DFT1 and DFT2. Several chemotherapeutic medicines have been on trial for DFT1 but not even one has shown any real efficacy towards treating this disease. Preliminary trials of immunotherapy have shown better promise in case of DFT1. So, what is actually been done to save these Tasmanian devils. The government of Australia has started a funded initiative with the aim of saving this species. Research is being directed that will help understand the cause of these growing tumours. The main objective is to develop a vaccine; and if not, at least some form of intervention or therapy.

Immune complex hypersensitivity (Type III) reactions

Type III hypersensitivity occurs when antigen and antibody complexes accumulate when they are not adequately cleared by immune cells. They give rise to an inflammatory response and attract leukocytes. Type II immune complex hypersensitivity will occur when there is an excess of antigen leading to complexes that are not cleared from the circulation. It involves soluble antigens that are not bound to cell surfaces unlike those found in Type II hypersensitivity. When these antigens bind the antibodies, immune complexes of various sizes will form. Large complexes can be cleared by macrophages but they have difficulty in the disposal of small immune complexes. These immune complexes will insert themselves into smaller blood vessels and joints causing symptoms. Such depositions in tissues often stimulate an inflammatory response and they can cause damage wherever they precipitate.

Otolaryngology

Define Sound Sound is a form of energy that is produced by vibrating objects. A sound wave is made up of compression and rarefaction of molecules of media like solid, liquid or air in which the sound waves travel. Velocity of sound is different in each media. In the air, sound travels at a speed of 1120 feet per second at a temperature of twenty degrees Centigrade. It is faster than this through liquids and much faster through the solid medium. What do you understand by the frequency of sound? It is the number of cycles per second. The unit of frequency of sound is measured in Hertz (Hz). This unit is named after the German scientist, Heinrich Rudolf Hertz. A sound wave of 1000 Hz will indicate 1000 cycles per second. What is complex sound? Give an example It is sound made with more than one frequency. Human voice is example of complex sound. The higher the frequency of sound, the greater will be the pitch. The complex sound has a fundamental frequency which the lowest at which a source vibrates. All frequencies above that particular tone are called overtones. These overtones establish the quality of the timbre of sound. What is a decibel in terms of measurement of sound? A decibel (dB) is measured as one-tenth of a bel unit named after Alexander Graham Bell who invented the telephone. The decibel represents a logarithmic ratio between two sounds – that is the sound being described along with the reference sound. Too many decibels constitute noise which can be defined as an aperiodic complex sound. There are three types of noise levels – White Noise, Narrow Band Noise and Speech Noise. What is the dynamic range of sound? It is the difference between the most comfortable level of sound and the discomfort level which can be measured in terms of decibel loudness. The dynamic range of sound is reduced in patients who have positive recruitment phenomenon in the case of a cochlear type of hearing loss. The sound level meter is the instrument used to measure level of noise and other sounds.

Atrophic Rhinitis

What is atrophic rhinitis? Atrophic rhinitis is a chronic nasal condition that is characterised by the formation of thick dry crusts in the nasal cavity. It results from progressive wasting away or decreasing in size (atrophy) of the mucous nasal lining (mucosa) and its underlying bone. It also affects the glands and turbinate bones. Special forms of chronic atrophic rhinitis are rhinitis sicca anterior and ozaena. Etiology • Hereditary factors • Endocrinal imbalance - the disease tends to start at puberty and mostly involves females • Racial factors - whites are more susceptible than natives of equatorial Africa • Nutritional deficiency in vitamins A , D or iron • Autoimmune factors - viral infection may trigger antigenicity of the nasal mucosa Symptoms • Most commonly seen in females • Reported among patients from lower socioeconomic groups • The nasal cavities become roomy and are filled with foul smelling crusts which are black or dark green and dry, making expiration painful and difficult. • Microorganisms are known to multiply and produce a foul smell from the nose, though the patients may not be aware of this, because their elements (responsible for the perception of smell) have become atrophied. This is called merciful anosmia. • Patients usually complain of nasal obstruction despite the roomy nasal cavity, which can be caused either by the obstruction produced by the discharge in the nose, or as a result of sensory loss due to atrophy of nerves in the nose, so the patient is unaware of the air flow. • Bleeding from the nose, also called epistaxis, may occur when the dried discharge (crusts) are removed. • Septal perforation and dermatitis of nasal vestibule can occur. The nose may show a saddle-nose deformity. Management Treatment of atrophic rhinitis can be either medical or surgical. Medical measures include: • Nasal irrigation using normal saline • Removal of crusts using alkaline nasal solutions prepared by dissolving a spoonful of powder containing one part sodium bicarbonate, one part sodium biborate and two part sodium chloride. • 25% glucose in glycerine can be applied to the nasal mucosa to inhibit the growth of proteolytic organisms which produce foul smell • Local antibiotics, such as chloromycetine • Vitamin D(Kemicetine) • Systemic streptomycin (1g/day) against Klebsiella organisms. Surgical interventions include: • Modified Young's operation • Narrowing of nasal cavities, sub-mucosal injection of Teflon paste, section and medial displacement of the lateral wall of the nose • Transposition of parotid duct to maxillary sinus or nasal mucosa

