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[arushmichael]

Chronic Myeloid Leukemia

By Arush Emmanuel Michael

Chronic myeloid leukemia or chronic granulocyte leukemia is characterised by the presence of increased leukocytes known as leukocytosis and immaturity of granulocytes along with basophilia (increased basophils), splenomegaly (enlargement of spleen) which is all caused by a stem cell disorder which is the result of the formation of BCR-ABL fusion gene which is also known as the Philadelphia chromosome which is the hallmark diagnostic features of chronic myeloid leukemia.

Molecular biology of Chronic Myeloid Leukemia

The reciprocal translocation of long arm of chromosome 22 and chromosome 9 results in the formation of the BCR-ABL fusion gene which encodes for greater activity of tyrosine kinase and impedes apoptosis (cell death). Increased tyrosine kinase of the stem cell causes uncontrolled proliferation and multiplication of the myeloid cells which results in the condition which is Chronic Myeloid Leukemia. If you are diagnosed with any condition and are prescribed treatment you can now buy medicines online in India.

Phases of Chronic Myeloid Leukemia

Chronic Myeloid Leukemia has three phases namely

The chronic phase

The accelerated phase

The blastic phase

If you are diagnosed with the condition and are prescribed medication you can now order medicines online in India.

Symptoms and Clinical features of Chronic Myeloid Leukemia

The disease is insidious in onset with a feeling of fatigue, not feeling hungry and general abdominal discomfort. The person's weight decreases and there is increased sweating. Leukostasis leads to development of visual disturbances and venous thrombosis. There is mild to moderate pallor which might develop. The person's spleen is enlarged moderately as a result of leukemia infiltration and there is resultant pain in the lefts side of abdomen as a result of inflammation of the spleen. The leukemia infiltrate might also result in enlargement of the liver. Leukostasis can cause painful penile erections in male patients.

Haematologic findings of Chronic Myeloid Leukemia

There is a decrease in haemoglobin however the red blood cells are normal in size and colour. There is leukocytosis which refers to the increase in the total leukocyte count There is the presence of immature white blood cells in the blood with a preponderance of myelocytes. The patient also demonstrates basophilia and Eosinophilia. The neutrophil alkaline phosphatase is decreased to zero to twenty. Conclusion

Most patients are known to present in the chronic stable phase which lasts for around two to five years. The patient then progresses into the accelerated phase lasting for a few months with the blasts proliferating and finally the patient enters the blastic phase which is fatal and the patients undergo marrow fibrosis amongst other features.

[arushmichael]

Aplastic Anaemia: Causes, Clinical Features and Treatment

By Arush Emmanuel Michael

Aplastic Anemias include a group of disorders characterised by the replacement of the haematopoietic cells of the bone marrow by fat which results in the gradual decrease of the overall cell count in the blood and cytopenias. Over time, the decrease in neutrophils/ neutropenia results in infections and the decrease in platelets/thrombocytopenia results in bleeding episodes.

Causes of Aplastic Anaemia

Aplastic anaemia can be caused by a number of factors namely:

Idiopathic Aplastic Anaemia: In round about sixty percent of the cases of aplastic anemia the cause of the condition can’t be found and thus the disease is idiopathic.

Inherited Aplastic Anaemia: The condition can be inherited in the case of fanconi’s syndrome as the genetic make-up of the person predisposes them to aplastic anaemia.

Acquired Aplastic Anaemia: The condition that is aplastic anaemia can also be acquired due to physical agents such as ionizing radiations, chemical agents like benzene and commercial solvents. Patients infected with the Hepatitis A virus as well as non-A and non-B Hepatitis virus, Parvo virus B-19 have a predisposition to undergo bone marrow aplasia, this occurs around six to sixteen weeks after jaundice. These patients with viral infections have a poor prognosis as the disease progresses. A major cause of acquired aplastic anemia is drugs. Intake of antibiotics, anti inflammatory drugs, anti rheumatoid drugs, anti thyroid drugs, psychotropic drugs, anti convulsant drugs and cytotoxic drugs can induce aplastic anaemia in a person.

Pathogenesis of Aplastic Anaemia

A defect in the stem cells and their failure to proliferate and differentiate is the most probable cause that aplastic anaemia develops in a person. There are two conditions that can be resulting in the stem cells defect. Environmental factors and immune mechanisms involving the CD8 cells (T cells) hampering the proliferation and differentiation of stem cells are the two implied factors resulting in development of the condition that is aplastic anaemia.

Clinical Features of Aplastic Anaemia

Thrombocytopenia (decrease in platelets), neutropenia (decrease in neutrophils) and anaemia (decrease in haemoglobin) are the cause of the clinical features in aplastic anaemia.

Petechial haemorrhages, bruises(following trauma) and bleeding from gums are the bleeding manifestations in patients of aplastic anaemia.

Infections of respiratory tract and skin are common in patients of aplastic anaemia due to neutropenia.

Feeling of tiredness, progressive pallor and lassitude also end up developing in patients of aplastic anaemia. . If you are diagnosed with the condition that is aplastic anaemia and are prescribed treatment for the same you can now order medicines online in India.

The patients with severe aplastic anaemia have a very bad prognosis with only a ten percent survival rate after a period of one year. Spontaneous improvement might occur in some cases but patients with moderately severe aplastic anaemia generally do better than patients of severe aplastic anaemia. In some patients, the condition might progress to other stem cell disorders like paroxysmal nocturnal haemoglobinuria and myeloid dysplastic syndrome.

Treatment of Aplastic Anaemia

The patients generally suffer from a decrease in the levels of the blood cells present in the blood, that is pancytopenia. Supportive measure can be given in the form of packed red cells for anaemia, platelets for thrombocytopenia and antibiotics for prophylactic measures in order to prevent infections in patients with severe neutropenia. Marrow activity can be tried to be restored with the help of immunosuppressive therapy, anabolic steroids and allogenic bone marrow transplantation. If you are diagnosed with the condition that is aplastic anaemia and are prescribed treatment for the same you can now order medicines online in India.

Conclusion

 After you consult a doctor, the doctor shall ask you your chief complaints and as to what made you come to the hospital. After this, the doctor shall ask relevant questions pertaining to your condition and your symptoms in order to complete your medical history. This will be followed by a physical examination to check for any more signs and symptoms that might be important in your case. Aplastic anaemia is a serious condition which can be very harmful for you therefore if you face symptoms of the same or any other condition in fact you should immediately consult a doctor and get treatment for the same. You should never self-medicate yourself and always consult a doctor before receiving treatment.

[arushmichael]

Everything you need to know about Ciprofloxacin

By Arush Emmanuel Michael

Spectrum of Ciprofloxacin

Ciprofloxacin mainly act against gram negative bacilli. Escherichia coli, Neisseria gonorrhoeae, Neisseria meningitidis, Enterobacter, Haemophilus influenzae and  Klebsiella pneumoniae are highly susceptible to Ciprofloxacin. Bacteria like P. aeruginosa, Bacillus anthracis and Mycoplasma are moderately susceptible to Ciprofloxacin while Streptococcus pyogenes and Streptococcus pneumoniae show very low susceptibility to Ciprofloxacin.

Anaerobic cocci and clostridium are resistant to the action of Ciprofloxacin. Once prescribed treatment you can now order medicines online in India. Ciprofloxacin has good bactericidal activity and high potency along with long post antibiotic effect on staphylococcus, pseudomonas and enterobacteriaceae.

Mechanism of Action of Ciprofloxacin

Ciprofloxacin acts by inhibiting the enzyme DNA gyrase in bacteria. DNA gyrase has two subunits i.e. A and B. The A subunit is responsible for nicking the DNA strands and resealing them after negative supercoils have been introduced by the B subunit. The two subunits together prevent excessive positive supercoiling of the DNA strands when they separate to permit proper transcription and replication of DNA. In gram positive bacteria, the drugs inhibit topoisomerase four which is responsible for nicking and resealing the DNA strands after replication has taken place. The bactericidal action is by the exonucleases which digest the DNA after the production of damaged DNA which acts as the stimulus. In mammalian cells, topoisomerase two is present instead of DNA gyrase and topoisomerase four. 

 Uses of Ciprofloxacin

 Ciprofloxacin is effective in a broad range of infections for empirical therapy however they shouldn’t be used in the cases of minor infection or when the causative organism is gram positive or an anaerobe. It is used for Urinary Tract infections, Chancroid, Bacterial gastroenteritis, Typhoid, Bone, soft tissue and gynaecological infection, Respiratory infections, Anthrax, Tuberculosis, Gram negative septicaemia, Meningitis, Prophylaxis of infections and Conjunctivitis.

