The Relation between Gout and Kidney Stones

Gout occurrences in certain individuals may be attributed to their kidney conditions. Uric acids found in purines are generally excreted out of the system and are not expected to be totally absorbed by the body. Uric acid levels are not wholly dependent in the amounts of purine rich food that body takes in.

It is also dependent on the ability of the kidney to excrete uric acids out of the system. Failure to excrete uric acid may cause uric acid to amass and reach the high-level point when uric acid crystals form and cause gout pains. Hence, there is an existing relationship between gout and kidney stones.

The kidney’s ability to excrete is affected by the formation of kidney stones. If the kidneys become impaired, excretion then poses a problem of retaining too much uric acid in the blood stream.

As uric acid amasses it will reach a certain level wherein uric acid will crystallize and lodge themselves in an individual’s joint where they will not be bothered. Hence, gout and kidney stones forge a relationship by the failure of the kidney to excrete uric acids and the ability of amassed uric acid to form into crystals that causes gout.

Causes and Treatments of Kidney Stones

Unlike gout, crystalline substances become kidney stones not only out of uric acids but also out of other insoluble substances that accumulate and combine in the renal system. Insoluble substances are known as oxalates which can either be salt, calcium or amino acids (cystine kidney stones).

The kidney stone sufferer must pay attention to his diet. If the kidney stones are acid oxalates, then the kidney sufferer’s diet should have more alkalines in order to neutralize the acid oxalates. An alkaline diet mainly consists of fruits and vegetables.

Dark red berries and cherries are the most recommended fruits to eat for people with kidney stones  caused by acid oxalates. Cherries and berries contain chemical nutrients that lower uric acid and have the ability to reduce inflammation. Hence, cherries or berries will not only neutralize the kidney stones but will also prevent gout since it can lower uric acid levels.

On the other hand, vegetable like spinach, asparagus and cauliflower although rich in alkaline are also rich in purines. Hence, if you are on an alkaline based diet, try to avoid these vegetables because they are liable to increase uric levels through their purine rich content.

Through this example, it is very important then to ascertain the type of kidney stones you are suffering from in order to determine the type of food you should eat. From there, it should be further determined which of the foods belonging to a food group is rich in purine. This way the treatment of any type of kidney stone will not result to increasing the level of uric acid that may later form into uric acid gout crystals.

The above therefore presents the relationship between gout and kidney stones. Diet plays an important role but it is also a matter of discerning how a concentration of one chemical nutrient may cause a disorder in another part of the body’s system.

Alvin Hopkinson is a leading researcher in the area of natural remedies and gout treatment. Discover how you can get rid of your gout for good using proven home remedies, all without using harmful medications or drugs. Visit his site now for more useful articles such as: How to Treat Gout the Easy Way

Dog Vomiting – What could make your dog vomit?

If your dog vomits from time to time, it may not be a reason for concern, but when this happens really often, and then it is time to get worried.

Dog vomiting can also mean tract inflammation, and this can also mean that the dog is lacking some digestive enzymes. The dog can also have an allergy to something or a problem in the intestinal tract.

If you see that the vomit puddle is filled with food that looks undigested, the vomiting can be due to stress or overeating. In some rare cases, the undigested food can also point to food poisoning. But this is up to the vet to decide and then prescribe the correct medicine.

Some dogs tend to eat whatever they encounter and this can be really bad for their stomach. Many dogs also tend to overeat and this can lead to vomiting episodes too. If you see blood in the vomit than it means the dog has a serious health condition. In this case professional assistance is required. Internal laceration can appear when the bowel and the intestines are inflamed.

In many cases the inflamed digestive track solves the problem by vomiting. But in some cases a visit to the vet is necessary. So make sure to keep the dog as comfortable as you can and let him vomit. Then notice how the vomit appears and take a sample for the vet to analyze. Do not frighten the dog when he is vomiting because this will add up to its stress. The dog already knows that bodily fluids on the carpet are a bad thing and you do not want to add up to its stress.

Sometimes, the puppies vomit because their digestive system is undeveloped and needs to learn how to cope with new food. Also, puppies are greedy and they want to eat as much as possible till they throw up. Puppies also tend to taste things just for the fun of it and they can get accidentally poisoned. So keep an eye on your new puppy and if you see any symptoms take it immediately to the doctor.

You should also know that digestive problems are quite common in puppies, especially ones that belong to large breeds.

But the rule is: if the dog vomits twice in 24 hours, for more than 2 days in a row, than take it to the vet for the proper investigation. Make sure to follow all the rules mentioned above. And also talk to the breeder that sold you the dog. Make sure you have the entire medical history of the puppy. If you also see that the dog is vomiting after lunch hours, prepare the area for it and wait for the vomiting episode to occur. Try to restrict his movements during those vomiting episodes so that you can handle the mess.

Make sure that you notice the vomit of your dog and never let the dog re-ingest the vomit. Also, it is best to take the dog to the vet if you notice the slightest symptoms and problems. You know what people like to say: better safe than sorry, right?

Information About Food Poisoning – alice rose

Food poisoning results when you eat food contaminated with bacteria or other pathogens such as parasites or viruses. Your symptoms may range from upset stomach to diarrhea, fever, vomiting, abdominal cramps and dehydration. Most such infections go undiagnosed and unreported. People often recognize these symptoms as a 24-hour stomach virus. The reason why we mistaken food poisoning as another type of medical condition is because exposure to food borne bacteria doesn’t always affect everyone in the same way. And even though you might enjoy a meal with your family and feel fine, your wife might be miserable two hours later.

Although food poisoning is such a complex problem, there are many means by which people can prevent it. When shopping, they can avoid purchasing packages that appear open or torn, waiting until the end of their shopping trip to buy frozen or cold items and taking them home immediately, and avoiding contact between raw foods (like meat) and other foods. Symptoms will vary depending on the type and amount of contaminants eaten. Some people may get ill after ingesting only a small amount of harmful bacteria, while others may remain free of symptoms after eating larger quantities. The most common symptoms of food poisoning include nausea, vomiting, diarrhea, stomach pain (cramps), fever, headache, and fatigue.

To prevent the disease, cook chicken thoroughly, with no pink remaining. Wash your hands frequently when handling raw chicken. Use paper towels to dry your hands. If you are using a sponge or dish-cloth to clean the counters, use a fresh one after working with raw chicken. Wash your cutting board with a diluted bleach solution before using again. One type of food poisoning that is rare but often times fatal is called botulism. Most of the times this is caused by a bacteria that is formed when foods are improperly canned. The foods that most commonly develop this are foods that are low in acid content like beans and corn. What happens is a bacteria that doesn’t get killed in the canning process develops and grows inside the jar which produces a toxin.

Anyone who has a food ailment will know that you will more than likely succumb to vomiting as a result of the poisoning. This will cause a great deal of the body’s nutrients to be flushed from the system along with the poison. Thus imbibing as much fluid in the form of water or water with electrolytes will help to further flush the system and replenish what has been lost. Then finish all of these remedies listed here off with plenty of sleep. Parasites are the least common form of food poisoning, but they are contracted in the same ways as bacterial and viral cases. The symptoms tend to be less intense than viral or bacterial food poisoning but last much longer. The Guardia parasite, also known as beaver fever, can cause watery diarrhea for two weeks.

Peptic Ulcer – Causes, Symptoms and Treatments

Peptic Ulcer, (also known as ulcus pepticum), is a raw and painful area that occurs in the gastro-intestinal tract as a result of mucosal erosion by acidic gastric juices. It may occur in the oesophagus, stomach, or duodenum. Mostly the duodenum (after the stomach; the first part of the small intestine) is most likely to be afflicted by the peptic ulcer. Peptic Ulcers could occur as single or multiple ulcers and they normally measure from 10mm to 25mm across and around 0.25mm in depth.

Causes

The lining of the duodenum is at continuous risk of erosion by the acidic juices produced by the stomach walls. The lower part of the oesophagus is at risk only if and when the reflux of the acidic juices from the stomach takes place. Reflux is when there is a backward flow of the acids, that is, when the acidic juices from the stomach backflow into the oesophagus (throat or food pipe).

Peptic Ulcers arise in the jejunum, only when there is a massive secretion of the gastric juices. The jejunum is a part of the small intestine, which is about 8 to 10 feet in length, between the duodenum and ileum. It helps in the absorption process of the bile salts and nutrients in digestion.

Some of the main causes of the occurrence of peptic ulcers mostly could be by the consumption of a lot of alcohol, or by excessive coffee drinking which induces high caffeine intake, or even by regular ingestion of aspirin. Other irritants could also be bile and bacteria among others. They are also caused by an increase in acid secretion and a reduction in mucus production. For some people, peptic ulcers occur due to genetics, as they are pre-disposed to developing these ulcers hereditarily.

If the occurrences are frequent in the family’s medical history, it is important to take preventive measures. Psychological stress also plays a major part in aggravating an existing ulcer, thus making it even worse. Even smoking worsens ulcers, as the nicotine in tobacco increases the amount and concentration of acids in the stomach and thus intensifying the existing ulcer or it could also lead to the creation of more ulcers. Smoking may also slow down the treatment and healing process of ulcers.

Both men and women are equally prone to the incidence of gastric ulcers, but when it comes to duodenal ulcers, more men are likely to suffer from them than women.

Symptoms

The most typical symptom is that of a gnawing persistent pain in the abdomen especially when the stomach is empty. Some people suffering from a peptic ulcer show no symptoms, but most people complain of a burning pain in the abdomen which also wakes them up in the nights at times. Eating relieves the pain of a duodenal ulcer, only for the pain to recur after a couple of hours.

Other symptoms which are common for both ulcers, that of duodenal and gastric ulcers, are: loss of appetite (although in the case of duodenal ulcers, it sometimes increases appetite), belching, weight loss, a bloated feeling, nausea, vomiting (which is sometimes even blood), waterbrash (rush of saliva to dilute the stomach acids after the reflux), and melena (unusual and bad smelling feces).

Treatments

Antacid Drugs neutralize the excess acid levels and help in the healing of the ulcers. If taken regularly, they can help in ultimately relieving the pain caused by the ulcers, along with taking some measures such as: avoiding smoking, avoid drinking of alcohol, coffee, and tea, and avoiding use of aspirin and other nonsteroidal anti-inflammatory drugs.

Other ways of treatment are by taking various medications such as acid blockers (also called histamine blockers; they reduce the quantity of hydrochloric acid that is released into the digestive tract, which lessens ulcer pain and supports healing), antibiotic medications; they are mostly prescribed to kill the bacteria, and also sometimes given in combination of other different antibiotics, or even Proton Pump Inhibitors, which are drugs which stop the “pumps” from secreting more acids.

