Thursday, 31 December 2015

HAPPY NEW YEAR 2016

HAPPY NEW YEAR 2016 ;-

TO ALL FRIENDS , FANS CLASSMATES ,RELATIVES & COMMUNITIES WITH BEST 

WISHES. .













Tuesday, 22 December 2015

Honey & Health Benefits.





Honey & Health Benefits ;-
Importent 10 Health Benefits of Honey:
Honey iz natural product but it have lote of health benefits & medicinal usages .
1. Prevent cancer and heart disease:
Honey contains flavonoids, antioxidants which help reduce the risk of some cancers and heart disease.
2. Reduce ulcers and other gastrointestinal disorders.
Recent research shows that honey treatment may help disorders such as ulcers and bacterial gastroenteritis. This may be related to the 3rd benefit…
3. Anti-bacterial, anti-fungal, anti-fungal:
“All honey is antibacterial, because the bees add an enzyme that makes hydrogen peroxide,” said Peter Molan, director of the Honey Research Unit at the University of Waikato in New Zealand.
4. Increase athletic performance.
Ancient Olympic athletes would eat honey and dried figs to enhance their performance. This has now been verified with modern studies, showing that it is superior in maintaining glycogen levels and improving recovery time than other sweeteners.
5. Reduce cough and throat irritation:
Honey helps with coughs, particularly buckwheat honey. In a study of 110 children, a single dose of buckwheat honey was just as effective as a single dose of dextromethorphan in relieving nocturnal cough and allowing proper sleep.
6.eye side & weight loss ,asthma ,sexual. 
Honey has been used in medicine  at least 4000 years and is considered to affect all three of the body’s primitive material imbalances positively. It is also said to be useful useful in improving eyesight, weight loss, curing impotence and premature ejaculation, urinary tract disorders, bronchial asthma, diarrhea, and nausea.


7. Blood sugar regulation:
Even though honey contains simple sugars, it is NOT the same as white sugar or artificial sweeteners. Its exact combination of fructose and glucose actually helps the body regulate blood sugar levels. Some honeys have a low hypoglycemic index, so they don’t jolt your blood sugar. (Watch this video Sweetener Comparison where I compare Stevie, brown rice syrup, honey, molasses and agave, and discuss the strengths and weaknesses of each.)
8. Heal wounds and burns:
External application of honey has been shown to be as effective as conventional treatment with silver sulfadiazene. It is speculated that the drying effect of the simple sugars and honey’s anti-bacterial nature combine to create this effect.


9. Probiotic:
Some varieties of honey possess large amounts of friendly bacteria. This includes up to 6 species of lactobacilli and 4 species of bifidobacteria. This may explain many of the “mysterious therapeutic properties of honey.”









  






10. Beautiful skin:
Its anti-bacterial qualities are particularly useful for the skin, and, when used with the other ingredients, can also be moisturizing and nourishing! For a powerful home beauty treatment for which you probably have all the ingredients in your kitchen already.