Assessment of Hearing - Otolaryngology

What are the three types of hearing loss? 1. Conductive hearing loss – It is caused by any disease process that interferes with the conduction of sound from external ear to the stapediovestibular joint. The cause may lie in the external ear or the Eustachian tube in the form of obstructions or in the tympanic membrane in the form of perforation or in the middle ear in the form of fluids or in the ossicles in the form of fixation or disruption. 2. Sensorineural hearing loss - This is caused by lesions of the sensory type of the cochlea or of the cranial nerve 8 and its central connections of the neural type. When the hearing loss is due to lesions of cranial nerve 8, it is known as retrocochlear and when it is because of the lesions of the central auditory connections, it is referred to as central deafness. 3. Mixed hearing loss – In this kind of hearing loss, both sensorineural and conductive elements of deafness are present in the same ear. There is an air-bone gap that indicates the conductive element and impairment of bone conduction that triggers sensorineural loss. Mixed hearing loss is found in cases of chronic suppurative otitis media and otosclerosis. What four factors are important while assessing the auditory functions? 1. Type of hearing loss – whether it is conductive, sensorineural or mixed. 2. Cause of hearing loss – it may be congenital or traumatic or it could be infection or an auto-immune process. 3. Degree of hearing loss – It could be mild or moderate or it could be severe or total. 4. Site of the lesion – If it is conductive hearing loss, the lesion may be at the external ear or the tympanic membrane or it could be at the middle ear or the Eustachian tube. Tympanometry is helpful in finding the site of lesions. If it is a sensorineural loss, it is to be determined whether the lesion is cochlear or central or retrocochlear. Often special tests of hearing are needed to differentiate the types of these lesions. How is hearing tested? It is done through clinical or audiometric tests. What are the four major clinical tests of hearing? 1. Finger Friction Test – It is a quick method of screening and it involves rubbing and snapping the thumb and a finger by positioning them close to the ear of the patient. 2. Watch Test – A watch that clicks is brought close to the ear of the patient and the distance at which it is heard is measured. 3. Speech or Voice Tests – For the purpose of the test, the patient has to hear a conversation at a distance of forty feet in quiet surroundings. Its disadvantage is the lack of standardisation in intensity. 4. Tuning Fork Tests – They are done with tuning forks of different frequencies. The average frequency is 512 Hz. The tuning fork is activated by striking it gently against the examiner’s elbow or heel of hand. Tuning forks of lower frequencies than 512 Hz produce sense of bone vibration. A vibrating fork is placed vertically in line with the meatus to test air conduction and it is kept about two centimetres away from the opening of the external auditory canal. The sound waves are transmitted through the tympanic membrane. Middle ear and the ossicles to the inner ear. In order to test bone conduction, the foot plate of the vibrating tuning fork is placed on the mastoid bone. Cochlea is stimulated directly by the vibrations conducted through the skull bones. What are some of the important and clinically useful tuning fork tests? 1. Rinne – Air conduction of the ear is compared with its bone conduction. A vibrating tuning fork is placed on the patient’s mastoid and when hearing stops, it is brought besides the meatus. If he still hears, air conduction is more than bone conduction. Rinne’s test can be concluded as false negative in severe unilateral sensorineural hearing loss. The patient does not hear any sound of the tuning fork by air conduction but responds to bone conduction. 2. Weber’s – A vibrating tuning fork is placed in the middle of the forehead and the patient is asked in which ear he or she can hear the sound. Normally, it is heard equally in both ears. It is lateralized to the worse ear in conductive deafness and to the better ear in sensorineural deafness. 3. Gelle’s – It is a test of bone conduction and examines the effect of increased air pressure in ear canal on hearing. It is performed by placing a vibrating tuning fork on the mastoid while changes in air pressure in ear canal are brought about by Siegel’s speculum. What are the four types of audiometry tests and explain briefly, giving details about tympanometry as part of impedance test 1. Pure Tone Audiometry- Audiometer is used to produce pure tones, Their intensity can be increased or decreased by 5 dB steps and the amount of intensity that has to be raised above the normal level is a measure of the degree of hearing impairment at that frequency. It is charted in the form of a graph called audiogram. It is used to measure the degree and type of hearing loss, prescription of hearing aid and degree of handicap for medico-legal purposes 2. Speech Audiometry- The patient’s ability to hear and understand speech is measured. The two parameters used are speech reception threshold and discrimination score. 3. Bekesy Audiometry- It is a self-recording audiometry where various pure tone frequencies automatically move from low to high while the patient controls the intensity through a device that indicates Type 1 – Type V degree. 4. Impedance Audiometry- There are two tests that make up this category. They are tympanometry and acoustic reflex measurements. Tympanometry is based on a simple principle that dwells on when a sound strikes the tympanic membrane; some of its energy is absorbed while the remainder is reflected. It helps in finding the degree of compliance or stiffness of the tympanic membrane to show the health of the middle ear. Five types of tympanograms are Type A, Type As, Type AD, Type B and Type C with the range being Type A as normal and Type C as maximum compliance.

Slowing Down the Ticking of Biological Clocks in Women

Women are obsessed with the fear of aging. They dread to lose their youth and try their utmost to preserve the freshness in their skin texture. Another fear women have is about marrying late in life and giving birth at that age. Obesity is of special concern as it can increase complications for the mother and child. There are considerable risks, as per the American College of Obstetricians and Gynecologists, related with obesity and pregnancy. The chances of requiring a caesarian delivery are high when a woman is obese. The fear of giving birth late could possibly be overcome by the use of stem cells technologies. It has been learnt through studies from the Biology Department of Harvard University that a woman could carry the egg stem cells in her ovaries right up to late adulthood. This brings out possibilities of the age being extended at which a woman can give birth. Stem cell technologies could now be used to rejuvenate an older woman’s eggs. The embryonic stem cells can give hope for regenerative medicine in which tissues can be repaired or even replaced. New fertility treatments from stem cell technologies will erase the biological clock fear in women and also slow down the ticking of that clock. Couples can even start thinking in terms of select babies then. In perhaps four decades from now, couples can go through tube fertilization to select the characteristics of their new born. Experts in the field of fertility feel that many women who do not have regenerative eggs of their own on account of their age, a medical condition or due to treatment of cancerous cells can now be helped by such technology. This can be a very big step that can be taken in the study of reproductive technologies in the generations to come.

