A Review on Clinical useful Tetracyclines

Presently, the name “tetracycline” refers to a number of antibiotics of either natural, or semi-synthetic origin, derived from a system of four linearly annelated six-membered rings (1,4,4a,5,5a,6,11,12a-octahydronaphthacene) with a characteristic arrangement of double bonds. The tetracycline molecule possesses five asymmetric centers: C-4, -4a, -5a, -6, and -12a.

Chemical properties
The reactions that tetracyclines undergo are generally of a sophisticated nature, dictated by the complex functionality and the sensitivity of the molecules to mild reaction conditions (acid, base, heat).
Acidic conditions
When exposed to dilute acid conditions, tetracycline undergoes dehydration to yield anhydrotetracycline. Anhydroterramycin suffers further cleavage and lactonization to apoterramycin:

Diluted acid promotes epimerization at C-4 as well.
Basic conditions
Mild alkali attacks 11a carbon of tetracycline, which is transformed to isotetracycline:

Formation of complexes
Tetracycline possesses a great tendency to form complexes with a number of chemical species, due to its B- and C-ring oxygen atoms:

It complexes most readily with Fe3+, Fe2+, Cu2+, Ni2+, Co2+, Zn2+, Mn2+, Mg2+, Ca2+, Be2+, Al3+ among metal ions, phosphates, citrates, salicylates, p-hydroxybenzoates, saccharin anion, caffiene, urea, thiourea, polivinylpyrrolidone, serum albumin, lipoproteins, globulins, and RNA
MECHANISM OF ACTION
Tetracycline is a short-acting antibiotic that inhibits bacterial growth by inhibiting translation. It binds to the 30S ribosomal subunit and prevents the amino-acyl tRNA from binding to the A site of the ribosome. It also binds to some extent to the 50S ribosomal subunit. This binding is reversible in nature. Additionally tetracycline may alter the cytoplasmic membrane of bacteria causing leakage of intracellular contents, such as nucleotides, from the cell.
Pharmcokinetics:
Metabolism:

Absorption: Bioavailability is less than 40% when administered via intramuscular injection, 100% intravenously, and 60-80% orally (fasting adults). Food and/or milk reduce GI absorption of oral preparations of tetracycline by 50% or more.
Protein binding: 20 – 67% protein bound
Route of elimination They are concentrated by the liver in the bile and excreted in the urine and feces at high concentrations in a biologically active form. Half life is 6-12 hours.
Antimicrobial properties
In the 1950s, when most of the tetracyclines were discovered, their antimicrobial spectrum was broader than of any othen antibiotic then known. Tetracyclines are characterized by their exceptional chemotherapeutic efficacy against a wide range of Gram positive and Gram negative bacteria, richettsia, spirochetes, and large viruses, such as members of the lymphogranuloma group. The main indications for the use of tetracyclines are infections due to Escherichia coli and Haemophilus influenzae, infections of the bile duct, bacterial respiratory disorders including bronchitis prophylaxis, mixed infections arising from the mouth, pharynx, or intestinal tract, brucellosis, tularemia, plague and other pasteurelloses, leptospirosis, lymphogranuloma inguinale, cholera, and rickettsiosis. Because of the development of strains of microorganisms resistant to the tetracyclines, these antibiotics have lost some of their usefulness. They are no longer the drugs of first choice for treatment of staphylococcal, streptococcal, or pneumococcal infections. The individual tetracyclines differ less in their potency that in pharmacokinetic properties such as resorption, tissue diffusion, and elimination.
RESISTANCE: Two genes have been recognized that contribute to the resistance in tetracyclines tet and otr . They donot allow the binding of tetracycline with the aminoacyl t RNA by changing the adenine to guanine.
STRUCTURE-ACTIVITY RELATIONSHIPS
1. Tetracycline molecules comprise a linear fused tetracyclic nucleus (rings designated A, B, C, and D to which a variety of functional groups are attached. The simplest tetracycline to display detectable antibacterial activity is 6-deoxy-6-demethyltetracycline and so this structure may be regarded as the minimum pharmacophore.

2. Features important for antibacterial activity among the tetracyclines are maintenance of the linear fused tetracycle, naturally occurring (α) stereochemical configurations at the 4a, 12a (A-B ring junction), and 4 (dimethylamino group) positions, and conservation of the keto-enol system (positions 11, 12, and 12a) in proximity to the phenolic D ring.
3. Chelation sites include the β-diketone system (positions 11 and 12) and the enol (positions 1 and 3) and carboxamide (position 2) groups of the A ring.
4. Replacement of the C-2 carboxamide moiety with other groups has generally resulted in analogs with inferior antibacterial activity, probably because bacteria accumulate these molecules poorly.
5. However, the addition of substituents to the amide nitrogen can impart significant water solubility, as in the case of rolitetracycline and lymecycline.
6. Consistent with the above observations, substitutions at positions 1, 3, 4a, 10, 11, or 12 are invariably detrimental for antibacterial activity.
7. A number of other substitutions at different positions on the B, C, and D rings are tolerated, and molecules possessing these substituents have given rise to the tetracyclines in clinical use today, as well as the new glycylcycline molecules that are currently undergoing clinical trials.
8. The extensive structure-activity studies referred to above revealed that with one exception, each of the rings in the linear fused tetracyclic nucleus must be six membered and purely carbocyclic for the molecules to retain antibacterial activity.
9. For instance, the nortetracyclines, derivatives in which the B ring comprises a five-membered carbocycle, are essentially devoid of antibacterial activity . Nevertheless, 6-thiatetracycline, which possesses a sulfur atom at position 6 of the C ring, is an apparent exception to the rule that a purely carbocyclic six-membered ring structure is required for activity, since molecules in this series have potent antibacterial properties.
Atypical tetracyclines:
These molecules, which also include the anhydrotetracyclines, 4-epi-anhydrotetracyclines, and chelocardin, appear to directly perturb the bacterial cytoplasmic membrane, leading to a bactericidal response (43, 198, 199). This contrasts with the typical tetracyclines, which interact with the ribosome to inhibit bacterial protein synthesis and display a reversible bacteriostatic effect. The membrane-disrupting properties of the atypical tetracyclines are probably related to the relative planarity of the B, C, and D rings so that a lipophilic, nonionized molecule predominates. On interaction with the cell, the atypical tetracyclines are likely to be preferentially trapped in the hydrophobic environment of the cytoplasmic membrane, disrupting its function. These molecules are of no interest as therapeutic candidates because they cause adverse side effects in humans (250), which are probably related to their ability to interact nonspecifically with eukaryotic as well as prokaryotic cell membranes.
Synthesis:

Doxycycline:
A synthetic tetracycline derivative with similar antimicrobial activity. Animal studies suggest that it may cause less tooth staining than other tetracyclines

Mecahnism:
Doxycycline, is lipophilic and can pass through the lipid bilayer of bacteria. Doxycycline reversibly binds to the 30 S ribosomal subunits and possibly the 50S ribosomal subunit(s), blocking the binding of aminoacyl tRNA to the mRNA and inhibiting bacterial protein synthesis. Doxycycline prevents the normal function of the apicoplast of Plasmodium falciparum, a malaria causing organism.
Pharmacokinetics:
Completely absorbed following oral administration. >90%Protein binding, undergoes hepatic metabolism. Route of elimination is it is concentrated by the liver in the bile and excreted in the urine and feces at high concentrations in a biologically active form. Half life is 18-22 hours.
Uses:
Doxycycline is indicated for use in respiratory tract infections caused by Mycoplasma pneumoniae, Haemophilus influenzae, Streptococcus pneumoniae, Legionella spp., or Klebsiella spp. It is also used for prophylaxis of malaria. Doxycycline is indicated for a variety of bacterial infections, from Mycobacterium fortuitum and M. marinum, to susceptible E. coli and Brucella spp. It can be used as an alternative to treating plague, tetanus, Campylobacter fetus.
Toxicity:
Symptoms of overdose include anorexia, nausea, diarrhoea, glossitis, dysphagia, enterocolitis and inflammatory lesions (with monilial overgrowth) in the anogenital region, skin reactions such as maculopapular and erythematous rashes, exfoliative dermatitis, photosensitivity, hypersensitivity reactions such as urticaria, angioneurotic oedema, anaphylaxis, anaphyl-actoid purpura, pericarditis, and exacerbation of systemic lupus erythematosus, benign intracranial hypertension in adults disappearing on discontinuation of the medicine, haematologic abnormalities such as haemolytic anaemia, thrombocytopenia, neutropenia, and eosinophilia.
Oxytetracycline
A tetracycline analog isolated from the actinomycete Streptomyces rimosus and used in a wide variety of clinical conditions.

Pharmacodynamics:
Oxytetracycline is known as a broad-spectrum antibiotic due to its activity against such a wide range of infections. It was the second of the tetracyclines to be discovered. Oxytetracycline, like other tetracyclines, is used to treat many infections common and rare. Its better absorption profile makes it preferable to tetracycline for moderately severe acne, but alternatives sould be sought if no improvement occurs by 3 months.
Oxytetracycline inhibits cell growth by inhibiting translation. It binds to the 30S ribosomal subunit and prevents the amino-acyl tRNA from binding to the A site of the ribosome. The binding is reversible in nature. Oxytetracycline is lipophilic and can easily pass through the cell membrane or passively diffuses through porin channels in the bacterial membrane.
Metabolism:

Indication
Oxytetracycline is indicated for treatment of infections caused by a variety of Gram positive and Gram negative microorganisms including Mycoplasma pneumoniae, Pasteurella pestis, Escherichia coli, Haemophilus influenzae (respiratory infections), and Diplococcus pneumoniae.
Toxicity
Adverse effects may include stomach or bowel upsets and rarely allergic reactions. Very rarely severe headache and vision problems may be signs of dangerous intracranial hypertenion.
Minocycline
A tetracycline analog, having a 7-dimethylamino and lacking the 5 methyl and hydroxyl groups, which is effective against tetracycline-resistant staphylococcus infections.

Minocycline, the most lipid soluble and most active tetracycline antibiotic, is, like doxycycline, a long-acting tetracycline. Minocycline’s effects are related to the inhibition of protein synthesis. Although minocycline’s broader spectrum of activity, compared to other members of the group, includes activity against Neisseria meningitidis, its use as a prophylaxis is no longer recomended because of side effects (dizziness and vertigo). Current research is examining the possible neuroprotective effects of minocycline against progression of Huntington’s Disease, an inherited neurodegenerative disorder. The neuroprotective action of minocycline may include its inhibitory effect on 5-lipoxygenase, an inflammatory enzyme associated with brain aging.
Mechanism of action
Minocycline passes directly through the lipid bilayer or passively diffuses through porin channels in the bacterial membrane. Tetracyclines like minocycline bind to the 30S ribosomal subunit, preventing the binding of tRNA to the mRNA-ribosome complex and interfering with protein synthesis.
Pharmacokinetics:
Rapidly absorbed from the gastrointestinal tract and absorption is not significantly impaired by ingestion of food or milk. Oral bioavailability is 100%. 55% to 76% protein binding. Undergoes hepatic metabolism. Half life is 11-22 hours.
Indication
For the treatment of infections caused by susceptible strains of microorganisms, such as Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsial pox and tick fevers caused by Rickettsiae, upper respiratory tract infections caused by Streptococcus pneumoniae and for the treatment of asymptomatic carriers of Neisseria meningitidis.
Toxicity
Minocycline has been observed to cause a dark discoloration of the thyroid in experimental animals (rats, minipigs, dogs and monkeys). In the rat, chronic treatment with minocycline has resulted in goiter accompanied by elevated radioactive iodine uptake and evidence of thyroid tumor production.
Lymecycline
A tetracycline with a 7-chloro substitution.