At times, when these Proton Pump Inhibitors are taken in high dosages and over a prolonged period of time, it could result in the fracture of the hip, so mostly it is advisable to take calcium supplements as the treatment is on. In some severe cases, even surgery is required, such as vagotomy or gastrectomy. Sometimes, passing a suction tube through the nose to drain out the digestive juices is also adequate treatment. It is always best to visit a doctor, to be explained the surgical remedies offered for the treatment of ulcers.

To Your Health!

How to Select an Antacid

The stomach secretes hydrochloric acid for digestion of food. Sometimes overindulgence or emotional stress lead to a condition called hyperacidity. Antacids are used to treat this condition for which a no of brands of antacids are available, many of which are aggressively advertised. Despite the variety of brand names, antacids contain only a few different ingredients. Sodium bicarbonate, Calcium carbonate, Aluminum hydroxide, Magnesium carbonate and Magnesium hydroxide are typical components.

Sodium bicarbonate, commonly called baking soda, is an old standby antacid. It is safe and effective for occasional use by most people, but it is not recommended to those with hypertension (high blood pressure) because high concentrations of sodium-ions tend to aggravate the condition further. Some sodium bicarbonate containing antacids also contain citric acid and aspirin. When they are placed in water, the reaction of bicarbonate ions with hydronium ions from the acid produces the familiar fizz due to liberation of carbon dioxide. Such antacids may be dangerous because the aspirin is harmful to people with ulcers and other stomach disorders.

Calcium carbonate, commonly called precipitated chalk, is another common antacid ingredient. It is safe in small doses, but regular use can cause constipation. It can also cause increased acid secretion after a few hours. Thus temporary relief may be achieved at the expense of a worse problem later. Aluminum hydroxide is also an antacid ingredient which occurs in combination in may popular products. But there are two draw backs with its use, firstly like calcium carbonate it can cause constipation in large doses and secondly aluminum ions deplete the body of essential phosphate ions by forming insoluble aluminum phosphate which is excreted from the body. Moreover aluminum ions are reported to be toxic also.

Magnesium compounds constitute yet another category of antacids. These include magnesium carbonate and magnesium hydroxide. Milk of magnesia is suspension of magnesium hydroxide in water. It is sold under a variety of brand names. In small doses, magnesium compounds act as antacids. But in large doses, they act as laxatives as magnesium ions are not only poorly absorbed in the digestive tract but also these small di-positive ions draw water into the colon causing the laxative effect. This is the reason that variety of popular antacids combines aluminum hydroxide with its tendency to cause constipation with a magnesium compound in order to counteract its laxative effect.

Above all antacids may interact with other medications. As such any one taking any other type of medication should consult a qualified and genuine physician before taking antacids. It is to be remembered that antacids are safe and effective for occasional uses only and that too in small doses. Undoubtedly if a person is otherwise in good health he/she may go for a product of choice but those with severe or repeated attacks of indigestion must avoid self medication as it might be both blundering as well as deadly dangerous for them in respect of its consequences. In any case indiscriminate and frequent uses of antacids are not advisable.

Antacids differ in how quickly they work and how long they provide relief. Those that dissolve rapidly in the stomach, such as magnesium hydroxide and sodium bicarbonate, bring the fastest relief. Antacids that contain calcium carbonate or aluminum dissolve more slowly and can take up to 30 minutes to begin working. The longer an antacid stays in the stomach, the longer it works. Those that contain calcium carbonate or aluminum work longer than those that contain sodium bicarbonate or magnesium. Also, taking any kind of antacid after a meal, instead of on an empty stomach provides longer-lasting relief because the medicine stays in the stomach.

Though many brands of antacid products and generic forms can be bought without a prescription and come in tablet (regular and chewable), lozenge, and liquid forms, antacids are meant to be used only occasionally. They should not be taken continuously for more than two weeks unless under a physician’s directions. Taking antacids over long periods could mask the symptoms of a serious stomach or intestinal problem, such as peptic ulcer disease. Older people should be especially careful, as they may have ulcers without showing the typical symptoms.

If any signs of appendicitis or inflamed bowel are present, antacids should not be taken. Symptoms of appendicitis include cramping, pain, and soreness in the lower abdomen, bloating, and nausea and vomiting. Anyone whose symptoms do not improve after taking antacids or who has black, tarry stools should call a physician. These symptoms could be signs of a serious condition that needs medical attention. When an antacid interacts with some other medicines the effects of one or both drugs may change, or the risk of side effects may be greater. Antacids may also affect the results of some medical tests. When scheduling a medical test, one must ask whether it is all right to take antacids before the test.

Side effects are very rare when antacids are taken as directed. They are more likely when the medicine is taken in large doses or over a long time. Minor side effects include a chalky taste, mild constipation or diarrhea, thirst, stomach cramps, and whitish or speckled stools. These symptoms do not need medical attention unless they do not go away or they interfere with normal activities. Other uncommon side effects may occur. Anyone who has unusual symptoms after taking antacids should get in touch with his or her physician.

Gastritis – Causes and Natural Home Remedies

Gastritis is a disorder characterized by inflammation and even depletion of stomach lining. When the stomach fails to produce or produces inadequately certain protective enzymes, the hydrochloric acid level mounts and corrosively acts on stomach lining consuming it bit by bit. This leads to gastritis. Under severe conditions, the stomach lining even bleeds. Gastritis causes gnawing pain in upper abdomen and much discomfort that takes a toll on the person’s capacity to work. The painful condition is often termed as dyspepsia.

Gastritis can affect people of all ages. Gastritis often results in severe indigestion and ulcer formation. Apart from pain, gastritis produces symptoms like belching, bloating, nausea, vomiting, burning sensation and fullness in upper abdomen, weakness, coated tongue, headache, giddiness, lethargy, urinary problems, diarrhea or constipation, loss of appetite, foul breath, depression and acidity. Gastritis may be acute or chronic in nature. The causes of gastritis may be listed as follows:

1. Too much eating of junk food or food cooked in adulterated oil.
2. Habitual over-eating
3. Stress and anxiety for prolonged period
4. Excessive intake of alcohol
5. Excessive intake of strong caffeine
6. Swallowing of acids
7. Swallowing foreign bodies like pins or paper clips.
8. Certain drugs like aspirin, steroids, non-steroidal anti-inflammatory drugs, potassium supplements, iron tablets, chemotherapy medications etc.
9. Autoimmune diseases
10. Pernicious anemia
11. Peptic ulcers
12. Radiation treatment
13. Surgery consisting in the removal of a part of stomach
14. Medical procedures like endoscopy
15. Infections like bacterial (H.Pylori), fungal, viral, parasitic.
16. Syphilis
17. Tuberculosis
18. Iron deficiency
19. Chronic vomiting.

Home Remedies for Gastritis

1. Mix carom seeds with a pinch of black salt and consume. This relieves gastritis.

2. Drink half cup potato juice before meals to get rid of gastritis.

3. Consume 2 bowls of rice gruel twice daily. This is a useful gastritis remedy.

4. Add a pinch of black salt and 3 grams of Sprague to half pound of curd and consume. This checks gastritis.

5. Drink glassful buttermilk twice daily to avoid gastritis.

6. Drink coconut water everyday to free yourself from gastritis.

7. Mix cumin water and asafetida into tamarind water and drink daily. This cures gastritis.

8. Chew fresh ginger before meals to escape gastritis pain.

9. A glass of fresh lemon juice daily will safeguard you from gastritis.

10. Chew roasted fennel seeds before meals to get relief from gastritis.

11. Dissolve carrot juice in to glassful spinach juice. This prevents gastritis.

12. Mix 2 grams of Sprague powder and a pinch of black salt in to 1 and half glass of warm water and drink. This is an effective home remedy for gastritis.

13. A tablespoon of an infusion prepared from the herb marigold, if taken twice daily, gives instant relief from gastritis.

14. 1 teaspoon honey may be taken twice daily to get cured of gastritis problem naturally and quickly.

15. Application of hot water bottle on empty stomach 2 times daily is an effective way to treat gastritis.

Medical tourism in India and heart cardiac surgery

Medical tourism in India and heart cardiac surgery Heart disease is the leading cause of death in the United States as of 2007. Thus Cardiac surgery is a procedure on the heart and/or vessels performed by a specialized trained surgeon. Some of the common heart diseases are-:

  • Coronary heart disease
  • Cardiovasculaysteinemia and hypercholesterolemia.
  • Hereditary heart disease,
  • Hypertensive heart disease
  • Inflammatory heart disease,
  • Valvular heart disease

These heart ailments can also be broken down according to the origination. 1. Diseases of the Electrical System of the Heart 2. Diseases of the Muscle of the Heart 3. Diseases of the Outer Lining of the Heart 4. Diseases of the Heart Valves 5. Diseases of the Blood Vessels of the Heart 6. Diseases related to infections and Inflammation of the Heart Diseases of the Electrical System of the Heart These diseases are also referred as Cardiac electrophysiology. It the science of the mechanisms, functions, and performance of the electrical activities of specific regions of the heart. Names of few diseases are-:

  • Tachycardia
  • Cardiac arrhythmias
  • Premature ventricular contraction
  • Ventricular tachycardia
  • Ventricular fibrillation
  • Sick sinus syndrome
  • Bundle branch block
  • Heart block
  • Brugada syndrome
  • Long QT syndrome
    • Andersen-Tawil syndrome
    • Romano-Ward syndrome
    • Jervell and Lange-Nielsen syndrome
  • Short QT syndrome
  • Wolff-Parkinson-White syndrome (WPW syndrome)

Diseases of the Muscle of the Heart It is also referred to as the Disorders of the myocardium. The common diseases that effect the muscles of the heart are-:

  • Cardiomyopathy
    • Ischemic cardiomyopathy
    • Nonischemic cardiomyopathy
    • Arrhythmogenic right ventricular dysplasia (Arrhythmogenic right ventricular cardiomyopathy)
    • Restrictive cardiomyopathy
  • Congestive heart failure
  • Ventricular hypertrophy
  • Myocardial rupture

Diseases of the Outer Lining of the Heart It is also referred to as the disorders of the pericardium. The common diseases that effect the outer lining of the heart are-:

  • Pericarditis
  • Pericardial tamponade
  • Constrictive pericarditis

Diseases of the Heart Valves singapore heart medical The common diseases that effect the heart valves are-:

  • Aortic valve disorders
  • Mitral valve disorders
  • Pulmonary valve disorders
  • Tricuspid valve disorders

Diseases of the Blood Vessels of the Heart It is also referred to as the vascualar diseases. The common diseases that effect the blood vessels f the heart are-:

  • Vasculitis
  • Atherosclerosis
  • Aneurysm
  • Varicose veins
  • Economy class syndrome
  • Diseases of the aorta
  • Diseases of the carotid arteries

Diseases related to infections and Inflammation of the Heart Some of the diseases are -:

  • Myocarditis
  • Pericarditis
  • Endocarditis
    • Rheumatic heart disease

Tests and procedures for Heart Diseases The following tests have to be done for finding out about severity of heart diseases-:

  • Blood tests
  • Echocardiogram
  • Cardiac stress test
  • Electrocardiogram (ECG or EKG)
  • Ambulatory Holter monitor
  • Electrophysiologic study
  • Myocardial Fractional Flow Reserve (FFRmyo)
  • IVUS (IntraVascular UltraSound)

Heart The heart in our human body is a muscular organ in all vertebrates responsible for pumping blood through the blood vessels by repeated, rhythmic contractions, or a similar structure in annelids, mollusks, and arthropods. The term cardiac means “related to the heart” and comes from the Greek word ‘kardia’, for “heart.”Heart of a vertebrate is composed of cardiac muscle, an involuntary muscle tissue which is found only within this organ. The average human heart, beating at 72 beats per minute, will beat approximately 2.5 billion times during a lifetime (about 66 years). It weighs on average 250 g to 300g in females and 300 g to 350 g in males. Cardiac surgery is the surgery on the heart and/or great vessels performed by a surgeon. Often, it is done to treat complications of ischemic heart disease (for example, coronary artery bypass grafting), correct congenital heart disease, or treat valvular heart disease created by various causes including endocarditis. These also include heart transplantation. Open heart surgery In this kind of surgery, the patient’s chest is opened and surgery is performed on the heart. The term “open” refers to the chest, not to the heart itself. The heart may or may not be opened depending on the particular type of surgery. Doctors realized the limitations of hypothermia – complex intracardiac repairs take more time and the patient needs blood flow to the body (and particularly the brain); the patient needs the function of the heart and lungs provided by an artificial method, hence the term cardiopulmonary bypass. Angioplasty This is the technique of mechanically widening a narrowed or obstructed blood vessel; typically as a result of atherosclerosis. In this procedure tightly folded balloons are passed into the narrowed locations and then inflated to a fixed size using water pressures some 75 to 500 times normal blood pressure (6 to 20 atmospheres). Percutaneous coronary intervention (PCI), commonly known as ‘coronary angioplasty’ is a therapeutic procedure to treat the stenotic (narrowed) coronary arteries of the heart found in coronary heart disease. These stenotic segments are due to the build up of cholesterol-laden plaques that form due to atherosclerosis. A few top Medical tourism providers are ThaiMediHealth.com, MalaysiaMediTravel.com and Indiaheals.com. With time more and more visitors will flock to this part of the globe for their treatment and relaxation needs.

Symptoms of Lymphedema

Before taking into account the symptoms of lymphedema, it is essential to understand this health ailment that people experience. Lymphedema can be defined as the swelling of the limbs as a result of the non-functioning of the lymphatic system. A condition which is known as primary lymphedema may be inherited due to genetic factors and lineage of the individual. The other type of lymphedema is secondary lymphedema, where the patient may acquire the ailment as a result of an injury or obstruction to the smooth functioning of the lymphatic system.

Although lymphedema symptoms are seen mainly in the arms and legs, the ailment can influence any body part. The obvious sign of the disease is a swelling present in the area. The limb may feel heavy due to fluid accumulation. Lymph fluid may build up in the region of the head and neck; there may be skin discoloration or patches appearing on the affected limb. General first impression that the patient gets is a feeling of fullness in the limb. A cut or an injury to the limb treated for cancer could be a trigger for the swelling. An airplane trip may also be the first instance to prompt a lymphedema attack. Symptoms of lymphedema that you would notice are a sudden tightness in the wrist or ankles, restricting movement. Sometimes, it could be difficult to fit into your clothes or a ring or bracelet you could wear easily is suddenly becoming tight.

Many a times, lymphedema is a side-effect of breast cancer therapy. Women who undergo lumpectomy, mastectomy or the removal of lymph nodes in the armpit are prime candidates for the condition. In such cases, there is a change in the pathway of the lymph fluid, which is the reason for the condition. The symptoms may show up at any time after the operation and the condition may aggravate if not treated in time.

Recent studies state that controlled weight lifting may reduce the incidence of lymphedema for women who have had a mastectomy. Weight lifting may provide protective benefits to the affected arm by boosting the strength in that arm and improving circulation. Generally, an exercise schedule is a part of the lymphedema treatment therapy that is recommended by doctors.

Since treatment for cancer may lead to lymphedema, persons who have been treated for cancer are at a high risk for contracting the condition. Hence, such patients must be vigilant to note any symptoms of lymphedema. Treating the problem at the initial stage arrests the progress of the condition. If the symptoms are ignored, the ramifications can be severe and the damage may be irreversible. A nutritious diet with proper exercise plays an important role in maintaining the health of the lymphedema patient. A skin care routine is also essential. Lymphedema patients should protect themselves from any injury as much as possible to avoid the complications that may arise later. Even though there may not be a cure for lymphedema, it can be controlled with proper care and treatment.

Heart Diseases Part V – Heart Diseases—heart Diseases Affecting Heart Valves

As we mentioned in the previous articles, heart diseases are caused by high blood pressure that contributes to the hardening of the arteries. High levels of bad cholesterol (LDL) build up in the arteries as a result of uncontrolled diet with high levels of saturated fat and trans fat.

Heart diseases affecting heart valves occur when the mitral valve in the heart narrows, causing the heart to work harder to pump blood from the left atrium into the ventricle.

Here are some types of heart disease affecting heart valves:
1. Mitral Stenosis
Mitral Stenosis is a heart valve disorder that involves a narrowing or blockage of the opening of the mitral valve causing the volume and pressure of blood in the left atrium increases.

2. Mitral valves regurgitation
Mitral regurgitation is the heart disease in which your heart’s mitral valve doesn’t close tightly causing the blood to be unable to move through the heart efficiently. Symptoms of mitral valve regurgitation are fatigue and shortness of breath.

3. Mitral valves prolapse
In mitral valve prolapse, one or both leaflets of the valve are too large resulting in uneven closure of the valve during each heartbeat. Symptoms of mitral valves prolapse are palpitation, shortness of breath, dizzy, fatigue and chest pains.

4. Aortic Stenosis
With aging, protein collagen of the valve leaflets are destroyed and calcium is deposited on the leaflets causing scarring, thickening, and stenosis of the valve therefore increasing the wear and tear on the valve leaflets resulting in the symptoms and heart problems of aortic stenosis.

5. Aortic regurgitation
Aortic regurgitation is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle. Symptoms of aortic regurgitation include fatigue or weakness, shortness of breath, chest pain, palpitation and irregular heart beats.

6. Tricuspid stenosis
Tricuspid stenosis is the narrowing of the orifice of the tricuspid valve of the heart causing increased resistance to blood flow through the valve. Symptoms of tricuspid stenosis include fatigue, enlarged liver, abdominal swelling, neck discomfort and leg and ankle swelling.

7. Tricuspid regurgitation.
Tricuspid regurgitation is the failure of the right ventricular causing blood to leak back through the tricuspid valve from the right ventricle into the right atrium of the heart. Symptoms of tricuspid regurgitation include leg and ankle swelling and swelling in the abdomen.

I hope the above information will help you to understand heart diseases better. If you would like to read more of the above subject, please visit my home page at:
http://medicaladvisorjournals.blogspot.com
http://heartdiseasespartv.blogspot.com/

Coronary Artery Disease – Causes, Symptoms and Treatments

CAD (Coronary Artery Disease) refers to the contracting of the heart arteries because of atherosclerosis. The heart muscle doesn’t get sufficient oxygen when the heart arteries are contracted. If your heart is starving out of oxygen, then the pain in the chest arises which is called as angina. If your artery is totally blocked then the result would be heart attack. In medical terms, the heart attack is referred as myocardial infarction (MI). Coronary Artery Disease is considered to be the most usual type of the heart disease and the heart attack has been considered to be leading killer for both men as well as women.

Many of such deaths could be prevented by taking in control few risk factors which might lead to CAD. Few of such risk factors which need to be controlled are high blood pressure, diabetes and high blood cholesterol. There’re other risk factors that are required to be controlled related to our lifestyle, like quit smoking, maintain a perfect weight as well as start including physical activities or exercise in your daily routine.

Even though today there are numerous treatment coming up for heart disease, but the main way of preventing death and illness from Coronary Artery Disease is by controlling the risk factors.

Coronary Artery Disease causes are:

Mostly the heart faces lower oxygen supply because of atherosclerosis and this is even termed as hardening of the arteries. At the time of such condition, plaques which are actually fatty deposits get formed in the blood vessels’ linings. These plaques (at the time of formation) make your arteries narrow and because of this only few amount of blood vessel is able to reach the heart, therefore the supply of oxygen also gets lessen. Atherosclerosis arise frequently because of more amount of bad cholesterol as well as triglycerides that circulate in your bloodstream.

Coronary Artery Disease Symptoms –

Few of the individuals with Coronary Artery Disease may contain no symptoms unless this disease has become serious enough and might cause pains in their chest, or say angina pectoris.

Angina being stable is frequently considered as the very 1st symptom from which a person can find out that he or she is suffering from CAD. Discomfort or chest pain may occur due to the activity and might disappear when they take proper rest. If the angina is unstable then it could be difficult to predict the disease and could rise when one is relaxing. This indicates the fast progression of Coronary Artery Disease and there are superior chances of heart attack as well as one must meet the physician immediately.

Coronary Artery Disease Treatments –

A doctor could suggest any of the following treatments –

– Cholesterol lowering medications could decline the bad cholesterol level which is present in ones blood by increasing the good cholesterol level.

– Antiplatelet medication doesn’t allow the clots to form.

– Blood pressure declining agents could decline the heart attack risk dramatically when one has superior blood pressure.

If you believe to have that disease please consult a doctor.

To Your Health!

Heart Attack: Delaying Brain Death In Cardiac Arrest Victims

Heart Attack: Delaying Brain Death in Cardiac Arrest Victims

As the victim of a heart attack stops breathing, a process of irreversible brain damage starts to occur within the first three or four minutes.  Or, does it?

Years ago, while researching heart attack and cases of sudden cardiac arrest, I stumbled upon an article in Newsweek Magazine about a boy drowning in icy waters.  Despite being submerged for over half an hour, he was pulled from the frigid river, resuscitated, and lived to recover completely.  He suffered no brain damage, and I wondered how this could happen.