Peptic Ulcer Drugs Classification Therapeutic Utility

Peptic ulcer disease (PUD) occurs with a break in the lining of the stomach, first part of the small intestine or occasionally the lower oesophagus. Common causes include the bacteria, Helicobacter Pylori and non-steroidal anti-inflammatory drugs (NSAIDs). Classification of PUD 1. Esophagus 2. Stomach 3.Ulcers 4.Duodenum 5.Mucosa 6.Submucosa 7.Muscle Differential Diagnosis • Gastritis • Stomach cancer • Pancreatitis • Hepatic congestion • Cholecystitis • Inferior myocardial infarction Classify the drugs used in treatment of peptic ulcer For the treatment of peptic ulcers, the main objective of pharmacotherapy is to eradicate Helicobacter Pylori infection and to reduce morbidity. This is to prevent complications in patients with peptic ulcers. Acid suppression is the general pharmacologic principle of medical management when treating acute bleeding from peptic ulcers by using Histamine II receptor antagonists (H2RAs) and Proton Pump Inhibitors (PPIs). Both these classes are available in oral and intravenous preparations. Discontinuation of NSAIDs is necessary if it is clinically possible. For those patients who have to continue with their NASAIDs, the maintenance of PPI is always recommended so that recurrences are prevented even after the eradication of Helicobacter Pylori. Explain their mechanism of action and their therapeutic utility The recommended primary therapy for treatment of peptic ulcers and helicobacter pylori infection is the proton pump inhibitor (PPI). It is combined with antacids and an anesthetic like viscous lidocaine or an antispasmodic may also be used as a symptomatic therapy. If the helicobacter pylori eradication is not achieved despite repeat treatment, then anti-secretory therapy is recommended. The patients are possibly suffering with the Zollinger-Ellison Syndrome as a secondary cause of duodenal ulcer. This is a disorder in which severe peptic ulceration is found due to edema or hyperplasia of islet of pancrease that secrete gastrin resulting in hyperchlorhydria. Classification of PPIs:- • Omeprazole (Prilosec) – It decreases gastric acid secretion by inhibiting the parietal cell H+/K+ ATP pump. It will decrease the incidence of NSAID-induced peptic ulcers and it can be used to help prevent peptic ulcers in long term NSAID users at high risk. Omeprazole and Domperidone Omeprazole and Domperidone contain a proton pump inhibitor and anti-dopaminergic agent, prescribed for ulcers, indigestion and acid stomach. Same trade names. • Lansoprazole (Prevacid) – It decreases gastric acid secretion by inhibiting the parietal cell H+/K+ ATP pump. It is given with clarithromycin and amoxicillin or metronidazole if the patient is allergic to penicillin. • Rabeprazole (Aciphex) – It decreases gastric acid by inhibiting the parietal cell H+/K+ ATP pump. It is used for a short term treatment of two months and elief of symptomatic erosive gastroesophageal reflux disease. If patients are not healed in this time, then an additional treatment of two months is prescribed. • Esomeprazole (Nexium) – This is an S-isomer of Omeprazole. It inhibits gastric acid secretion by inhibiting the H+/K+-ATPase enzyme system at the secretory surface of gastric parietal cells. It is used in severe cases. • Pantoprazole (Protonix)- It suppresses gastric acid secretion by inhibiting H+/K+ ATPase enzyme system at the secretory surface of the gastric parietal cells. Pantoprazole Pantoprazole is a proton-pump inhibitor, prescribed for gastro-oesophageal reflux disease (GERD), ulcers, Zollinger-Ellison Syndrome, and erosive oesophagitis. It decreases the amount of acid made in the stomach. Trade Names - Pandom | Acidwel | Azpan - DM | Histamine II Blocker Treatment Classification:- • Cimetidine (Tagamet) – It can be used as primary therapy to heal peptic ulcers that are not associated with helicobacter pylori infection. The duration of treatment is two months. • Famotidine (Pepcid) – This inhibits histamine at H2 receptor of gastric parietal cells effectively resulting in reduced gastric acid secretion, gastric volume and hydrogen ion concentrations. Famotidine is a histamine (H2-receptor antagonist), prescribed for ulcer. Trade Names - Famoflam (20 mg) | Acidosh (20 mg) | Blocacid (20 mg) | • • Nizatidine (Axid) – This inhibits histamine at H2 receptor of gastric parietal cells resulting in reduced gastric acid secretion, gastric volume and hydrogen ion concentrations. • Ranitidine (Zantac) – This inhibits histamine stimulation of the H2 receptor in gastric parietal cells and reduces gastric acid secretion, gastric volume and hydrogen ion concentrations. Ranitidine and famotidine, which are both H2 receptor antagonists, provide relief of peptic ulcers, heartburn and indigestion. They decrease the amount of acid in the stomach helping with healing of ulcers. When Helicobacter Pylori infection is present, the most effective treatments are combinations of two antibiotics (e.g. clarithromycin, amoxicillin, tetracycline, metronidazole) and a proton-pump inhibitor (PPI), sometimes together with a bismuth compound. This is acid reducing medication. Ranitidine is an antacid, anti-reflux agent and anti-ulcerant, prescribed for peptic ulcer. Trade Names - Giran | Intac | Acispas | Ani -Spa Younger patients with ulcer-like symptoms are often treated with antacids or H2 antagonists before endoscopy is undertaken. People who are taking non-steroidal anti-inflammatories (NSAIDs) may also be prescribed a prostaglandin analogue (misoprostol) in order to help prevent peptic ulcers. Classification of Drugs for Peptic Ulcers Aluminum Hydroxide and Magnesium Hydroxide Aluminum Hydroxide and Magnesium Hydroxide contains antacids, prescribed for preventing ulcers, heartburn relief, acid indigestion and stomach upsets. Aluminum Hydroxide and Magnesium Hydroxide neutralizes acid in the stomach. Trade Names - Aludrox | Dizicum | Glycopyrrolate Glycopyrrolate is a muscarinic anticholinergic agent, prescribed for peptic ulcer in combination with other medicines and also used in anesthesia as preoperative medication. It reduces acid and saliva secretions. Trade Names - Camolate (0.2 mg) | Glyco P (0.2 mg) | Vagolate (0.2 mg) | Lafutidine Lafutidine is an antacid, prescribed for ulcer. Trade Names - Laciloc (10mg) | Lafaxid (10mg) | Lafutax (10 mg) | Mepenzolate Mepenzolate is an anti-muscarinic agent, prescribed for the treatment of peptic ulcer combined with other medication. It decreases acid secretion in the stomach and control intestinal spasms. Trade Names – A Kare and Mifenac. Misoprostol Misoprostol is a synthetic prostaglandin; prescribed for ulcer, labor induction, induced abortion, miscarriage, postpartum hemorrhage (blood loss during birth) and other gynecological uses. Trade Names – Misonac and Safeguard Oxyphenonium Oxyphenonium is an anti-muscarinic agent, prescribed for peptic ulcer and it prevents muscle spasm in the gastrointestinal tract. Trade Names - Alupromate D | Oxyphenonium Bromide | Ulpane | Pirenzepine Pirenzepine is an antacid, prescribed for peptic ulcer. Trade Name – Same. Propantheline Propantheline is an anti-muscarinic agent, prescribed for peptic ulcer, and urinary incontinence. Trade Names - Pepler | Probanthine | Sere Banthine | Ulsedin |