Pharmacodynamics
Lymecycline is a tetracycline broad-spectrum antibiotic. It is approximately 5000 times more soluble than tetracycline base and is unique amongst tetracyclines in that it is absorbed by the “active transport” process across the intestinal wall, making use of the same fast and efficient mechanism by which carbohydrates are absorbed. It inhibits cell growth by inhibiting translation.
Lymecycline inhibits cell growth by inhibiting translation. It binds to the 30S ribosomal subunit and prevents the amino-acyl tRNA from binding to the A site of the ribosome. The binding is reversible in nature. Lymecycline is lipophilic and can easily pass through the cell membrane or passively diffuses through porin channels in the bacterial membrane. Cells become resistant to lymecycline by at least two mechanisms: efflux and ribosomal protection. In efflux, a resistance gene encodes a membrane protein that actively pumps lymecycline out of the cell. This is the mechanism of action of the tetracycline resistance gene on the artificial plasmid pBR322. In ribosomal protection, a resistance gene encodes a protein which binds to the ribosome and prevents lymecycline from acting on the ribosome.
Pharmacokinetics:
Absorption is fast and efficient. Bioavailability is 100% following oral administration.
Indication
For the treatment of infections and to treat acne. It may also be used to treat urinary tract infections, gum disease, and other bacterial infections such as gonorrhea and chlamydia. Lymecycline is also used commonly as a prophylactic treatment for infection by Bacillus anthracis (anthrax). It is also effective against Yersinia pestis and malaria and is also prescribed for the treatment of Lyme disease.
Toxicity
Adverse effects include nausea, vomiting, diarrhoea, glossitis, enterocolitis, dysphagia, dermatitis, hypersensitivity reactions, proctitis, and vaginitis.
Rolitetracycline

Mechanism of action
Rolitetracycline is a semisynthetic broad-spectrum tetracycline antibiotic used especially for parenteral administration in cases requiring high concentrations or when oral administration is impractical. Rolitetracycline passively diffuses through porin channels in the bacterial membrane and reversibly binds to the 30S ribosomal subunit, preventing binding of tRNA to the mRNA-ribosome complex, and thus interfering with protein synthesis.
Indication
Rolitetracycline is a broad-spectrum antibiotic used in cases needing high concentrations or when oral administration is impractical.
Toxicity
Symptoms of overdose include anorexia, nausea, diarrhoea, glossitis, dysphagia, enterocolitis and inflammatory lesions (with monilial overgrowth) in the anogenital region, skin reactions such as maculopapular and erythematous rashes, exfoliative dermatitis, photosensitivity, hypersensitivity reactions such as urticaria, angioneurotic oedema, anaphylaxis, anaphyl-actoid purpura, pericarditis, and exacerbation of systemic lupus erythematosus, benign intracranial hypertension in adults disappearing on discontinuation of the medicine, haematologic abnormalities such as haemolytic anaemia, thrombocytopenia, neutropenia, and eosinophilia.
Tigecycline
Tigecycline is a glycylcycline antibiotic developed and marketed by Wyeth under the brand name Tygacil. It was given a U.S. Food and Drug Administration (FDA) fast-track approval and was approved on June 17, 2005. It was developed in response to the growing prevalence of antibiotic resistance in bacteria such as Staphylococcus aureus.

Tigecycline is the first clinically-available drug in a new class of antibiotics called the glycylcyclines. Glycylcyclines are a new class of antibiotics derived from tetracycline. These tetracycline analogues are specifically designed to overcome two common mechanisms of tetracycline resistance, namely resistance mediated by acquired efflux pumps and/or ribosomal protection. Glycylcycline antibiotics have a similar mechanism of action as tetracycline antibiotics. Both classes of antibiotics bind to the 30S ribosomal subunit to prevent the amino-acyl tRNA from binding to the A site of the ribosome. However, the glycylcyclines appear to bind more effectively than the tetracyclines.
Tigecycline is the first clinically-available drug in a new class of antibiotics called the glycylcyclines. Glycylcyclines are a new class of antibiotics derived from tetracycline. These tetracycline analogues are specifically designed to overcome two common mechanisms of tetracycline resistance, namely resistance mediated by acquired efflux pumps and/or ribosomal protection. Glycylcycline antibiotics have a similar mechanism of action as tetracycline antibiotics. Both classes of antibiotics bind to the 30S ribosomal subunit to prevent the amino-acyl tRNA from binding to the A site of the ribosome. However, the glycylcyclines appear to bind more effectively than the tetracyclines.
Metabolism
Tigecycline is not extensively metabolized. In vitro studies with tigecycline using human liver microsomes, liver slices, and hepatocytes led to the formation of only trace amounts of metabolites. A glucuronide, an N-acetyl metabolite, and a tigecycline epimer (each at no more than 10% of the administered dose) are the primary metabolites.

Indication
For the treatment of infections caused by susceptible strains of the designated microorganisms in the following conditions: Complicated skin and skin structure infections caused by Escherichia coli, Enterococcus faecalis (vancomycin-susceptible isolates only), Staphylococcus aureus (methicillin-susceptible and -resistant isolates), Streptococcus agalactiae, Streptococcus anginosus grp. (includes S. anginosus, S. intermedius, and S. constellatus), Streptococcus pyogenes and Bacteroides fragilis. Complicated intra-abdominal infections caused by Citrobacter freundii, Enterobacter cloacae, Escherichia coli, Klebsiella oxytoca, Klebsiella pneumoniae, Enterococcus faecalis (vancomycin-susceptible isolates only), Staphylococcus aureus (methicillin-susceptible isolates only), Streptococcus anginosus grp. (includes S. anginosus, S. intermedius, and S. constellatus), Bacteroides fragilis, Bacteroides thetaiotaomicron, Bacteroides uniformis, Bacteroides vulgatus, Clostridium perfringens, and Peptostreptococcus micros.
Toxicity
Since glycylcyclines are similar to tetracyclines, they share many of the same side effects and contraindications as tetracyclines. These side effects may include nausea/vomiting, headache, photosensitivity, discoloration of growing teeth, and fetal damage.

Natural Remedies For Cystic Acne

Acne is caused due to dead cells of skin or oil filling up in the skin’s pores. Sometimes, acne can become serious and you can get pimples on your skin. This is called Cystic acne. This kind of acne needs to be treated immediately as it is very unpleasant. There are numerous treatments available to cure cystic acne. You can use these treatment options, but sometimes, these treatments can cause side effects. This may not be good for your skin. It is better if you try out the numerous home remedies or natural treatments that are generally prescribed to cure cystic acne.