My investigations shifted to how some people can apparently drown in cold water, have their heart stop beating (as in acute myocardial infarction or cardiac arrest,) stop breathing, and upon resuscitation — sometimes up to an hour later — completely recover and experience no brain damage. 

I wondered if a person’s chance for survival from a heart attack without brain damage could be extended past the 4-minute mark, as if he were submerged in cold water. 

My investigations became centered around why there is a delay of brain damage and brain death in cold water drowning victims and could that transfer to heart attack victims.

Brain Injury

An injury to the brain occurs when the flow of blood is disrupted.  It’s called a hypoxic-anoxic brain injury or “HAI.”  Hypoxic means partial lack of oxygen, anoxic means total lack of oxygen.

When oxygen deprivation to the brain is caused by an internal event like a heart attack, or acute myocardial infarction, it is considered an Hypoxicischemic injury – or HII.  The most frequent cause is from cardiac arrest.     

Driven to Research

I became curious… Every day I thought about “What if?”

What if…  we could delay brain death by submersing the heart attack victim in cold water? 

What if…  in an emergency – a victim could be placed in cold water at the first signs of cardiac arrest.

What if…  we could trigger this delay of brain damage in the event of an acute myocardial infarction by placing the victim in a cold shower?  What if…  that would delay the onset of an hypoxic brain damage injury?  What if… there was just something we could do to delay brain death in heart attack victims – like in cold water drownings…

The real question remained: In an emergency can the delay of brain damage be extended in cardiac arrest victims? 

If this were possible, to delay brain damage past four minutes, it would allow critical extra time before brain damage would start to occur to allow emergency personnel to reach heart attack victims and apply CPR, chest compressions or other therapy.

What if… you lived in the country and your spouse had a heart attack, and you didn’t know CPR?  Would submersion in cold water delay the onset of brain damage?  Because your choices of what you can do would be very poor without this kind of option.  You could call for help or an ambulance, then you could watch.  Sorry if this doesn’t sound good, but that’s the reality of it.

The questions kept me up at nights for years.

I kept thinking about it and thinking about it – what is it about cold water that delayed brain damage?  Can this be used in heart attack victims?  What if… if it worked?  How many lives it would save. 

I spent the nights and weekends, and the next few summers in the Philadelphia medical hospital libraries.  Days and nights of research.  Until I figured out the answer.  And here it is.

Here’s how to delay brain damage in heart attack victims.

My research into cold water drowning victims showed that the hypothermia created by the cold water helps to delay brain damage in cold water drowning victims.  But that’s not the specific reason cold water drowning victims survive up to an hour with no brain damage. 

The specific reason cold-water drowning victims survival without brain damage is due to the triggering of a natural reflex called the Mammalian Diving Reflex.  This oxygen-conserving reflex – found in all mammals – is responsible for delaying brain death and saving cold water drowning victim’s lives without brain injury, or HAI. 

My research also uncovered that the specific trigger point of initiating the diving reflex is a facial immersion in cold water.  Just the face.  Cold water — face only, triggers this entire reflex. 

Hypothesis:

When the oxygen supply to the brain of a person is shut off by heart attack or acute myocardial infarction, I believe it is possible to delay the onset of brain damage by triggering the mammalian diving reflex. 

The Dobkin Technique to trigger the diving reflex is to apply wet, cold compresses TO THE FACE of the victim.  When a person has a heart attack and stops breathing, immediately apply cold water, cold wet towels, or cold compresses (58 degrees or colder) to the face of the victim specifically covering the eyes.

The eyes, the ophthalmic nerve, is the exact trigger point to initiate the diving reflex — and delay the onset of brain damage formerly thought to occur within 3 to 4 minutes of oxygen deprivation to the brain.

The most apparent and immediate application for initiating the Dobkin Technique is to delay brain damage in heart attack victims. Heart attacks are the fourth largest cause of death in the U.S.  Using The Dobkin Trigger to initiate the diving reflex would expand the 3 or 4 minute safety window by delaying brain damage and brain death up to a half hour, maybe longer in heart attack victims.

The Dobkin Technique to delay brain death in heart attack victims will also work in victims of suffocation (asphyxia), electrocution, drug overdose, warm water drownings (which does not trigger this reflex), chest trauma – all these people could be helped by this easy to use, time-buying procedure of a simple cold wet towel or cold water compress to the face to delay the onset of brain damage. 

You can help.  You can help a lot.  Simply be aware you may be able to save someone’s life by initiating the Dobkin Technique – the immediate application of cold water or cold wet towels to the face of a heart attack victim in an emergency.

The Dobkin Technique is a simple-to-do, non-invasive time-buying procedure to delay brain damage.  It can be explained over the phone.  The procedure can be  done someone who is not trained; or by a child.

Please help.  Please report any instances of cold water drownings or the application of The Dobkin Technique to Delay Brain Damage to the writer – we’ll make sure to post all results.

You can make a real difference. Right here, right now. Pass it on. Publish this article on your website.  Please forward this article to family and friends, anyone you care about.  This simple technique may save someone’s life. Maybe the life of someone you know – or the life of one of their children.  Thanks.

Cardiovascular Diseases

The cardiovascular diseases are those diseases which are caused by disorders of heart and blood vessels. Coronary heart disease, cerebrovascular disease, hypertension, artery disease, rheumatic heart disease, congenital heart disease and failure of heart came under the category of cardiovascular diseases.

Most of the western countries face the high and increasing rate of cardiovascular diseases. More people are killed by this disease every year as compare to cancer. A survey concludes that diseases of the heart alone caused 30% of all deaths, with other diseases of the cardiovascular system causing substantial further death and disability. Every 2 out of 3 cardiac deaths occur without any diagnosis of cardiovascular disease.

After a survey it was conclude that this is the prime cause of death and disability in the United States and most European countries. A large histological study (PDAY) showed vascular injury accumulates from adolescence and makes primary prevention efforts necessary from childhood. An estimated concludes that17.5 million people died from cardiovascular disease in 2005 and this is about the 30 % of all global deaths. 7.6 million out of these were died due to heart attacks and 5.7 million were due to stroke.

Around 80% of these deaths occurred in developing or under developed countries as they have low and middle income. If not step is taken against it then according to an estimate, by 2015, 20 million people will die from cardiovascular disease every year and most of them will be from heart attacks and strokes.

Causes- The cause of cardiovascular disease is a blockage that prevents blood to go to the heart or to the brain. The most important and main cause of cardiovascular disease is build up of fatty deposits in the inner wall of blood vessels. In this particular condition, blood vessels become narrower and less broad and heart doesn’t receive the blood. In that case it results to failure of heart.

Reasons- The major reasons of having cardiovascular disease are tobacco, unhealthy diet and physical inactivity. An early form of fatty deposits, which is known as fatty streaks can also be found in children. Some children may be younger than 10 years. These deposits get slowly worse as the person gets older.

Helpful tips- If you are obese or overweight then it increase the risk of heart attacks and strokes. To maintain an ideal body weight, you should take regular physical activity and eat a healthy diet.

To Evaluate the Extent of Side Effects of Anti-tuberculous Therapy (att) on Different Body Systems in Various Age Groups:

Authors:Bhurgri Ghulam Rasool,Momina Taki Muhammad,Shamim-Ur-Rehman,ShahMurad,RajKumar Chohan,DahriGhulam Mustafa, Shaikh zulfikar,

INTRODUCTION:

TUBERCULOSIS:

Tuberculosis, one of the oldest diseases known to affect human, is caused by bacteria belonging to mycobacterium tuberculosis complex. The disease usually affects the lungs, although in up to one third of cases other organs are involved. If properly treated, tuberculosis caused by drug susceptible strains is curable in virtually all cases. If untreated, the disease may be fatal within 5 years in more than half of cases. Transmission usually takes place through airborne spread of droplet nuclei produced by patients with infectious pulmonary tuberculosis (Mario C Raviglione, Richard JO Brein, 2003).

Tuberculosis is a disease of great antiquity. Today, tuberculosis gas become the most important communicable disease in the world, with over 8 millions cases of pulmonary tuberculosis occurring each year 95% which are in developing countries (A Gordon Leitch, 2000).

Tuberculosis is chronic granulomatous disease of human and other mammals caused by a group of closely related obligate pathogens, the mycobacterium tuberculosis complex, and comprising M. tuberculosis. The human tubercle bacillus – M. bovis – the bovine tubercle bacillus, -agricanum – a heterogeneous type found principally in effuational Africa with properties intermediate between the former two species and M-microti-a rare cause of disease involves and other small mammals but attenuated for humans. (PDO D awis et al, 2003).

Annual risk of infection

Areas

Current

Level

Annual decline

Trend (%)

Health resource

Availability

Industrialized

0.04-0.1

>10

Excellent

Middle income Latin America

West Asia

0.5-1.5

5-10

Good

Middle income East and South

Eest Asia

1.0-2.5

<5

Good

Sub-Saharan Africa

Indian Subcontinent

1.0-2.5

0-3

Poor

                                                                                                                                (A Gordon Leitch, 2000)

In 1994 World Health Organization (WHO) declared that tuberculosis (TB) constituted a global emergency. It developed a five point strategy known as direct observe treatment strategy (DOTS) in order to combat the increasing incidence of the disease. The main aim was to detect 70% of smear positive tuberculosis (TB) cases and to treat85% of smear positive new cases successfully. This strategy has improved worldwide cure rates. Tuberculosis is an increasingly important cause of morbidity and mortality in refugees and displaced populations, particularly during the post acute phase of complex emergencies (Alison H Rodger et al., 2002).

EPIDEMIOLOGY:

In Pakistan, only limited data is available, however, the prevalence of tuberculosis is estimated to be as high as 250,000 cases annually. According to official estimates, the rate of open bacillary cases among adult population (15 years and above), was 17% and among children 5 to 9 years of age, 13% were infected with tuberculosis. It is thought to be the fourth major cause of all deaths in Pakistan (Shamim A Qazi et al., 1998).

PATHOLOGY OF TUBERCULOSIS:

CASE WITH INFECTOUS TUBERCULOSIS

Cough and generate droplet nuclei which are ingaled by a contact

Primary

Onset of CMI response

Bacillimia                                                   Apical Implant

Sterilization of the primary complex

Immunosuppressive event

Multiple of tubercle bacilli

Restoration of CMI

Caseation of necrosis

        Infectous tuberculosis

Figure: Schematic representation of the basic events in the pathogenesis of tuberculosis.

CMI: Cell mediated immune.

(VB Balasurbramanian et al., 1994).