After you consult a doctor, the doctor shall ask you your chief complaints and as to what made you come to the hospital. After this, the doctor shall ask relevant questions pertaining to your condition and your symptoms in order to complete your medical history. If you have a travel history to areas where the infection is prevalent it can imply that the diagnosis of the condition might be a condition which is very common in those areas. This will be followed by a physical examination to check for any more signs and symptoms that might be important in your case. Once you are diagnosed and prescribed treatment you can now buy medicines online in India. The doctor will now refer some tests in order to confirm the probable diagnosis so that treatment can be started.

 Conclusion

Ciprofloxacin is generally a safe drug with less side effects. In the skin, they cause itching, rash, urticaria, swelling of lips and sensitivity to light. In the gastrointestinal tract it can cause vomiting, nausea, bad taste and anorexia. Diarrhoea doesn't occur as it doesn't affect the gut flora. Tendonitis and tendon rupture can occur in some cases.

[arushmichael]

Naegleria fowleri Infection: Pathogenesis and Symptoms

By Arush Emmanuel Michael

Naegleria fowleri causes a fulminating and acute primary amoebic meningoencephalitis (PAM). A wide variety of water bodies like freshwater lakes, swimming pools and hote springs is where the parasite lives and all these infective forms can lead to an infection by Naegleria fowleri.

Morphology of Naegleria fowleri

The flagellate has two morphological forms the trophozoite and cyst. The trophozoite form also has two distinct forms namely the amoeboid and flagellate forms.

The amoeboid trophozoite form is around ten to twenty micrometre in length and can appear elongate. This particular Morphologic form is actively motile by the means of rounded pseudopodia which are also known as lobopodia which help the amoeboid form move around in the soil. The nucleus of the amoeboid form has a large central karyosome but doesn't have any peripheral nuclear chromatin. When the amoeboid form reaches the water it changes from the amoeboid form into the flagellate form. The flagellate form is pear shaped with two flagella present at its anterior end with which it moves rapidly forward or in circles it can spin. To multiply and proliferate, the flagellate form has to revert back to its amoeboid form as it cannot multiply in its flagellate form. The cyst form is uninucleate that is it has a single nucleus while its shape is spherical with a diameter of seven to ten micro metre. The cyst wall is relatively thin and covers the cyst completely. In the body tissues or cerebro spinal fluid the flagellate forms or the cyst forms of Naegleria fowleri have never been isolated or found.

How does the infection by Naegleria fowleri occur? By swimming in fresh water bodies like swimming pool, ponds, fresh water lakes which contain infective forms of Naegleria fowleri, the person is at a risk of contracting the infection. Inhaling dust containing infective forms of Naegleria fowleri is another way of acquiring the infection which can end up becoming fatal for your health.

Pathogenesis of Infection of Naegleria fowleri

The amoebic form of the parasite penetrates the nasal mucosa and then invades the cribriform plate after which it travels along the olfactory nerve to reach the brain leading to an infection which spreads rapidly known as primary amoebic meningoencephalitis or PAM. Yung adults and children have a recent history of swimming in fresh water bodies which have been mentioned earlier are high risk groups of developing the infection.If you are diagnosed with the condition and are prescribed treatment by your doctor you can now order medicines online in India.

Symptoms of Infection by Naegleria fowleri

The incubation period of developing the infection after the amoeboid form invades the nasal mucosa is round about two to fifteen days, the mean time period is about five days. The infected patient develops fever, severe frontal headache and meningeal irritation and it's signs. Certain other symptoms like visual disturbances, confusion, seizures and coma might also end up developing. If left untreated the person might end up dying a week after the onset of symptoms begins after the incubation period of the disease.

To diagnose the condition, a cerebro spinal fluid specimen is collected so that the amoeboid forms of the parasite can be demonstrated. Refrigeration of the specimen should never be done as it may kill the pathogen. Staining of a wet mount preparation of the cerebro spinal fluid specimen can be done and then it can be observed under a microscope. Fluorescent staining can also be done to demonstrate the amoebae by fluorescent antibody staining of CSF. If you are diagnosed with the condition and are prescribed treatment by your doctor you can now buy medicines online in India.

Conclusion

After you consult a doctor, the doctor shall ask you your chief complaints and as to what made you come to the hospital. After this, the doctor shall ask relevant questions pertaining to your condition and your symptoms in order to complete your medical history. If you have a travel history to areas where the infection is prevalent it can imply that the diagnosis of the condition might be Taeniasis or Cysticercosis as the condition is very common in those areas. This will be followed by a physical examination to check for any more signs and symptoms that might be important in your case. The doctor will now refer some tests in order to confirm the probable diagnosis so that treatment can be started

[arushmichael]

Cholera: Pathogenesis, Diagnosis and Treatment

By Arush Emmanuel Michael

Vibrio cholera

The bacterium that is Vibrio cholerae is a gram negative organism. The bacteria has a polar flagellum and displays darting motility which can be diagnostic when the hanging drop preparation is utilised to check for motility. The bacteria are non-capsulated and non-sporulate, therefore they don’t have the ability to form a capsule or spores under unfavourable conditions of growth for protection from their natural surroundings.

Toxins produced by Vibrio cholerae

Vibrio cholerae produces a heat stable endotoxin and a heat labile enterotoxin.

The heat labile enterotoxin is also known as cholera toxin or Cholera Toxin. Cholera Toxin resembles the heat labile toxin produced by Escherichia coli known as LT. Cholera Toxin is a protein with a molecular weight of around ninety thousand and shows resemblance to LT antigenically and in mechanism of action. Cholera Toxin however is more potent than LT and its production is mediated by phage integrated with the bacterial chromosome unlike LT whose production is plasmid mediated.

Cholera Toxin has two subunits namely A (active) subunit and B (binding) subunit. The A subunit further has two fractions i.e. A1 and A2. The B subunit binds to a Gm1 ganglioside receptor in an intestinal epithelial cell and facilitates the entry of subunit A into the cell. The A subunit splits into its two fractions and then A2 fraction facilitates the binding of A1 and B which further stimulate and activate adenyl cyclase. Adenyl cyclase converts ATP to cAMP whose concentration then increases in the cell. The increased cAMP concentration increases the release of electrolytes and water into the lumen of the intestine and decreases the absorption of sodium and chlorine from the lumen of the intestine. These effects lead to the rice watery stool and purging diarrhoea in Cholera.

Pathogenesis of Cholera

The disease results after consumption of contaminated of food and water with a high infective dose which is necessary to bypass the acidic gastric barrier. The bacteria multiply and proliferate in the alkaline medium which the intestine provides. The bacteria do not penetrate the gut wall to produce bacteremia but become adherent to the intestinal epithelium with the help of special fimbirae known as Toxin co-regulated pilus. The bacteria then produce the enterotoxin which is known as Cholera toxin and causes the clinical manifestations of the diarrhoeal disease that is cholera. If you are diagnosed with the condition and prescribed treatment you can order medicines online in India.

Symptoms and Clinical Features of Cholera

The enterotoxin/ Cholera toxin causes a purging diarrhoea of rice water stool. The diarrhoea caused due to increased water and electrolytes in the stool leads to a massive loss of these electrolytes which results in:

·        Haemoconcentration (concentration of blood), anuria (no urination) and hypovolaemic shock as a result of the dehydration caused by loss of water.

·        Acidosis caused by a base defecit resulting of the loss of essential body constituents in the stool

·        Loss of potassium results in its deficiency causing hypokalemia which manifests as muscle cramps.

·        There might be renal failure in untreated cases which results in death and the mortality rate is as high as sixty to seventy percent in untreated cases of cholera.

Diagnosis of Cholera

After you consult a doctor, the doctor shall ask you your chief complaints and as to what made you come to the hospital. After this, the doctor shall ask relevant questions pertaining to your condition and your symptoms in order to complete your medical history. If you have a travel history to areas where the infection is prevalent it can imply that the diagnosis of the condition might be Dracunculiasis as the condition is very common in those areas. This will be followed by a physical examination to check for any more signs and symptoms that might be important in your case. Once you are diagnosed and prescribed treatment you can now buy medicines online in India. The doctor will now refer some tests in order to confirm the probable diagnosis so that treatment can be started.

