http://www.diabetes.nhs.uk/safe_use_of_insulin/
http://www.mims.co.uk/Tables/882439/Insulin-Preparations/
Πέμπτη 30 Δεκεμβρίου 2010
Τετάρτη 29 Δεκεμβρίου 2010
Spasm and Spasticity
Spasm: muscles to contracting tightly and painfully
Spasticity: muscles are stiff and resistant to movement
http://www.nhs.uk/Conditions/Multiple-sclerosis/Pages/Symptoms.aspx
Spasticity: muscles are stiff and resistant to movement
http://www.nhs.uk/Conditions/Multiple-sclerosis/Pages/Symptoms.aspx
Talipes-Clubfoot
I was reading about Bethlem myopathy and I came across the term talipes.
I am uploading a picture I found online as "a picture is worth a thousand words".
http://www.eorthopod.com/content/clubfoot
http://www.muscular-dystrophy.org/about_muscular_dystrophy/conditions/663_bethlem_myopathy
I am uploading a picture I found online as "a picture is worth a thousand words".
http://www.eorthopod.com/content/clubfoot
http://www.muscular-dystrophy.org/about_muscular_dystrophy/conditions/663_bethlem_myopathy
Τετάρτη 22 Δεκεμβρίου 2010
Παρασκευή 17 Δεκεμβρίου 2010
Τετάρτη 15 Δεκεμβρίου 2010
Alpha-Fetoprotein
BNF states:
"In view of the increased risk of neural tube and other defects associated, in particular, with carbamazepine, lamotrigine, oxcarbazepine, phenytoin, and valproate, women taking antiepileptic drugs who may become pregnant should be informed of the possible consequences. Those who wish to become pregnant should be referred to an appropriate specialist for advice. Women who become pregnant should be counselled and offered antenatal screening (alpha-fetoprotein measurement and a second trimester ultrasound scan)."
I decided to search for the term AFP and I found the following definition:
http://www.rndsystems.com/molecule_detail.aspx?m=1049&gclid=CLrI69Ou7qUCFQkf4QodUhXUog
Τετάρτη 20 Οκτωβρίου 2010
Παρασκευή 8 Οκτωβρίου 2010
Interesting point
Emergency Contraception can be also offered in Brook centres. http://www.brook.org.uk/find-a-centre.
Κυριακή 19 Σεπτεμβρίου 2010
Κυριακή 12 Σεπτεμβρίου 2010
Epigenetics
I came across the term epigenetics during Roche-Continents Workshops.
This is a link with information of what it is:
http://learn.genetics.utah.edu/content/epigenetics/
http://learn.genetics.utah.edu/content/epigenetics/inheritance/
This is a link with information of what it is:
http://learn.genetics.utah.edu/content/epigenetics/
http://learn.genetics.utah.edu/content/epigenetics/inheritance/
GABA-A receptor
http://www.google.com/imgres?imgurl=http://media.wiley.com/CurrentProtocols/NS/ns0706/ns0706-fig-0001-1-full.gif&imgrefurl=http://www.currentprotocols.com/protocol/ns0706&usg=__Rv4x2ttXFQH_rVZ0t6P0ZifMMFw=&h=255&w=363&sz=5&hl=el&start=39&zoom=1&tbnid=udPgYmqRsn2AXM:&tbnh=140&tbnw=200&prev=/images%3Fq%3Ddiazepam%2Bbinding%2Bsite%26um%3D1%26hl%3Del%26rls%3Dcom.microsoft:el:IE-SearchBox%26rlz%3D1I7GGLL_el%26biw%3D1259%26bih%3D573%26tbs%3Disch:10%2C942&um=1&itbs=1&iact=hc&vpx=900&vpy=225&dur=5553&hovh=188&hovw=268&tx=103&ty=111&ei=Ip6MTJGUDs2Vswaq5PG1Ag&oei=GJ6MTPSoFoaBswbUlPDlAQ&esq=3&page=3&ndsp=20&ved=1t:429,r:12,s:39&biw=1259&bih=573
http://www.currentprotocols.com/protocol/ns0706
Porphyria
I was reading about the skeletal muscle relaxants and I came across with the term porphyria.
According to BNF54 acute porphyria is a hereditary disorder of haem biosynthesis. Subdivisions include: Acute intermittent porphyria (AIP), Variegate porphyria (VP), Hereditary coproporphyria (HCP), or ALA dehydratase deficiency porphyria.
There are drugs can cause acute porphyrias and their use must be avoided. If that is not possible urinary porphobilinogen excretion should be measured regularly.
A list of drugs safe to use in acute porphyrias can be found here:
http://www.wmic.wales.nhs.uk/pdfs/porphyria/Porphyria_Safe_List_2010_with_letter_August%202010.pdf
According to BNF54 acute porphyria is a hereditary disorder of haem biosynthesis. Subdivisions include: Acute intermittent porphyria (AIP), Variegate porphyria (VP), Hereditary coproporphyria (HCP), or ALA dehydratase deficiency porphyria.
There are drugs can cause acute porphyrias and their use must be avoided. If that is not possible urinary porphobilinogen excretion should be measured regularly.
A list of drugs safe to use in acute porphyrias can be found here:
http://www.wmic.wales.nhs.uk/pdfs/porphyria/Porphyria_Safe_List_2010_with_letter_August%202010.pdf
In acute porphyria crises, haema arginate (normosang) is given as an IV infusion.
More information can be found here:
http://www.wmic.wales.nhs.uk/porphyria_info.php
Σάββατο 11 Σεπτεμβρίου 2010
Tetanus
Tetanus is an serious, acute infection caused by the bacterium Clostridium tetani, which is found in the soil, dust and manure. The bacterium usually enters the skin through grazes, wounds and burns.
After entering the body, it needs up to 21 days to incubate and usually symptoms appear after the 10 days. Symptoms include muscle spasm which is particularly apparent on the face, fever, sweating, tachycardia and hypertension. If it is not treated it can lead to fatal complications which include septicaemia, asphyxia, heart attack and kideny failure.
To prevent infection wound must be cleaned and antiseptics must be used or if severe the wound should be treated appropriately by a healthcare professional. Vaccination might also need to follow.
Antibiotics may also be given to limit the bacteria growth and the neurotoxin tetanospasmin spreading. Penicillin or metronidazole are usually given and tetracycline is given to those allergic to the aforementioned antibiotics.
Muscle spasms are treated by anticonvulsants (phenobarbital), muscle relaxants (diazepam, baclofen, dantrolene) and neuromuscular blocking agents (vecuronium).
A high calorie and protein-rich diet might be also necessary due to increased muscle activity and energy consumption.
After entering the body, it needs up to 21 days to incubate and usually symptoms appear after the 10 days. Symptoms include muscle spasm which is particularly apparent on the face, fever, sweating, tachycardia and hypertension. If it is not treated it can lead to fatal complications which include septicaemia, asphyxia, heart attack and kideny failure.
To prevent infection wound must be cleaned and antiseptics must be used or if severe the wound should be treated appropriately by a healthcare professional. Vaccination might also need to follow.
Antibiotics may also be given to limit the bacteria growth and the neurotoxin tetanospasmin spreading. Penicillin or metronidazole are usually given and tetracycline is given to those allergic to the aforementioned antibiotics.
Muscle spasms are treated by anticonvulsants (phenobarbital), muscle relaxants (diazepam, baclofen, dantrolene) and neuromuscular blocking agents (vecuronium).
A high calorie and protein-rich diet might be also necessary due to increased muscle activity and energy consumption.