DRUG TREATMENT OF TUBERCULOSIS

Tuberculosis is among the top ten cause of global mortality and affects low icome countries in particular. The treatment of smear positive tuberculosis using World Health Organizzation (WHO) directly  observed treatment, short course, Direct observe treatment strategy (DOTS) has far highest impact while BC immunization recuces childhood tuberculosis mortality (Martien W Borgdorff et al.m 2002).

Drugs used in the treatment of tuberculosis can be divided into two major categories. First line after combined the greatest level of efficacy with unacceptable degree of toxicity. These include isoniazid, rifampin, ethambutol, streptomycin and pyrazinamide. Excellent results for patients with non drug resistant tuberculosis can be treated with 6 month course of treatment, for the first 2 months, isoniazid, rifampin and pyrazinamide are given, followed by isoniazid and rifampin for remaining 4 months (William A Petri Jr, 2001).

RIFAMPIN

Rifampin is a semisynthetic broad spectrum bactericidal antibiotic derived from streptomyces mediaterani.The introduction of this antibiotic that permitted the development of the first effective short course of 9 month chemotherapy for tuberculosis.

It is an addition of antituberculosis activity, it has wide range of activity against other bacteria including staphylococcus, Streptococcus, Clostridium, Coliforms, Pseudomonas, Proteus,Shigella and Legionella. Rifampin is almost completely absorbed from gastrointestinal tract after an oral dose. When it is taken is an empty stomach the plasma levels of 6-7 ug/ml are reached at 3 hours and its half-life of about 5 hours (A Gordon Leitch, 2000).

Adverse effects:

Rifampin dependent antibodies are considered responsible for most of immunological side effects in which hepatotoxicity, thrombocytopenia and allergic reactions are important (Mehta YS et al., 1996). Rifampin causes anorexia, nausea, vomiting, diarrhea, fever, dizziness, bone pain, shortness of breath, urine and saliva are colored orange red (Cheema MA, 2000).

ISONIAZID

Since its  introduction in 1952 isoniazid has been widely recognized as a safe and effective chemotherapeutic agent against tuberculosis. Numerous studies of isoniazid in combination with other tuberculous drugs have repeatedly demonstrated its therapeutic efficacy (Richard et al.,1972).

Isoniazid is the most widely used antituberculosis agent. It is an ideal in many aspects, being bactericidal, relatively non-toxic easily administered and inexpensive. It is readily absorbed from the gastrointestinal tract, with peak concentration of approximately 5ug/ml occurring about 2 hour after administration. It penetrates to all tissues including cerebrospinal fluids (C.S.F.) some part of drug excreted in urine in unchanged form but proportion is acetylated by hepatic acetyl transferase to an inactive form. Drug is usually given orally with combination of rifampin and pyrazinamide are available (A Gordon Leitch, 2000). Isoniazid is still most important drug world wide for the treatment of all types of tuberculosis. The commonly usual dose is 10-50 mg/kg/day with maximum of 300 mg (William A Petri Jr, 2001).

The incidence of adverse effects of isoniazid are skin rash, fever , jaundice hypersensitivity to isoniazid may result in fever, various skin eruption occurs (William A Petri Jr, 2001).

Isoniazid preventive therapy is contraindicated in persons with chronic active hepatitis should be given caution to person who consumes alcohol daily (M Suess, 1994).

ETHAMBUTOL

Ethambutol is a synthetic, water soluble, heat stable compound. Susceptible strains of Mycobacterium tuberculosis and other mycobacteria are inhibited in vitro by ethambutol. Ethambutol is an ingibitor of mycobacterial arabinosyl transferases, which are encoded by the embCAB operon. Arabinosy1 transferases are involved in the polymerization reaction of arbinoglycan, an essential component of the mycobacterial cell wall (Henry FC, 2001). It is rapidly absorbed from intestine. It is excreted in urine. It should not be given in renal disease (MA Cheema, 2000). The most important side effect is optic neuritis, resulting decrease of visual acuity and loss of ability to differentiate red from green (William A Petri Jr, 2001).

Hypersensitivity to ethambutol is rare. The most common serious adverse event is retrobulbar neuritis causing loss of visual acuity and red green color blindness. The dose related side effect is more likely to occur at a dosage of 25 mg/kg/day continued for several months. The peripheral neuropathy owing to demyelinization. Other less common adverse effects include gastrointestinal intolerance, hyperurecemia, and hypersensitivity reactions including rash, and rarely thrombocytopenia. It is safe during pregnancy with no known teratological effects (Edwards D,Chan,2003).

PYRAZINAMIDE

Pyrazinamide is bactericidal in an acid environment and as sterilizing effect on intracellular mycobacteria. It is well absorbed from gastrointestinal tract, with peak concentration of about 50ug/mloccurring 1.5-2 gour after ingestion. It penetrates well into tissues including cerebrospinal fluid (A Gordon Leitch, 2000).

Pyrazinamide is synthetic orally effective bactericidal ant tubercular agent used along with isoniazid and rifampin (William A Petri Jr, 2001).

The reasons for this increased incidence of hepatotoxicity reactions in developing countries are unclear, Perhaps poor nutrition, increased age, wide spread parasitism, chronic infections, indiscriminate use of various drugs without prescription may play a role individually or collectively (H Turktas et al.,1994).

Gastrointestinal reactions, cutaneous reactions, sidiroblastic anemia (A Harries, 2003). Moreover pyrazinamide is considered to be significantly less hepatotoxic than isoniazid and rifampin. Less common adverse reactions to pyrazinamide include rhabdomyolysis with myoglobinuric renal failure, gouty arthritis, photosensitivity, maculopapular raxh, thrombocytopenia, increased serum iron, urticaria, and other hypersinsitivity reactions (Edward DE Ehan et al., 2004).

STREPTOMYCIN

Streptomycin is tuberculocidal, but less effective than isoniazid or rifampin, acts only on extracellular bacilli (because of poor penetration into cells). Thus, host defense mechanisms are needed to eradicate the disease. It penetrates tubercular cavities, but does not cross to the cerebrospinal fluid (CSF), and has poor action in acidic medium. Resistance developed rapidly when streptomycin was used alone in tuberculosis most patients had a relapse (Tripathi, 2003). Streptomycin is bactericidal for tubercle bacillus in vitro. Concentration as low as 0.4 mg/ml may inhibit the growth. Vast majority of strains of mycobacterium tuberculosis are sensitive to 10mg/ml (William A Petri Jr, 2001)

Untoward effects include rash and fever, auditory and vestibular function of eighth cranial nerve is affected (William A Petri Jr, 2001).

BCG

Unfortunately, the protective efficacy of BCG, the most widely used vaccine against pulmonary tuberculosis varies from 0% to 80%. BCG gives good protection (75-80%) against disseminated tuberculosis includes tuberculous meningitis, in childhood, BCG is given at birth or as soon as possible, therefore after and although the duration of protection is uncertain, it may not be longer than 15 years, this limiting protection against infectious pulmonary tuberculosis, which may occur mainly in adults (Martein W Borgdorff et al., 2002).

Today over, 70 years of BCG development, it is still the only tuberculosis vaccine availed, and the achievements of tuberculosis vaccine research have been largely operational, such as expanding delivery of BCG through the expanded programe on immunization and holding field trials in different geographical locations (Ann M Ginberg,2002).

MATERIAL AND METHODS

This study was carried out in the department of Pharmacology and Therapeutics, Basic Medical Sciences Institute (BMSI), Jinnah Postgraduate Medical Centre, Karachi, from January 2005 to June 2005.

The 100 newly diagnosed patients of pulmonary tuberculosis, enrolled is this study after taking informed and written consent.

The patients were selected as diagnosed cases of pulmonary tuberculosis from medical chest OPD and chest ward of Jinnah Postgraduate Medical Center, Karachi. Out of these 97 patients were associated through out the study period. Out of remaining three have not come for follow up.

                                     

All patients, in this study, were selected according to following criteria:

INCLUSION CRITERIA:

  • Diagnosed cases of pulmonary tuberculosis.
  • Age between 2o to 70 years.
  • Sex either male or female.

EXCLUSION CRITERIA:

  • Patients suffering from liver disease.
  • Patients suffering from cardiac disease.
  • Patients suffering from renal disease.
  • Patients suffering from diabetes mellitus.
  • Patients suffering from other respiratory disease.
  • Patients suffering from HIV infections.
  • Pregnant or nursing women.
  • Patients with previous multiple drug resistance.

The study period extended up to 24 weeks and 12 follow up visits of patients were taken. The required information such as name, age, sex, occupation, address, details of follow up visits and laboratory investigations etc, of each patients were recorded on proforma especially designed for this study.

The selected patients were divided according to untoward effects of drugs during study period.

Group1:                 In this group those patients were included who manifested the hepatitis in different age groups

Group2:                 In this group those patients were included who manifested the peripheral neuropathy inh defferent age groups

Group3:                 In this group those patients were included who manifested the skin rashes in different age groups

Group4:                 In this group those patients were included who manifested the joint pain in different age group

Group5:                 In this group those patients were included who manifested the optic neuritis in different age group

Group6:                 In this group those patients were included who manifested the thrombocytopenia in different age group

Group7:                 In this group those patients were included who manifested the nephrotoxicity in different age group

Group 8:                In this group those patients were included who manifested the ototoxicity in different age group

MATERIALS

  • Isoniazid—adult 5 mg/kg -maximum 300 mg
  • Rifampin—-adult 10 mg/kg -maximum 450 mg
  • pyrazinamide 15-30 mg/kg
  • Ethambutol 15-25 mg/kg-maximum 300 mg
  • Streptomycin — 15 mg/kg – maximum 1 gm
  • Disposable syringes.
  • C.P. bottles.
  • Kits for the liver function test, measurement of urea, creatinine

Ninety seven patients were studied after medications with anti tuberculosis therapy and divided in eight groups after the manifestation of untoward effects of therapy.

The observations of all the treatment groups were recorded on day 0, day 30 and day 80.

