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Archive for the ‘Diabetes’ Category

Duetact (Glimepiride, Pioglitazone)

Friday, November 6th, 2009

###table###
SKIN DISORDERS IN ADULTS: LIFTING AND RIDGED NAILS
Lifting Nails
Like flaky, weak nails, this condition occurs almost exclusively in women. Here the end of the nail plate lifts off its bed, leading to a secondary infection with Candida. Accidentally banging the nail on a hard object will cause the nail to either break or lift off its bed, especially if the nails are long and hard. Again, repeated wetting and drying of the nails can cause them to separate from the nail beds.
Lifting of the nails can be prevented by keeping your nails moderately short, wearing cotton gloves inside rubber or vinyl gloves for all wet work and making sure your nails are properly dried (by using a hair dryer) when they get wet.
Once the nails have lifted, secondary infection usually occurs, which requires treatment with anti-fungal lotions such as Canestan or Dakarin. Oral antibiotics are of no use.
Ridged Nails
As people get older, their nails become more ridged, in a similar way to wrinkles appearing on the skin. There is no specific treatment for this condition.
*54/150/5*

Benfotiamine (Diabecon)

Friday, November 6th, 2009

###table###
DIABETES: PROBLEMS WITH BLOOD GLUCOSE TESTING
Getting blood
If you have problems obtaining blood, a quick test can become a prolonged misery. Some people have thicker skin than others – most finger-pricking systems have several different platforms allowing different depths of penetration of the lancet. Some trial and error will help you to find the right depth. If your fingers are cold you will have trouble obtaining blood. Squeezing the finger tip hard makes it sore and dilutes the blood with serum, giving an unduly low reading. So warm your hands before testing. Milk the blood up from the base of your finger. Another trick to increase blood flow is to shake your hand vigorously with the fingers downwards by your side. See your fingertips go pink. (This is rather like shaking the sauce bottle to get the last drops out!) People with thin skin or who bruise easily need less needle penetration so use a thicker platform. Your fingers should not become sore. If they are ask your diabetic specialist nurse for help.
Inaccurate results
If you do not put the right amount of blood on the test strip you will not obtain an accurate answer. Smearing or dabbing invalidates the result as does drowning the pad in a giant drop. If you mistime the reaction the result will be meaningless – this includes failing to look at your watch or not pressing the button on the meter or biosensor immediately. Failure to press the biosensor button as soon as the blood touches the pad will lead to unduly low readings. Do not tilt the strip or biosensor while the blood drop is on the strip. Cold, heat, wind or rain can all make nonsense of the result by affecting the glucose oxidase (heat, cold) or by drying out (heat, wind) or diluting the blood drop (rain).
John is 15. He has had diabetes since infancy. He always produces a neat diabetic diary. But his clinic glucose concentrations are always higher than his home tests. One day, away from the hospital, I saw him test his glucose. He pricked his finger, smeared some blood onto the test strip, counted up to sixty out loud, wiped the blood off on his trousers, counted up to sixty (faster this time) and glanced at the strip – “9,” he said, casually.
*6/102/5*

Avandamet (Rosiglitazone, Metformin)

Friday, November 6th, 2009

###table###Avandamet(Rosiglitazone,Metformin)
DIABETES AND JOB: ENERGY NEED AND INSULIN COVER

Energy need
When planning your therapy consider your energy need first. You should eat most before or during your times of greatest energy expenditure. If you are working a night shift, you need a good ‘breakfast’ in the evening and a substantial midnight meal.
When planning your insulin pattern it is helpful to think of the day as four separate periods: from getting up until the middle of the working day; the middle of the day until end of work; the end of work until bed-time; and sleeping. During this time you will have three meals, the first when you wake up, the second in the middle of the working day and the third at the end of the working day. You will also have snacks when necessary.
Insulin cover
Each of these periods of time needs insulin cover. Glucose balance on shift work is difficult to control on a once-daily insulin pattern. Either of the two most common patterns of insulin dosage can be adapted. Thus, rapid-acting and medium-acting insulin can be given in a larger dose to cover the larger meals and a smaller dose can be given for sleeping. The morning and evening quantities should be reversed when the waking and sleeping parts of the day are reversed. The other method is to use a very long-acting insulin as background and to add fast-acting insulin before breakfast and before your last big meal, adjusting the quantity as needed. On either regimen, extra doses of rapid-acting insulin can be added if necessary, before other meals or at times of changeover.
If you write down what you have done about meals and insulin and what effect it had on your blood glucose level you can use the successful regimen repeatedly as your shifts change during the year.
*76/102/5*