Δευτέρα 30 Αυγούστου 2010
Κυριακή 22 Αυγούστου 2010
Urea Cycle Disorders
http://www.nucdf.org/about.htm
http://www.nucdf.org/ucd.htm
http://www.nucdf.org/UCD_Clinical_Trials.html
http://www.medschool.lsuhsc.edu/genetics_center/louisiana/article_metabolic_dietary.htm
http://www.hyperiontx.com/clinical_trials
http://www.helpucd.com/HTML%20pages/Main.htm
http://www.nucdf.org/ucd.htm
http://www.nucdf.org/UCD_Clinical_Trials.html
http://www.medschool.lsuhsc.edu/genetics_center/louisiana/article_metabolic_dietary.htm
http://www.hyperiontx.com/clinical_trials
http://www.helpucd.com/HTML%20pages/Main.htm
Πέμπτη 19 Αυγούστου 2010
West Nile Virus
Insects carrying the West Nile Virus have infected people in North Greece. So I have decided to find more information about the trasmission of the virus and the symptoms it causes. The virus is trasmitted from infected birds to insects and then to humans and other animals. The virus is trasmitted through blood and not through touching infected animals and people.
http://www.cdc.gov/ncidod/dvbid/westnile/cycle.htm
Once infected, the symptoms can develop 2-15days after the infection. 4 out of 5 humans infected have no symptoms but do develop natural immunity which might fade over the years, 20% have West Nile fever with flu-like symptoms and rash in their body and 1 in 150 infected people might develop symptoms of encephalitis (brain inflammation), meningitis (inflammation in the membrane surrounding the brain and spinal cord), meningoencephalitis (inflammation of the brain and the membrane surrounding it) or polymyelitis ( inflammation of the spinal cord). The symptoms are severe including severe headaches, high fever, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, and paralysis.
Sometimes patients might develop milder symptoms for a couple of days and then have severe symptoms and sometimes patients with severe West Nile disease might have permanent effects. Patients suffering from the West Nile fever have symptoms lasting from a few days to a few weeks and they are gone on their own. Although there are not available medicines to cure this infection, patients have to seek medical advice. People at higher risk are those over 50 years and immunocompromised patients.
As we do not know whether we are going to be infected or not, some preventative measures are:
applying insect repellent, such as Deet 50% to exposed skin, spraying clothes, shoes, bed nets with repellents containing permethrin, using bed nets, wearing long-sleeved shirts and trousers, keeping doors and windows closed, staying indoors at dawn, dusk and night if possible, changing the water in the plant pots and animal bowls quite regurarly.
More information can be found here:
http://www.cdc.gov/ncidod/dvbid/westnile/wnv_factsheet.htm
More information on insect repellents can be found here:
http://www.cdc.gov/ncidod/dvbid/westnile/RepellentUpdates.htm
http://www.cdc.gov/ncidod/dvbid/westnile/qa/prevention.htm
And frequently asked questions here:
http://www.cdc.gov/ncidod/dvbid/westnile/q&a.htm
Info for prevention in Greek:
http://www.travelforall.gr/faq.asp?facid=34
Τετάρτη 11 Αυγούστου 2010
Dantrolene-Dantrium
Oral dantrolene is used as a muscle relaxant at a dose of 75mg tds.
It acts peripherally and is better than other muscle relaxants which act on the CNS.
It also used intravenously to treat malignant hyperthermia cause by volatile anaesthetics and suxamethomium.
Its chemical synthesis is as follows: 
It also used intravenously to treat malignant hyperthermia cause by volatile anaesthetics and suxamethomium.Its chemical synthesis is as follows:
http://basic-clinical-pharmacology.net/chapter%2027_%20skeletal%20muscle%20relaxants_files/image021.gif
http://www.spepharm.com/admin/PageImages/1693.jpg
http://www.chemdrug.com/databases/SYNTHESIS/SYN/11/11245903a.gif
Παρασκευή 16 Ιουλίου 2010
Σάββατο 3 Ιουλίου 2010
Πέμπτη 3 Ιουνίου 2010
Πέμπτη 27 Μαΐου 2010
Δευτέρα 24 Μαΐου 2010
Κυριακή 23 Μαΐου 2010
Σάββατο 22 Μαΐου 2010
POMPHOLYX
It is a type of ezcema that usually appears in the hands or feet. Its cause is unknown, but it is thought to be linked to stress, a reaction to neomycin or an irritation from perfumes, chemicals, metals.
http://www.patient.co.uk/health/Pompholyx.htm
http://www.patient.co.uk/health/Pompholyx.htm
Τετάρτη 19 Μαΐου 2010
Κυριακή 16 Μαΐου 2010
Chimeric fusion proteins
They can bind 2mols of TNFα and prevents rec interaction by steric hindrance.
http://mct.aacrjournals.org/content/6/11/2995/F1.large.jpg
http://www.arthritis.co.za/images/enbrel%20img1E.jpg
Σάββατο 15 Μαΐου 2010
Dismutation
A reaction involving a single substance but producing two products; e.g., two molecules of acetaldehyde may react, producing an oxidation product (acetic acid) and a reduction product (ethyl alcohol).
http://www.mondofacto.com/facts/dictionary?query=dismutation
Hyaluronan
http://www.nature.com/nm/journal/v11/n11/images/nm1105-1161-F1.jpg
One of the chief components of the extracellular matrix, hyaluronan contributes significantly to cell proliferation and migration, and may also be involved in the progression of some malignant tumors. It is secreted by fibroblasts (synovial in RA)
http://en.wikipedia.org/wiki/Hyaluronan
http://en.wikipedia.org/wiki/Hyaluronan
Πέμπτη 13 Μαΐου 2010
Solutions
1.Linctuses (Oral Solutions):
liquid oral prep, used as demulcent, expectorants and sedatives to sooth throat and cough, formulated as viscous sugar solutions
2.Mixtures and solutions:
simple oral preps with dissolved drugs
3.Elixir:
liquid oral prep of potent / unpleasantly-tasting drugs. To mask taste: high sugar/sweetening agents (pediatric elixirs: fruit syrup) levels. Non-aqueous solvents/ solubilising agents.
4.Draught (= shot):
liquid prep. formulated as single dose in a larger volume than normal.
5.Pediatric (elderly, animals) drops:
oral liquid formulation of potent drugs in solution. Accuracy when given by nurse.
6. Gargles and Mouthwashes:
concentrated aqueous solutions, diluted before use.
7. Syrup (=flavoring vehicles):
viscous solution of sugar (sucrose).
8. Spirits:
Volatile solutions of 1/more active drugs in ethanol 96%/dilute ethanol.
9.Oils:
vehicles for fat soluble drugs/vitamins.
10.Juices, Aromatic water, water (potable, distilled, purified)
11. Preservatives:
hard to get good preservatives at a safe, efficient and efficacious level. Syrup over 65% and low pH, chloroform (volatile, loss through plastics, carcinogenic): 1:20dilution, ethanol. parabens.
12.Antioxidants:
non-toxic, non-irritant, effective at low []s, odorless, tasteless, soluble in vehicle, stable.
13. Viscosity enhancers:
improve palatability and ease of pouring.
14. Sweetening agents:
glucose, sucrose, syrups, honey
sorbitol, mannitol, xylitol
sodium&calcium saccharin, aspartame, acesulfate potassium, thaumatin
15.Flavoring agents:
juices (raspberry), extracts (liquorice), spirits (lemon), syrups (blackcurrant), tinctures (ginger), aromatic water (cinnamon)
16.Coloring agents:
non-toxic, non-irritant, compatible
mask unpleasant appearance, color-flavor, identification
17.Galenical preps of crude drugs
concentrated products of natural-origin drugs
liquid oral prep, used as demulcent, expectorants and sedatives to sooth throat and cough, formulated as viscous sugar solutions
2.Mixtures and solutions:
simple oral preps with dissolved drugs
3.Elixir:
liquid oral prep of potent / unpleasantly-tasting drugs. To mask taste: high sugar/sweetening agents (pediatric elixirs: fruit syrup) levels. Non-aqueous solvents/ solubilising agents.
4.Draught (= shot):
liquid prep. formulated as single dose in a larger volume than normal.
5.Pediatric (elderly, animals) drops:
oral liquid formulation of potent drugs in solution. Accuracy when given by nurse.
6. Gargles and Mouthwashes:
concentrated aqueous solutions, diluted before use.
7. Syrup (=flavoring vehicles):
viscous solution of sugar (sucrose).
8. Spirits:
Volatile solutions of 1/more active drugs in ethanol 96%/dilute ethanol.