The basic function that these treatments need to provide is the cleansing of your skin to remove the dead skin and the oil and keep the skin soft and smooth. Women, in particular, have to remove the makeup on skin before going to bed as cystic acne can affect adults as well as infants. Whatever activity you do to cleanse your skin will cure your acne in the long run. The food is a part of the factors that contribute to acne. Apart from food, lack of exercise can also lead to acne.

Your first step to clearing acne is to stop eating junk foods and processed foods. Foods that contain hydrogenated fat, fried or grilled food, concentrated sweeteners, soft drinks like coca-cola, pepsi and soda pop, and alcoholic drinks can lead to acne. If you replace these foods with foods like fruits, carrots, rice malt, barley malt, unrefined sea salt etc, then you will be a long way ahead in your treatment of acne. Changing your diet will cleanse your skin from the inside.

There are other mixtures that you can apply on your skin to remove the dead skin cells and oil formation on your skin. You should wash your skin with warm water and mild soap daily. Sandalwood paste and turmeric paste are very useful to cleanse your skin. You can also apply egg white to your skin which is a wonderful remedy for cystic acne. You can also use olive oil as this is a known skin cleanser. Olive oil was used as a moisturizer by the Greeks many centuries ago. Olive oil mixed with water dissolves the dead skin in the pores and cleans your skin. One of the ways to remove the toxins that have accumulated in your body is to sweat it out. You can try exercise, sauna and some other physical activities to sweat and keep the pores of your skin clean. Physical activities like exercise will bring balance to your body and relieve it of its stress.

These are some of the wonderful natural treatments available for treatment of cystic acne. The best way to keep acne away is to maintain your skin by cleansing it regularly using water and soap or other cleansing gels. Apart from this, you must keep your diet healthy as this will keep your body clean from the inside. Apart from keeping acne away, healthy diet can keep other diseases away too.

The Link Between Candida and Vitamin B12 Deficiency

Vitamin B12 is essential for good health in many different ways. It aids in helping the nervous system function properly, and also helps with blood cell production. This comes in many forms, but the most common sources are in meats, diary products, and in eggs. Though B12 deficiency can happen to anyone, strict vegetarians are often at risk because they don’t eat any of those mentioned things. There are many different things that occur with a deficiency, and there appears to be a link between Candida and vitamin B12.

There are some conditions that can attribute to a deficiency in B12. Some are common sense and some are surprising.

Alcoholics are at risk as are those who have Crohn’s disease. There is an intrinsic factor that helps the body absorb B12 in the stomach and intestines, and if someone has had surgery in either area, that factor may have been affected or is missing.

When that happens, the B12 can not be absorbed as it should be. Someone with this problem will have no appetite, bouts of loose stools, and they might feel very weak. They might also notice a shortness of breath, problems with tingling or numbness in the extremities, and might even experience some mental fog.

Anemia brought on by a vitamin B12 deficiency must be treated. This can be accomplished in a few different ways, but it is urgent that it happens quickly. This is something that is rather easy to treat, and that is the good news for anyone with this condition. Usually a balanced diet will take care of the deficiency, though this might be hard for the strict vegetarian. Many times diet changes and a supplement of B12 will do the trick, and in some cases, shots might be needed rather than a pill. Some people will require these injections for life.

So, you may be wondering if Candida can be effected by a vitamin b12 deficiency. This is a yeast that grows in the body, most notably in the vaginal area and in the intestines. In most cases, it is kept under control by the body’s immune system. However, when there is a lack of B12 the immune function is impaired and Candida can then grow out of control. When this happens, a person might notice headaches, mental fog, tiredness, sinus issues, mood swings, loss of concentration, and even a craving for sweet foods.

In order to treat Candida, the deficiency of vitamin B12 will need to be taken care of first. When the proper balance of B12 is restored, the Candida can then be kept in check after a course of treatment and it has reverted back to its normal state with in the body. Now that you know Candida and Vitamin B12 are related, the knowledge should encourage you to eat a more balanced diet to avoid the further complications associated with a b12 deficiency.

Post Hair Restoration Complications: Redness, Folliculitis, Swelling

A few months ago, at a Halloween party, a middle-aged man I met confided in me that he had had a hair transplant done in San Diego. He spoke about a minor post-surgical matter. This fellow party-goer was experiencing minor pain and tenderness on the recipient transplant areas like his hairline and crown. In addition, he saw what looked like red zits and scalp bumps in the same area as well.

Sensing I knew something about hair restoration procedures, he asked me, “am I supposed to be on antibiotics? Will this hinder hair growth in a timely manner?”

Inflammation of hair follicles, or folliculitis, especially of the hair, is considered normal in many patients and may be seen a few days after hair transplant surgery. In some cases, folliculitis may re-occur for as long as a few months after surgery as well.

Antibiotics are not a requirement to be taken unless the lesions do not get better on their own, or if cellulitis (infection and inflammation of the tissues beneath the skin), or skin redness and swelling become evident due to infection. This is considered rare on the scalp but still notable.

Also, folliculitis does not create an issue to the growth of transplanted hair and, in most cases, does not require any special treatment. The lesions usually open on their own but if they persist for more than two to three weeks, I suggest the person to revisit their hair transplant surgeon and have him open and drain the lesions.

For other cosmetic-related questions and answers, do a Web search on Dysport in Orange County. Also, if you’re curious about juviderm, restylane, or botox, check out an Woodland Hills Plastic Surgery center.

The Dangers Of Trileptal – What You Should Know

Attention deficit hyperactivity disorder (ADHD) is a condition that is caused by chemical imbalance in a certain part of the brain. ADHD affects as many as 5% of all children. About half the ADHD children carry the condition into adulthood. The major treatment of ADHD involves taking prescription medications. One drug that is commonly used to help treat ADHD symptoms is Trileptal. There are dangers of Trileptal that parents should know about before their child starts taking it.

Trileptal is also known as oxcarbazepine. It is an anti-seizure medication used to stabilize the levels of electrical activity in the brain. It is most often prescribed to patients who have ADHD combined with oppositional defiant disorder (ODD). While other anti-seizure medications have undergone various studies, the effectiveness of Trileptal has not been studied extensively.