Best Treatment for Oily Skin

You may feel that you are not finding a decent solution to remove the greasy look from your forehead and chin when you have oily skin. This is a condition that is often inherited from previous generations in a family. During the teen years, changes in hormone levels could cause skin to turn oily and result in acne outbreak. The best treatments for oily skin can be found at home. Cleaning your face in the morning and at night with a cleanser is probably the single most effective way to manage oily skin. You can use a gentle cleanser as harsh soaps can stimulate the skin to generate more oil. Like cleansers, toners that contain salicylic acid are most effective for oily skin. Oily skin can result from several factors. Genetics and family history can affect the make-up of the skin. Others may have a glandular condition that causes excessive generation of sebum by the sebaceous glands resulting in greasy skin. People in the past have adopted these treatments for oily skin:  Washing the face at least thrice a day.  Tomatoes have been used for their astringent and cooling properties. As tomatoes are rich in Vitamin A and C, they are helpful for reducing acne and getting rid of excessive oil from the skin. There are many anti-oxidants in tomatoes for them to be a popular treatment for oily skin. You have to cut the tomatoes in halves and rub those halves on the affected portions of your skin.  You have to apply make-up at least ten minutes after washing your face and not before because it will not allow the cosmetics to go down through the pores of the skin to create more blackheads and acne. Oily skin can be treated at home. These are the steps you have to take towards treatment for oily skin:  Keep your skin clean – The skin looks dirtier when it is oily. It is important for you to keep the skin clean by washing it at least thrice a day. The glycerine variety of soaps is effective like Pears.  Try Aloe Vera – Aloe Vera gels absorb oil and clear out pores. Dab the gel on to your face at least thrice a day after washing and then let it dry. Keep the gel in the refrigerator for the cooling effect.  Wipe with Astringents – Wiping the oily portions of your face with acetone or alcohol spirits can help in degreasing your skin.  Paper Facial Tissues – They can help soak up excess oil very fast. There are oil absorbing tissues that you can buy at the cosmetics stores.  Almond Honey Scrub – You can mix a small quantity of ground almonds with honey and gently massage or scrub the paste on to your skin with a hot washcloth and rinse thoroughly.  Use water-based cosmetics – If you cannot live without make-up or foundations, you can choose water-based products over the oil-based types and you can select spot concealers than coating your entire face. Try to use gel blushers or powders instead of cream foundations for oily skin. Blotting paper could be a great option for removing excess oil from your skin and the paper does not dry out your skin. These papers are lightly powdered for oily skin to reduce the shine further. Applying masks and clays to the skin also helps draw out oils and cleanses the pores. But excessive use can dry out the skin. They have to be applied only on the problem areas and that too, not frequently. You have to remember that there is no way to completely prevent oily skin. You can watch your diet too. A reduction of fish and iodized salt in your diet is recommended for oily skin treatment.

Ten Soups that are Ideal when Dieting

When you are dieting, you can safely think in terms of soups. There are many delicious soups that you can concoct to lead a healthy life. Tiffany Tse is a Lifestyle writer with a focus on healthy living. She writes regularly for Shape Magazine. She firmly believes that soups can provide ample nutrition when you are dieting. She has compiled eleven ideal soups for people to eat regularly when they diet. 1. Lentil Chili Soup – This is a healthy stew and the fiber rich lentils that are low in fat keep the calorie count in control. Spice could be added with a little dash of chili powder. This recipe is provided by Maris Callahan who is a writer for `Diets in Review’. 2. Mushroom and Barley Soup – You can use nutty grains of barley to get that chewy texture and mushrooms would be able to satisfy as a low calorie treat. This is one of Tiffany Tse’s favorite dieting soups. 3. Red Pepper Bisque – You can shop for crisp and sweet bell peppers and yellow onions. Liquefy them into a colored puree. This will be full of antioxidants and the concoction can turn into a healthy meal with an addition of mixed greens and whole grains. This recipe is also provided by Maris Callahan from `Diets in Review’. 4. Chicken Zucchini and Potato Soup – Good chunks of potato, chicken breast and zucchini make up this stew and it is ideal for a cold day. The vegetables make this stew a filling one. This recipe was taken by Tse from Chris Powell who is a trainer from Extreme Makeover. 5. Crème de Tomate – This is a simple one and must have been made numerous times at home. It is better to make fresh at home than rely on the canned soups. You can chop, roast, simmer and blend the tomatoes to give that silky mélange touch with the combination of onions and red peppers. The recipe remains one of Tse’s top few when dieting. 6. Turkey Rice Soup – When you want to make use of some leftovers, brown rice and turkey cooked in chicken broth with some frozen mixed vegetables can give you a “mouth watering, robust gumbo” as per Tiffany Tse. 7. Spaghetti Squash Noodle Soup – This a low carb combination with strips of spaghetti squash noodles mixed with onions and potatoes. Cook the spaghetti squash and then bake it. Prepare vegetables in a pot and heat with olive oil. Add the squashed noodles and cook for about ten minutes. This recipe was supplied to Tse by `Veg Obsession’. 8. Chicken and Dumplings Soup – This is usually high in calories and sodium but can be turned into a healthy recipe with many nourishing vegetables for a stew and whole wheat pastry flour for the crisp dumplings. This recipe has been provided by the `Gracious Pantry’. 9. Moroccan Chickpea Stew – Tender chickpeas will give this stew a nutritious pep. The chickpea nuggets will be full of protein and fiber and can serve as a filling addition to any meal. Cook the chickpeas in tomato sauce and let it boil. You can add frozen spinach and noodles to the stew. The recipe has been provided by `Gluten Freedom’. 10. Minestrone – This soup is low in carbohydrates and calories. It is made with potatoes, corn, carrots, tomatoes, white beans and lentils. As with the Crème de Tomate, this soup will provide you with lycopene. It will add fiber, protein and iron to your diet. This combo has been supplied to Tiffany Tse by `Young Married Chic’. You may read more for details on how to make these soups for a healthy diet in these articles listed below. http://www.shape.com/healthy-eating/meal-ideas/10-healthy-soups-fill-you-not-outrovided http://www.fitday.com/fitness-articles/nutrition/healthy-eating/7-healthy-soups-to-fit-your-diet.html#b