Karela

Friday, November 6th, 2009

###table###
GETTING THE BEST OUT OF YOUR DIABETES TREATMENT: DIET
Nowadays, we all know that a diabetic diet, in common with any diet, should have a high fibre content and not include too many saturated fats. It should also contain the correct number of calories to maintain your body weight at the acceptable average for your height, sex and age, or to achieve this level if you are overweight.
The diabetic diet is fundamental to the treatment of diabetes and should be one of the first lessons learned by all new diabetics, whether it is their only treatment or whether they also need oral hypoglycemic pills or insulin injections. However carefully you manipulate your insulin or oral hypoglycemic treatment, lack of attention to diet can lead to poor glucose balance both immediately and in the long term.
If you have non-insulin-dependent diabetes it is likely that you are overweight. This makes your body resistant to the action of insulin. The most important part of your treatment is to return to the ideal body weight for your height and stay there, by eating healthy high fibre foods and avoiding sugary foods and excessive amounts of saturated fats.
Nowadays, we all know that a diabetic diet, in common with the diet advised for the whole country, should contain lots of starchy carbohydrate with plenty of fibre, very little saturated fat or sugar and some protein. You should eat the amount needed to keep your weight within the acceptable range for your height. This weight should give you a body mass index of about 22. You can calculate this from your weight in kilogrammes and your height in metres. (1 kg = 2.2 lbs. 1 inch = 2.54 cm.) The body mass index (usually abbreviated to BMI) is your weight divided by your height squared. Thus John who weighs 15 stone (95.5 kg) and is 6 foot (1.83 m) tall has a BMI of 95.5/1.83×1.83 = 28.5. He should weigh 73.7 kg.
At least 55 per cent of the total calories should be starchy carbohydrates or pulses, with over 30g fibre a day, fat should account for less than 35 per cent of the total calories (10 per cent saturated, 20 per cent polyunsaturated or monounsaturated), and between 10-15 per cent protein. Sugar should be less than 4 teaspoons of sucrose or the equivalent, added salt less than 3g daily.
Many of you will have been taught to weigh your food and to count exchanges of carbohydrate, and even of fat or protein. If you feel comfortable with this then continue, but nowadays dietitians are moving away from such rigid dietary control. I once met someone who dipped a urine testing strip into everything she drank to see if it was too sugary. She felt she needed an extremely strict diet to manage her diabetes and became very distressed when she was away from home and unable to calculate her exchanges exactly. She had become a prisoner of her diabetic diet.
*11/102/5*

Glucotrol (Glipizide)

Friday, November 6th, 2009

###table###
SKIN DISORDERS: DIFFERENT TREATMENT OF PSORIASIS
Topical cortisone creams
Topical cortisone creams are probably the most popular form of treatment. They are safe, cosmetically acceptable and do not stain clothing. They are generally helpful but by themselves do not usually clear the lesions. They are most useful when used in combination with other treatments.
Tar creams
Tar creams have been used for centuries and there is no doubt that they are useful in psoriasis although they rarely completely clear the lesions. They are more helpful when used in conjunction with ultraviolet light and their effectiveness varies, depending on where the tar comes from. The main problem with tar creams is that they are messy, smelly and often stain clothing. They are very useful, however, when used on the scalp as tar-based shampoos.
Dithranol cream
Dithranol cream has been used since the 1930s. It is extremely effective in psoriasis and can completely clear the lesions. The main problem with Dithranol is that it stains skin, hair, clothing and bed linen. If a cream containing triethanolamine is used after Dithranol cream, however, staining can be significantly reduced. Dithranol can burn the skin, especially in the first few days of use. Nonetheless, it is very safe and effective and so is still frequently used.
Sunlight
Sunlight has been used in treating psoriasis since at least Egyptian times. It is not certain how this treatment works, although recent studies suggest that it affects the immune system.
The main problem with this treatment is that sunlight is not available all year round and certain parts of the anatomy cannot be modestly exposed to it. Moreover, excessive exposure to sunlight carries with it the risk of skin cancer. Sunlight is, however, a very popular form of treatment where it is readily available. The Dead Sea region in Israel is renowned for its psoriasis treatment centers, and it seems the sunlight is more important than the Dead Sea minerals in treating the condition.
Artificial sunlight
Artificial ultraviolet В light is effective in treating psoriasis, but requires careful monitoring and preferably should be performed in a doctor’s surgery, so that burning will not occur. The main risk of this treatment is the possibility of developing skin cancer in the long term. For this reason it is not a good idea to use sunlamps at home – it is easy to ‘overdose’, causing significant burns and even cancer.
*57/150/5*