9.Oils:
vehicles for fat soluble drugs/vitamins.
10.Juices, Aromatic water, water (potable, distilled, purified)
11. Preservatives:
hard to get good preservatives at a safe, efficient and efficacious level. Syrup over 65% and low pH, chloroform (volatile, loss through plastics, carcinogenic): 1:20dilution, ethanol. parabens.
12.Antioxidants:
non-toxic, non-irritant, effective at low []s, odorless, tasteless, soluble in vehicle, stable.
13. Viscosity enhancers:
improve palatability and ease of pouring.
14. Sweetening agents:
glucose, sucrose, syrups, honey
sorbitol, mannitol, xylitol
sodium&calcium saccharin, aspartame, acesulfate potassium, thaumatin
15.Flavoring agents:
juices (raspberry), extracts (liquorice), spirits (lemon), syrups (blackcurrant), tinctures (ginger), aromatic water (cinnamon)
16.Coloring agents:
non-toxic, non-irritant, compatible
mask unpleasant appearance, color-flavor, identification
17.Galenical preps of crude drugs
concentrated products of natural-origin drugs
maceration (soaking in fluid), percolation (filter), decotation (boiling), digestion (by bac), infusion (pouring)
18.Tinctures:
alcoholic liquids containing low [crude drugs]
maceration, percolation
19.Infusions (~Tea bag):
dilute solutions of readily soluble drugs, made by pouring boiling water on drug, then comminutation (filter through sieve) and maceration.
20.Oxymels:
preps of acetic acid+honey vehicles for crufe drugs
21.Powder mixtures:
simple form of preps for reconstitution (ensure drug evenly dispersed in powder mix by uniform particles)
22.Granules for reconstitution:
granulated preps-more elegant appearance than powders, involves heating, contact with solvents, less dense than powders and may require larger containers.
Τετάρτη 12 Μαΐου 2010
GMP- Definitions
GMP stands for Good Manufacturing Practice and cGMP for current good manufacturing practice. It is of the Quality Assurance (QA) and ensures that manufacturing mett the standards. More specifically, it ensures that products are consistently produced and controlled to quality standards appropriate to their intended use.
QA is a wide ranging concept, it covers all matters which influence quality of product and it is defined as the sum of organised arrangements with object of ensuring med. products are of quality for intended use (GMP) and factors outside Orange Guide.
Quality control is GMP sampling, specifications, testing, organisation, documentation, release procedures to ensure the necessary and relevant tests are actually carried out and that materials not released to use or products for sale and supply, until their quality judged satisfactory.
Marketing Authorisation (=Product License)
any UK medicinal product--> PL/MA on packaging
2 basic requirements to gain:
1. Dossier (dif. for new chemical entity vs generic) with evidence on safety, efficacy and quality --> MHRA
2. pharmaceutical manufacturer holds:
Manufacturer's Licence (by MHRA) AKA Manufacture's Authorisation
site inspected by MHRA to ensure safety
GMP certificate (UK contract manuf.), letter of certificate (overseas contract manuf.)
In EU alternative ways to obtain MA. A central registration for the whole EU/ rgistration in one member state and a reciprocal arrangement to allow for a simplified MA in other member states.
FDA, PFSB, TGA, EMEA=MHRA
Orange Guide: Rules and Guidance for Pharmaceutical Manufacturers and Distributors
John Sharp
QA is a wide ranging concept, it covers all matters which influence quality of product and it is defined as the sum of organised arrangements with object of ensuring med. products are of quality for intended use (GMP) and factors outside Orange Guide.
Quality control is GMP sampling, specifications, testing, organisation, documentation, release procedures to ensure the necessary and relevant tests are actually carried out and that materials not released to use or products for sale and supply, until their quality judged satisfactory.
Marketing Authorisation (=Product License)
any UK medicinal product--> PL/MA on packaging
2 basic requirements to gain:
1. Dossier (dif. for new chemical entity vs generic) with evidence on safety, efficacy and quality --> MHRA
2. pharmaceutical manufacturer holds:
Manufacturer's Licence (by MHRA) AKA Manufacture's Authorisation
site inspected by MHRA to ensure safety
GMP certificate (UK contract manuf.), letter of certificate (overseas contract manuf.)
In EU alternative ways to obtain MA. A central registration for the whole EU/ rgistration in one member state and a reciprocal arrangement to allow for a simplified MA in other member states.
FDA, PFSB, TGA, EMEA=MHRA
Orange Guide: Rules and Guidance for Pharmaceutical Manufacturers and Distributors
John Sharp
Κυριακή 9 Μαΐου 2010
Τρίτη 4 Μαΐου 2010
Δευτέρα 3 Μαΐου 2010
Targeting HIV-1 Cell Entry
Engineered zinc fingers designed to span a specific site on the CCR5 gene (TM gene). ZFN-nuclease cleaves DNA, a new gene is inserted, editing and making CD4+cells resistant to HIV-1 infections.
Παρασκευή 30 Απριλίου 2010
Examples of controlled release
Implantable devices:
Advantages include: Convenience, compliance, control and commercial, disadvantages surgery is need to be inserted/removed, possibility of failure, potency, reactions with body and commercial (time and money).
they can be used for pain, contraception, diabetes, incontinence, systemic infection, ocular and dental purposes. Contraceptives include rods, vaginal rings and IUD coil. Mirena is a diffusion-contolled DDS for local delivery and it is easily reversible. The coil is removed by pulling the strings of the device. Norplant and Jadelle (newer device where drug and matrix combined) rods involve 6 rods being implanted in the arm.
Intraocular delivery is also possible. Drug can be even inserted under sclera in the back of the eye. It is unpleasant to insert an implant in the eye, but is better than injections. RESISERT (diffusion-controlled delivery) was the first CR device for eye delivery and is used to treat chronic noninfectious uveitis lasts for 30months before removed by taking off the sutures and decreases chances of reoccurance of uveitis. The matrix device has a drug core and a polyvinyl membrane. IVATION INTRAVETREAL IMPLANT (diffusion-controlled DSS) is used for AMD, DME and glaucoma. It looks like a screw, but is tiny compared to a coin. It consists up an erodible polymer and it can stay in the sub-conjuctiva of the eye for around 2 years. MEDIDUR is an device which is injected/dropped at the back of the eye and replaced after 36months, but is currently under phase III clinical trials, VITRASERT lasts for 5-8months and OCUSERT is a device used once weekly instead of 28drops squeezed in the eye.
There is also a Pressure-responsive Intraocular implantable delivery device which works by electronically-controlled pump. It is inserted in the conjuctiva and a reservoir contains the drug. When neccesary an injection of drug is being done to refill the reservoir. The advantage is that instead of injecting the eye, the device is being punched. The device then self-heals and release the drug by repsonding to mechanical force.
Drug-eluting stents (diffusion or chemically controlled release) which is an artificial 'tube' inserted into a natural passage/conduit in the body to prevent, or counteract, a disease-induced, localized flow constriction (stenosis of blood vessels). Restenosis (amount of cells reinfiltered after stent loss) limits effectiveniness though. Used to deliver cytotoxic drug such as Paciltaxel.
Examples of osmotic delivery devices include: DUROS, a catheter direct drug specifically to 1 point protected by body all time. The drug is pushed out of the orifices by a semi-permeable membrane.
Examples of degradable devices include: DURIN (chemically-controlled DDS, drug and rate-limiting polymer mixed into fibre, rod or tablet), GLIADEL wafers used in the treatment of malignant gliomas.
Mechanical pumps are also available. An example is the one to control insulin release. It monitors glucose, transmits reading to pump and secrete insulin. There is also an implantable pump controlled by the phycisian. It is implanted every 3 months and contains 6000units of insulin. However, if pump fails, it will cause trouble to patients.
There are also mechanical pumps for intrathecal delivery for severe chronic tumour pain management with morphine sulphate.
Lastly, in the future, Micro-scale delivery will be feasible. In a microfibrated osmotic engine, water flow increases and pushes balloon upwards to the hole to be released and delivered to patients. Osmotic agent pushes drug dwon. The size of the device is tiny with V capacity of microL, so drug needs to be potent!