There are several side effects associated with Trileptal. These can range from mild to severe. While not every patient who takes Trileptal experiences these side effects they are quite common. Trileptal side effects are divided into two categories: nuisance and dangerous.

Nuisance side effects are those that may be difficult to deal with but do not pose any additional health threat.

Headache – One of the most common side effects of taking Trileptal, headaches can range from mild to severe and are often hard to get rid of.

Fatigue – Often patients taking Trileptal report a constant general fatigue or sleepiness. This may improve with time.

Gastronomical problems -These include nausea, diarrhea, constipation, abdominal pain and vomiting. If these symptoms appear persist, the patient can become weak from lack of nutrients.

Agitation – Trileptal can cause increased agitation in some people. This could add to the already unstable behavior of an ADHD child or adult.

Acne – Many patients on Trileptal report increased acne which may be due to hormone imbalance.

Skin reactions – Patient may develop skin rash or irritation. If the rash is severe or does not go away, you should notify your doctor.

Concentration and memory problems – These may be hard to diagnose because they are also ADHD symptoms experienced by some patients. If these side effects worsen, you should talk to your doctor.

Dangerous side effects of Trileptal are not only annoying but can also pose serious health hazards to those taking the drug.

Inflammation of the liver – Also known as hepatitis which can be caused by prolonged use of the drug.

Chronic inflammatory diseases – These include osteoarthritis, rheumatoid arthritis, inflammatory lung disease, inflammatory bowel disease, atherosclerosis and psoriasis.

Low blood sodium levels – Which can lead to many other problems in the body. Patients should have their blood tested to determine the sodium levels are correct.

Discuss with your doctor the dangers of Trileptal before starting on the medication. If you experience any Trileptal side effects, let your doctor know so that he can prescribe a lower dosage or an alternative ADHD medication for you. Seek immediate medical attention for severe reactions to Trileptal.

Signs and Symptoms of Heroin Abuse and Addiction

How to spot heroin use?

In the beginning stages, look for:

Dry mouth, causing excessive thirst. The user will keep a liquid at all times and sip often.

Constricted pupils is another indication. Many drug of abuse can cause this, but it will be present with heroin.

Being sleepy at odd times is another indication of heroin abuse. Drowsiness and drifting into stupor even during conversations is in indication of a recent dose.

Wakefulness and marked alertness can be seen with smaller doses, but these will usually be short-lived and soon give way to the lack of attention and sleepy demeanor.

Nausea is a very common side effect of the abuse of heroin. Vomiting and other digestive troubles such as diarrhea and stomach cramps are common and even expected by heroin addicts. Eventually, as a result of frequent vomiting, stomach acid, deposited on teeth can cause rapid dental decay and tooth loss.

When abuse gives way to addiction, the signs will be:

Lethargy and an apathetic attitude toward activities which were formerly considered important.

In personal hygiene, a marked lack of care. Carelessness also in personal relations and in handling personal possessions. Belongings which were once kept close will become neglected and ignored. The addict’s car or motorcycle will go un washed and uncared for.

Injection marks on arms, legs, between fingers and toes, just about anywhere a vein can be accessed will show holes and infected bumps and suppuration, the forming and discharge of pus. These wounds can and do become serious and life-threatening at times due to lack of attention and the pain killing effects of the drug.

More signs include:

  • Presence of drug paraphernalia
  • Changes in attitude
  • Changes in friends
  • Changes in performance in work or school
  • Dishonesty and theft
  • An inability to face people and consequences

These are by no means the only signs of heroin abuse, but some of these will be present when your suspicions of the use of heroin are correct.

The answer is to get this individual into treatment, now. Addiction to opiates such as heroin can escalate rapidly and getting this person to treatment today will definitely be his or her best chance for a speedy and complete recovery.

The Different Causes of Panic Attacks

You may not know it but statistics showed that panic attacks are a common condition. It affects both men and women. Panic attacks are a sudden onset of fear or overwhelming anxiety. It is when your heart beats so fast, you can’t breathe, you feel nauseated and you feel like dying. Panic attacks can happen anytime even if you are asleep. Some people experience a panic attack only once in a long while but in most people, it reoccurs quite frequently. Panic attacks, if left untreated, can affect a person’s life badly. It may prevent you from engaging in activities you once liked or going to places you once loved. If you think you are suffering from panic attacks, it will be best for you to distinguish what is causing these. Find out the answer to the question “what are panic attacks caused by?” by reading the rest of this article.

One of the causes of panic attacks is genetics. Studies have found out that panic attacks run in families. This means that it can be inherited just like hair and eye color. But this does not mean that if no one in your family haven’t experience any panic attacks, you will not have it, too. Even if there is no family history of panic attacks, you may develop it. Usually, it occurs more in people who have an above average intelligence.

Phobias are also a cause of panic attacks. When someone is exposed to a phobic situation or object, he/she will experience panic attacks. This is because that person would want to get rid of the object or get out of the situation. If he/she is not able to do so, the panic attack may become worse. Because of this, facing one’s fears is one of the effective treatments to get rid of panic attacks.

Another answer to your question “what are panic attacks caused by?” is the use of certain medications. You must be aware that some medications have panic attacks as a side effect. Such medications are SSRIs or selective serotonin reuptake inhibitors, fluoroquinolone-type antibiotics and methylphenidate. Panic attacks may occur as a side effect as you start taking these drugs. But if it continues to occur then you must tell it to your doctor to have your dosage or medication changed. Panic attacks may also happen when you suddenly stop taking some medicines. Because of this, you must follow your doctor’s instructions on how to stop taking certain medicines.

Certain events in one’s life may also trigger panic attacks. Situations like the death of someone you love, a significant change in life or a life transition can cause panic attacks. One may constantly worry that these things may happen again and not get over it.

Lastly, disorders and conditions such as hypoglycemia, post traumatic stress disorder, hyperthyroidism, obsessive compulsive disorder, mitral valve prolapse, Wilson’s disease, labyrinthitis or inner ear disturbances and pheochromocytoma can cause panic attacks.