Table 1 and figure 1 show hepatitis after taking the anti tuberculosis drugs. The hepatitis was manifested more in combined therapy during medication of pulmonary tuberculosis. The hepatitis found significant different with p < 0.01 among anti tuberculosis therapy. Out of 97 patients, there were 15 patients were affected by this untoward effect. The highest proportion of hepatitis in isoniazid (10.3%) followed by pyrazinamide (3.1%) and rifampin (2.1%

 The hepatitis in different age groups. The decade between 20-29 of age has shown maximum number of hepatitis (5.1 & followed by the extreme age 60-69 years (P<0.05), keeping the high proportion of isoniazid as compared to pyrazinamice (1.03%) and rifampin (2.06%) in different age groups. Isoniazid manifested 4 cases of hepatitis in age group 20-29 years, pyrazinamide 1 respectively. Four patients produced hepatitis in age between 60 to 69. Pyrazinamide produced hepatitis in age between 60 to 69. Pyrazinamide produced hepatitis (2.66%). INH and rifampin affected with equal percentage (1.03%). Two patients were produced hepatitis in age between 30-39 years. The INH and rifampin affected with equal (1.03%) in this age group respectively. It was non significant statistically. One patient was affected by isoniazid in the age group of 50-59 years. It was non significant statistically

 The peripheral neuropathy in 25 patients out of 97 patients. The isoniazid produced more peripheral neuropathy than other causative drugs. The isoniazid affected 11.3% patients. The pyrazinamide and ethambutol produced the peripheral neuropathy in same percentage (7.2%). It was non significant statistically.

The peripheral neuropathy in different age groups. The age between 60 and above was more affected than other age groups. Isoniazid produced 602% peripheral neuropathy in this age group. Ethambutol produced 1.03% peripheral neuropathy. The age group between 20-29 developed peripheral neuropathy by isoniazid 301%, pyrazinamide 2.01% and ethambutol 1.03% respectively. The total patients were 6 with this age group. The age between 30-39 manifested peripheral neuropathy by isoniazid 1.03% and ethambutol 1.03% respectively. The age between 40-49 was affected by peripheral neuropathy by pyrazinamide 3.1% and ethambutol 3.1%                                                                                                  

Therapy produced, 3 patients, thrombocytopenia. The rifampin produced thrombocytopenia in 3.1% males.

 Thrombocytopenia according to age groups. The combined therapy affected in age between 40-49, 1.03%, 50-59, 1.03% and 60 and above 1.03% respectively. The rifampin produced this side effects with same percentages i.e. 1.03% in age groups 40-49, 50-59 and above.

            Table 10 and figure 10 show the joint pain as an adverse effect of anti tuberculosis drugs. The combined therapy affected 8 patients out of 97. pyrazinamide produced joint pain in 8.24% patients.

Table 12 and figure 12 show the joint pain according to age groups. The pyrazinamide affected 3.09% in age between 60 and above, 2.06% in age between 20-29 and 1.03% in further age groups respectively.

 The optic neuritis. The combined therapy produced optic neuritis in 7 patients out of 97. ethambutol produced 7.2% optic neuritis

 The optic neuritis according to age groups. The combined therapy produced the optic neuritis in 3 in 6o to69, 2 in 50-59 and one in 30-39 and 40-49 years respectively. The ethambutol produced the optic neuritis in 3.09 in age between 60-69, 2.06% in 50-59 and 1.03% in 40-49 and 30-39 tears.

 Skin rashes as an adverse effect of anti tuberculosis drugs. The skin rashes found significant (P<0.01) by combined therapy. The combined therapy produced skin rashes in 6 patients out of 91 patients. The pyrazinamide produced skin rashes (4.12%) and rifampin produced 2.1% respectively.

Skin rashes in age groups. The combined therapy produced skin rashes in 2 from 20-29 years age group, 1 from 40-49 years, 1 from 60-69 respectively. The pyrazinamide produced skin rashes 2.06% in age between 20-29 years, 1.03% in 50-59 years, 1.03% in 60-69 years age group, 1.03% in 50-59 years respective

 Nephrotoicity as an adverse effect. Streptocomycin was main drug to manifest the nephrotoxicity in combined therapy during treatment of pulmonary tuberculosis in combined therapy during treatment of pulmonary tuberculosis patients. Out 97 patients, there were 3 reactions documented in this study.   Nephrotoxicity in gender after taking the anti tuberculosis drugs. Two males and one female was affected during the study

The nephrotoxicity in different age group. In the age group 30-39 1, 40-49 1, and 50-59 1 reaction was documented in this study.

 The ototoxicity after taking anti tuberculosis drugs. There were 2 reactions recorded in this study.

Adverse effect

Pyrazinamide

Isoniazid

Ethambutol

Rifampin

Streptomycin

Total

%

95% CI

Peripheral neuropathy

7 (7.2%)

11 (11.3%)

7 (7.2%)

25

25.8

17.80-35.1

Hepatitis

3 (3.1%)

10 (10.3%)

2 (2.1%)

15

15.5

9.2-23.7

Joint pain

8 (8.2%)

8

8.20

3.9-15.0

Optic neuritis

7 (7.2%)

7

7.20

3.2-13.7

Skin rashes

4 (4.2%)

2 (2.1%)

6

6.20

2.5-12.4

Table show overall side effects of ATT in this study.

FIGURES:

Overall Frequency of Adverse Effect

(n=69)

DISCUSSION:

This study observed the untoward the untoward effects of antituberculous drugs in pulmonary tuberculosis patients. The selected patients were divided into two groups according to the age and sex. In this study the following reaction i.e., hepatitis, peripheral neuropathy, thrombocytopenia, joint pain, optic neuritis, ototoxicity and nephrotoxicity were recorded in the first line antituberculous drugs used in pulmonary tuberculosis patients.

The adverse effects of antituberculous drugs i.e., isoniazid (INH), pyrazinamide, rifampin, ethambutol and streptomycin were observed during this study, discussed here.

Isoniazid (INH) 300 mg per day was started in selected 97 tuberculosis patients. The major side effects were recorded after two weeks of medication, which included hepatitis and peripheral neuropathy.

Hepatitis – there were 10 reactions of hepatitis were documented in this study. In a group of gender, there were 7 reactions in male and 3 reactions in female. According to age group between 20-29, the isoniazid produced 4 reactions, 3 reactions in 40-49, 1 reaction in other age groups. Isoniazid was stopped but remaining other drugs rifampin, pyrazinamide, ethambutol and streptomycin were continued in these patients.

After the stoppage of isoniazid, the liver function test was normal in 6 cases, isoniazid was reintroduced after 2-3 weeks with dose of 50 mg per day and was increased subsequently to 300 mg per day. There were 4 cases referred to the Medical Outpatient Department (OPD) for management of liver disease.

Peripheral neuropathy – isoniazid produced 11 reactions of  peripheral neuropathy out of 25 reactions in this study. According to gender, 4 reactions were produced in male and 7 reactions in female. According to age group the peripheral neuropathy produced in age group 30-39 and 40-49 respectively. This showed the higher side effect of isoniazid in older age group.

Pyrazinamide (1-2 g/day) – the major side effect of this drug were produced after 3-4 weeks of medication. The hepatitis 3, peripheral neuropathy 7, joint pain 8, and skin rashes were documented in this study.

Hepatitis – the pyrazinamide produced 3 reactions of hepatitis in this study. According to gender, 1 male and 2 female reactions were recorded in this study. According to age, pyrazinamide produced 2 reactions in age group of 60-69 and 1 reaction 20-29 of age group. The 1 reaction of pyrazinamide was subsided when drug was stopped. But 2 reactions in older age group, the liver function test did improved and they were referred to the Medical Outpatient Department (OPD) for the management of liver disease.

Peripheral neuropathy – there were 7 reactions caused by pyrazinamide were documented in this study, according to gender, 2 reactions in male and 5 reactions in female according to age group, age between 50-59 3 reactions and 1 reaction in age group 20-29 and 40-49 respectively. These reactions were reversible after decreasing dose of pyrazinamide.

Skin rashes – the pyrazinamide produced 4 reactions out of 6 reactions of antituberculous drugs in this study. According to gender, in female 3 reactions and 1 reaction in male were recorded in this study. According to age group, 2 reactions were recorded in age group of 20-29 and 1 reaction in 50-59, 60-69 respectively. Skin rashes were subsided after stoppage of pyrazinamide for 3 weeks.

Joint Pain – there were 8 reactions of joint pain documented in this study. This study showed that pyrazinamide was only causative drug for joint involvement, the uric acid level was done before and after the start of drug. A remarkable increase level of uric acid was noted after the pyrazinamide treatment. Thus the drug was stopped in these 8 patients and later the level of uric acid significantly decreased and joint involvement clinically improve.

                Ethambutol was administered at dose of 15-30 mg/Kg/Day. The side effects of this drug were manifested after 2-3 weeks of treatment. The peripheral neuropathy and optic neuritis were recorded as main side effects.

Peripheral neuropathy – there were 7 reactions of peripheral neuropathy recorded in this study. The ethambutol produced these reactions in 2-4 weeks after starting of treatment. According to gender, 5 in female and 2 reactions in male, were observed in this study. According to age group, 3 reactions in 50-59 and 1 reaction in each age group respectively. These reactions were reversible after stoppage of the drug.

Optic neuritis – the ethambutol produced the 7 side effects of optic neuritis in this study. According to gender, male manifested 4 and female 3 reactions of optic neuritis in this study. According to age group 3 reactions in 60-69 age group and 2 in 50-59 group and 1 reaction in 50-59, 30-39 age group respectively in this study. Drug was discontinued in these 7 cases of optic neuritis but the remaining four other drugs were continued. They were referred to Eye Outpatient Department for the management of optic neuritis. Only in two patients drug was reintroduced with low dose 15-20 mg/Kg/Day.

Rifampin (450 mg/day) – after 2-3 weeks of starting with combined therapy, the major side effects were manifested. When this drug was hold, the hepatitis 2 and skin rashes 3 were improved and reactions of thrombocytopenia were documented in this study.

Hepatitis – according to gender, 1 reaction of hepatitis in male and 1 in female produced by rifampin. According to age group, 1 reaction in 30-39 and 60-69 were produced by rifampin. One side effect of hepatitis was improved when drug was stopped after one week and other patient was referred to Medical out patient department for further management.

                Skin Rashes – the rifampin developed the skin rashes in two patients; one in male and one in female in this study. According to age group, 1 adverse effect in 40-49 and 50-59 were observed respectively. These skin rashes were reversible after stoppage of drug.

Thrombocytopenia – after 5-11 weeks of treatment of tuberculosis patients, the level of platelets were decreased and clinically the patients were complaint epistaxis, bruises, and petechial rashes. Rifampin was stopped in 3 patients but the remaining other four drugs were continued.

Streptomycin (1 g per day) – it was started with other drugs. After 3-7 weeks of medication, 3 patients complaint of oliguria and 2 patients presented during follow up with hearing deficit. These reactions proved clinically and laboratory investigations.

Nephrotoxicity was recorded in these patients two in male and 1 in female. According to age group 1 in 30-39, 2 40-49 and 1 50-59 side effects were documented in this study. Drug was stopped for 3 weeks and found that blood urea nitrogen and creatinine levels were decreased, therefore this drug was permanently stopped and the remaining four drugs were continued.