Controlled release microchip: a metal mould with conical holds with sealing top with erodible. Underneath insoluble polymer sealing. Only way drug escape is through top. Each hole can be filled with different polymers to give a pulsatile effect. It works via erosion and PLGA tailors the rate of erosion, by changing the lactic acid, hydrophobicity and MR (methyl groups) is increased, making it harder to degrade as opposed to the hydrophilic glycolic acid.
Controlled delivery devices
Controlled dlievery systems are preparations designed in such a way that they release rate or location of active drug is controlled. They are needed to reduce fluctuations in [plasma] (imp. For reducing side effects of narrow therapeutic window drugs), reduce dosing frequency (imp. for patient compliance), control delivery site (colon) for optimum activity and timed release the drug (e.g. pulsatile action for hormones or angina).
There are four main mechanisms for controlling Drug Release.
The first one is Diffusion-control DDS. When diffusion takes place through a non-porous or micro-porous membrane and water-insoluble polymers coat the drug core [(s)/(l)], the device is called Reservoir and the drug goes in solution when in aqueous environment. Monolithic devices is the second type of diffusion-control DDS. Diffusion takes place through bulk water-insoluble polymer, when water penetrates, drug in solution diffuses. The drug is dissolved in polymer solution prior to device formation and dispersed throughout the device. This tends to be used for implantable devices.
The second type of CDDS is Chemically-controlled ones, where diffusion is similar to the matrix monolithic device. Drug is dissolved in (natural or synthetic and water-soluble or water degradable) polymer solution prior to device formation and is released as the polymer matrix breaks down. Predominantly for long-term implantation. There are two subtypes: monolithic devices, where either pure polymer erodes (surface erosion, decreasing ph, increases autocatalytic degradation of polymer backbone by acid addition or SAVIT delivery technology where coating is non-erodible and active erodible matrix erodes at both ends) or combination of erosion and diffusion takes place (bulk erosion, PLGA is commonly used and FDA approved). Multiple drug can be delivered at specific times and locations through the CHRONOP delivery technology and alternative pulsative release is also possible, when at fixed time drug will erode from inside. This is particularly useful for prolonged GIT absorption. The second subtype is Pendant systems where hydrolysis pendant group to break it free and be released from the backbone and diffusion of bulk polymer takes place. The rate of release depends on the hydrolysis of ester. Also in the HLB ratio. The more hydrophobic functional groups of polymer, the more slow release rate.
The third type is Water penetration- controlled DSS. The drug is being delivered through osmosis (Water transport through semipermeable membrane to form concentration solution inside, drug is pushed out through the hole) or swelling (water penetration into glossy polymer). Osmosis can be direct or indirect and more controlled, depending on the needs. An example of an osmotic device is OROS which provides CR for 24hrs, can be used for high doses of poorly and highly soluble drugs and improve bioavailability. It has been used to improve PK profile of oxybutin. Swelling controlled devices is affected by polymer structure (physichochemical properties, x-linking), hydrophobicity (polymer and drug contribute) and drug (concentration). The more concentrated, the greater gradient outside and inside. The more hydrophilic (pectin), water enters in rapidly and increases swelling, hydrophobic compounds (HPMC) decrease swelling rate. Mixture of hydroxypropyl and methyl controls swelling rate. There are also devices that can control rate by erosion, swelling and diffusion. Properties of gel can also be tailored by LBG (nice, straight polymer):Xanthan (helical polymer stabilises H-bonding) ratio. When gel formulation is wetted, water ingress allows drug to diffuse out gel. GEMINEX delivery technology combines two drugs together in a bilayer with a unique release profile. By altering polymer properties we can change where and how quickly drug is released. Distance betwee polymer chains is also important when high amylose starch is being used in formulations, such as CONTRAMID. It is safe, compressible, biogegredable, can be chemically x-linked, has a high drug capacity, fexible release profiles and can release multiple drugs. There are more complex systems to, such as GEOMATRIX. It has a hydrophilic HPMC core with drug in it, changing the properties alter parameters of device and tailored released depends on drug barrier. Both layers can expands or it can swell thinly. Water penetration controlled DSS working by swelling are capable of 0 order, quick slow, slow-quick, binary, positioned, acce;erated, delayed and pulsatile release. Burst can also take place in the swelling mechanism and the thicker the membrane, the slower the release. Alginate is an example of a polysaccharide working in this way.
There are four main mechanisms for controlling Drug Release.
The first one is Diffusion-control DDS. When diffusion takes place through a non-porous or micro-porous membrane and water-insoluble polymers coat the drug core [(s)/(l)], the device is called Reservoir and the drug goes in solution when in aqueous environment. Monolithic devices is the second type of diffusion-control DDS. Diffusion takes place through bulk water-insoluble polymer, when water penetrates, drug in solution diffuses. The drug is dissolved in polymer solution prior to device formation and dispersed throughout the device. This tends to be used for implantable devices.
The second type of CDDS is Chemically-controlled ones, where diffusion is similar to the matrix monolithic device. Drug is dissolved in (natural or synthetic and water-soluble or water degradable) polymer solution prior to device formation and is released as the polymer matrix breaks down. Predominantly for long-term implantation. There are two subtypes: monolithic devices, where either pure polymer erodes (surface erosion, decreasing ph, increases autocatalytic degradation of polymer backbone by acid addition or SAVIT delivery technology where coating is non-erodible and active erodible matrix erodes at both ends) or combination of erosion and diffusion takes place (bulk erosion, PLGA is commonly used and FDA approved). Multiple drug can be delivered at specific times and locations through the CHRONOP delivery technology and alternative pulsative release is also possible, when at fixed time drug will erode from inside. This is particularly useful for prolonged GIT absorption. The second subtype is Pendant systems where hydrolysis pendant group to break it free and be released from the backbone and diffusion of bulk polymer takes place. The rate of release depends on the hydrolysis of ester. Also in the HLB ratio. The more hydrophobic functional groups of polymer, the more slow release rate.
The third type is Water penetration- controlled DSS. The drug is being delivered through osmosis (Water transport through semipermeable membrane to form concentration solution inside, drug is pushed out through the hole) or swelling (water penetration into glossy polymer). Osmosis can be direct or indirect and more controlled, depending on the needs. An example of an osmotic device is OROS which provides CR for 24hrs, can be used for high doses of poorly and highly soluble drugs and improve bioavailability. It has been used to improve PK profile of oxybutin. Swelling controlled devices is affected by polymer structure (physichochemical properties, x-linking), hydrophobicity (polymer and drug contribute) and drug (concentration). The more concentrated, the greater gradient outside and inside. The more hydrophilic (pectin), water enters in rapidly and increases swelling, hydrophobic compounds (HPMC) decrease swelling rate. Mixture of hydroxypropyl and methyl controls swelling rate. There are also devices that can control rate by erosion, swelling and diffusion. Properties of gel can also be tailored by LBG (nice, straight polymer):Xanthan (helical polymer stabilises H-bonding) ratio. When gel formulation is wetted, water ingress allows drug to diffuse out gel. GEMINEX delivery technology combines two drugs together in a bilayer with a unique release profile. By altering polymer properties we can change where and how quickly drug is released. Distance betwee polymer chains is also important when high amylose starch is being used in formulations, such as CONTRAMID. It is safe, compressible, biogegredable, can be chemically x-linked, has a high drug capacity, fexible release profiles and can release multiple drugs. There are more complex systems to, such as GEOMATRIX. It has a hydrophilic HPMC core with drug in it, changing the properties alter parameters of device and tailored released depends on drug barrier. Both layers can expands or it can swell thinly. Water penetration controlled DSS working by swelling are capable of 0 order, quick slow, slow-quick, binary, positioned, acce;erated, delayed and pulsatile release. Burst can also take place in the swelling mechanism and the thicker the membrane, the slower the release. Alginate is an example of a polysaccharide working in this way.