Wednesday, 9 December 2015

PARACETAMOL TOXICITY

 Paracetamol Toxicity





PACETAMOL *              GENERIC-**ACETAMINOPHEN

OVERVIEW
  • Most common OD in the west
  • Hepatic metabolism
  • Following overdose glucuronidation and sulphation pathways are rapidly saturated -> increased metabolism to NAPQI (N-acetyl-P-benzoquineimine)
  • Glutathione is required to inactivate NAPQI and when levels depleted -> hepatocellular death takes place
CLINICAL FEATURES
  • overdose of > 10g or > 200mg/kg
  • doses of > 250mg/kg associated with massive hepatic necrosis and liver faillure
  • be aware of the late presenters (> 8 hours since OD and start NAC empirically)
Stage 1 (0-24hrs)
  • asymptomatic or GI upset only
Stage 2 (24-48 hrs)
  • resolution or nausea and vomiting
  • RUQ pain and tenderness
  • progressive elevation of transaminases, bilirubin, PT
Stage 3 (48-96 hrs)
  • hepatic failure (jaundice, coagulopathy, encephalopathy)
Stage 4
  • death from hepatic failure
  • normalisation of LFT’s and complete resolution of hepatic architecture by 3 months
RISK FACTORS FOR TOXICITY
Underlying hepatic impairment
  • viral hepatitis
  • alcoholic liver disease
Microsomal enzyme induction
  • phenobarbitone
  • carbamazepine
  • phenytoin
  • rifampicin
  • OCP
  • chronic alcohol ingestion
  • starvation
Acute glutathione depletion states
  • acute illness with decreased nutrient intake
  • anorexia/bulimia/malnutrition
  • chronic alcoholism
  • HIV
INVESTIGATIONS
  • paracetamol (APAP) levels:
    -> compare to Australasian nomogram (modified version of Rumack-Matthews nomogram)
    -> no role in chronic toxicity
    -> treat if above threshold @ 4 hrs
    -> a level of > 153mg/L is above treatment threshold regardless of time of ingestion
    -> NAC must be given within 8 hours of OD (if level going to take longer than 8 hours start NAC empirically)
  • transaminases: peak @ 72 hrs
  • PT: if >180 seconds on day 4 will need transplantation
  • renal failure
  • metabolic acidosis = poor prognostic marker
MANAGEMENT
Resuscitation
A: may require intubation and intubation if polypharmacy overdose and unrousable
B: lung protective ventilation
C: volume resuscitation
D: dextrose for hypoglycaemia
Evaluation
History
  • Timing
  • Quantity
  • Dose
  • Other meds
  • Psychiatric history
Examination
  • Fuliminant hepatic failure signs
  • Signs of other drug toxicity
Investigations
  • LFTs
  • paractamol level
  • urine tox
  • coag’s
  • ECG
  • lactate
  • amylase
  • blood alcohol
  • pregnancy test
  • ECG
Treatment
Specific
  • decrease absorption: activated charcoal if presented within 4 hours (controversial as if NAC given then this is a benign OD)
  • N-acetyl cystine in D5W (based on 4 hour level or empirically if > 8 hours since OD):
    -> 150mg/kg LD
    -> 50mg/kg over 4 hours
    -> 100mg/kg over 16 hours
  • can be administered at any time of presentation (up to 72 hours post ingestion with some improvement in outcome)
  • can be administered orally but efficacy reduced by 40% if given with activated charcoal
  • provides a substrate of glutathione and acts as an alternative substrate for NAPQI metabolism via the cytochrome P450 pathway
  • watch for adverse effects: rash, bronchospasm, hypotension, angioedema (antihistamines helpful and also slowing of infusion)
Liver failure management
  • don’t correct coagulopathy unless bleeding (vitamin K IV, blood products)
  • arterial ammonia (aids in prognostication: absolute level and failure to fall)
  • glucose monitoring
  • avoid hypothermia
  • reverse jugular venous saturation monitoring
  • ICP monitoring (controversial)
  • avoid hyponatraemia
  • ventilate to normocapnia
  • thiopentone and indomethacin infusions (consult with liver unit)
  • renal failure management
  • MARS therapy: some benefit shown in paracetamol OD as a bridge to transplantation
General
  • don’t give FFP until discussed with transplant unit as indicated or liver function (unless bleeding)
  • metabolic acidosis from hepatic and renal failure -> supportive care
  • withhold any renal or hepatotoxic medications
  • intubation and ventilation if indicated
  • GI prophylaxis
  • attention to pressure areas
  • feed
  • airway toilet
Disposition
  • discuss early with transplantation team (develop liver failure within 48 hours)
  • admit to medical/gastro unless requires ICU
  • will require psychiatric assessment if was an intentional overdose
Prognostication — can use the O’Grady criteria:
  • acidaemia (pH < 7.3)
  • renal impairment (creatinine > 300micromoles/L)
  • hepatic encephalopathy (grade III or IV)
  • PT > 100 seconds (INR > 6.5)
  • factor V level < 10%

ANTIEMETIC DRUGS & PREGNENCY

Antiemetic drugs in Pregnancy anti   - mean =against  emet - mean =vomiting  tic     - mean =drug  Those drug which we can sued ...