Avandaryl (Glimepiride, Rosiglitazone)

Friday, November 6th, 2009

###table###Avandaryl(Glimepiride,Rosiglitazone)
SKIN DISORDERS IN ADULTS: NICKEL AND PLANTS AS CAUSES OF CONTACT ALLERGIC DERMATITIS
Nickel
Nickel is present in fake jewellery, particularly earrings, which can cause dermatitis around the ears. The most common way people become allergic to nickel is by having their ears pierced. Nickel is also present in bra clips, coins, keys, jeans studs and watch clips. There is a number of things you can do if you are allergic to nickel:
- Wear real gold or silver jewellery. You must remember, however, that the clips, especially those on clip-on earrings, must also be made of real gold or silver.
- Glue a small sequin or button onto the earring clips so that the nickel will not come directly into contact with your skin.
- Metal watch clips can be changed over to plastic or painted with clear nail polish.
- Sew material over jeans studs or bra clips so that the metal will not touch your skin.
- A chemical called dimethylglyoxine can be used to test whether nickel is present in a metal object. If nickel is present, the liquid will turn pink.
Plants
Not everything natural is good for the skin. Although many plants are beautiful in the garden, they can produce nasty reactions on the skin. In children especially, severe allergic reactions can afflict the face and can also produce a streaky rash on the arms. Rhus is well known for producing this sort of reaction, but chrysanthemums, grevillea, lilies, oleander and primula can all cause similar reactions.
Decorative plants and flowers are more likely to produce allergic reactions, particularly in those who work in florist shops and nurseries. Alstramera, a member of the tulip family, is increasingly used in bouquets and can cause severe and even chronic hand dermatitis.
*47/150/5*

Prandin (Repaglinide)

Friday, November 6th, 2009

###table###Prandin(Repaglinide)
TAKING COMMAND OF DIABETES: FINGER’S PRICK AND BLOOD GLUCOSE TEST
How should I prick my finger?
Many people are not very enthusiastic about pricking their fingers. There are devices to make it easier and less painful. Autolet II, Monojector and Softouch are automatic finger prickers with a spring to do the pricking (also Lancet in the United States), and they are designed to produce the smallest hole needed to obtain an adequate drop of blood. Some people simply use a little lancet on its own (for example, Monolets, Glucolet II, Unilets) or a fine needle. You can prick the pulp of the finger or the sides of the fleshy part at the base of the nails. Some people prick their ear lobe. Before pricking, wash your hands with soap and warm water, rinse them well and dry them on a clean towel. If they are dirty use an antiseptic swab but make sure that you wipe off all traces of antiseptic with clean absorbent cotton, or cotton wool, or gauze because antiseptic may interfere with the chemical reaction on the testing strip. It is easier to get blood out of a warm finger. A cold room or outside temperature may also cause low glucose results.
Doing a blood glucose test
When doing a blood glucose test, set out what you need before pricking your finger (it saves getting blood everywhere while searching for things). You need:
1. A clean, warm finger or ear lobe
2. a. Glucose testing strips ± your meter
or b. Your Biosensor + strips
3. A lancet or needle and automatic pricker if used
4. Clean cotton wool
5. A watch with a second hand or timer if necessary
6. A water bottle if using Dextrostix
7. Three minutes peace on your own
8. A good light for checking the result.
The blood glucose concentration is in mmol/1 in Europe, or in mg/dl in North America; 1 mmol/1 = 18 mg/dl.
*5/102/5*

Glucophage (Metformin)

Friday, November 6th, 2009

###table###Glucophage(Metformin)
SKIN DISORDERS IN ADULTS: PSORIASIS AND ITS TREATMENT
Psoriasis is probably the most troublesome and difficult skin condition seen in the adult population. It occurs in approximately five per cent of the population, but accounts for more than ten per cent of dermatology consultations. Psoriasis was first described in ancient Egypt as a type of leprosy. It is a very scaly condition which is quite conspicuous and can be a source of some embarrassment, although it is not contagious.
The exact cause of psoriasis is not well understood. Hereditary factors are important, although there is no strict inheritance pattern. Recent research has shown that immune factors may be important because AIDS sufferers have a higher incidence of psoriasis. It is also known that stress, alcohol and lack of sunlight can cause psoriasis to suddenly appear.
Psoriasis can appear almost anywhere on the body. It commonly occurs on the scalp, elbows and knees, and sometimes on the face. It can also affect the nails and joints.
Treating psoriasis
Psoriasis is treatable, however it cannot be cured. For centuries, sufferers have been the victims of many misleading claims of ‘miracle’ cures. Even the Government of Victoria was hoodwinked into subsidizing the development of a miracle cure for the condition. Like all other fads, this one came and went, while the government lost several million dollars. Likewise, special diets, particularly those high in fish oils, have been advocated for the treatment of psoriasis, but these have not proven very successful. As far as diet is concerned, alcohol is the only substance which should be kept to a minimum.
There is no universal treatment for psoriasis. Rather, there are many different treatments, each having its advantages and disadvantages. Treatment is dependent on things like previous disease patterns, the severity of the condition and the treatment facilities available. It should also be kept in mind that psoriasis can improve spontaneously, irrespective of the treatment used.
*56/150/5*