The fourth and last type of DSS is responsive DSS. Drug release can be controlled by temperature (some polymers undergo a sol-gel transition upon a temp. change), ph (changes in ionisation or cleavage of functional groups due to altered ph can affect sol-gel behaviour, drugs can be loeaded in acidic branched polymers and by repleiing drug can go out), chemicals, enzymes (GIT lots of bac. espesh in colon have enzymes that can be used in delivery systems and an increased drug plasma concentration is being observed as the drug is released by degrading enzymes), ultrasound, magnetism, light, mechanical force (disrupts matrix by compression, sqeezing drug out and allowing it to be released) and IR radiation (insulin released from nanoparticles).
Reflecting on aseptic practical
I have concluded that maybe it is better and safer for patients and me to work as a community pharmacist. Aseptic practical today was really useful to understand what can go wrong in the preparation of these products and how to handle syringes, which is different learning all these information theoretically or watching a youtube video from being in a lab preparing a injection product. I think that in my practical several things went wrong and I have actually realised how precise and responsible technicians and clinical pharmacists should be when dealing with such preparations. Also, through the practical, I have realised that I am actually needlephobic. :S Lastly, I have reflected on the option of doing a pre-registration in hospital and I have concluded that however interesting hospital pharmacy may be, I would enjoy more dealing with all the community health care cases and the business, management and marketing side of pharmacy. I like business&management anyway. I am finally more orientated on my final goal and the future carrer outcome of my degree.
Πέμπτη 22 Απριλίου 2010
THE SEVEN PRINCIPLES
1. MAKE THE CARE OF PATIENTS YOUR FIRST CONCERN
2. EXERCISE YOUR PROFESSIONAL JUDGEMENT IN THE INTERESTS OF
PATIENTS AND THE PUBLIC
3. SHOW RESPECT FOR OTHERS
4. ENCOURAGE PATIENTS TO PARTICIPATE IN DECISIONS ABOUT THEIR CARE
5. DEVELOP YOUR PROFESSIONAL KNOWLEDGE AND COMPETENCE
6. BE HONEST AND TRUSTWORTHY
7. TAKE RESPONSIBILITY FOR YOUR WORKING PRACTICES
2. EXERCISE YOUR PROFESSIONAL JUDGEMENT IN THE INTERESTS OF
PATIENTS AND THE PUBLIC
3. SHOW RESPECT FOR OTHERS
4. ENCOURAGE PATIENTS TO PARTICIPATE IN DECISIONS ABOUT THEIR CARE
5. DEVELOP YOUR PROFESSIONAL KNOWLEDGE AND COMPETENCE
6. BE HONEST AND TRUSTWORTHY
7. TAKE RESPONSIBILITY FOR YOUR WORKING PRACTICES
Δευτέρα 19 Απριλίου 2010
Κυριακή 18 Απριλίου 2010
10 Diet Commandments for Pain Patients
ttp://health.msn.com/health-topics/pain-management/fibromyalgia/slideshow.aspx?cp-documentid=100246652&imageindex=1
Δευτέρα 12 Απριλίου 2010
Xanthomas
I was reading through a msn article today on cholesterol. You can find here: http://health.msn.com/health-topics/cholesterol/articlepage.aspx?cp-documentid=100252282&page=1>1=31007 and I didn't know what xanthomas are, so I have decided to check the term out.
Xanthomas are fat deposits found under the skin and it looks pretty much like this:
More information and pictures can be found in medline plus link:
Τετάρτη 31 Μαρτίου 2010
Additional reader
I have just noticed that this blog has 2 readers and I am quite happy and impressed about it! The texts/ videos in here are not mine, they are just a collection of resources that I find in the process of learning! I think that blogging is a great way of applying CPD cycles and it is a really handy way of tracing what one has learned and remind themselves what they have learned and are supposed to know. At least that is how it works for me. I also hope to write something on my own one day and not just have a collection of links and texts written by others. In any case, I hope you find this blog useful.
Σάββατο 20 Μαρτίου 2010
Παρασκευή 19 Μαρτίου 2010
MIchael Neary
Michael Neary is a retired Irish consultant obstetrician/gynecologist. He gained notoriety when it was discovered that he had performed what was considered an inordinate number of caesarian hysterectomies during his time at Our Lady of Lourdes Hospital in Drogheda, County Louth. He was suspended by the Irish Medical Council in 1999 pending their investigations, and then struck off the Register of Medical Practitioners in 2003. As a result of the Medical Council's investigation, which discovered a number of alarming aspects to the case, an inquiry was set up in April 2004 by the then Minister for Health and Children, Micheál Martin to investigate the matter. Their report was made public by the Tánaiste, and Minister for Health Mary Harney in February 2006. The Lourdes Hospital Inquiry report was written by Judge Maureen Harding-Clarke, a prominent Irish judge. She and her team interviewed Dr Neary himself, most hospital staff in Drogheda and various action groups and patients.
During the inquiry, Judge Harding-Clarke's offices were broken into at least three times, she has said.
Her report repeated many findings of the Medical Council's investigation (which she criticised for taking too long), but delved much deeper into Dr Neary's actions, and those of his colleagues.
During the inquiry, Judge Harding-Clarke's offices were broken into at least three times, she has said.
Her report repeated many findings of the Medical Council's investigation (which she criticised for taking too long), but delved much deeper into Dr Neary's actions, and those of his colleagues.
http://en.wikipedia.org/wiki/Michael_Neary_(surgeon)
http://www.rte.ie/tv/whistleblower/index.html
Τετάρτη 17 Μαρτίου 2010
Κυριακή 14 Μαρτίου 2010
Difference between Diabetes Inipidus and Diabetes Mellitus
Diabetes Insipidus is a result of other pituitary not secreting enough vasopressin or kidneys not responding to vasopressin. This has as a consequence excessive water secretion, as water cannot be reabsorbed. Usually polyuria is sudden, polydipsia and dehydration are also symptoms of Diabetes Insipidus. If it is Central Diabetes Insipidus, then desmopressin is recommended as a tretment. In Nephrogenic Diabetes Insipidus a low sodium intake is recommende and treatment includes the concomintant use of thiazide and potassium-sparing diuretics.
Diabetes Mellitus is associated to insulin. In Type 1 Diabetes, there not enough insulin being secreted, whereas in type 2 insulin is present but cells fail to respond to it. Type 1 Diabetics are treated with insulin replacement, whereas type 2are treated by Oral sulfonylureas (like glimepiride, glyburide, and tolazamide), Biguanides (Metformin), Alpha-glucosidase inhibitors (such as acarbose),Thiazolidinediones (such as rosiglitazone) and Meglitinides (including repaglinide and nateglinide. Metformin is usually the treatment of choice. As for the symptoms present in Diabetes Mellitus include polyuria, polydipsia, polyphagia, weight changes, tiredness and skin infections.
http://www.diabetesinsipidus.org/4di_di_vs_dm.htm
Diabetes Mellitus is associated to insulin. In Type 1 Diabetes, there not enough insulin being secreted, whereas in type 2 insulin is present but cells fail to respond to it. Type 1 Diabetics are treated with insulin replacement, whereas type 2are treated by Oral sulfonylureas (like glimepiride, glyburide, and tolazamide), Biguanides (Metformin), Alpha-glucosidase inhibitors (such as acarbose),Thiazolidinediones (such as rosiglitazone) and Meglitinides (including repaglinide and nateglinide. Metformin is usually the treatment of choice. As for the symptoms present in Diabetes Mellitus include polyuria, polydipsia, polyphagia, weight changes, tiredness and skin infections.
http://www.diabetesinsipidus.org/4di_di_vs_dm.htm
Σάββατο 13 Μαρτίου 2010
Παρασκευή 12 Μαρτίου 2010
Generics for Epilepsy?
http://mediazone.brighttalk.com/comm/Wiley/8a1bbf4f92-15186-3326-16098
http://mediazone.brighttalk.com/comm/Wiley/2da40f9b0b-15187-3326-16100
http://mediazone.brighttalk.com/comm/Wiley/99fa6f0cac-15185-3326-16099
http://mediazone.brighttalk.com/comm/Wiley/e8636b31df-15188-3326-16101
Interesting Presentations
http://mediazone.brighttalk.com/comm/Wiley/2da40f9b0b-15187-3326-16100
http://mediazone.brighttalk.com/comm/Wiley/99fa6f0cac-15185-3326-16099
http://mediazone.brighttalk.com/comm/Wiley/e8636b31df-15188-3326-16101
Interesting Presentations
For Applications and Interviews
Applicants are advised to show interest in company or trust they apply for, not just community or NHS. It is useful if they read about the hospital or company and what they offer and cliches should be avoided.