Hashimoto Thyroiditis

Hashimoto’s Thyroiditis is an autoimmune and chronic lymphocytic disease in which the thyroid gland is attacked by numerous cells and antibody influenced immune processes. They cause primary thyroidism. This is one of the first auto immune diseases to be recognised. This is a condition where the immune system attacks the thyroid which is a small gland at the base of your neck below the Adam’s apple. This gland is a part of the endocrine system that produces hormones which coordinate many activities in your body. The inflammation that results from Hashimoto’s disease leads to an underactive thyroid gland or hypothyroidism. It affects mostly middle aged women. Treatment is prescribed by way of hormone replacement and it is an effective process. This disease progresses slowly over the years and causes thyroid damage and that leads to a drop in the thyroid hormone levels in the blood. The symptoms are those of hypothyroidism or an underactive thyroid gland. Signs and symptoms of hypothyroidism • Fatigue and sluggishness • Increased sensitivity to cold • Constipation • Pale, and dry skin • A puffy face • Hoarse voice • Unexplained weight gain — occurring infrequently and rarely exceeding 10 to 20 pounds, most of which is fluid • Muscle aches, tenderness and stiffness, especially in your shoulders and hips • Pain and stiffness in your joints and swelling in your knees or the small joints in your hands and feet • Muscle weakness, especially in your lower extremities • Excessive or prolonged menstrual bleeding (menorrhagia) • Depression

Ten Most Likely Causes of Low Back Pain

1. Sprains and Injuries – A simple sprain of a muscle or a ligament while lifting something heavy or after an awkward twisting movement could give us low back pain. Injuries to the back with trauma or fracture will also result in low back pain. 2. Awkward Seating – An improper seating position during the day while we are at our workstations may also result in low back pain. 3. Sleeping Position – Low back pain can result by a wrong sleeping position or the kind of mattress that we are sleeping on. 4. Pregnancy - The expanding uterus will shift the center of gravity and stretch out the abdominal muscles resulting in the weakening of the muscles, changing of the posture and straining of the back. 5. Menstrual Periods – Women, during their menstrual cycle, will experience intense low back pain as the uterus contracts and presses against the surrounding muscles. 6. Obesity – Carrying the bulky weight is a common cause of back pain. 7. Degenerated Discs – Back aches may result from deterioration in the disc condition of the spine. 8. Herniated Disc - A spinal nerve may become trapped when the disc ruptures and presses outward, straining the lumbar spine. Some spinal nerves could be pinched to give us continuous pain. 9. Arthritis – A common cause of back ache in elderly adults is arthritis of the spine. It feels worse when they lie down to sleep. 10. Cervical Stenosis - It is a tightening of the spinal cord that can result in considerable back pain.

Garlic supports Healthy Dieting

The health magazine, `Health.am’, has reported research that has been done at the Weizmann Institute in Israel showing that garlic has been recognized for its health benefits such as preventing heart ailments, diabetes and cancer. Researchers are also endorsing the fact that garlic supports healthy dieting and helps in the reduction of body weight. It contains that vital compound called allicin that suppresses appetite and helps people in losing weight. Allicin has been known to reduce the blood pressure, triglyceride and insulin levels in the animals tested in the laboratories. These animals were fed a diet that was rich in sugar. It has been published in a study in the American Journal of Hypertension that animals that had developed high levels of insulin, blood pressure and triglycerides had their levels reduced by the intake of allicin. It went on to control their levels. During the research, rats were also fed allicin and observed for few days. They did not gain weight but the rats in the other group that were not fed the garlic compound did gain weight. Diana Herrington, Author of `Eating Green and Lean’, writing for the Care2 Magazine, says that “Garlic acts as an appetite suppressant as it gives the brain signals of satiety when it is eaten.” A person with the daily dose of garlic would be inclined to eat less during the day. Garlic has also been known to increase the metabolism rate of our body. The American Journal of Hypertension states that garlic stimulates the nervous system to release the adrenaline hormone which increases the rate of metabolism. This high rate of metabolism can help a person to burn more calories and eventually lose weight. Garlic can be used widely in the daily diet towards weight loss. It can be used in the dishes cooked or it can be used in the salads. Garlic bread also can be eaten along with other garlic products to keep your weight in check and reduce it gradually. It is popular because it is economically priced and easy to find in the food markets. As per the American Journal of Hypertension, garlic has also been considered herbal drug. It has been used in many civilizations as a cure for common cold, influenza and even the plague. Garlic has also helped to make the body more resistant to various allergies. It helps loosen and release the plaque from the walls of the arteries. It has also been considered as the best option to eliminate parasites like pin worms from your body. Garlic is packed with many nutrients and vitamins. Garlic may have been called the `stinking rose’ in the world but it is known for more than its odor. It is an aphrodisiac and is very beneficial for your health. Garlic gets its odor properties from a sulphur compound. These compounds are known for their pungent odors. To read more about the benefits of garlic as a supplement for healthy dieting, you may explore http://www.health.am/weightloss/more/garlic-for-weight-loss/.