Conclusion

Cholera is a deadly disease with a high mortality rate and steps should be taken in order to prevent it from spreading and causing widespread infection. There should be better facilities for sewage disposal and the purification of water supplies. The infected patients should be isolated and the carriers should be identified and treated.

[arushmichael]

Beta Lactam Antibiotics and their uses

By Arush Emmanuel Michael

Mechanism of action of beta lactam antibiotics

Beta lactam antibiotics act by inhibiting the synthesis of bacterial cell wall in bacteria that are susceptible to the action of these antibiotics. Beta lactam antibiotics interfere in the cell wall synthesis by preventing the cross-linking between the peptide and the glycine chain in peptidoglycan. The pentaglycine chain binds to the alanine present at the fourth position of the pentapeptide chain. Penicillin binding proteins present in the cell membrane including transpeptidases are responsible for the cross linking and formation of peptidoglycan. Beta lactam antibiotics act by preventing the action of transpeptidases, as they are structural analogues of D-Alanine.

Uses of Beta Lactam Antibiotics

These antibiotics which include penicillin are mainly used for treatment of infections caused by bacteria susceptible to their action. After you consult a doctor, the doctor shall ask you your chief complaints and as to what made you come to the hospital. After this, the doctor shall ask relevant questions pertaining to your condition and your symptoms in order to complete your medical history. If you have a travel history to areas where the infection is prevalent it can imply that the diagnosis of the condition might be a common infection as the condition is very common in those areas. This will be followed by a physical examination to check for any more signs and symptoms that might be important in your case. Once you are diagnosed and prescribed treatment you can now buy medicines online in India. The doctor will now refer some tests in order to confirm the probable diagnosis so that treatment can be started.

 1.      Streptococcal infections such as otitis, scarlet fever, pharyngitis and rheumatic fever can be treated with a normal dose of penicillin as streptococcus pyogenes has not developed much resistance to penicillin. Sub acute bacterial endocarditis caused by Streptococcus viridians and Streptococcus faecalis can be treated with high doses given along with the drug gentamicin for a period of two to six weeks.

2.      Lobar pneumonia and meningitis caused by Pneumococcus is now infrequently treated with penicillin

3.      An intravenous injection of high doses of penicillin can be used to treat meningitis caused by meningococcus.

4.      Penicillin is the drug of choice for the treatment of syphilis as Treponema pallidum has not shown any resistance to penicillin.

5.      Leptospirosis can also be treated with the help of penicillin.

6.      Treatment of diphtheria is primarily done with anti-toxin therapy but the carrier states can be prevented by procaine penicillin administration.

7.      Penicillin can kill the causative organism and provides adjuvant value in the treatment of Tetanus and gas gangrene caused by Clostridium.

8.      Certain rare infections like rat bite fever, anthrax, actinomycosis, trench mouth (acute necrotising ulcerative gingivitis) can be treated by penicillin in combination with metronidazole.

9.      A decreased concentration of penicillin can help to prevent colonisation of Steptococcus which causes Rheumatic fever ultimately.

10.   Dental extractions, catheterisation and endoscopies may result in bacteremia which ultimately causes endocarditis in patients with valvular defects.

Adverse Effects of Beta Lactam Antibiotics

One of the most non toxic antibiotics is benzyl penicillin. According to the dose, benzyl penicillin has local irritancy and direct toxicity. The penicillin causes paint at the site of the intra muscular injection, nausea and thrombophlebitis of the injected vein. If an intravenous injection of a high dose of penicillin is used it might result in toxicity of the central nervous system causing mental confusion, convulsion and coma. If a procaine penicillin is accidentally infused intra venously might cause Central nervous system stimulation which manifests as convulsion and hallucinations. Therefore, it is necessary to only consume medicines when prescribed by a health care provider who has done all the necessary tests and accordingly prescribed you the drug. You can now order medicines online in India once you have been prescribed treatment.

Conclusion

In one to ten per cent cases of penicillin use, hypersensitivity reaction may occur. Hypersensitivity is a major problem in the use of benzyl penicillin. Benzyl penicillin is the most important drug implicated in drug allergies. Frequent manifestations of hypersensitivity include rash, itching, urticaria and fever. Less commonly, wheezing, angioneurotic edema, serum sickness and Exfoliative dermatitis may also occur after administration of benzyl penicillin. Anaphylaxis rarely occurs and when it occurs it can be fatal due to its manifestations.

[arushmichael]

C. parvum infection: Everything you need to know

By Arush Emmanuel Michael

Out of all the twenty  species known, only one i.e. C. parvum infects humans. In 1907. Tyzzer first described the species in the gastric crypts of mouse. In 1976, Human infection was reported for the first time. The infection is trandsmitted by the oro-faecal route. C. parvum is a zoonotic infection. The infection is acquired by humans through the oro-faecal route by consuming food and water contaminated with faeces. The thick walled oocyst ingested and then travels down the gastro-intestinal tract. In the intestine, excystation of the thick walled oocyst occurs and sporozoites are released. The sporozoites transform and develop into trophozoites which initiate the schizogony. The trophozoite develops into a type 1 meront which releases eight merozoites into the neighbouring epithelial cells. these merozoites form a type 2 meront which develops and releases four merozoites which initiate the sexual reproductive cycle. The sexual stages formed in the host cell by merozoites are microgamont and macrogamongt. The microgamont gives rise to numerous microgametes while a macrogamont only releases one macrogamete. The two gametes undergo fertilisation and form an unsporulated oocyst. The unsporulated oocyst might develop into a thick walled oocyst or a thin walled oocyst. The thick walled oocyst is responsible for spreading the infection to healthy individuals while the thin walled oocyst causes reinfection of the same individual. Other animals like calves might also serve as natural reservoirs of the parasite responsible for spreading human infections. 

The Oocyst is the infective form of the parasite and it has the following features:

·        Spherical or oval in shape

·        Two to five micrometre in diameter

·        Colourless

·        Acid fast

·        It does not stain with iodine

·        The oocyst contains 4 sporozoites which are pointed anteriorly and rounded posteriorly. There is a prominent nucleus present towards the rounded posterior end.

There are two types of oocysts:

1.      Thin walled oocyst- Reinfects the same host over and over again

2.      Thick walled oocyst- It passes through the faeces and infects new hosts.

In the case of any other infections your doctor prescribes you medication for, you can now order medicines online in India. 

Clinical Features of C. parvum infection

Two days to two weeks is the incubation period of the condition after which it produces its clinical symptoms.

In normal healthy individuals, the disease is characterised by a mild diarrhoea which is self limiting in one to two weeks.

The disease can be severe and fatal especially in immunocompromised patients like AIDS patients.A cholera like, life threatening and prolonged condition develops which is characterised by:

·        Profuse and watery diarrhoea

·        Weight loss

·        Fluid loss as much as twenty five litres a day leading to severe dehydration

·        Vomiting

·        Nausea

·        Pain in the abdomen

·        Fever (low grade)

There are certain extra-intestinal infections which might also end up developing in immunocompromised patients like respiratory cryptosporidiosis, cholecystitis and hepatitis. It is difficult for immunocompromised individuals to overcome the parasitic infection and the disease keeps on spreading to other organs and symptoms. Therefore, it is essential to receive supportive treatment for the condition as soon as possible. Once you are prescribed medicines by your doctor for any condition, you can now buy medicines online in India.

How is the infection diagnosed?

After you consult a doctor, the doctor shall ask you your chief complaints and as to what made you come to the hospital. After this, the doctor shall ask relevant questions pertaining to your condition and your symptoms in order to complete your medical history. If you have a travel history to areas where the infection is prevalent it can imply that the diagnosis of the condition might be this infection as the condition is very common in those areas. This will be followed by a physical examination to check for any more signs and symptoms that might be important in your case. The doctor will now refer some tests in order to confirm the probable diagnosis so that treatment can be started.

The specimens collected include:

·        Stool

·        Sputum in the case of respiratory cryptosporidiosis

·        Blood for antigen detection

·        Biopsy for examination done histopathologically

Serological tests like Immunofluorescence test and Enzyme linked immunosorbent assay might be employued to check for the antibodies to the parasite which is present in the blood.

Conclusion

The infection has no effective treatment available to fight the infection.  As no medication can be given against the parasite, only supportive treatment can be given to prevent dehydration.