Πέμπτη 11 Μαρτίου 2010
PANDAS
PANDAS, is an abbreviation for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. The term is used to describe a subset of children who have Obsessive Compulsive Disorder (OCD) and/or tic disorders such as Tourette's Syndrome, and in whom symptoms worsen following strep. infections such as "Strep throat" and Scarlet Fever.
The children usually have dramatic, "overnight" onset of symptoms, including motor or vocal tics, obsessions, and/or compulsions. In addition to these symptoms, children may also become moody, irritable or show concerns about separating from parents or loved ones. This abrupt onset is generally preceeded by a Strep. throat infection.
What is the mechanism behind this phenomenon? At present, it is unknown but researchers at the NIMH are pursuing a theory that the mechanism is similar to that of Rheumatic Fever, an autoimmune disorder triggered by strep. throat infections. In every bacterial infection, the body produces antibodies against the invading bacteria, and the antibodies help eliminate the bacteria from the body. However in Rheumatic Fever, the antibodies mistakenly recognize and "attack" the heart valves, joints, and/or certain parts of the brain. This phenomenon is called "molecular mimicry", which means that proteins on the cell wall of the strep. bacteria are similar in some way to the proteins of the heart valve, joints, or brain. Because the antibodies set off an immune reaction which damages those tissues, the child with Rheumatic Fever can get heart disease (especially mitral valve regurgitation), arthritis, and/or abnormal movements known as Sydenham’s Chorea or St. Vitus Dance.
In PANDAS, it is believed that something very similar to Sydenham’s Chorea occurs. One part of the brain that is affected in PANDAS is the Basal Ganglia, which is believed to be responsible for movement and behavior. Thus, the antibodies interact with the brain to cause tics and/or OCD, instead of Sydenham Chorea.
http://intramural.nimh.nih.gov/pdn/web.htm
Τρίτη 9 Μαρτίου 2010
The best healthy fast-foods in America
Some of the tips on how to reduce the calories of meals and drinks ae really good.
http://eatthis.womenshealthmag.com/slide/best-restaurant-sundae?slideshow=98360#title
http://eatthis.womenshealthmag.com/slide/best-restaurant-sundae?slideshow=98360#title
Κυριακή 7 Μαρτίου 2010
Citation Online only2010;.Elizabeth Lee did not contribute to patient’s death, says coroner
Elizabeth Lee’s dispensing error has not contributed towards Carmel Sheller’s death.
However, from her error there are several things that when improved dispensing will be safer, such as packaging, checking and breaks.
Pharmaceutical companies should not make similar packets, having the same colour.
Double checking should be always done, even if the Pharmacy dispenses the medicine.
Pharmacists should have proper breaks, even if that means they have to leave the premises.
http://www.pjonline.com/news/elizabeth_lee_did_not_contribute_to_patient%E2%80%99s_death_says_coroner
However, from her error there are several things that when improved dispensing will be safer, such as packaging, checking and breaks.
Pharmaceutical companies should not make similar packets, having the same colour.
Double checking should be always done, even if the Pharmacy dispenses the medicine.
Pharmacists should have proper breaks, even if that means they have to leave the premises.
http://www.pjonline.com/news/elizabeth_lee_did_not_contribute_to_patient%E2%80%99s_death_says_coroner
Πέμπτη 4 Μαρτίου 2010
The truth about tanning
It is a BBC programme where Nicola Roberts is exploring the truth about tanning. In the programme Nicola makes various home visits accross the country to make people aware about the risks of sun-tanning and fake tanning. In a trial to persuade funs of tanning to not overdo it, she highlights the importance of natural beauty and conservation of natural colour. With this programme Nicola participated in a campaign and sheded light into skin cancer associated with tanning.
To watch it follow the link.
If you are a non-UK resident try to find videos on you tube.
Τρίτη 2 Μαρτίου 2010
Regulation of the Pharmaceutical Industry
UK: Medicines and Healthcare products Regulatory Agency
MHRA previously called the MCA ( http://www.mhra.gov.uk/ )
Europe European Agency for the Evaluation of Medicinal Products
EMEA ( http://www.emea.eu.int/ )
USA Food and Drug Administration
FDA ( http://www.fda.gov/ )
Japan Pharmaceutical and Food Safety Bureau
PFSB ( http://www.mhlw.go.jp/english/org/policy/p13-14.html )
Australia Therapeutic Goods Administration
TGA ( http://www.health.gov.au/tga/ )
International International Committee on Harmonisation
( http://www.ich.org/ )
MHRA previously called the MCA ( http://www.mhra.gov.uk/ )
Europe European Agency for the Evaluation of Medicinal Products
EMEA ( http://www.emea.eu.int/ )
USA Food and Drug Administration
FDA ( http://www.fda.gov/ )
Japan Pharmaceutical and Food Safety Bureau
PFSB ( http://www.mhlw.go.jp/english/org/policy/p13-14.html )
Australia Therapeutic Goods Administration
TGA ( http://www.health.gov.au/tga/ )
International International Committee on Harmonisation
( http://www.ich.org/ )
Τρίτη 23 Φεβρουαρίου 2010
Cinchonism
side effect of antimalarial quinine
a condition resulting from an excessive dose of cinchona bark or its alkaloids, characterized chiefly by headache, ringing in the ears, and vomiting
Κυριακή 14 Φεβρουαρίου 2010
How much time needed to burn off a 360-calorie blueberry muffin for a 70 kg, 30-year old women?
66 minutes of lean mowing,
77 minutes of cycling at an easy pace,
92 minutes of vacuuming and
115 minutes of weightlifting.
http://iceycodez.blogspot.com/2009/08/exercising-make-you-fat.html
Τετάρτη 3 Φεβρουαρίου 2010
Sleeping Sickness
"Human African trypanosomiasis or sleeping sickness is a widespread tropical disease that can be fatal if not treated. It is spread by the bite of an infected tsetse fly (Glossina Genus).
The tsetse fly bite erupts into a red sore and within a few weeks the person can experience fever, swollen lymph glands, aching muscles and joints, headaches and irritability.
In advanced stages, the disease attacks the central nervous system, causing changes in personality, alteration of the biological clock (the circadian rhythm), confusion, slurred speech, seizures, and difficulty walking and talking. These problems can develop over many years in the Gambiense form and some months in the Rhodesiense form; if not treated, the person will die.
Control of sleeping sickness is based on reduction of the reservoirs of infection by early diagnosis and control of tsetse flies."
http://www.who.int/topics/trypanosomiasis_african/en/
The tsetse fly bite erupts into a red sore and within a few weeks the person can experience fever, swollen lymph glands, aching muscles and joints, headaches and irritability.
In advanced stages, the disease attacks the central nervous system, causing changes in personality, alteration of the biological clock (the circadian rhythm), confusion, slurred speech, seizures, and difficulty walking and talking. These problems can develop over many years in the Gambiense form and some months in the Rhodesiense form; if not treated, the person will die.