Januvia (Sitagliptin)

Friday, November 6th, 2009

###table###
GROWING UP OF CHILDREN WITH DIABETES: SELF-DESTRUCTION
For some mixed-up teenagers, their diabetes provides the ideal weapon to get back at their parents, doctors and teachers. But, unfortunately, the only people they really harm are themselves. Every diabetic clinic has a small group of teenagers who are for ever in and out of the hospital in hypoglycemic coma or ketoacidosis. They give themselves insulin overdoses or stop their insulin for days at a time. They are usually very good at judging exactly how much extra insulin to give or how little. But every so often, one of them gets it wrong. Instead of waking up to find Mum and Dad looking anxiously down at them, they die. Those who survive may have done themselves permanent harm. Many of the ketoacidosis experts have had so many intravenous drips that they no longer have any clear veins left into which life-saving drugs can be injected.
Very few self-destructive diabetics are quite as calculating as I have suggested. Some of them may be desperately trying to get across the message that they are very unhappy.
Martin was fourteen years old when I first met him. He had had diabetes for three years and for half of that time he had been in and out of hospital with extremely severe hypoglycemia. On several occasions he had been unconscious for days at a time.
He went on a diabetic camp holiday and for the first three nights was severely hypoglycemic every night. Then a member of the staff saw him injecting himself with ten times the amount of insulin he should have had. Martin knew he had been seen and for the next few nights his diabetic control yo-yo’d from very low to very high, ending up with an episode of diabetic ketoacidosis.
When he returned home he confessed that he had been overdosing with insulin for eighteen months. He had been doing it because he felt it was the only way he could express how much he hated having diabetes and having to inject himself every day. He is happier now that he can talk about his feelings and has stopped overdosing, although his glucose control is still not very good.
What many teenagers with diabetes do not realize is that doctors and others involved in looking after diabetes understand that being diabetic can seem an impossible burden at times. You can say anything you like to your doctor, he is not just there to tell you to eat the right things and measure your blood glucose and give you the right amount of insulin. We know that everyone with diabetes has times when their control is very far from perfect. Plenty of diabetics have forgotten to give themselves an insulin injection at the right time at some stage. No one can be perfect all the time. All we ask is that you try your best. If things are going wrong, tell us – perhaps we can help. If you are feeling fed up and frustrated, tell us. When you are seeing the doctor, however busy he seems, you have the right to talk about your problems. If you feel that you need more time to talk, ask for another appointment and explain why.
Many clinics have diabetic specialist nurses or other helpers. Some people find them less intimidating and easier to talk to than the doctor. If you really feel that you cannot talk about all your worries and fears to the doctor who looks after your diabetes, ask your family doctor if you can see someone else. Similarly, if your family doctor is really not on your wavelength, ask him if you can see another doctor.
*53/102/5*

Precose (Acarbose)