[arushmichael]

Anticholinergic Drugs and their actions

By Arush Emmanuel Michael

Classification of anticholinergic Drugs

Anticholinergic Drugs are classified into 3 classes:

Natural alkaloids: Drugs in this category include Atropine and Hyoscine.

Semisynthetic derivatives: Drugs in this category include Ipratropium bromide and Atropine methionitrate.

Synthetic derivatives: These drugs are further classified into Mydriatics, Antisecretory antispasmodics, antiparkinsonian and vasoselective drugs. Antisecretory antispasmodics include quarternary compounds (Isopropamide and Propantheline) and tertiary compounds (Dicyclomine and Valithamate). Mydriatics include cyclopentolate and tropicamide while vasicoselectives include oxybutyrin and flavoxate. Antiparkinsonian anticholinergics mainly pertain to benzhexol and procyclidine. You can now buy medicines online in India.

Pharmacological actions of anticholinergic Drugs

Actions on Central nervous system: The drugs doesn't penetrate the brain well and acts mainly peripherally having a stimulating effect mainly on areas like the medullary centres- vasomotor, respiratory and vagal. It decreases vestibular excitation leading to its antimotion sickness property. It's decreases tremors and rigidity in Parkinson's disease by reducing cholinergic overactivity of the basal ganglia. At high doses, there are hallucinations ,restlessness, delirium and hallucinations followed by respiratory depression and coma.

Actions on Cardiovascular System: Atropine mainly acts to block the M2 receptors and M3 receptors causing an increase in heart rate and tachycardia. The AV conduction increases and the PR interval in the ECG decrease.

Actions on the eyes: On topical instillation, there is mydriasis, abolition of the light reflex and cycloplegia which causes photophobia and blurring of near vision. In near angle glaucoma, this results in increase of intra ocular tension

Actions on blood pressure: Cholinergic impulses not involved in the vascular tone. Atropine has no marked effect on the blood pressure. Tachycardia and stimulation of the vasomotor centre causes an increase in the blood pressure while histamine release and the action of vasodilation results in decrease in the blood pressure.

Action on Smooth Muscles: By blocking the M3 receptors it causes, relaxation of visceral smooth muscles receiving parasympathetic innervation. The bronchioles gets dilated which causes a decrease in airway resistance which is helpful for asthma patients. The stomach and intestine show reduced tone and amplitude of contraction which might cause constipation but mainly used to stop spasms. There is relaxation in the urinary bladder which increases bladder capacity and controls detrusor reflexes.

Action on Glands: There is decreased sweating and saliva secretion which causes difficulty in talking and swallowing. The secretions in stomach and other parts of the gastrointestinal tracts like intestine and the pancreas is also decreased.

The body temperature is increased as well.

Uses of Anticholinergic Drugs

Antisecretory Uses: Used as a pre anaesthetic medication to prevent laryngospasm and vasovagal attack. They are used in pulmonary embolism to reduce pulmonary secretion as well as to check increased sweating and salivation. Once prescribed drugs for treatment you can now order medicines online in India.

Antispasmodic uses: It provides symptomatic relief in abdominal cramps, spastic constipation and inflammatory bowel syndrome. It is used to control nervous and drug induced diarrhoea. It also helps to relive urinary frequency and increase bladder capacity.

Used in Bronchial asthma and Chronic Obstructive pulmonary disease to control exacerbations and for regular prophylactic use.

As mydriatic for testing refraction and for performing a fundoscopy. Therapeutically used for treatment of iritis, keratitis and corneal ulcer.

As a cardiac vagolytic to counteract heart block and sinus bradycardia.

Used as adjuvant with levodopa for treatment of parkinsonism.

Hyoscine is most effective anticholinergic for motion sickness and should be given prophylactically before the symptoms appear. The action of the drug lasts for four to six hours and can be administered behind pinna transdermally for three day protection.

Used as an antagonist for muscarinic actions of drugs and poisons.

Conclusion

Side effects of anticholinergic drugs are common and toxicity may manifest as belladona poisoning if the patient overdoses or consumes seeds or berries of belladona. Children are highly susceptible to this toxicity. The person suffers from dry mouth, scarlet rash, fever, dilated pupils, photophobia, blurring of vision, convulsions, respiratory depression and coma. the ingested poison is removed through a gastric lavage with tannic acid. The patients vital should be checked and he/she should be kept in a quite dark room. Physostigmine should be administered and cold sponging ice baths should be given to reduce body temperature.

[arushmichael]

Pulsating headache and its treatment

By Arush Emmanuel Michael

A pulsating headache can end up manifesting as a migraine. The headache comes in attacks lasting in a range of 4-48 hours and is commonly restricted unilaterally. There are basically two types of migraine, classical migraine and common migraine. A classical migraine shows the presence of aura while the common migraine does not.

A migraine can be divided into 5 stages which include the prodrome stage, aura, main attack, resolution and finally recovery or postdrome stage. A person having a migraine may show the following symptoms in the respective phases: 1)     Prodrome Stage: Constipation, mood changes, food cravings and frequent urination 2)     Aura:  Pins and needles sensation, difficulty speaking, weakness or numbness in the face or one side of the body. 3)     Main Attack: unilateral headache, photosensitivity (sensitivity to light) , nausea and vomiting 4)     Postdrome Stage: Confusion and weakness

A person experiencing the above symptoms should consult a physician who shall make the appropriate diagnosis and prescribe a treatment if necessary. A migraine can be triggered by a number of factors like caffeine, alcohol, chocolate, changes in sleep pattern, stress, bright lighting, use of tobacco, hormonal changes and medications like oral contraceptives. If a person is under stress for whatever reason, they are also at a high risk of developing a migraine. Hormonal changes especially in woman during pregnancy and menopause can also result in a migraine. Not eating enough or eating certain food products might also be a trigger apart from the factors mentioned above.

There are two theories which can explain why migraines actually occur- The Vascular Theory and the Neurogenic theory. The Vascular theory suggests cerebral ischaemia as a cause while the Neurogenic theory blames a depression of cortical electrical activity. According to the specific frequency and intensity of migraines the treatment of migraines is adjusted. The drugs are prescribed accordingly to the patient, if a patient finds it difficult to go personally and buy them they can always order medicines online in India.

The severity of a migraine may be mild, moderate and severe. On the basis of the severity of the migraine the treatment and the drugs prescribed vary.

Mild Migraine: Patient having lesser than one attack per month of headache. Simple analgesic like paracetamol or aspirin may suppress and abort most mild attacks. Non Steroidal Anti Inflammatory  Drugs (NSAIDs)  such as Ibuprofen and Naproxen either alone or in combination with an antihistamine or sedative are found more responsive in some patients. Antiemetics like metoclopramide relieve gastric stasis and nausea. Moderate Migraine: There are one or more attacks per month of more intense headache accompanied by nausea or vomiting or both. Stronger NSAIDs are more  beneficial with the combinations mentioned above in such cases. Antiemetics are needed to ward of gastric symptoms.  Triptans like Sumatriptan can also be used for patients who don’t respond to NSAID’s. Severe Migraine : Patient has 2-3 attacks per month of severe headache with vomiting and other symptoms. Specific antimigraine drugs needs to be prescribed i.e. Triptan’s and Ergot Alkaloid’s accompanied with antiemetics. Along with these medicines a prophylactic regimen to prevent recurrence of attacks is also prescribed.

Treatment of a Migraine

If a person is experiencing any of the symptoms of a migraine they should immediately consult a physician for the same. Self medication can be harmful and should not be done. According to your symptoms and the type of migraine you’re suffering from you will be prescribed a drug regimen. With the current pandemic going on, it is a great help that you can buy medicines online with discount.

Conclusion

A migraine can result in your day to day activities being affected leading to you being lesser productive and resulting in your whole life taking a step back. Therefore, it is imperative that if your life is being affected by the symptoms of a migraine you go to a health care centre and get yourself diagnosed because the cause of a headache can be a multitude of conditions ranging from minor to fatal. But the bright side is that a migraine or most of the conditions in today’s day and age are treatable and preventable the only condition is that a person consults a physician at the latest so that the appropriate steps be taken for a person to live a healthier and more productive lifestyle.

[arushmichael]

Manifestations of Gonorrhoea and their treatment

By Arush Emmanuel Michael

Gonorrhoea is a sexually transmitted disease caused by the bacteria Neisseria gonorrhoeae which involves and mainly affects the urethra(the tube that drains  in both the sexes producing inflammation characterised by a purulent discharge (discharge containing pus).