Control of sleeping sickness is based on reduction of the reservoirs of infection by early diagnosis and control of tsetse flies."
http://www.who.int/topics/trypanosomiasis_african/en/
Τετάρτη 27 Ιανουαρίου 2010
Πέμπτη 21 Ιανουαρίου 2010
Proteins post-translational modifications
http://images.google.com/imgres?imgurl=http://bass.bio.uci.edu/~hudel/bs99a/lecture26/phosphoaa.gif&imgrefurl=http://bass.bio.uci.edu/~hudel/bs99a/lecture26/lecture7_3.html&usg=__nGDeOefIMjPxSoliWo8T1c2Jsxs=&h=581&w=510&sz=18&hl=el&start=8&um=1&itbs=1&tbnid=DGnhgZ7y7pScjM:&tbnh=134&tbnw=118&prev=/images%3Fq%3Dserine%2Bphosphorylation%26hl%3Del%26lr%3D%26rls%3Dcom.microsoft:el:IE-SearchBox%26rlz%3D1I7ADBF_en%26sa%3DN%26um%3D1
http://themedicalbiochemistrypage.org/protein-modifications.html
http://themedicalbiochemistrypage.org/protein-modifications.html
Τετάρτη 20 Ιανουαρίου 2010
Stevens-Johnson syndrome
It can be a side of antiretroviral Nevirapine:
Stevens-Johnson syndrome is a rare, serious disorder in which your skin and mucous membranes react severely to a medication or infection. Often, Stevens-Johnson syndrome begins with flu-like symptoms, followed by a painful red or purplish rash that spreads and blisters, eventually causing the top layer of your skin to die and shed.
Stevens-Johnson syndrome is an emergency medical condition that usually requires hospitalization. Treatment focuses on eliminating the underlying cause, controlling symptoms and minimizing complications.
Recovery after Stevens-Johnson syndrome can take weeks to months, depending on the severity of your condition. If your doctor determines that your case of Stevens-Johnson syndrome was caused by medication, you'll need to permanently avoid the medication and all others related to it.
http://www.mayoclinic.com/health/stevens-johnson-syndrome/DS00940/DSECTION=symptoms
Stevens-Johnson syndrome is a rare, serious disorder in which your skin and mucous membranes react severely to a medication or infection. Often, Stevens-Johnson syndrome begins with flu-like symptoms, followed by a painful red or purplish rash that spreads and blisters, eventually causing the top layer of your skin to die and shed.
Stevens-Johnson syndrome is an emergency medical condition that usually requires hospitalization. Treatment focuses on eliminating the underlying cause, controlling symptoms and minimizing complications.
Recovery after Stevens-Johnson syndrome can take weeks to months, depending on the severity of your condition. If your doctor determines that your case of Stevens-Johnson syndrome was caused by medication, you'll need to permanently avoid the medication and all others related to it.
http://www.mayoclinic.com/health/stevens-johnson-syndrome/DS00940/DSECTION=symptoms
Τρίτη 19 Ιανουαρίου 2010
Τρίτη 12 Ιανουαρίου 2010
Wilson disease
Wilson disease is a genetic disorder that prevents the body from getting rid of extra copper. A small amount of copper obtained from food is needed to stay healthy, but too much copper is poisonous. In Wilson disease, copper builds up in the liver, brain, eyes, and other organs. Over time, high copper levels can cause life-threatening organ damage.
Vitamin D metabolism
Pro-Vit.D--> Vit.D3 (in skin with UV light)
Vit.D3--> 25-0H (in liver)
25-OH--> 1,25 (0H)2 (in kidneys)
http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/otherendo/vitamind.html
Vit.D3--> 25-0H (in liver)
25-OH--> 1,25 (0H)2 (in kidneys)
http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/otherendo/vitamind.html
Κυριακή 10 Ιανουαρίου 2010
Grief
"Grief is the normal process of reacting to the loss. Grief reactions may be felt in response to physical losses (for example, a death) or in response to symbolic or social losses (for example, divorce or loss of a job). Each type of loss means the person has had something taken away. As a family goes through a cancer illness, many losses are experienced, and each triggers its own grief reaction. Grief may be experienced as a mental, physical, social, or emotional reaction. Mental reactions can include anger, guilt, anxiety, sadness, and despair. Physical reactions can include sleeping problems, changes in appetite, physical problems, or illness. Social reactions can include feelings about taking care of others in the family, seeing family or friends, or returning to work. As with bereavement, grief processes depend on the relationship with the person who died, the situation surrounding the death, and the person’s attachment to the person who died. Grief may be described as the presence of physical problems, constant thoughts of the person who died, guilt, hostility, and a change in the way one normally acts.
Bereavement is the period after a loss during which grief is experienced and mourning occurs. The time spent in a period of bereavement depends on how attached the person was to the person who died, and how much time was spent anticipating the loss.
Mourning is the process by which people adapt to a loss. Mourning is also influenced by cultural customs, rituals, and society’s rules for coping with loss."
"Being aware of your feelings and their natural flow has several advantages. Your feelings both warn you and assure you. They act as indicators of how you are at the moment or over a stretch of time. Feelings can gauge of your sense of being fully alive.
Feelings can be locked inside and consequently, keep an experience very much alive. If this is a painfilled emotion, the weight of it can drag you down year after year. To prevent being diminished in any way, it is important that we recognize that the feeling exists, understand why it is there, talk about it with someone that is trustworthy, let go of it, and move on.
Your feelings reflect the way you perceive the world around you, as well as yourself. Without awareness of your feelings, we have no real awareness of life itself. You may be afraid to express your honest feelings out of fear or rejections, ridicule, or loss of control of your feelings. The negative feelings, such as anger, depression or loneliness, are often buried deep inside. But these feelings are buried alive and in time will surface. Unfortunately, they may appear when you least expect them and you may misdirect them. It is essential that you express your honest feelings. Feelings can keep people apart or bring them together; they can build walls or build bridges. What is important is that they are shared with a significant someone in your life. The expression of feelings will not always change a situation, but it may change the understanding and attitude regarding the situation."
http://www.hospicenet.org/html/grief_guide.html
http://www.rainbows.org/index.asp
http://www.rainbows.org/docs/feelings.pdf
http://www.rainbows.org/docs/HELPINGCHILDREN.pdf http://hcd2.bupa.co.uk/fact_sheets/html/Bereavement.html
Bereavement is the period after a loss during which grief is experienced and mourning occurs. The time spent in a period of bereavement depends on how attached the person was to the person who died, and how much time was spent anticipating the loss.
Mourning is the process by which people adapt to a loss. Mourning is also influenced by cultural customs, rituals, and society’s rules for coping with loss."
"Being aware of your feelings and their natural flow has several advantages. Your feelings both warn you and assure you. They act as indicators of how you are at the moment or over a stretch of time. Feelings can gauge of your sense of being fully alive.
Feelings can be locked inside and consequently, keep an experience very much alive. If this is a painfilled emotion, the weight of it can drag you down year after year. To prevent being diminished in any way, it is important that we recognize that the feeling exists, understand why it is there, talk about it with someone that is trustworthy, let go of it, and move on.
Your feelings reflect the way you perceive the world around you, as well as yourself. Without awareness of your feelings, we have no real awareness of life itself. You may be afraid to express your honest feelings out of fear or rejections, ridicule, or loss of control of your feelings. The negative feelings, such as anger, depression or loneliness, are often buried deep inside. But these feelings are buried alive and in time will surface. Unfortunately, they may appear when you least expect them and you may misdirect them. It is essential that you express your honest feelings. Feelings can keep people apart or bring them together; they can build walls or build bridges. What is important is that they are shared with a significant someone in your life. The expression of feelings will not always change a situation, but it may change the understanding and attitude regarding the situation."
http://www.hospicenet.org/html/grief_guide.html
http://www.rainbows.org/index.asp
http://www.rainbows.org/docs/feelings.pdf
http://www.rainbows.org/docs/HELPINGCHILDREN.pdf http://hcd2.bupa.co.uk/fact_sheets/html/Bereavement.html
http://www.crusebereavementcare.org.uk/
http://www.mind.org.uk/
http://www.rcpsych.ac.uk/
http://www.childbereavement.org.uk/
Τρίτη 5 Ιανουαρίου 2010
Wernicke-Korsakov syndrome
Detoxification may precipitate Wernicke’s encephalopathy, which must be treated urgently with parenteral thiamine. There is a very small risk of anaphylaxis with parenteral vitamin supplementation. This is less likely with the intramuscular route. There has been one case of anaphylaxis solely attributable to intramuscular Pabrinex since 1996.