Dopamine

Dopamine is a compound which is present in the body as a neurotransmitter and a precursor of substances such as adrenaline. It is an organic chemical of the catecholamine and phenethylamine families. It plays an important role in the brain and the body. Its name is derived from its chemical structure. It is an amine synthesised by removing a carboxyl group from a molecule of its precursor chemical L-DOPA. It occurs in brain cells and adrenal cells. In the brain cells, it is transported to synaptic locations and packaged into vesicles for release that occurs during synaptic transmission. After its release, the dopamine that is free is either reabsorbed into the pre-synaptic terminal for reuse or it is broken down by the enzymes like monoamine oxidase or COMT. It produces a variety of degradation metabolites whose end products are eventually excreted in the urine. Our brain includes numerous dopamine systems and they play an important role in behaviour hat is reward motivated. Most rewards increase the level of dopamine in the brain and many addictive drugs increase dopamine neuronal activity. Other systems that are affected by dopamine are the motor control activities that control the release of several hormones.

Top Foods that Burn Fat and are Good for Weight Loss

The calories that you burn during a workout may depend on the kinds of calories you take in before that workout, as suggested by research done in the field of nutrition. The research has been done by Dr. Mike Roussell. He is the author of `6 Pillars of Nutrition’ and a renowned nutritional consultant. People who take in rich carbohydrates for breakfast such as muesli, skimmed milk and yogurt before working out in the gym do not get their blood sugar levels spiked. They will be able to burn about fifty per cent more fat during their post breakfast workout in comparison with those kinds of people who spike up their blood sugar levels with food like white bread or corn flakes. Carbohydrates that cause the blood sugar levels to rise are referred to as high-glycemic index carbs. The carbohydrates that do not boost up the blood sugar levels are called low-glycemic index carbs. It is not easy to categorize the so-called `fat burning’ foods. Dr. Roussell states that “most foods do not proactively elicit increase in calorie burning but instead create a physiological environment in which fat burning is more easily accomplished”. For example, broccoli does not boost up your rate of metabolism but it can be categorized as a low calorie food that consists of carbohydrates that are slow to digest; it also contains fiber and phytochemicals that help in clearing off estrogen. Bahar Takhtehchian, a Co-Editor of Shape Magazine, also endorses the view that low glycemic index carbohydrates will help burn almost fifty per cent more fat than the high glycemic index carbs. Her favorite suggested recipe is cherry-almond-yogurt parfait. Two other popular fat melting foods are green tea and hot peppers. The American Journal of Clinical Nutrition has published a new study that finds mono-unsaturated fats, that are found in avocados and olive oil, can be added to the long list of foods that help you burn calories and fat faster. Additionally, peanuts, hazelnuts and Macadamia nuts are also among the top fat burners. Apart from muesli, skimmed milk and yogurt, other forms of low glycemic index carbohydrates are whole grains, whole grain cereals, oats, soy and linseed bread. Barry Braun, Director of the Energy Metabolism Laboratory at the University of Massachusetts at Amherst, has done some research on eating prior to exercise. He feels that “eating large amounts of high glycemic index carbohydrates right before exercise is probably as detrimental for overweight people as it is for the normal weight ones”. He feels that the high glycemic index carbs will come in handy for a marathon runner who needs high energy immediately before running a marathon. Regardless of whatever goals you set for yourself, it always starts with food for anyone who tries to lose weight. Dr. Mike Roussell feels that if you increase soy protein in your diet, it will help tone your muscles to burn your fat at a quicker pace and give you a contoured physique. If you want to burn your fat and lose weight at a rapid pace, it is important to pay attention to what Dr. Roussell is talking about in the Shape Magazine.

Four Examples of Hyperplasia

Hyperplasia is a condition where there is an increase in the volume of organic tissues which results from cell proliferation. It leads to enlargements of organs. It is a common type of pre-neoplastic response to stimulus. Under a large microscope, the cells get increased in numbers even though they may look like normal cells. 4 Types 1. Benign prostatic hyperplasia – This condition is also known as enlargement of the prostate. 2. Congenital adrenal hyperplasia- This is an inherited disorder of the adrenal gland. 3. Endometrial hyperplasia – This is due to the hyper proliferation of the endometrium. It results from estrogen stimulation in a setting of polycystic ovary syndrome and exogenous administration of hormones. This may also lead to endometrial adeno carcinoma. 4. Hemihyperplasia – This happens when only one side or half of the body is affected.