Neisseria gonorrhoea may affect:  

Urethra

Prostate, testes, seminal vesicles and epididymis in males

Cervix, uterus, fallopian tubes and ovaries in females

Liver

Conjunctiva (in newborn)

How does gonorrhea spread?

The infection usually spreads through sexual contact with a human carrier or less commonly a patient as gonorrhoea is a disease found exclusively in humans. In women, the infection might be asymptomatic in many cases making them a source of spread among their sexual partners. Ophthalmia neonatorum is a type of gonococcal conjunctivitis which a newborn develops due to a mothers infected birth canal.

Symptoms of Gonorrhoea

The incubation period for the bacteria is 2-8 days after which the symptoms begin to manifest themselves. It is imperative to know that the infection in many patients whether male or female may be asymptomatic in many cases which make them a potential source of infection to others. The symptoms vary in males and females.

Symptoms in Males

Pain/burning during urination

Increased frequency of urination

Redness at the opening of penis

Purulent discharge

Pain in the testicles

Sore throat

Symptoms in Females

Vaginal discharge

Fever

Increased frequency of urination

Pain/burning during urination

Pain during sexual activity

Sore throat

If untreated, gonorrhoea may lead to fibrosis, stricture formation and pelvic inflammatory disease which may result in sterility and other complications. Therefore, if you show any of the above mentioned symptoms kindly consult a physician who will diagnose you and provide you the appropriate treatment.

Medicine delivery in India is available round the clock if it is unsuitable for you to venture outside especially during the current pandemic.

Diagnosis of Gonorrhea

On consulting a physician, your history will be taken followed by a physical examination.According to your symptoms, your doctor will run microscopic, culture and serological tests on specimens collected from you which may include :

urethral discharge

cervical discharge (in females)

urine

blood

If your result is positive for Gonorrhoea you will be prescribed treatment. Once you get to know you have gonorrhoea kindly inform all your sexual partners of the same.

Treatment of Gonorrhoea

There is growing problem of resistance developing in the strains of bacteria responsible for gonorrhoea resulting in requirement of alternative treatments for patients infected with resistant bacteria.Two drug regimens are used for the treatment of gonorrhoea depending on whether the bacteria developed penicillin resistance by releasing penicillinase or not.

Non Penicillinase Producing N. gonorrhoea: Amoxicillin/ Ampicillin with Probenecid is prescribed

Penicillinase Producing N. gonorrhoea: Ceftriaxone intramuscular / Cefuroxime intramuscular / Azithromycin with Probenecid is prescribed

Alternative drugs include Cefixime, Doxycycline and Erythromycin.

Co-infection with C. trachomatis is common in patients with gonorrhoea therefore dual therapy is frequently recommended.

There are no over the counter treatments available for gonorrhoea therefore if one shows symptoms they should immediately go to a primary healthcare provider. You can now buy medicines online in India once you are prescribed treatment. Once diagnosed sexual abstinence needs to be performed to prevent spread of infection.

Conclusion

Gonorrhoea and other sexually transmitted disease (STD) can easily be prevented from spreading if necessary measures are taken for the same. Always have protected sex with a condom. You have a higher chance of getting infected if you have a history of another STD or if you have a new sexual partner or if you have multiple sexual partners.Kindly be a responsible citizen and perform sexual abstinence if you have gonorrhoea. If you show symptoms consult a doctor so that you can be treated faster and appropriately so that you don’t suffer from any complications.  Gonorrhoea is easy to treat and if measures are taken early, complications such as infertility can be prevented. Health is a public matter and if you give a proper history and follow your healthcare providers directions rampant spread can be prevented. In the end, prevention is always put before cure and if we can stop a disease at its bud and prevent it from spreading its roots the health and well-being of the whole population flourishes.

[arushmichael]

E. histolytica Infection: Everything you need to know

By Arush Emmanuel Michael

Infection with the amoeba Entamoeba histolytics is termed as amoebiasis. The amoeba might cause intestinal amoebiasis (amoebic dysentery) and extraintestinal amoebiasis.

What is Entamoeba histolytica?

It is an amoebic parasite which is worldwide in distribution whose trophozoites reside in the tissues of the large intestine.

Life Cycle of Entamoeba Histolytica

Humans are the only host of the amoeba. The infective form is the mature quadrinucleate cysts which are passed on through the faeces of carriers and hosts. After consumption of food containing the infective cysts, the person becomes infected. Sexual contact can also result in a person acquiring amoebiasis. The cyst breaks in the large intestine due to action of trypsin and results in the release of a tetranucleate amoeba which finally forms 8 metacystic trophozoites by binary fission. These metacystic trophozoites lodge in the large intestine tissue where they multiply by binary fission. The trophozoites release proteolytic enzymes which leads to destruction and damage of tissue. The faeces may contain blood and mucous with the trophozites which is known as amoebic dysentery. The trophozoites might also enter into the circulation and infect other parts of the body such as liver. Finally, after healing starts encystations occurs leading to release of infective cysts.

Symptoms of E. histolytica infection

The infection might be asymptomatic as well and that is when the person is termed a carrier however when symptoms do appear they might vary depending on the type of the infection:

Bloody diarrhoea

Fatigue

Weight loss

Fever

Pain in the abdomen (hepatic amoebiasis)

On showing any of these symptoms kindly consult a doctor who shall prescribe medicines depending on your condition. You can now buy medicines online in India for any prescribed medication.

Clinical Features of E. histolytica infection

Intestinal Amoebiasis: 1-4 weeks is the incubation period of the condition. Ulcerative lesions are produced in the large intestine along with bloody diarrhoea which is profuse in nature. The ulcers might be generalised in the intestine or localised to some parts.

Extrantestinal amoebiasis: Hepatic amoebiasis might develop in some people suffering from intestinal amoebiasis. A liver abscess is formed which might be localised with pus having a characteristic red-brown anchovy sauce appearance. The pus contains liver cells, red blood cells and white blood cells.

Complications of Liver Abscess

The trophozoites from the abscess might enter into the surrounding organs when the abscess ruptures. It might affect the lungs, pleural cavities, subphrenic abscess and peritoneal cavity. The trophozites might enter the circulation and have an effect on brain, spleen and other organs.

Diagnosis of E. histolytica infection

If you experience blood stools or any symptoms suggestive of amoebiasis you should consult a doctor. Once you consult, you shall be subjected to some history taking and a physical examination. While taking your history, the doctor might ask questions regarding the frequency of your bloody diarrhoea along with history of pain in the abdomen. Apart from this indications of loss of weight along with tiredness might be suggestive of the condition. The physician might now suggest some tests in order to confirm their diagnosis.

Stool Examination: You shall be requested for a stool sample which is required and imperative for the examination. The cysts might be concentrated using some methods for easier identification. The trophozoites and cysts might be visible during microscopy on a normal saline preparation.

Blood Tests: The changes in the normal blood cell count might be suggestive of amoebiasis.

Serological Techniques: Enzyme linked immunosorbent assay and indirect fluorescent antibody test might also be used to confirm the diagnosis of amoebiasis.

DNA probes: Used to detect the amoeba in stool specimens.

Liver Biopsy or Aspiration: The hepatic abscess might be aspirated to show pus which on microscopy shows the presence of trophozoites. On biopsy of a liver tissue there might be presence of trophozoites and other forms of the amoeba.

On diagnosis of your condition you will be prescribed a treatment regimen.

Treatment of E. histolytica infection

The treatment of amoebiasis can be done by the use of metronidazole and nitroimidazole, which are effective in the intestinal tissues and the lumen as well

Di-iodohydroxyquin and diloxanide furoate only act in the lumen of the intestine.

Electrolyte and fluid replacement might also be necessary due to the water loss through dysentery.

24 hour medicine delivery is now available online in India. Do not self-medicate yourself if you have not been prescribed the above drugs as it can be dangerous.

Conclusion

In order to prevent the infection you should:

Eat clean food and drink clean water free of faecal contamination.

Human faeces are to be disposed of properly.

Treatment of asymptomatic carriers is also important and necessary.

[arushmichael]

Tumours arising from neuroglia

All tumours arising from neuroglia or more specifically neuroectodermal epithelial tissues are know as gliomas.They are most common of the primary Central Nervous System (CNS) tumours (40% of all intracranial tumours)As per WHO classification they are all classified under diffuse astrocytic and oligodendroglial tumours and include tumours arising from:

Astrocytes (Astrocytomas and Glioblastoma)

Oligodendrocytes (Oligodendroglioma)

Ependymal cells (Ependymoma)

They might be poorly or well differentiated but are never well demarcated or encapsulated, therefore they all infiltrate adjacent brain tissue. They rarely metastasise beyond the CNS but are disseminated within the CNS through the Cerebrospinal fluid (CSF).