The proximal renal tubule cells may accumulate aminoglycoside, accounting for nephrotoxicity associated with aminoglycosides. The mechanism of renal toxicity is hypothesized to by the inhibition of intracellular phospholipase in the proximal tubule. The renal insufficiency is typically characterized by the nonoligouric decrease in glomerular filtrate rate occurring after at least taking a week therapy. Baseline and periodic surveillance of analysis blood urea nitrogen levels, creatinine values is indicated (Edward et al., 2004).

Streptomycin is nephrotoxic and should used with caution in patients with renal impairment. If reaction is trouble some which is an infrequent occurrence, the dose may be reduced (NCG,2002).

Ototoxicity – there were 2 reactions recorded in this study. According to gender, 1reaction was in male and 1 in female was documented in this study. Side effects of streptomycin were recorded. One in age group 20-29 and one in 40-49. The drug was a stopped and patients were advised to consult in Ear Nose and Throat OPD. Remaining other drugs were continued.

Interestingly, the damage may be fairly isolated to either the choclear or vestibular component, or rarely both. The mechanism for the cochlear toxicity is unclear, although the target site is considered to the outer hair cells of the organ of corti.

Aminoglycoside induced cochlear dysfunction is generally considered to be irreversible. Injury to the hair cells of the ampullar cristae by aminoglycosides is the mechanism of the vestibular toxicity. Sign and symptoms of vestibular toxicity include nausea, vomiting, vertigo and nystagmus (Edward et al., 2004).

Our study matches with study of Menzies et al (2005), who observed the side effects of antituberculous therapy. They reported that at least monthly a nurse, a case manager, a treating physician saw the 430 test patients who had active tuberculosis therapy . At the time of their visit patients were questioned specifically about the occurrence of common side effects of their tuberculosis drugs. Liver enzyme levels were checked routinely in all patients after one month of treatment. Patients were encouraged to return at any time if symptoms or problems arose during therapy.

The striking observation is that pyrazinamide was association with rate of toxicity that was threefold higher than isoniazid and rifampin and 20-fold higher than ethambutol. The rate of toxicity with pyrazinamide was 1.5 per 100 person – months compared with 0.5 per 100 person – months for isoniazid. Pyrazinamide rashes attributed to pyrazinamide may have led to in appropriate drug discontinuation. It seems that pyrazinamide-related rashes usually resolve spontaneously and not considered a reason to stop therapy. While in this study the rate of toxicity of pyrazinamide was higher than isoniazid and rifampin. Therefore, causative drugs like pyrazinamide, isoniazid and rifampin was stopped, because they induced hepatitis, which increase risk of liver damage. However, ethambutol and streptomycin were continued in this study.

In case of skin rashes, pyrazinamide was responsible drug but it was discontinued from therapy, skin rashes were improved after three weeks.

                There was a difference between this study and Menzies study may be due to short duration of study period, difference in number of patients studied. Moreover, his study conducted in United States of America. In this study there was a short duration of study and small selected number of patient and many environmental factors were involved. The patients selected in this study belong to poor socioeconomic class and they could not repeatedly visit Doctors for their checkup the occurrence of side effects of antituberculous drugs.

The British Thoracic Society (1998) guides that if the aspartate aminotransferase and alanine transferase are two or more times normal, liver function should be monitored for two weeds, then two weekly until normal. If the aspartate aminotransferase and alanine transferase under two times normal, liver function should be repeated at two weeks. If the aspartate aminotransferase and alanine transferase level rises to five times normal or bilirubin level rises, rifampin, isoniazid and pyrazinamide should be stopped. Alternative treatment will need to be considered if the patient is unwell or is smear positive and within two weeks of starting treatment.

Reactions most frequently observed with intermittent regimens of rifampin are cutaneous syndrome consisting of flushing and/or pruritus, with or without rash, involving particular face, and scalp, often with redness and watering of eye (Fried et al., 2004). Pyrazinamide produce GIT reactions, cutaneous reactions and sidero blastic anaema (Harries, 2004).

The results of this study matches with the study of Pelletier et al (2003), who observed the side effect of antituberculous drugs in 4.30 patients between 1990-99. They stated that the major adverse reaction of first line antituberculous drug, which results in discontinuation of that drug, has severely implication. They may be considerable morbidity even mortality particular may drug-induced hepatitis. Alternative agents may gave greater problems with toxicity and often less effective so that treatment must be prolonged, with attendant challenged to ensure complains as a risk of treatment failure and relapse are higher. In their results, only 37 patients had major side effects on six occasions. Severe hepatitis resulted in discontinuation of the isoniazid and pyrazinamide and neither were restarted. In three instances (two of rash and one of the severe gastrointestinal intolerance). Rifampin and pyrazinamide were stopped not rechallenged. They observed the rifampin did not commonly cause the drug-induced hepatitis. The drug mostly responsible for occurrence of hepatitis or rash during therapy of antituberculosis in tuberculosis hepatitis or rash during therapy of antituberculosis in tuberculosis patients was pyrazinamide.

                In this study, pyrazinamide manifested more side effects than other antituberculous drugs were documented according to age and gender. But incidence of drug-induced hepatitis was observed more in isoniazid than other antituberculous drugs. The rifampin had shown less side effects than other antituberculous drugs.

                The occurrence of side effects in the present study was noted to be much higher than the study done by Pelletier and colleagues. In this study there is a short duration of study and small selected number of patient and many environmental factors were involved. The patients selected in this study belong to poor socio-economical class and they could not repeatedly visit Doctors for their checkup the occurrence of side effects of antituberculous drugs.

Hepatotoxicity is one of the most serious adverse effects of anti tuberculosis drugs (ATD). Although many risk factors gave been associated with antituberculosis drugs induced hepatotoxicity, their influence on hepatitis severity has not been studied systematically. This study evaluated whether the presence of hepatotoxicity risk factors (advanced age, chronic liver diseases, abuse of alcohol or other drugs or malnutrition) influences the severity of ATD induced hepatotoxicity (Villar et al., 2004).

The results of present study match with the study of Fernanoted it al (2004). Their prospective cohort study of 471 active tuberculosis diseased patients treated with isoniazid, rifampicin and pyrazinamide were followed in tuberculosis clinic between January 1998 and July 2002. The incidence of antituberculous drug induced hepatitis was 18.2% patients in a risk group and 5.8% patients in non-risk group. Antituberculous drug-induced hepatitis is a significant and more severe in patients with risk factors. Our study correlates with this study because our big part of population live in a risk factor i.e., poverty, malnutrition, lack of clean water, combine family structure, high prevalence of viral hepatitis. So in our study there were more cases of hepatitis due to pyrazinamide, isonaizid and rifampin gave been responsible for drug-induced hepatitis.

Manifestations of hepatotoxicity include a symptomatic elevation in serum aminotransferase, jaundice and liver tenderness. One recommendation for monitoring for rifampin and pyrazinamide induced hepatitis is to determine the levels of aminotransferase at baseline and at 2, 4 and 6 weeks of treatment and to discontinue rifampin/pyrazinamide when there is (a) serum aminotransferase level that exceeds five times the upper limit of normal in an a symptomatic individual (b) any elevation of serum aminotransferase that accompanied by symptoms of hepatitis (c) any elevation in serum bilirubin (Edward et al., 2004).

The results of this study also match with the results of study carried out by Dossing et al (1996). They observed 61 patients out of 127 patients had elevated aspartate aminiotranferase after the treatment of antituberculous drug. Most of these were men with daily alcohol consumption of 60 g. Hepatitis were confirmed by challenged with pyrazinamide 7 and isoniazid 6 cases.

In the present study, we monitored that occurrence of untoward effects of antituberculous drugs. There was a difference between two studies due to short duration of study and small selected patients. In this study, the cases of hepatitis were recorded more than the study done my Dossing et al.

                This study also matched with the study of Ferner (1990). He observed that ethambutol dose related toxicity. He reported sub clinically impairment of color discrimination relatively common in 54 patients received about 15 mg/Kg/Day of ethambutol as a part of antituberculous therapy. In the present study, the ethambutol produced the opticneurites in high percentage than the Ferner’s study. But similar results were observed in old age patients group who were affected more in both studies. The peripheral neuropathy has been reported in 3 tubercular patients who had receiving the athambutol by 13 to 50 mg/Kg/day.

Peripheral neuropathy was manifested by ethambutol in our study. There were 7 reactions of peripheral neuropathy produced by ethambutol but these reactions were reversible after stoppage of ethambutol.

                In patients prescribed ethambutol it is recommended that after obtaining baseline visual acuity and color perception tests, these tests be repeated every 4 to 6 weeks, especially with new visual symptoms (Chan et, 2004).

                Zinc is found in high concentration in choroids, retina, and ganglion cells and is used by retinal dehydrogenase for transformation of retinal. This last step is important for color vision. Most case of color toxicity are bilateral and result from a dose related retro bulbar optic neuritis that can either axial or peripheral. Axial neuritis involves the papillomacular bundle. It reduces visual acuity and causes central scotomas and color vision deficits. The peripheral visual field deficits but stable visual acuity and color vision (DorothyNahm Friedberg et al.,2004).

                Ellard et al (1976) in their study observed the occurrence of joint pain on a reduction of renal elimination of urate in man caused by administration of pyrazinamide.

                The urinary excretion of pyrazinamide, pyrazinoic acid, 5-hydroxypyrazinoic acid and uric were determined in healthy subjects after giving single or multiple doses of pyrazinamide or its metabolites pyrazinoic acid. The results obtained demonstrated that 5-hydroxypyrazinoic acid is major metabolite of pyrazinoic acid in man and supported previous evidence under that retention of uric acid caused by the administration of pyrazinamide is mediated by pyrazinoic acid. After giving 3 g pyrazinamide the urinary excretion of uric acid was maximally suppressed for 24 hours. Prolonged exposure to pyrazinoic acid resulted in a net reduction in the urinary excretion of uric acid. The finding suggested that the degree of uric acid retention in patients treated with pyrazinamide containing regimens could be reduced by giving pyrazinamide intermittently (Ellard et al., 1976).

This study matched with study conducted by Ellard and coworkers. Pyrazinamide was responsible for joint pain for different age group and gender in the present study. The old age group was commonly affected by pyrazinamide.

                In a study of Hussain et al (2003), ocular reaction and toxic neuropathy were produced by ethambutol in patient’s age between 11 to 80 years. The defected color vision was fouced in 76% of eyes and 27% of eyes had defect in color vision inspite having visual acuity of 6/9 or 6/6. Dilated fundus examination revealed normal optic disc in 66 (67%) of eyes, disc pallor in 27 (28%) of eyes and 4 (4%) eyes had swollen by hyperemic disc.