Friday, November 6th, 2009

###table###Precose(Acarbose)
BLOOD GLUCOSE MONITORING FOR DIABETICS: GLYCOSYLATED HAEMOGLOBIN
A single blood glucose measurement tells you what your glucose level is at that moment. It does not tell you what your glucose level was ten minutes ago or what it was earlier the same day. If you test several times a day and record all your results you can build up a picture of what is happening to your blood glucose level over weeks or months. If you wish, you can calculate your average blood glucose level at a given time of day or throughout a given period, as in the computer system I have just mentioned. Alternatively, hospital clinics are now using a single blood test which can give an indication of your average blood glucose level over a period of several weeks before the blood was taken. This is the glycosylated hemoglobin or hemoglobin A1c test.
Hemoglobin carries oxygen in the blood stream, inside the red blood cells, and is responsible for their red colour. Each person has several types of hemoglobin including one called hemoglobin A1c. During the 120 days in the life of a red blood cell the hemoglobin A1c (like many other body proteins) is exposed to the prevailing blood glucose levels. Glucose is ‘attached’ to the hemoglobin A1c to form glycosylated hemoglobin. The percentage of glycosylated hemoglobin depends on how high the blood glucose level has been during the life of the red cells. Different hospital laboratories have different ways of measuring glycosylated hemoglobin, and thus different normal ranges, but as a rough guide, your glycosylated hemoglobin should be below about 8 per cent. The test is useful as a check on whether finger prick blood tests are giving a representative picture of what is happening to the blood glucose level. It is especially useful for diabetics who rarely or never test their blood glucose level. For example, Mark, who is thirty-nine, works in a horse racing stable and finds that his hands are too dirty to allow finger prick tests. When he went to his clinic, his blood glucose level (from a vein) was 7 mmol/1 (126 mg/dl) which looked very good. Then we saw that his glycosylated hemoglobin level was 18 per cent, indicating that he had had very high blood glucose levels over the preceding few weeks. His glucose level was 7 mmol/1 that day because he had missed his lunch rushing to get to the clinic. One of the difficulties in interpreting the glycosylated hemoglobin result is that a normal level may represent relatively high blood glucose concentrations alternating with hypoglycemia. Also, if you are anaemic or have any condition in which the life of the red blood cells is shortened, the result of the test is difficult to interpret. Nevertheless, it is a helpful test and some clinics now use it instead of blood glucose estimations.
*8/102/5*

Glucovance (Glyburide)

Friday, November 6th, 2009

###table###Glucovance(Glyburide)
SKIN DISORDERS IN ADULTS: PUVA TREATMENT OF PSORIASIS
PUVA (oral psoralen plus ultraviolet A light) is a special form of ultraviolet A light which is highly effective in treating psoriasis. It was first developed in the early 1970s and is still the most effective treatment available. PUVA involves taking one tablet of Psoralen two hours before exposure to ultraviolet A light. Psoralen sensitizes the skin to the ultraviolet A light, causing the psoriasis to disappear over twenty to thirty treatment sessions.
The main problems with PUVA therapy are the risk of long-term skin cancer and premature ageing of the skin. Special eye protection is also necessary, as the Psoralen tablets also sensitize the eyes to ultraviolet light.
In order to minimize the risk of skin cancer, it is best to combine PUVA therapy with Tigason, which is also taken in tablet form. It is also advisable to cover areas of the body that do not have psoriasis such as the hands, face and genital regions. More recently, ‘bath’ PUVA has become popular. Rather than taking a tablet prior to ultraviolet A light exposure, the sufferer is bathed in a special Psoralen solution which sensitizes the skin to ultraviolet A light.
*58/150/5*

Actoplus Met (Metformin and Pioglitazone)

Friday, November 6th, 2009

###table###
DIABETES AND YOUR EYES
Diabetic retinopathy is a condition in which the small blood vessels supplying the light-sensitive retina at the back of the eye become damaged. Eventually they can no longer supply nutrients and the starved retina releases an unknown factor which encourages proliferation of new vessels. Unfortunately these grow forwards away from the retina into the clear jelly or vitreous through which we see. The new vessels can tear and bleed into the vitreous, obstructing vision.
Such severe proliferative retinopathy is uncommon. Generally the only sign that the diabetic process is affecting the eye is what is called microaneurysm formation, when tiny red dots can be seen on or near the damaged blood vessels. These very early changes can be seen through an ophthalmoscope (a magnifying torch shone through the pupil of the eye) and warn of the development of retinopathy. Microaneurysms do not affect vision, but hemorrhages and fatty deposits (exudates) may also start to form on the retina. If these exudates lie over the area of best vision, which is called the macula (see the diagram opposite), sight may be impaired.
Diabetic retinopathy
1 Can be detected at an early stage
2. Can be treated successfully
3 May be prevented by careful attention to glucose control.
*30/102/5*

Actos (Pioglitazone)

Friday, November 6th, 2009

###table###Actos(Pioglitazone)
BLOOD GLUCOSE MONITORING DURING DIABETES: CHECK POINTS, THE FUTURE
Check points
Are your strips in date? Are they the right ones for your meter? Have you calibrated your meter/biosensor for this particular batch of strips? Is your meter working properly? Have you followed up any error messages? Does it need a new battery?
Have you kept your strips dry and not too cold or too hot? (If you have left the top off the bottle, throw the strips away and start a new pot.) And make sure you put the top on firmly as soon as you have taken a strip out.
Is your equipment clean? Clean meters according to instructions, especially the window through which the strip is read. Biosensors need little cleaning and nothing but the test strip should be placed in the entry port. Is your finger-pricker clean? Change the lancet and platform every time if you wish, although most people reuse platforms if they are the only user. If you are caring for someone else, Glucolet II is a lancet designed to avoid needle-stick injury. Always change lancets and platforms every time if several people are using the same finger-pricker. This avoids transmission of blood-bourne diseases.
The future
Glucose sensors which can be implanted have been available for some time but are still in the experimental stage and tend to be too fragile for everyday use.
There are several meters on the market which have a memory and will hold a variable number of previous blood glucose results. It is likely that this type of meter will be used increasingly. Some meters download this information into a computer held at home or at the diabetes centre. This allows calculation of average blood glucose levels for different times of day, for example.
*7/102/5*