Astrocytomas

Most common type of Gliomas. They occur mostly in the cerebral hemispheres but sometimes in the spinal chord. Usually occur in 6th decade of life but prevalent in late middle life.

Diagnosis of Astrocytomas:After you consult a doctor, the doctor shall ask you your chief complaints and as to what made you come to the hospital. After this, the doctor shall ask relevant questions pertaining to your condition and your symptoms in order to complete your medical history. This will be followed by a physical examination to check for any more signs and symptoms that might be important in your case. The doctor will now refer some tests in order to confirm the probable diagnosis so that treatment can be started.

Routine h&E morphology

Immunohistochemical staining with glial fibrillary protein.

Electron microscopic demonstration of glial filaments

Proliferation markers (Ki67 and PCNA) to assess mitotic activity

Once you are diagnosed with any condition are prescribed treatment, you can now buy medicines online in India.

They progress from lower grades to higher grades of anaplasia. The low grade Astrocytomas evolve slowly while the higher grades cause rapid clinical deterioration of the patient. Earlier WHO classified Astrocytomas from grade 1 to grade 4 but now they're classified on the basis of molecular and genetic features:

Diffuse Astrocytoma (WHO grade 2)

Classical type- Fibrillary astrocytoma

Another variant- Gemistocytic astrocytomaPresence of IDH1, IDH 2, ATRX and TP53 mutations.More favourable course than IDH wild type tumours.Gross Features:

Found commonly in frontal lobes

Poorly defined, grey- white tumour

Variable size

Merges with surrounding tissue

Distorts underlying Brain tissue

Histologic features:

Well differentiated astrocytes

Fibrillary background of variable amount ( composed of astrocytic processes)

Anaplastic Astrocytoma (WHO grade 3)

Generally evolves from low grade astrocytoma.

Gross Features: may not be distinguishable from low gradeHistologic features:

Hypercellularity

Distinct nuclear atypia

Mitoses

Necrosis and vascular proliferation (rare)

Glioblastoma (WHO grade 4)

Most aggressive astrocytoma which arises by neoplastic changes in mature astrocytes. IDH wild type is more prevalent than the IDH mutant type.Gross Features:

Variegate appearance

Some areas grey-white

Some areas yellow and soft with foci of necrosis and haemorrhage

Surrounding Brian tissue distorted and invaded by yellow tumour tissue.

Histological features:

Anaplastic and cellular appearance

Variation in cell types- fusiform cells, small poorly differentiated round cells, pleomorphic cells and giant cells.

Frequent mitoses

Scanty glial fibrils

Areas of tumour necrosis with pseudopalisading around

Microvascular endothelial proliferation

Pilocytic Astrocytoma (WHO grade 1)

Classified under other astrocytic tumours which was separated out based on genotype.Most commonly glioma in children and adolescentsGross features:

Cystic or solid and circumscribed

Occurs in cerebellum, third ventricle and optic nerve pathway

Microscopic features: Fusiform pilocytic astrocytes with unusually long, wavy fibrillary processes

You can now order medicines online in India for any condition you might be having once you are prescribed treatment for the same.

Oligodendroglioma

Diagnosis:

X-ray and CT scan show well defined mass with numerous small foci of ccalcification.

Deletions and translocations of chromosome 1p and 19q and IDH 1 or IDH 2 mutations

Gross Features:

Well circumscribed tumour

Grey-white gelatinous mass with cystic areas

Foci of haemorrhages and calcification

Occurs in cerebral hemispheres, most commonly the frontal lobes or in the ventricles

Histological Features:

Uniform cells- Round to oval nuclei with clear cytoplasm halo and well defined cell membrane

Endothelial cell hyperplasia of varying degree

Anaplastic changes

Conclusion

Tumours arising from neuroglia can be dangerous to health and can affect day to day activities. If you do suffer from any symptoms affecting your health you should immediately consult a healthcare provider.

[arushmichael]

L. donovani infection: Everything you need to know.

By Arush Emmanuel Michael

Visceral Leishmaniasis is caused by the parasite Leishmania donovani which is an obligate intracellular parasite of the reticuloendothelial system. In India, it is endemic in specific states such as Bihar, West Bengal and Uttar Pradesh.

What is L. donovani?

It is a parasite which is found in two morphological forms:

Amastigote form which is without a flagella and is found in the reticuloendothelial cells of humans

Promastigote form which is the flagellar extracellular stage found in the vectors of the disease i.e. sandflies

Life Cycle of L. donovani

The female sandfly of the genus Phlebotomus and humans are the two hosts in which the parasite passes its life cycle. Humans are the sole reservoir of the parasite in India, thus it is a non-zoonotic infection. The infected human’s reticuloendothelial cells become packed with the amastigote form multiplying inside it. This finally results in the cell rupturing and the amastigote form being released into the blood circulation. When a sandfly bites an infected human the amastigote form enters into its midgut and transforms into the promastigote form. Inside the sandfly it multiplies by binary fission. Finally when the sandfly bites a healthy human, the promastigotes enter its blood and when a macrophage engulfs the parasite it converts into the amastigote form and the cycle continues.

Symptoms of L. donovani infection

The time period for the development of the disease is around three to six months. During this time, the amastigote forms infiltrate the reticuloendothelial cells of various organs. The symptoms that are shown in a patient include:

·        Fever (Pyrexia)

·        Enlargement of the spleen

·        Enlargement of the liver

·        Swollen lymph nodes

·        Skin changes on face, hands, feet and abdomen

·        Features of Anaemia (Fatigue, Weakness, Difficult breathing, Pale skin, Dizziness)

Around seventy five to ninety percent of untreated patients of Kala-Azar die within a period of two years. The death occurs predominantly due to secondary infections. One of the most important ooportunistic infections in HIV is Visceral Leishmaniasis. It is essential to receive timely treatment for the condition as if it is left untreated it can be fatal. Once you are prescribed drugs for any condition, you can now buy medicines online in India

Diagnosis of L. donovani infection

If you show any symptoms of Kala-Azar you should immediately consult a healthcare provider. After taking your history and conducting a physical examination to confirm the history findings, the doctor shall prescribe some laboratory tests to confirm the diagnosis. These tests are necessary in order to differentiate the disease from other similar diseases such as malaria, trypanasomiasis, histoplasmosis, brucellosis, tuberculosis and myeloid leukemia.

The laboratory diagnosis can be done through any of the following methods:

·        Demonstration of Leishmania Donovan (LD bodies) in the circulating monocytes or neutrophils in a peripheral blood smear.

·        N.N.N culture medium or Hockmeyer’s medium can be used to demonstrate promastigote forms. Blood or organ aspirates can be inoculated on to the culture mediums.

·        Microscopic examination of bone marrow aspirate and splenic puncture can be done to demonstrate amastigote forms.

·        Antigen detection tests such as ELISA and KATEX can be utilised to confirm the diagnosis.

·        On doing a complete blood count, the neutrophils and red blood cell counts are significantly low.

·        Leishmanin or Montenegro test is a skin test which is negative for kala-azar but is positive in dermal leishmaniasis and for people who have recovered from visceral lesihmaniasis (kala-azar)

Treatment of L. donovani infection

·        Miltefosine is an oral drug which has come up recently and can be utilised for treatment.

·        A pentavalent antimonial compound known as Sodium stibogluconate can be given intravenously for treatment but nowadays antimony resistance has become very prevalent.

·        Amphoctericin B and pentamidine can be administered and prescribed for drug resistance cases.

Once you are prescribed treatment for Kala-Azar or any other condition you can now get 24 hour delivery of medicines in India.

Conclusion

Early detection and treatment of cases is necessary for Kala-Azar as it can be very fatal with a high mortality rate. Therefore, measures need to be taken in order to prevent its spread. Eradication of sandflies and personal prophylaxis by using insect repellents can be carried out to reduce the incidence of the disease. There are no vaccines or immunisation available for kala-azar.