So there you have it. Your question “what are panic attacks caused by?” should be, by now answered. This will help you better understand your situation and help you to better get rid of your panic attacks.

Importing Bovril to the USA From a British Food Shop – Is it Legal?

It is a fact of life that many brands of UK foods are hard to purchase in the USA. Although there are many wonderful food brands in the USA, there are some popular products you would find in a British food shop that ex-patriots find they cannot buy in their new country of residence. Sometimes, a familiar flavour is more than just a food craving, and can bring back memories of the friends and family a person has left behind.

It is no surprise to learn that many people resort to importing there own food from there native countries, to obtain the flavour of familiar foods that they have come to know and love.

Bovril is one such food that can be hard to find in the USA. After the BSE (Bovine Spongiform Encephalopathy / Mad Cow Disease) outbreak, Bovril was banned in many countries due to it’s beef content. The recipe for Bovril was changed in 2004 to make it into a vegetarian product; this did not prove so popular with many Bovril lovers, whom complained that it tasted different, and the original recipe returned in 2006 after the European Commission lifted its ban on the export of Britain’s beef products.

It has been rumoured that Bovril is no longer allowed to be imported into the USA and other countries due to it’s beef content. This is quite simply not true. Provided the correct paperwork is completed by the exporter there is no risk of the item being stopped and seized by customs as a restricted product, and Bovril is perfectly legal to import from a British food shop.

The 48 Hour Colon Cleanse – Epsom Salt Enema

Many people have been talking about the benefits of doing a 48 hour colon cleanse lately. Even certain celebrities have been endorsing them. The 48 hour colon cleanse involves either ingesting Epsom salt or using it in an enema. While the benefits can be great, there are also very serious risks involved with Epsom salt enemas. Read this short article and be informed so that you can decide what’s best for you.

Epsom salt is magnesium sulfate. While magnesium sulfate is relatively safe to ingest, (it is found in many, many foods that we eat), it can be very dangerous if taken in large amounts. It’s rare, but deaths have even occurred as a result of too much magnesium sulfate in the system. A condition called hypermagnesemia can set in if someone introduces too much Epsom salt into their system. Often times, different Epsom salt recipes will call for dangerous amounts of magnesium sulfate to be shot into the system and should not be followed.

If you have a preexisting stomach condition like ulcers or heartburn, Epsom salt enemas should not be given. Magnesium sulfate can be hard on the stomach in large amounts and while it will help to clean out the colon, it can do much more harm than good if ingested in large amounts.

Magnesium sulfate can also have very adverse reactions if you are currently taking other medications. There is a laundry list of drugs that do not mix well with magnesium sulfate so if you do decide to perform an Epsom salt enema, you should absolutely ensure that no drugs you are currently taking will conflict. Also, women who are pregnant or nursing should not ingest large amounts of Epsom salt.

Dire consequences rarely occur while performing the 48 hour colon cleanse but you should be aware of the possibilities. Doing an Epsom salt enema is not recommended because of the possibility of adverse side effects and because an enema can be just as effective without it.

Information on Cardiomyopathy –

Cardiomyopathy is a type of heart disease in which the heart becomes abnormally enlarged (enlarged heart), thickened and/or stiffened. As a result, the heart muscle’s ability to pump and/or receive blood is impaired. This condition is generally progressive and may lead to heart failure. Cardiomyopathies may be caused by a wide range of conditions, including chronic diseases, alcoholism, viral diseases, heart attacks and many others. An affected heart may grow larger either by dilatation, thickening (hypertrophy) or both. Additionally, the heart may suffer from a reduced ability to relax.

The heart muscle in people with restrictive cardiomyopathy becomes rigid and less elastic, meaning the heart can’t properly expand and fill with blood between heartbeats. While restrictive cardiomyopathy can occur at any age, it most often tends to affect older people. It’s the least common type of cardiomyopathy and can occur for no known reason (idiopathic). The condition may also be caused by diseases elsewhere in the body that affect the heart, such as amyloidosis, a rare condition in which abnormal proteins present in the blood are deposited into the heart.

Cardiomyopathy is a weakness in the muscle of the heart due to inadequate oxygen delivery to the myocardium with coronary artery disease being the most common cause. Anemia and sleep apnea are relatively common conditions that can contribute to ischemic myocardium and hyperthyroidism can cause a ‘relative’ ischemia secondary to high output heart failure. Individuals with ischemic cardiomyopathy typically have a history of myocardial infarction (heart attack), although longstanding ischemia can cause enough damage to the myocardium to precipitate a clinically significant cardiomyopathy even in the absence of myocardial infarction. In a typical presentation, the area of the heart affected by a myocardial infarction will initially become necrotic as it dies, and will then be replaced by scar tissue (fibrosis).

Cardiomyopathy is disease of the heart muscle. In most cases, cardiomyopathy causes the heart muscle to become weak. Various medical disorders cause various types of cardiomyopathy, but all types of cardiomyopathy ultimately do the same thing – they reduce the efficient functioning of the heart muscle, and diminish the ability of the heart to meet the needs of the body. When the heart can no longer pump enough blood to meet the needs of the body, heart failure is said to be present.

Cardiomyopathy is the loss or weakening of heart muscle tissue caused by ischemia or silent ischemia. The ischemia usually results from coronary artery disease and heart attacks. Treatment for ischemic cardiomyopathy is similar to that for other forms of cardiomyopathy, with special attention given to treating coronary artery disease. For patients whose hearts have been seriously damaged by ischemic cardiomyopathy, doctors may recommend that a heart transplant be considered.

Cardiomyopathy (KAR-de-o-mi-OP-a-the) refers to diseases of the heart muscle. These diseases have a variety of causes, symptoms, and treatments. In cardiomyopathy, the heart muscle becomes enlarged or abnormally thick or rigid. In rare cases, the muscle tissue in the heart is replaced with scar tissue.