Diamicron Mr (Gliclazide)

Friday, November 6th, 2009

###table###
SKIN DISORDERS IN ADULTS: TREATING EXCESSIVE FACIAL HAIR
Facial hair not related to hormone levels can be removed by electrolysis. While this method is slow and painful, it is also the most permanent. Like many techniques, electrolysis is operator dependent, so it is critical to choose someone who is well trained in this field.
Other methods of removing hair include waxing, plucking and the use of depilatory creams. All of these are safe and effective, but less permanent. It is often believed that hair removal by waxing will make it grow back thicker, which is untrue. Regular waxing over a period of years will actually make hair growth less coarse and more sparse. It is also possible to pluck or wax hairs around moles without adverse effects. Bleaching the hair is also safe and disguises rather than removes the hair.
Women who produce an excess amount of the male hormone testosterone can benefit from hormone treatment. The drugs Aldactone and Androcur are used for this purpose. Both block the conversion of testosterone to its more active compound, dihydrotestosterone, which stimulates ‘male-type’ facial features such as coarse facial hair, oily skin and receding hairline around the scalp. These drugs reduce excessive facial hair and certain types of acne. It does, however, take at least nine to twelve months for the effects to be seen. The main advantage of these drugs is that they have minimal side effects, but they cannot be taken during pregnancy.
The main side effects include breast tenderness, nausea, headaches and decrease in libido. They may also stimulate the appetite and lead to weight gain. However, if food intake remains the same, weight will not be put on. Slight fluid retention can occur initially, but will usually disappear in about two months.
*51/150/5*

Amaryl (Glimepiride)

Friday, November 6th, 2009

###table###Amaryl(Glimepiride)
SKIN DISORDERS IN ADULTS: DANDRUFF, STRETCH MARKS AND TINEA
Dandruff
Dandruff is a mild form of psoriasis which occurs in the scalp. It produces white flakes which gather in the hair and fall onto the clothes. Like psoriasis, dandruff tends to be inherited. It responds best to medicated tar-based shampoos including Ionil T, Polytar, Sebitar and T/Gel. In severe cases topical cortisone creams or tar-based creams may also be needed.
Stretch Marks
Stretch marks occur commonly during pregnancy and at puberty. They relate to hormonal changes, genetic factors and excessive weight gain in adolescence and, as noted in chapter 4, are due to combinations of hormonal effects, genetic tendency and rapid skin expansion during pregnancy.
As noted earlier, stretch marks cannot be prevented or eradicated by applying baby oils or vitamin creams. Stretch marks become less obvious over time and using Retin-A following pregnancy may be helpful.
Tinea
Tinea, which is caused by a fungal infection, occurs in over fifty per cent of the population at some stage in their lives. This fungal organism is quite ubiquitous, surviving in many environments and thriving especially in wet, warm conditions. It is able to withstand both antiseptics and chlorine in water. The effects of tinea may be evident as soggy skin between the toes, scaly, itchy feet, crumbling toe nails, patchy hair loss and a rash in the groin or a white, scaly rash on the body.
*61/150/5*

Micronase (Glyburide-Glibenclamide)