[arushmichael]

E. granulosus infection: Symptoms, Diagnosis and Treatment

By Arush Emmanuel Michael

Hydatid disease is prevalent worldwide, but it is more commonly found in cattle and sheep raising countries. In India, the hydatid disease is present in many areas. The larval form of Echinococcus granulosus produces the disease in humans. The adult cestode is present in the small intestine of dogs and other canines, which gives it the common name of dog tapeworm.

Life Cycle of E. granulosus

There is an intermediate and a definitive host in the life cycle of the parasite

Definitive Host: Dog is the optimum host but other canines (wolf, fox and jackal) can also act as a definitive host. The adult parasite lives in the small intestine of the definitive host and releases eggs in the faeces.

Intermediate Host: The intermediate hosts include humans and other animals (sheep, pig, cattle, goat) as well. The larval stage is present giving rise to hydatid cyst.

Mode of Infection of E. granulosus

The infection occurs by ingestion of the eggs which can occur through

·        Direct contact with infected canines

·        Eating from the same utensil as the canine

·        Consumption of uncooked vegetables contaminated with the canine faeces

Hydatid Cyst

The embryo secretes the cyst wall which has two layers namely the ectocyst and the endocyst.

Ectocyst:

·        It is the outer layer (1mm thick) and has the appearance of the white of a hardboiled egg.

·        It is acellular, tough, elastic and laminated hyaline membrane.

·        On incision, it curls on itself and exposes the endocyst.

Endocyst

·        It is the thin germinal or inner layer.

·        It gives rise to ectocyst on outer side and the scolices and brood capsules towards the inner side. The endocyst is also responsible for secretion of hydatid fluid.

·        Embryos which break free from the membrane and float in the fluid inside the cyst are known as hydatid sand.

·        Hydatid fluid characters:

1.      Clear, colourless or pale yellow

2.      Slightly acidic with low specific gravity

3.      Contains salts of sodium and calcium

4.      Antigenic in nature and therefore used for Casoni’s test

5.      Highly toxic (absorption leads to anaphylaxis)

Symptoms and Clinical Features of E. granulosus infection

The condition remains asymptomatic for many year but might sometimes cause pressure effects and swelling.

Organs and tissues involved:

·        Liver- Most commonly involved, particularly the right lobe. In case of liver cysts, chronic abdominal discomfort may be present.

·        Lung- Second most commonly involved. Cysts are mostly asymptomatic but might cause breathlessness, cough and chest pain

·        Brain

·        Kidney

·        Spleen

·        Heart

·        Bone

·        Muscle

Rupture of a hydatid cyst due to surgery or trauma can result in death after anaphylactic shock. Once you are diagnosed with any condition and are prescribed treatment you can now buy medicines online in India.

Diagnosis of E. granulosus infection

Laboratory Diagnosis includes following tests:

1.      Casoni Test (Immediate hypersensitivity skin test)

·        Antigen used- Sterile hydatid fluid produced after filtering hydatid fluid drawn from unilocular hydatid cysts from human cases or animals in slaughterhouses.

·        Procedure- 0.2 ml sterile normal saline is injected intradermally in one arm as the control. 0.2 ml of antigen injected intradermally in one arm as the test.

·        Positive case- Test site develops a large wheal with multiple pseudopodia in a period of 30 minutes.

2.      Blood examination: CBC shows eosinophilia

3.      Serological Tests (for antibody detection)

·        ELISA

·        IFA

·        IHA

·        Latex agglutination tests

4.      Cyst fluid examination: Diagnostic puncture of cyst is not advised as it might result in anaphylactic shock. Hydatid cysts removed surgically can be aspirated for cyst fluid which can then be examined for diagnosis. It reveals hooklets, scolices and brood capsules.

5.      Antigen detection tests:

·        ELISA

·        Countercurrent immunoelectrophoresis (CIEP)

·        Co-agglutination test

·        Latex agglutination test

6.      Radiological Examination: X-ray, ultrasonography, MRI and CT-scan may be utilised for diagnosis of  hydatid disease.

7.      Histological Examination

Treatment of E. granulosus infection

Surgical removal of hydatid cysts- There are recurrences after surgical removal therefore post-operative chemotherapy is carried out for two years.

Chemotherapeutic agents include- Praziquantel and Albendazole. You can order medicines online in India once you are prescribed treatment by your doctor.

Conclusion

After you consult a doctor, the doctor shall ask you your chief complaints and as to what made you come to the hospital. After this, the doctor shall ask relevant questions pertaining to your condition and your symptoms in order to complete your medical history. If you have a travel history to areas where the infection is prevalent it can imply that the diagnosis of the condition might be hydatid disease as the condition is very common in those areas. This will be followed by a physical examination to check for any more signs and symptoms that might be important in your case. The doctor will now refer some tests in order to confirm the probable diagnosis so that treatment can be started. 

[arushmichael]

T. gondii Infection: Diagnosis and Treatment

By Arush Emmanuel Michael

The infection is caused by the obligate intracellular parasite which is scientifically known as Toxoplasma gondii. The parasite is found in many nucleated cells and especially reticuloendothelial cells. Toxoplasma gondii belongs to the class Sporozoa and phylum Apicomplexa. Nicolle and Monceaux first described the parasite in 1908 in a small rodent called gondi (Ctenodactylus gondii). The trophozoite of the parasite has a curved shape from where its name comes from; ‘Toxon’ in Greek refers to arc or bow which refers to the curved trophozoite. Most infections from Toxoplasma gondii are benign with no symptoms; however the parasite is found worldwide and causes a large number of infections.

Mode of infection of T. gondii infection

Infections in humans might occur by:

·        Eating undercooked meat infested with tissue cysts

·        Contamination of food and water with cat’s faeces, followed by their intake

·        Organ transplantation

·        Blood transfusions

·        From mother to foetus through transplacental transmission

·        Infections through accidental infection to persons handling the parasite in the laboratory

Pathogenesis of T. gondii infection

In debilitated patients, fatal infections have a tendency to develop. The majority of the infections caused by the parasite are asymptomatic even though they are present throughout the world. Diffuse encephalitis or meningoencephalitis may develop if the infection involves the central nervous system especially in immunocompromised patients. Secondary central nervous system infections in AIDS patients are most commonly caused by Toxoplasma gondii.

Congenital Infection

Abortion or still birth may be caused by a congenital infection during the first trimester of pregnancy. A less sever neurological damage is induced by a second and third trimester infection.

Infection acquired postnatally

A congenitally acquired infection is much more severe than a post-natally acquired infection. Swollen lymph nodes is the most common manifestation of Toxoplasmosis. Pneumonitis, meningoencephalitis and myocarditis are some rare manifestations of the infection. The most common manifestation is encephalitis particularly in the case of patients whose immunity is compromised.

Ocular toxoplasmosis is also known to develop. Congenital infections mostly lead to ocular manifestations but it may be acquired postnatally as well.

Symptoms of T. gondii infection

Most people suffering infected with toxoplasmosis show no symptoms or manifestations. The symptoms prevalent in toxoplasmosis include:

·        Fever (pyrexia)

·        Headache

·        Pains and aches in the muscles

·        Lymphadenopathy (swollen lymph nodes especially in the neck)

·        Sore throat

The manifestations might resolve in a month or so. If the condition is not treated it might result in complication mentioned above in pathogenesis. Complications and infections progress rapidly especially in immunocompromised patients. In order to prevent these complications it is essential to receive treatment as soon as possible. Once you are prescribed treatment for any condition by your doctor you can now order medicines online in India.

Diagnosis of T. gondii infection

After you consult a doctor, the doctor shall ask you your chief complaints and as to what made you come to the hospital. After this, the doctor shall ask relevant questions pertaining to your condition and your symptoms in order to complete your medical history. If you have a travel history to areas where the infection is prevalent it can imply that the diagnosis of the condition might be Toxoplasmosis as the condition is very common in those areas. This will be followed by a physical examination to check for any more signs and symptoms that might be important in your case. The doctor will now refer some tests in order to confirm the probable diagnosis so that treatment can be started.

The specimens collected for diagnosis include:

·        Blood

·        Aspiration of bone marrow

·        Cerebrospinal fluid

·        Amniotic fluid

·        Bronchoalveolar lavage (especially in immunocompromised individuals like AIDS patients)

·        Tissue biopsy (Brain, Spleen and Lymph Nodes)

Treatment of T. gondii infection

A combination of pyrimethamine and sulphadiazine is the treatment of choice for Toxoplasmosis. Spiramycin, Clindamycin, Trimethroprim and Sulphamethoxazole are other alternative drugs. The doctor shall give you a route of treatment that is preferable and right for you. You should never self medicate and you should always consult a doctor for any condition you are suffering from. You can now buy medicines online in India once you are prescribed the treatment by your health care provider.