When cardiomyopathy results in a significantly enlarged heart, the mitral and tricuspid valves may not be able to close properly, resulting in murmurs. Blood pressure may increase because of increased sympathetic nerve activity. These nerves can also cause arteries to narrow. This mimics hypertensive heart disease (high blood pressure). That’s why some people have high blood pressure readings. Because the blood pressure determines the heart’s workload and oxygen needs, one treatment approach is to use vasodilators (drugs that “relax” the arteries). They lower blood pressure and thus the left ventricle’s workload.

Healing Those Cheerleading Bruises

The 26th annual report from the National Center for Catastrophic Sports Injury Research at the University of North Carolina at Chapel Hill listed cheerleading as “the most dangerous sport.” Fortunately, serious cheerleading injuries are decreasing, but any sport can lead to bumps and bruises.

There are natural remedies for cheerleaders’ small injuries which can keep them from interfering with the enjoyment of the sport.

First, we need to understand how bruises form. When you hit a body part, perhaps by falling during a cheer routine, small blood vessels break and leak blood underneath the skin. The blood pools and shows through the skin. This is the source of the discoloration that shows as a bruise.

This can be painful. Even if the bruise doesn’t hurt much, cheerleading is a performance art as well as a sport, so we want to get rid of the discoloration as fast as possible.

As the body heals itself, the blood cells that have gathered under the skin break down and wash away. You can see the process as the bruise changes color and disappears. It can take days or even weeks for a bruise to heal completely, and there are a number of factors that affect the length of time involved.

There are some immediate actions you can take to speed the healing process:

  • A cold compress can slow down the blood flow to the area and keep the bruise from getting larger.
  • Raising the bruised body part above the head lets gravity keep the blood from flowing into the area.

There are also some natural remedies that can help speed healing:

  • Bromelain, a natural fruit enzyme found in papayas, has been shown in medical studies to speed the healing of bruises. Since bromelain is found mostly in the stems and leaves of the plant, taking the enzyme in medical form is more effective than simply eating more pineapple.
  • Papain is another fruit enzyme, found in papaya. Papain has been shown in clinical trials to be effective in treatment of edema and inflammation, and to speed the healing of wounds.
  • Arnica is an herb, used extensively to speed healing. While it shouldn’t be taken internally, topical application of creams or balms containing arnica has a vasodilating effect. This means that it enlarges the small blood vessels beneath the skin, making it easier to carry away the blood and fluids that build up in a bruise.

Bruises can be painful and unsightly, and for athletes they may not be preventable, but fortunately they are treatable.

Symptoms of a Panic Attack – Freak Out Symptoms

Panic attacks can truly set one into a real “panic” that can go beyond upsetting. This especially applies if a person is going through symptoms of a panic attack for the first time. It not only takes over the body and mind. It also shakes up the soul of whoever is doing their best to not feel like they are going crazy when everything feels out of focus and seems crazy. This is why knowledge of the symptoms should be known to a potential sufferer of this condition.

Those who suffer with a panic attack for the very first time may end up calling 911 for help. Because they do honestly believe that, they are in the midst of either having a nervous breakdown or heart attack. Effects of an anxiety attack are as different as are people. Panic and anxiety attacks are linked to the fear of not being able to get away from a situation that may be bad and or agoraphobia, which is an anxiety disorder that is marked, by the avoidance of public and strange places and the fear of having a panic or anxiety attack in a place one cannot readily escape from easily.

Anxiety attacks bring with them a fear of the unknown for first time victims. Nonetheless, it is through understanding of the problem itself, one can begin to learn to deal with the upsetting episodes for what they truly are in essence. Getting all the knowledge that a person can on panic attacks is the key to easing the fear generated by them. Knowledge is power and power over panic attacks is what someone wants to be in control again.

Panic attacks do not have any triggers. That are obvious; however, there are some key symptoms. That is evident of this disorder. They are as follows:

1. Generated fear that one is actually about to die

2. Chest pains

3. Presence of hot flashes or chills

4. Shortness of breath

5. Presence of heart palpitations and sweating profusely

Panic attacks can have varying symptoms. Some of the ones mentioned here are just an example of a few on the list. These symptoms are the very thing that help a mental health expert to diagnose a patient. Panic and anxiety attack symptoms also include smothering, choking, light-headiness, feeling of nausea, uncontrollable trembling, amid some of the traits.

However, there may be no obvious real triggers for some panic attacks as was previously stated. Panic disorder in itself does have some causes and amid these causes are heredity, phobias, hyperventilation syndrome, the use of some medications, chronic/serious illness, and lack of assertiveness in one’s life, the list goes on.

Understanding the various symptoms of panic and anxiety attacks is a step in the right direction towards understanding what panic attacks are all about overall. The key symptoms can actually make a person believe that their body is about to be done with when in actuality it is just the opposite.

The numerous symptoms that come into play are protecting the body from any impending harm. This physiological reply is known as the fight or flight response where a person’s body is being prepared to take on something very strenuous in nature if one must. The symptoms of a panic attack do not spell doom only eventual sweaty survival.

Dog Heart Attack – How To Protect Your Dog’s Heart

Owning a dog comes with a great deal of responsibility, and when it comes to a dog’s health, there are many illnesses that are better prevented than cured. And, this includes canine heart attacks.

Dogs, like humans, suffer from heart disease and can suffer from heart attacks, which are typically brought on by diabetes, old age, and obesity as well as by congenital heart defects and diseases of the heart.

Diabetes and obesity often causes the arteries of a dog’s heart to become blocked or they may narrow due to fatty deposits while the heart of an older dog may suffer from a weakening of the heart muscles with the result that your dog’s heart may no longer function as well as it did when your pet was younger. Congenital abnormalities, which are usually present at the time of a dog’s birth, tend to cause heart issues earlier in a dog’s life and are much harder to treat.

Heart disease in dogs is not uncommon. The three major forms of dog heart disease are dilated cardiomyopathy (or DCM), an enlarged heart, and heart murmurs—all of which can cause your dog to have a heart attack. However, knowing what to look for and how to prevent your pet from suffering from a heart attack can mean the difference between him or her living to a ripe old age or passing away prematurely.