Five Reasons you do not lose Fat when Dieting

Are you dieting and not losing fat? You are not aware of some common diet mistakes that you may be committing. Kathleen Zelman, Director of Nutrition for WebMD, says that you “may be eating a lot more calories than you think when you are on a diet”. You can check out the common diet mistakes everyone makes as per Adam Bornstein who contributes to `Shape.com’ by writing articles on weight loss strategies. 1. Not sticking to the basics – Exercises are created to relax you. Your workout has to be enjoyable. You are not going to get fit any faster if you are doing a ball balancing act on one leg. The basics will get you the same results. You will find them in the classic multi-muscle exercises such as squats and dead lifts. The fat on your butts and legs will definitely melt. While doing this, you cannot eat whenever you feel like. Do not be a victim of “eating amnesia” when you put your hand to mouth without knowing it. This happens mostly in front of a television in your living room when you snatch something from a packet or while reading a book. How can you kick this habit of mindless eating? You can get out of this habit by trying a cup of tea or a glass of water or simply chewing sugarless gum. 2. Performing more Cardio – Cardio may help you burn those calories and fat but it is not the answer or a primary solution. It is the weight training that is more likely to burn your fat. Cardio has to be secondary to weight training. Our hectic daily schedules have made us get into the unhealthy habit of eating fast. Tara Gidus, a Spokeswoman for the American Dietetic Association, says, “We need to adopt more of the leisurely European-style eating so that we can savor our food”. 3. There is no intensity in your workout – People try to focus more on the social aspect in the gym than concentrate on the workout itself, particularly if they go to the gym with a cycle of friends. Workout has to be intense and short. The idea is to feel your muscles work while sweating it out. You must be skipping meals besides going to the gym. Breakfast skipping is a big mistake. Research has shown that breakfast eaters weigh less on an average than breakfast skippers. Two meals, at least per day, should be taken. 4. Taking in too many liquid calories – You may not know but liquid calories from sodas, teas, sweetened juices, coffee and smoothies add that extra fat on to you. Alcohol is also in this list. A study has found that more than twenty per cent of people get their extra calories from beverages. 5. Choosing unhealthy Add-ons – When you are on a diet, you try to increase the portions in the size of your snacks or meals for the simple reason that you feel you are doing regular exercise and also skipping meals. You also develop a habit of topping your topping your diet salads with high-fat add-ons like creamy dressings, croutons, bacon and cheese.

Holistic Dieting and Top Ten Considerations about it

A holistic diet goes beyond what you eat. It transcends beyond the food on your table or the burning of calories through exercising. It concerns you as a total person and gives you a healthy lifestyle in a package. Its main aim is to nourish your body, arrest chronic health concerns and increase your levels of energy to create an overall sense of well being. World Health Organization has explained health to be “more than the absence of disease; Health is a state of optimal well being”. Amanda Landis, a practicing nutritionist and Principal of Pure Balance Plan LLC has talked about the important considerations of a holistic diet while writing for `Livestrong.com’ and spelt out the ten most important considerations about a holistic diet to understand its objectives. 1. Developing a healthy and balanced diet – One of the basic principles of a holistic diet is the need to balance the macronutrients like carbohydrates, proteins and fats. Neda Smith, the Co-Editor of Holistic Nutrition, talks about the foods that give us nourishment. She talks about how not all carbohydrates are bad and they need not be eliminated from your diet. 2. Maintaining an adequate diet – It is important to eat natural food in a holistic diet and to avoid processed foods. Natural foods include fish, whole grains, vegetables, meats, fresh juices, herbal teas and coffee substitutes. 3. Balancing your diet – You have to balance the macronutrients in your diet with the micronutrients like fiber, minerals and vitamins to help the body in optimizing energy so that it reaches high levels of physical and emotional health. 4. Eating moderately – It is better to eat moderately foods that have high sugar and fat content. 5. Digesting your food properly – It is important for you to digest your food to maintain good health. Cold beverages and cold foods do not help the cause as they are slow to digest. Also, you have to chew the food well before you swallow it. It may come as a surprise to you but foods that contain probiotics or friendly bacteria are strongly recommended as they contribute to your good digestion and your intestinal health. 6. Laying the foundation for good emotional health – Sandra Caton, Editor for the American Holistic Health Association, talks about how you can be consciously aware of your thoughts, behavior and feelings towards your family, friends and the people you interact with. 7. Building up respect for your environment – You can participate in the community and neighborhood projects of cleaning up and respecting the `Go Green’ philosophy. 8. Gathering information to make well informed wellness oriented choices – Making the right kind of food choices can help you to avoid health problems in the future such as hypertension, diabetes, obesity and cancer. 9. Participating actively in your health decisions and your healing process – This can be done through disciplining yourself to maintain a nutritional diet and following a regular exercise regime. 10. Integrating nourishment for your mental and spiritual health – This can be done through various modes of attaining mental peace and it can come through Yoga, simple meditation and recreation like reading or listening to music. Do you wake up with enough enthusiasm for the day that is ahead?

The Advantages of taking Copper Supplements

Copper is a mineral that our body needs. It plays a major role in fighting iron deficiency that leads to anaemia. Iron cannot be absorbed from the intestinal tract without the circulation of small amounts of copper in the body. People are not aware of the full health benefits of copper supplements and they do not take enough of this important nutrient. Copper supplements can give you benefit in several ways. The most important function of this mineral is in the production of energy and in the formation of haemoglobin. Throughout history, people involved in the business of healing have understood the importance of copper in staying healthy. Copper supplements have been used in the past for the treatment of diseases. Copper has been advised for medicinal purposes as far back as ancient Egypt, Greece and Rome. It was being used as an application to the body even by the ancient Aztec Civilization. Ancient Egyptian medical texts mention the use of copper as an agent of sterilization for drinking water and treating wounds. It has also been used for headaches, palsy and burns. Hippocrates, who is regarded as the father of modern medicine, has mentioned in his doctrines that copper is to be used as treatment for leg ulcers which are associated with varicose veins. Copper supplements make it easy for the body to use iron. Researchers have identified that copper makes a difference in the treatment of osteoporosis, high blood pressure and cancer. Studies have associated copper deficiencies with heart ailments by means of bad cholesterol levels, leading to hypertension. Other signs of copper deficiency include anaemia, baldness and skin sores. It is to be remembered that copper can be toxic if you take it in excess. Excessive copper intake can give side effects like nausea, vomiting and joint pains. The National Academy of Sciences has set a maximum allowance level of three milligrams per day for adults and two and a half milligrams per day for children. Most of the multi vitamins include copper as a supplement. Oral copper supplements can be found in gels and solutions. Copper supplements are an important part of a nutritional program for the healing of wounds. Many medical researchers believe that infusion of copper into wound dressings will help in healing faster and the regeneration of skin cells. Copper supplementation has also been found crucial in the treatment of arthritis. It has been established that copper supplements are important to the health of our nerves as these supplements are required to build and maintain myelin which is like an insulation that protects and covers our nerve cells. Our body requires copper supplements to help an enzyme which is essential for the production of the connective tissue proteins such as collagen and elastin. Copper works with Vitamin C and zinc to form elastin. Copper supplements are also needed for the development and maintenance of our bones and skin including our blood vessels and joints. Copper is also instrumental in the healing process related with melanin which is the pigment connected with our hair color and skin.