Prevention of T. gondii infection

Measures that can be taken for the prevention of infection include:

·        Avoid contact with uncooked meat and cat faeces

·        Wash fruits and vegetables before consuming them

·        Meat should be properly cooked before its consumption

·        Always wash your hands before consuming food

[arushmichael]

Bordetella pertussis: Pathogenesis and Treatment

By Arush Emmanuel Michael

The bacteria Bordetella pertussis causes this highly communicable disease known as whooping cough which is acute in nature in childhood.

 What is Bordetella pertussis?

It is a small, ovoid, gram negative coccobacillus which is non-sporing, capsulated and non-motile in nature. It is the causative agent of Pertussis which is better known as Whooping Cough.

 Prevalence of Bordetella pertussis infection First of year of life is when whooping cough shows the highest incidence and mortality, therefore it is generally a pediatric disease. The patient most infective during the early stage of the disease is the source of infection. Air droplets is how this most infectious of bacterial diseases spreads among children. There are no asymptomatic carriers or healthy carriers that were identified and although immunity develops after natural infection there is a chance of a second attack.  In adults especially, a reinfection can be fatal.

Development of Bordetella pertussis infection After the bacteria is transmitted via droplets from the source of infection, the incubation period for the disease is around 2 weeks. The disease develops in three stages lasting two weeks each:

1.      Catarrhal Stage: It is the early stage of infection where the patient is most infective, however, diagnosis during this stage is difficult.

2.      Paroxysmal Stage: There is continuous coughing with violent spasms. The empty lungs get a long inrush of air with a ‘whoop’.

3.      Convalescent Stage: Coughing decreases in severity and frequency

 Symptoms

 The stage of the disease determine the symptoms of pertussis:

1.      Catarrhal Stage: Low grade fever, running nose and an occasional cough which is mild in nature

2.      Paroxysmal Stage:  Continuous coughing with violent spasms followed by exhaustion and vomiting

3.      Convalescent Stage: Gradual recovery with occasional coughing

If the symptoms mentioned above are noticed kindly consult a healthcare provider as soon as possible so that a diagnosis can be made. Following diagnosis treatment is necessary otherwise the disease may lead to complications which can be fatal. You can now buy medicines online in India for any prescribed treatment.

 Complications of Bordetella pertussis infection

Complications might result in pertussis even though the disease is self limiting. These complications include:

·        Lung collapse

·        Bronchopneumonia

·        Subconjuctival haemorrhage

·        Convulsions

·        Coma

Diagnosis of Bordetella pertussis infection

A doctor shall carry out diagnosis by a history taking, followed by a physical examination and finally some laboratory diagnostic techniques to confirm the possible diagnosis. The laboratory diagnostic techniques utilised are:

·        Microscopy: By using the fluorescent antibody technique the bacilli can be demonstrated in the respiratory secretions.

·        Culture: The catarrhal stage is when the bacilli are most prominent in the upper respiratory tract. There are a variety of culture methods that can be used:

1.      Pernasal Swab- The floor of the nasal cavity is used to pass a swab over which is then cultured and checked for bacteria.

2.      Cough Plate Method: When the patient is having a bout of coughing, the culture plate is held in front of their face.

3.      Postnasal swab: Pharyngeal wall secretions are collected by passing the swab through the nose. The swab is then cultured to check for bacteria.

·        Polymerase Chain Reaction: Preferred for direct diagnosis of whooping cough.

·        Serological tests: Agglutination test, complement fixation test and ELISA might be employed to diagnose the condition which is pertussis or whooping cough.

 Treatment of Bordetella pertussis infection

The first line drug of choice for the treatment of pertussis is Erythromycin. However, the bacteria Bordetella pertussis itself is susceptible to the action of a number of antibiotics such as ampicillin, chloramphenicol and tetracycline.You can now any prescribed drugs you want on the best pharmacy app in India.

 Prevention of Bordetella infection

 The most effective way is to immunise infants and children with the killed vaccine. DwPt and DaPT are the two vaccine types available. At an interval of four to six weeks before six months of age, three injections are given followed by one booster dose at the ending of first year of life.

Children who come in contact with a case are required to receive a booster dose and erythromycin given prophylactically for a period of five days.

The infection is a harmful disease which can lead to multiple complications and increased mortality in infants and children. However, with appropriate measures and treatment this disease can be easily overcome.

[arushmichael]

Streptococcus pyogenes: Virulence Factors

By Arush Emmanuel Michael

Toxins

1)      Haemolysins

·        Streptococcus is responsible for the production of two haemolysins, namely streptolysin O and streptolysin S.

·        Streptolysin O is inactivated in the presence of oxygen but can be reactivated by treatment with reducing substances. It is lytic to erythrocytes and is cytotoxic to neutrophils, platelets and cardiac tissue. It is also heat labile apart from being antigenic. Its antigenic nature leads to production on Anti streptolysin O (ASO) and a titre in serum bove 200 units indicates a streptococcus infection.

·        Streptolysin S on the other hand is oxygen stable and is responsible for the haemolysis seen in blood agar plates on incubation. It has some leucocidal action but is not antigenic in nature.

2)      Streptococcal pyogenic exotoxin (SPE)

It is also known as erythrogenic toxin which is of three types classified antigenically i.e, Type A, B and C. SPE is released by Group A streptococci and is responsible for streptococcus toxic shock syndrome and scarlet fever. Type A and Type C SPE are released by bacteriophage genes while Type B SPE is released by chromocomal genes. SPE are superantigens, they are T mitogens which cause massive release of inflammatory cytokines in the body of the infected individual. The antigen exotoxin is neutralised by antibodies which are present in the convalescent sera. SPE are responsible for pyrogenecity, cytotoxicity and increased susceptibility to the endotoxin.

Enzymes

1)      Streptokinase (Fibrinolysin)

It breaks down clots and fibrin barriers by causing conversion of plasminogen to plasmin. The enzyme is antigenic in nature and neutralising antibodies found in convalescent sera can be utilised to be estimated for retrospective study. Streptokinase causes the break down of fibrin barriers around the lesion which facilitates the spread of infection. Clinically, streptokinase is used for the treatment of early myocardial infarction and thromboembolic disorders. Once you are prescribed medicines for treatment, you can now order medicines online in India.

2)      Deoxyribonucleases (Streptodornases)

Four different antigenically different deoxyribonucleases are elaborated by group A streptococci. Type B streptodornase is the most active antigenically and the antibodies prepared against it are useful in retrospective studies in the diagnosis of streptococci infections. These deoxyribonucleases are responsible for the digestion of DNA in the thick pus derived from the nuclei of the necrotic cells. Therefore, the exudates in streptococci lesions are thin and serous. A combination of streptolysins and streptodornases are used clinically to liquefy localised collections of thick exudates like in empyema.

3)      Nicotinamide adenine dinucleotidase (NADase)

It is considered to be leucotoxic and antigenic in nature. The enzyme liberates nicotinamade by acting on NAD. NADase is released by streptococci of Group A, C and G.

4)      Hyaluronidase

This enzyme is responsible for the breakdown of hyaluronic acid which is present in the tissues and help in the spread of the infection and the lesion. The enzyme produced by the bacteria is antigenic in nature and antibodies produced against it can be found in the sera of the infected patient. Production of this enzyme seems like a self-destructive process as the capsule of the bacteria also contains hyaluronic acid. However, it is found that the capsule is not present in strains which produce a large quantity of this hyaluronidase.

5)      Other extracellular products like neuraminidase, esterases, phosphatise, lipase and amylase are also released by the bacteria. The exact pathogenic mechanism of these extracellular products is not really known.

After you consult a doctor, the doctor shall ask you your chief complaints and as to what made you come to the hospital. After this, the doctor shall ask relevant questions pertaining to your condition and your symptoms in order to complete your medical history. If you have a travel history to areas where the infection is prevalent it can imply that the diagnosis of the condition might be Streptococcus infection as the condition is very common in those areas. This will be followed by a physical examination to check for any more signs and symptoms that might be important in your case. Streptococcus infections cane be dangerous and fatal to health, therefore it is necessary to receive timely and correct treatment. You should never self medicate yourself as it can be fatal to your health. Prevention is always better than cure and all precautions for prevention of a streptococcus infection should be taken.