                The results of present study matched with the results of study conducted by Hussain and coworkers because the ethambutol was effected in the same pathogeneses in old age group.

                Ethambutol is an effective treatment for tuberculosis. It can cause a multitude of dose and time dependent ocular side effects including color changes, visual field defects, and either unilateral or bilateral optic neuritis. Gradual decreases in central visual acuity and green red color vision problem (or less commonly blue yellow color vision defects) have been reported. These defects continue to progress for 1 to 2 months after drug is discontinued (Katherine, 2002).

                This study was also correlated with the study of Mehta (1996). He observed thrombocytopenia in three patients of pulmonary tuberculosis during therapy. Rifampicin was causative drug. The immunological studies in all three patients showed the presence of antiplatelets antibodies reaction resulting in thrombocytopenia.

Moreover, binding of these antibodies to platelet membrane was more avid in presence of rifampicin. In present study, thrombocytopenia was major side effect of rifampin in different age and gender groups. These three patients were separated on the bases of blood complete picture and clinically showed bleeding from nose, petechial rashes and bruises. The pyrazinamide was stopped and it did not reintroduced in these cases.

                Tuberculosis is a granulomatous disease, caused by mycobacterium tuberculosis. As world Health Organization estimates more than 300,000 new cases of tuberculosis develop in Pakistan every year. Cure of infectious cases of tuberculosis is the key to effective control of the disease. Treatment of tuberculosis patients reduces suffering and, if adequately, prevents death from tuberculosis. The first tine of drugs used in the treatment of tuberculosis consists of isoniazid, pyrazinamide, rifampin, streptomycin, and ethambutol. The major side effects are those giving rise to serious health hazards, and require discontinuation of the drug and referral to chest physician. Minor side effects cause relatively little discomfort; they often respond to symptomatic or simple treatment but occasionally persist for the duration of drug treatment. Chemotherapy should be stopped or temporarily interrupted only of severe drug intolerance or toxicity occurs. In fact tuberculosis drugs are relatively toxic and mild side effects are not uncommon but most do not warrant drug withdrawal.


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Japanese Fuji released the global appliance market economy General Survey in 2009

     1, the overall situation of

     Fuji economy released on the 18th, “2009 General Survey global consumer electronics market,” the report said 2008 annual global production of about 1.7 billion consumer electronics market 34.73 million units in the next few years will maintain a 2% to 3% per year compound annual growth rate continue to grow; to 2013 years will grow to 1.9 billion 99.3 million units.

     Reported that the mature markets of Japan and to Europe and the United States demand for high value-added products replacement; as well as the BRICs (BRIC) as represented by per capita disposable income in emerging markets increased, to enhance purchasing power to drive new demand for household appliances into the “outbreak period”; two factors will drive the global consumer electronics market within the next five years to maintain a rapid growth momentum. In addition, Southeast Asia, Eastern Europe and Central and South America and other countries (regions), home appliance market from infancy to the formation of phase transitions, will become the global home appliance market in the next few years, new growth points and will drive the global home appliance industry, industrial chain and industrial pattern of the allocation of a new round of adjustment.

     From the national and regional production trends point of view, China, as a “world factory” bear 77% of the global home appliances market, production capacity, which hold an absolute advantage. Yet the United States, Europe and other household appliances production in most countries and regions are showing a significant reduction of the corresponding momentum. However, Japan (2.7%) and other countries in the multi-functional, intelligent, digital, environmental protection and energy-efficient production of high value-added home appliances has shown a certain degree of growth momentum. In addition, Southeast Asia, Thailand, Vietnam, India and Asia • Oceania region (7.2%) are being gradually becoming the world’s largest white goods, one of the main origin.

    Products, Japan’s Fuji economic forecasts, with the improvement of living standards in emerging markets, washing machines, electric irons, vacuum cleaners and other clothing to live will be significantly associated with product demand growth in mature markets is expected to offset the negative impact of declining demand, thereby maintaining about 2 ~ 4% The annual compound growth rate continued to grow. In addition, the warm water washing toilet seat, water purifier, ionic water trap to high value-added products, may face limits to growth in Japan and Europe and the United States markets, thus promoting these products continue to expand the functions and values to stimulate consumer demand in mature markets such as Europe and the United States the same time, Development of the low prices to stimulate new demand in emerging markets.

    Lighting, the Fuji economic forecast, the world’s light output in 2013 compared with 2008 decreased 22.1%, decreased to 8.4 billion 12.35 million, of which 2013 annual LED (light-emitting diode) light output would be greater than in 2008 14.75 million increased by 40 % or so, is expected to reach 20.65 million or more. Fuji economic forecasting, said that with the strengthening of national environmental protection measures, high-energy ordinary incandescent lamp market demand and the sharp reduction in production will show a significant trend; while the long-life fluorescent lamps and LED lamp replacement demand will be substantially upgraded so as to drive the global lighting rapid market into “LED era.”

    Cooking-related aspects of the kitchen appliances, Fuji economic report said that demand in mature markets while a great fall trend, but in emerging markets, particularly China household electrical appliances to the countryside, consumer trade-in policies to stimulate the active promotion, the Chinese mainland and refrigerators kitchen appliances showed explosive growth in demand, which offset the decline in demand in other countries the negative factors, and 2013 is expected to yield a global culinary kitchen appliances would be more in 2008 grew by about 15.7% to reach 670.16 million units.

    Reported that air-conditioning, fans both products occupy air-conditioning, water heater for about 70% of the production. At the same time, an important feature of this market is China’s real estate to consumer, that is, China’s domestic production and domestic consumption, the ratio is much higher than other products. In the countryside, driven by household appliances, China’s domestic manufacturers have launched low-priced products, thereby accelerating the process of popularization of the middle class, China has become the world’s air-conditioning, water heater’s largest producer and consumer. In addition, China’s air filters, dehumidifiers, humidifiers and other products production and sales, but also with the increase in consumer incomes rising demand showing momentum. Fuji economic forecast, driven by the China effect, the global air-conditioning, hot water associated with the market in the future will keep 3 to 4% per year compound annual growth rate. On the other hand, production and sales are an absolute majority of the world’s Zhan Zhao in China market, so the next 3 to 5 years of the global market.

    Health and beauty products, home appliances, the next few years will show a steady growth, limited room for growth in the mature markets of the circumstances, the rise of China’s new rich class and the low price of the product, in the middle income group to pursue the high quality of life, etc. factors, both will lead China to become the next few years, the global beauty health home appliances market in the “new growth point.” The North American market, electric toothbrushes, sphygmomanometer and other personal care products will remain the trend of steady progress, thus promoting the global market will grow 16.51% over 2008 to reach 552.37 million units.

    Second, the three most popular products

    In addition, Fuji economic reports, LED lights, air filters, electric water heaters and other products will become the three major global consumer electronics market over the next few years, a major hit. As the new influenza, the 2009 major companies have varying degrees of expansion of the air filters of the production capacity, product type from the popularity of high-functioning that extends to form a relatively complete camps of goods. 2009 Annual Global Air Cleaner production, China accounts for about 8 into a weak, large companies with characteristics of the flow of market demand in Asia, has increased in China and the surrounding areas the proportion of production. Meanwhile, the Chinese OEM manufacturers introduced new products were particularly noticeable.

    LED light is called the richest growth products. Fuji Economic Forecasting, 2013 Annual LED (light-emitting diode) light output would be greater than in 2008 14.75 million increase of about 40%, is expected to reach 20.65 million or more. And predicted that, with the strengthening of national environmental protection measures, high-energy ordinary incandescent lamp market demand and the sharp reduction in production will show a significant trend; while the long-life fluorescent lamps and LED lamp replacement demand will be substantially upgraded so as to drive the global lighting market quickly into the “LED era.”

    Electric water heaters and air-source heat pump is considered second only to the second most popular LED light products. Reported that, at present these two categories of products produced in China, rapid growth, accounting for more than half of the world, followed by Japan into three or so, Western Europe into one. On the other hand, known as the “green Cute” air-source heat pump, then popular in Japan, which accelerated the trend, making the country known as the world’s largest market; at the same time, Europe and China’s demand is also growing slowly . However, by the boiler system, “pre-emptive effect”, demand up the pace of expansion slowed.

Pneumonia Vaccine Side Effects –

A recent study by the National Institute of Health states that the pneumonia vaccine prevents most cases of pneumonia. Some people believe that administering the pneumonia vaccine will result in contracting pneumonia . However it is not so, as the vaccine is not a live vaccine. Along with the required effects, all vaccines have side effects. They are usually minor and temporary. However, in rare cases, pneumonia vaccine side effects are serious, like allergic reactions which cause breathing difficulties, tachycardia, dizziness, throat swelling, and at times, even behavioral changes.

There are some general side effects caused by most vaccines like pain, redness, swelling or a small lump at the site of the injection. These side effects usually resolve in a few days. Other side effects include fever, headache, muscle aches and pains or a rash. Only in rare cases (about one in a million) does a vaccine cause serious side effects like an allergic reaction called anaphylaxis. This is easy to identify, as it begins moments after the vaccination is administered and includes distinct symptoms such as hives, rashes, swelling of the lips and even severe anxiety.

The following are notable side effects of the pneumonia vaccine:
•Common side effects from pneumonia vaccine include redness, soreness, a hard lump, swelling or pain at the site of injection. These pneumonia shot side effects can occur with the administration of any vaccine, and do not need medical attention unless they continue for a long period of time.
•Some other rare side effects for a pneumovax shot are aches or pain in joints or muscles, fever, skin rash, swollen glands, unusual tiredness or weakness. You should consult a doctor if these symptoms occur.
•Another one of pneumonia vaccine side effects is having high fever (around 102 degree Fahrenheit). If this occurs, it is necessary to seek medical attention as soon as possible.
•Pneumonia shot side effects like allergic reactions occur only in rare cases. This can be life threatening and should be taken seriously.
It is not necessary that everyone suffers from some or the other side effects of the vaccine. Also, treatments for pneumonia shot side effects are not always necessary, as they usually subside on their own. Only if a side effect lasts longer than five days is it necessary to consult a doctor. Though pneumonia vaccine is considered to be safe, it is best if only those people who are at a risk of acquiring it get vaccinated.

Pneumonia can be a life threatening condition, especially for elderly people, children and those with weak immune systems. Thus, it is better to take precautions in such cases. After all, the pneumonia vaccine side effects are far less as compared to pneumonia symptoms themselves!

Pneumonia Vaccine Side Effects