Friday, November 6th, 2009

###table###Micronase(Glyburide-Glibenclamide)
SKIN DISORDERS IN ADULTS: BALDING TREATMENT
There are a number of options open to men who are going bald:
- Topical Minoxidil is useful, especially when combined with Retin-A. It is best to start using it when thinning begins, before complete baldness occurs. It is only effective while it is being used but becomes more effective over time.
- Hair transplantation has been available now for over thirty years. Early hair transplants looked extremely unnatural, but the technique has now been refined, producing a better aesthetic result.
- Scalp reduction is a useful technique for large bald areas, which can be reduced by cutting them out and sewing the scalp back together. It is still too early to say how effective scalp reduction is, although so far good results have been achieved.
- Hair pieces have never really taken off in Australia although toupees are very popular in both Europe and the United States. Hair pieces now look much more natural and are also more durable than they used to be.
- Hair fusion is a technique whereby hair is either glued or sewn (or melted if synthetic hair is used) to a person’s own hair. This creates the illusion of thicker hair and although it is an expensive process it does not have any side effects. As the hair grows out, however, the glue loses its effectiveness and the artificial hair becomes loose, so the process must be repeated every month or so in order to maintain the appearance of thicker hair.
- Hair integration is a custom-made network of hairs which is applied to the scalp. One’s own hair is tied to the meshwork to create a fuller appearance.
- Make-up can be applied to the bald spots on the scalp to decrease the colour contrast between the scalp and hair. This creates an optical illusion of thicker hair. These special make-ups, such as Hair Thickener and Mane, can be bought from the chemist.
- Hair styling can also create ‘thicker’ hair. Women do this with hair gels, hair sprays and perms. There is no reason why men cannot become expert in these grooming techniques.
*35/150/5*

Glycemil

Friday, November 6th, 2009

###table###
SKIN AND AIDS
In Australia approximately 500 new cases of AIDS are diagnosed each year. The incidence of new AIDS cases has actually leveled off over the last three years, and this is probably related to widespread education about safe sex, needle exchange programmes and the fact that blood products are now routinely screened for the HIV virus, which is responsible for the disease. (This is not the case, however, in other parts of the world.) The survival rate among AIDS sufferers has also dramatically improved over the last few years, especially with the introduction of new anti-viral drugs such as Azidothymidine (AZT).
AIDS damages the body’s immune system, leaving sufferers open to severe opportunistic infections such as viral, bacterial and fungal infections, as well as certain cancers. The skin is a very important organ in the manifestation of AIDS, and a dermatologist may be the first one to make the diagnosis.
Seborrhoeic dermatitis can be one of the first signs of AIDS. In AIDS sufferers the condition is often severe and is resistant to normal therapeutic creams. Psoriasis can also be a manifestation of AIDS. Again, this condition is often unresponsive to the usual healing creams. Other treatments can interfere with the immune system and so may worsen AIDS. On the other hand, psoriasis in those with AIDS often responds well to the new anti-AIDS drugs such as AZT.
Skin infections due to viruses and fungi are also very common in AIDS sufferers. Warts and molluscum contagiousum occur frequently and extensively, causing major cosmetic problems. These conditions are also resistant to normal treatments. Likewise, herpes infections tend to occur more severely, with extensive ulceration. Fortunately, these infections often respond well to anti-viral drugs such as Acyclovir (Zovirax) or foscarnet. Shingles, which is also caused by the herpes virus, can be severe and extremely painful in those with AIDS, and must be treated with high doses of Acyclovir.
Fungal infections such as tinea and thrush also readily occur. Persistent tinea of the face and groin are often resistant to conventional forms of therapy, as is thrush of the mouth.
Skin cancers tend to be more prevalent and more aggressive in AIDS sufferers. As most sufferers are under fifty, however, skin cancer is not a major cause of morbidity. Kaposi sarcoma, a cancer of the blood vessels, is a particular feature of AIDS. It can produce many bruise-like lesions on the skin so that surgical removal is rarely a practical therapeutic option, and chemotherapy is often necessary.
*64/150/5*

Lyrica (Pregabalin)

Friday, November 6th, 2009

###table###Lyrica(Pregabalin)
SKIN DISORDERS IN ADULTS: TEMPORARY, GENERALISED HAIR LOSS IN WOMEN
This type of hair loss can occur very rapidly, causing marked anxiety. It can occur for a number of reasons:
- Iron deficiency. This is common in women who have heavy periods. It can also occur during breast-feeding, as the newborn baby extracts iron from the mother’s milk. Iron deficiency can also occur in vegetarians and people on special diets. The best source of iron is red meat. Vegetable sources have iron but in a form which is poorly absorbed by the body. Iron tablets are not as well absorbed as iron from meat but are necessary if significant iron deficiency occurs.
- Oral contraceptive pills. Oral contraceptive pills which are high in progestogen often aggravate hair fall. This is due to their male hormone-like activity. On the other hand, pills high in oestrogen promote hair growth.
- Pregnancy. During pregnancy the hair grows more rapidly due to certain hormonal changes. After pregnancy, however, the hair falls out, beginning six weeks to three months after delivery. It can last for three or four months but will eventually stop. Breast-feeding can aggravate hair loss, especially if iron deficiency occurs.
- Severe illness. Any severe or prolonged illness can also lead to hair fall. This tends to occur six weeks to three months after the illness but the hair will eventually completely grow back to normal without treatment.
- Weight loss. Sudden or dramatic weight loss is one of the most common causes of hair loss. The body interprets weight loss as a state of starvation and tries to preserve protein by stopping hair and nail growth. Once the weight stabilizes the hair will re-grow. Weight loss can sometimes be complicated by vitamin or iron deficiency which requires replacement therapy.
- Stress. Stress can also cause temporary hair loss. Once the stress decreases, the hair will re-grow.
*36/150/5*