The five most prevalent signs of your dog having a heart attack are:

  1. Breathing difficulties;
  2. Excessive panting;
  3. Drowsiness;
  4. Coughing; and
  5. Lethargy.

Veterinarians diagnose heart failure in dogs by testing their heart rhythm and blood pressure as well as conducting more in-depth cardiograms, which record you dog’s heart activity. Treatment for heart failure is often costly and complex with your pet having to be hospitalized, being put on a drip, and taking a cocktail of drugs, which allow its heart to recover and function better in the future. However, as with humans, once your pet has suffered from a heart attack, special care and a diet will have to be followed to ensure that he or she has a certain quality of life.

While a dog heart attack can be treated by a veterinarian and possibly have a successful outcome, prevention is far better than a cure. This is why a product has been manufactured and is now available to protect your dog’s heart from heart attacks, using natural ingredients that have anti-clotting properties.

Aspirin should never be given to dogs as it can prove fatal; however there is an aspirin substitute that can protect your dog’s heart and may save your dog’s life or at the very least prevent your dog from living with debilitating injury caused by canine heart attack and that aspirin substitute for dogs is: Petsprin-D.  For more information on Petsprin-D visit http://www.petsprin.com

What is a Normal Blood Pressure Reading?

You can get a blood pressure reading with various blood pressure monitors. These include a wrist monitor, an ambulatory blood pressure monitor, or the good old fashioned kind complete with inflatable ball and mercury bubble. No matter which monitor you use, however, a normal blood pressure reading will always fall within a certain range.

Normal Reading

To understand what makes up a normal blood pressure reading, it’s important to know what blood pressure is. The heart pumps blood through the four heart chambers and into major arteries that transport blood throughout the body via the circulatory system. Each time the heart muscle contracts, it creates pressure known as systolic blood pressure. This pressure is measured to produce the first numbers got through a blood pressure reading. When the heart muscle relaxes, between beats, is the moment that systolic blood pressure can be measured.

For most healthy people, blood pressure falls within a certain range. Those who suffer from stress, high cholesterol or obesity often have increased heart rates that are known as high blood pressure. On the other end of the range, some people also suffer from low blood pressure, but this is almost always because of illness or blood loss. Extremely low blood pressure can cause shock and in the end, death.

Blood Pressure Range

A normal blood pressure reading almost always falls within the 120 to 130 beats per minute range. If someone is in excellent physical condition, the heart rate will beat at 120 or less beats per minute, systolic pressure. The diastolic pressure in a normal blood pressure reading will be between 80 -90 beats per minute. You may see a normal blood pressure reading written as 124/84, for example.

An even better normal blood pressure reading is anything under 120 and less than 80, like 118/78, for example. This reading points to the normal blood pressure reading of a normal, active adult. Some adults have blood pressure readings that are a little higher than normal for the general population, but not for them. A high, though still normal blood pressure reading, may measure from 130-139 for systolic pressure to 85-89 for diastolic.

Blood Pressure in Children

Children will display different blood pressure readings. A normal blood pressure reading for young children, those between 3 and 5 for example, are around 116/76. A young teenager may show a normal blood pressure reading of around 136/86. Children between these ages can show a normal blood pressure reading of between 122 and 136 for systolic pressure and 78-90 diastolic pressures.

Something to remember is that children have normal blood pressures in ranges that are lower than adults. But even so, a child is at as much risk of developing high blood pressure as an adult if lacking proper diet and exercise. High risk children also include those suffering from medical conditions or those taking medications that may raise blood pressure.

Remember that no one’s blood pressure is always the same. Sometimes, readings showing a high blood pressure may result from stress, illness or even anger. Knowing what a normal blood pressure reading is will help you see blood pressure readings that are not so normal.

Causes of Coronary Heart Disease – What is CHD ?

Causes of Coronary Heart Disease – Coronary Artery Disease is often called Coronary Heart Disease.  The coronary artery is the main blood vessel  that carries blood to your heart. Coronary heart disease is the leading case of death for both sexes and strikes approximately 13 million Americans every calendar year.

Your arteries can get built up with plague blocking the flow of blood and oxygen through them. Plague is a fatty substance made from cholesterol. It can happen in ay artery but it is much more serious if it is the coronary artery. Coronary heart disease can lead to life threatening conditions such as angina. It is characterized by the thickening and hardening of the arties. This loss of elastically and narrowing of the arteries can lead to high blood pressure and if left untreated, increases the chance of a stroke and a heart attack.

The people most at risk are generally overweight or have diabetes you are more at risk of coronary heart disease. High blood pressure and high cholesterol will also put a person more at risk. Men and women can both get coronary heart disease and it can develop as a person gets older and there is evidence that it can be hereditory. Causes of Coronary Heart Disease also include obesity, smoking, high blood pressure, diabetes, and lack of exercise, smoking, menopause in women, advance age (65 or older), and some types of infections of the artery walls. Coronary Heart Disease (CHD) is simply the disease of the coronary artery, a situation whereby the artery that supply blood to the heart is clogged or blocked, reducing blood flow to the heart muscles which need oxygen from the blood supply and this could lead to a complete artery blockage. When this happens in the heart, the result is heart attack medically known as myocardial infarction. The same process in blood vessels supplying the brain results in a stroke.

The most common symptoms of coronary heart disease include angina or chest pain. A person having frequent chest pain may be suffering from Coronary Heart Disease (CHD). If suffering from the Signs Of Heart Failure, you should consult a doctor as soon as possible. What Causes Heart Attacks are the beginning of coronary heart disease. Symptoms of coronary heart disease are most of the time very noticeable, but sometimes you can have the disease and not even know it. Chest pain or discomfort is the most common and noticeable of all the symptoms, typical chest pain feels heavy or like ou are being squeezed. The pain happens because there is not enough blood and oxygen getting to the heart. The most common symptom of Coronary Heart Disease (CHD) is Angina Pectoris. This can occur as a result of restriction of blood flow to the heart due to plague sticking in the coronary arteries. The pain is described as a crushing or gripping pain across the chest which may also be felt in the throat and teeth. This is usually followed by sweating, breathlessness and exhaustion.

Change your lifestyle – stop smoking, lose weight, take more exercise and eat a healthy low saturated fat diet.  Lower your blood pressure and blood cholesterol levels. All these actions will avert the Causes of Coronary Heart Disease .