Symptoms
◦confusion
◦ataxia, especially truncal ataxia
◦ophthalmoplegia
◦nystagmus
◦memory disturbance
◦hypothermia and hypotension
◦coma
http://www.sign.ac.uk/guidelines/fulltext/74/section4.html
Community Pharmacy and alcohol
Community pharmacy involvement in public health services
There is evidence of the effectiveness of community pharmacy-based public health
interventions such as smoking cessation and methadone maintenanceix for addictions, and in the management of osteoporosis, diabetes and raised cholesterol, but to deliver brief interventions, pharmacists and their staff will need substantial training and support. One study (on methadone-maintenance interventions) suggests that training in motivational interviewing changes pharmacists’ attitudes and belief in self-efficacy. Service users report positive experiences of using community pharmacy-based public health services, suggesting these services are acceptable as well as effective. Pharmacists can be reluctant to initiate discussions with customers on what they perceive to be ‘sensitive’ subjects, and as a result they tend to be reactive rather than proactive.
Choosing Health Through Pharmacy identified opportunistic advice, brief interventions and offering floor space to other health professionals as areas where community pharmacy could make a contributionxiii. These are activities with which community pharmacists can engage, particularly as their public health role has recently been formalised in the new contractual arrangements for Scotland, England and Wales. In England and Wales, pharmacies are required to participate in up to six public health campaigns each year, with topics decided by local primary care organisations (PCOs). In Scotland, Tier 2 of the public health component of the pharmacy contract stipulates participation in up to four public health campaigns each year and allocation of dedicated display space for posters.
Interventions for alcohol misuse
1. Alcohol screening and assessment
ease and speed of use
good sensitivity (to identify people at risk of alcohol misuse)
good specificity (to identify people not at risk of alcohol misuse)
2. Brief interventions
Brief interventions for alcohol misuse are of four main types:
alcohol education
simple advice
simple advice plus brief counselling and continued monitoring
referral to specialist services for diagnostic evaluation and treatment.
The main characteristics of brief interventions include the following:
duration of five to 45 minutes
optional use of protocols or guidelines
they are distinct from brief advice (which usually lasts up to three minutes).
3. Leaflets displayed
4. Cooperation with other Pharmacies, NHS services
5. Appropriate training, communication, psychology of change
http://www.rpsgb.org.uk/pdfs/commpharmalcmisuseservices.pdf
http://www.hm-treasury.gov.uk/d/pbr_csr07_psa25.pdf
There is evidence of the effectiveness of community pharmacy-based public health
interventions such as smoking cessation and methadone maintenanceix for addictions, and in the management of osteoporosis, diabetes and raised cholesterol, but to deliver brief interventions, pharmacists and their staff will need substantial training and support. One study (on methadone-maintenance interventions) suggests that training in motivational interviewing changes pharmacists’ attitudes and belief in self-efficacy. Service users report positive experiences of using community pharmacy-based public health services, suggesting these services are acceptable as well as effective. Pharmacists can be reluctant to initiate discussions with customers on what they perceive to be ‘sensitive’ subjects, and as a result they tend to be reactive rather than proactive.
Choosing Health Through Pharmacy identified opportunistic advice, brief interventions and offering floor space to other health professionals as areas where community pharmacy could make a contributionxiii. These are activities with which community pharmacists can engage, particularly as their public health role has recently been formalised in the new contractual arrangements for Scotland, England and Wales. In England and Wales, pharmacies are required to participate in up to six public health campaigns each year, with topics decided by local primary care organisations (PCOs). In Scotland, Tier 2 of the public health component of the pharmacy contract stipulates participation in up to four public health campaigns each year and allocation of dedicated display space for posters.
Interventions for alcohol misuse
1. Alcohol screening and assessment
ease and speed of use
good sensitivity (to identify people at risk of alcohol misuse)
good specificity (to identify people not at risk of alcohol misuse)
2. Brief interventions
Brief interventions for alcohol misuse are of four main types:
alcohol education
simple advice
simple advice plus brief counselling and continued monitoring
referral to specialist services for diagnostic evaluation and treatment.
The main characteristics of brief interventions include the following:
duration of five to 45 minutes
optional use of protocols or guidelines
they are distinct from brief advice (which usually lasts up to three minutes).
3. Leaflets displayed
4. Cooperation with other Pharmacies, NHS services
5. Appropriate training, communication, psychology of change
http://www.rpsgb.org.uk/pdfs/commpharmalcmisuseservices.pdf
http://www.hm-treasury.gov.uk/d/pbr_csr07_psa25.pdf
Δευτέρα 4 Ιανουαρίου 2010
Κυριακή 3 Ιανουαρίου 2010
Σάββατο 2 Ιανουαρίου 2010
Elective surgery:
Surgery that is subject to choice (election). The choice may be made by the patient or doctor.
For example, the time when a surgical procedure is performed may be elective. The procedure is beneficial to the patient but does not need be done at a particular time.
As opposed to urgent or emergency surgery.
http://www.medterms.com/script/main/art.asp?articlekey=14367
For example, the time when a surgical procedure is performed may be elective. The procedure is beneficial to the patient but does not need be done at a particular time.
As opposed to urgent or emergency surgery.
http://www.medterms.com/script/main/art.asp?articlekey=14367
Παρασκευή 1 Ιανουαρίου 2010
intertrigo
The diagnosis intertrigo refers to an inflammation of the body folds. This is usually located in the inner thighs, armpits, and underside of the breasts or belly. It is red and raw looking. It may itch, ooze or be a little sore.
It is most often due to chafing together of the warm, moist skin, especially in those who are overweight or diabetic. Infection with bacteria or yeast will then develop in the broken skin. A dermatologist should evaluate the condition since there are also several skin diseases that can cause an intertrigo to develop (inverse psoriasis, Haily-Haily, pemphigus, bullous pemphigoid, glucagonoma and others).
Yeast or bacterial infection can be treated with topical or oral medications. Oozing may be controlled with moist compresses with Burows solution 1:20 followed by air drying, preferably using a hair dryer with a "cool" setting. Prescription topical steroid creams such as hydrocortisone can be used, but only for a few weeks. Stronger topical steroid creams will be more rapidly effective, but if used for more than a few days may cause serious skin damage.
Keeping the area dry and exposed to the air can prevent recurrences. If obese, weight loss is helpful. A wad of soft absorbent cotton, or a band of cotton fabric will help absorb sweat. Antiperspirants will help if excess sweating is part of the problem but should only be tried when it has completely healed. It also helps to wash daily with an antibacterial soap and dust with Zeasorb AF Powder.
Relapses are common with this condition, and revisits periodically to the dermatologist may be needed to adjust treatments in many cases.
It is most often due to chafing together of the warm, moist skin, especially in those who are overweight or diabetic. Infection with bacteria or yeast will then develop in the broken skin. A dermatologist should evaluate the condition since there are also several skin diseases that can cause an intertrigo to develop (inverse psoriasis, Haily-Haily, pemphigus, bullous pemphigoid, glucagonoma and others).
Yeast or bacterial infection can be treated with topical or oral medications. Oozing may be controlled with moist compresses with Burows solution 1:20 followed by air drying, preferably using a hair dryer with a "cool" setting. Prescription topical steroid creams such as hydrocortisone can be used, but only for a few weeks. Stronger topical steroid creams will be more rapidly effective, but if used for more than a few days may cause serious skin damage.
Keeping the area dry and exposed to the air can prevent recurrences. If obese, weight loss is helpful. A wad of soft absorbent cotton, or a band of cotton fabric will help absorb sweat. Antiperspirants will help if excess sweating is part of the problem but should only be tried when it has completely healed. It also helps to wash daily with an antibacterial soap and dust with Zeasorb AF Powder.
Relapses are common with this condition, and revisits periodically to the dermatologist may be needed to adjust treatments in many cases.
http://www.aocd.org/skin/dermatologic_diseases/intertrigo.html
Gallstones
Stones in gallbladder. They can be cholesterol or pigment stones. Obesity is a contributing factor. Read more here:
http://digestive.niddk.nih.gov/ddiseases/pubs/gallstones/
http://digestive.niddk.nih.gov/ddiseases/pubs/gallstones/
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