Classification of Beta Lactam Antibiotics and Mechanism of Action of Benzyl Penicillin

β-lactam antibiotics (beta-lactam antibiotics) are a broad category of antibiotics. They contain all the antibiotic agents which have a β-lactam ring in their molecular structures. For example, all penicillin derivatives like penams and cephalosporins, carbapenems and monobactams. β-lactam antibiotics work by inhibiting the cell wall biosynthesis in the bacterial organism and are the most widely used group of antibiotics. Bacteria often develop resistance to β-lactam antibiotics by synthesizing a β-lactamase, an enzyme that attacks the β-lactam ring. To overcome this resistance, β-lactam antibiotics are often given with β-lactamase inhibitors such as clavulanic acid. Classification and Sub-Types of Beta-Lactam Antibiotics 1. Penams - 1.1.1 β-Lactamase-sensitive 1.1.2 β-Lactamase-resistant 1.3.1 Carboxypenicillins 1.3.2 Ureidopenicillins 2. Cephems - 2.2.1 With anti-Haemophilus activity 2.2.2 With anti-anaerobic activity 3. Carbapenems 4. Monobactams 5. β-Lactamase inhibitors Mechanism of Action of Benzyl Penicillin Benzyl penicillin is also known as Penicillin G. It is given typically by injection parenterally as it bypasses the intestines for the simple reason that it is unstable in the acidic stomach. 6- aminopenicillanic acid Penicilloic acid Route of elimination - Penicillin G is eliminated by the kidneys. Non-renal clearance includes hepatic metabolism and biliary excretion. Impact Ratio - Normal renal function is around 10 minutes. Clearance is 560 ml/ minute. Toxicity - Oral LD50 is 8900 mk/kg. Organisms that are affected by it - Enteric bacteria and other eubacteria Therapeutic Uses Benzyl Penicillin is given therapeutically for:- • Cellulitis • Infective Endocarditis • Meningitis • Aspiration pneumonia • Lung abscess • Community-acquired pneumonia • Syphilis • Septicemia in children • Septic Arthritis • Gangrene • Diphtheria As far as the antimicrobial potency of benzyl penicillin is concerned, it is effective against all gram-positive organisms – for example, Neisseria Gonorrhea. Adverse Effects of Benzyl Penicillin Common adverse reactions for benzyl penicillin and β-lactam antibiotics include diarrhea, nausea, rash, urticaria and candidiasis. Frequent ADRs include fever, vomiting, dermatitis and angio-edema. Pain and inflammation at the injection site is also common for parenterally administered β-lactam antibiotics.

Etiopathogenesis of Diabetes Mellitus

What are the complications? The basic phenomenon in diabetes mellitus is the destruction of the beta cell mass that leads to deficiency of insulin. There are three linked mechanisms in the Etiopathogenesis of diabetes mellitus. The first is genetic susceptibility; second is auto immune factors and the third is environmental factors. In genetic susceptibility, it has been observed in identical twins that if one twin has DM, there is more than half a chance of the second twin developing it. Studies on both animals and humans have shown various immunologic abnormalities as far as auto immune factors are concerned. There is presence of islet cell antibodies against glutamic acid decarboxylase and insulin. There is occurrence of lymphocytic infiltrate around the pancreatic islets and this is known as insulitis. Environmental factors include some viral infections that precede the onset of the disease like mumps and measles. Early exposure to bovine milk proteins leads to auto immune processes and chances of DM setting in. Obesity and hypertension and lack of physical activity play an important role in modulating the disease. Complications of Diabetes Mellitus The complications are less severe in people who have blood sugar levels that have been well controlled with medication. Wider health problems start creeping in with deleterious effects of diabetes including smoking, elevated cholesterol levels, obesity, hypertension and lack of regular exercise. Mechanisms of Chronic Complications Chronic elevation of blood glucose levels leads to damage of blood vessels and this is known as angiopathy. The endothelial cells that line the blood vessels take in more glucose than normal as they do not depend on insulin. They form more surface glycoproteins than normal and cause the basement membrane to grow thicker and weaker. These are related microvascular diseases when there is damage to the smaller blood vessels and macrovascular diseases when there is damage to the arteries. It has been recorded that forty per cent of all people suffering with diabetes mellitus develop neuropathy even after controlling their blood sugar levels. Auto immune relations destroy the beta cells of the pancreas and they may also cause retinopathy and nephropathy. Genetics also play a role in causing complications. Severe type of chronic complications may lead to diabetic cardiomyopathy, causing damage to the heart muscle. This leads to impaired relaxation and filling of the heart with blood. This is known as diastolic dysfunction. This is the eventual reason for heart failure. Diabetic nephropathy damages the kidney and leads to chronic renal failure. Diabetes mellitus is a common cause of kidney failure in adults in the developed world. Diabetic retinopathy results in growth of poor quality blood vessels in the retina and there is a mascular edema or a swelling of the macula, leading to loss of vision or blindness. Another complication is the diabetic foot which results out of a combination of sensory neuropathy and vascular damage. It also increases risk of skin ulcers and infection, leading in extreme case to necrosis and gangrene. This is the reason why diabetics are prone to more leg and feet infections and why it takes very long for them to heal from such wounds. Restrictive lung effect is known to be linked with diabetes mellitus. It could result from chronic low grade inflammation of tissue and micro-angiopathy.