Avandia (Rosiglitazone)

Friday, November 6th, 2009

###table###Avandia(Rosiglitazone)
CAUSES OF CONTACT ALLERGIC DERMATITIS: SUNSCREENS, TOPICAL MEDICATION CREAMS, ETC
Sunscreens
With the increased use of sunscreens and their incorporation into many cosmetics, allergic reactions to their various ingredients are on the rise. Although many people are aware that PABA can produce allergic reactions, other sunscreen components, especially benzophenones, may also cause the same reactions.
If an allergic reaction to a particular sunscreen occurs, patch testing should be done so that an alternative sunscreen can be found. The titanium dioxide-containing make-ups or sunscreens are a good alternative and include Ego Sunsensitive, Clinique City Block, Clinique Continuous Coverage and UV Low Allergenic Formula.
Topical medication creams
Many over-the-counter soothing creams can cause allergic reactions, the majority being either anesthetic or antihistamine creams. If you have an itch or a burn it is better to use a cream specific to your problem rather than a general anti-itch or soothing cream.
Rubber
Rubber allergy is commonly seen in people who frequently wear rubber gloves. Again, hairdressers are especially likely to develop it. Rubber in the form of elastic is also present in some clothing, especially underwear and lycra gymnasium tights. Rubber condoms are another source of rubber allergy. If this allergy develops, a non-rubber condom should be worn inside a rubber condom.
Shoes
Shoes can produce a most uncomfortable dermatitis on the feet, which is often wrongly diagnosed as tinea. It is usually either the glue or the rubber which causes this problem. If the allergy is to glue, custom-made shoes in which the shoe leather is stitched to the soles are necessary.
*49/150/5*

Orinase (Tolbutamide)

Friday, November 6th, 2009

###table###
TAKING COMMAND OF DIABETES: URINE GLUCOSE TESTS
What about urine tests? These tests have been the mainstay of self-monitoring for many years. The kidneys help to maintain the normal blood glucose concentration by saving glucose from being excreted. However, the kidneys do not conserve glucose indefinitely and when the blood glucose level rises above the kidney, or renal, threshold (which is slightly different in each person) glucose starts to appear in the urine. This threshold lies at about 10 mmol/1 (180 mg/dl) but may occasionally be very different from this. Someone with a very high renal threshold (for example, 15 mmol/1 or 270 mg/dl) would have negative urine tests until his blood glucose level rose above 15 mmol/1 (270 mg/dl). Someone with a low renal threshold (for example, 4 mmol/1 or 72 mg/dl) would sometimes show glucose in the urine even it he were not diabetic. The higher the blood glucose level rises above the renal threshold, the more glucose appears in the urine. High urine glucose concentrations draw water out of the body while the urine is being made, fluid is then lost and you become thirsty. This urine gradually collects in the bladder until it is emptied. The glucose concentration in a urine sample, therefore, represents how much above the renal threshold the blood glucose was during the time it took for the urine to collect in the bladder. Urine tests are therefore:
1. Not as accurate as blood glucose tests because they depend on each person’s renal threshold
2. An average, depending on how long the urine has been collecting in the bladder.
Even so, urine tests can be a useful indicator of general glucose control, especially if you know your approximate renal threshold. (You can work this out yourself by comparing blood and urine tests over the same time period.) Many diabetics use both blood and urine tests to monitor their glucose control. For example, if you test the first urine that you pass in the morning, that is, the urine that has been accumulating in your bladder while you are asleep at night, and it shows glucose, you know that for part of the night your blood glucose has been above the renal threshold even if your pre-breakfast glucose is normal. If you find that your fingers are getting sore from finger prick tests, try doing some urine tests instead (but check on your finger prick technique as well; perhaps you are going too deep).
Urine can be tested using strips such as Clinistix, Diastix, Tes-tape and Diabur 5000; in the United States, also Betascan Reagent Strips, Kyodex and Chemstrip uG. Either hold the strip briefly in the urine stream and read after the correct time or you can save urine samples during the day to test at home. As with the blood glucose monitoring strips, it is important that you follow the manufacturer’s instructions carefully.
*9/102/5*