Introduction of OpenDoor, project of OpenDoor for Success Association. Vancouver BC, Canada

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GOUT

 

Gout is a medical condition usually characterized by recurrent attacks of acute inflammatory arthritis- a red, tender, hot, swollen joints. Gout causes inflammation of your joints usually in your arms or legs. However, it can affect any of your joints, including those found in your feet and ankles, knees, hands, fingers, wrist and elbows.

According to the UK Gout Society, gout affects around 1 in every 100 people. It’s more common in men, particularly those aged 30 to 60 and in older people.

Causes:

You can develop gout if you have much uric acid in your body. Uric acid is a chemical that everyone has in their blood. Excess uric acid is passed through your kidneys and out of your body in your urine. However, the level of uric acid in your blood can rise if

1)    Yours kidneys don’t pass uric acid quickly enough.

2)    Your body produces too much uric acid.

If level of uric acid in your body is too high, it can form tiny crystals that collect in your tissues, particularly in and around your joints and may cause swelling and pain. These crystals tend to form at a cooler body temperature which is why gout is more common in your fingers and toes.

Who are at risk of Gout?

1)    Are men aged of 30-60

2)    Are women who has been through the menopause

3)    Eat a diet that contains high level of purines which are found in red meat, sea food and some other foods.

4)    Drink too much alcohol, especially beer.

5)    Do not drink enough fluid daily & become dehydrated

6)    Taken certain medicines, such as diuretics which increase the flow of urine from your body

7)    Have a family history of gout

8)    If your kidneys do not pass enough uric acid out in your urine

9)    Are overweight, have diabetes and high blood pressure

10) Have psoriasis ( itchy, dry & flaky skin ) which can sometimes cause your body to produce too much uric acid

11) Are taking certain types of cancer medicines

Diagnosis of gout:

1)    Take a sample of blood which will be sent to the laboratory to measure the level of uric acid

2)    Remove some fluid from your swollen joints with a needle, if uric acid crystals can be seen in your fluid so you have gout

3)    May need to have an x-ray of your joints in order to diagnose gout

Complications:

1)    The most common complication of gout is progressive joint damage which leads to long term pain, deformed joints & eventually disability

2)    Prolonged high level of uric acid in your body can increase your risk of vascular diseases which may lead to heart attack or stroke

3)    Damage your kidneys if uric acid crystals collect in your kidney tissues

Prevention:

1)    Gout can be prevented from reoccurring so often & so severely by making changes to your diet and taking medicines if needed

2)    Choose to eat and to drink that cannot increase the level of uric acid in blood

3)    Drink enough water every day that will help to dilute your blood and urine, results in lowering the level of uric acid in blood

4)    Doing regular exercise

  Self-help:

 There are number of steps you can take to reduce the pain & swelling from having gout

1)    Raise and rest your joints, do not attempt any vigorous physical activity

2)    Keep your joints cool and do not cover it. Ice the affected joints by using an ice pack or ice wrapped in a towel for about 20 minutes , at a time to reduce swelling and bruising. Do not apply ice directly to your skin, it can damage it

3)    Drink enough water

   Treatment:

 There are certain medicines that can prescribe to help to ease your pain and swelling from gout.

1)    Non-steroidal anti-inflammatory drugs ( NSAIDs ) , such as ibuprofen and naproxen which may relieve pain and inflammation but if you have heart attack, high blood pressure, kidney or lung disease, or over 65 so these medicines may be harmful & do not take aspirin because it can affect your uric acid level and make your gout last longer

2)    If NSAIDs are not suitable for you, your doctor may prescribe a medicine called colchicines which reduces pain & swelling.

3)    Third option is steroids tablets if you cannot take NSAIDs or colchicines

4)    Steroid joint injection is recommended if you have gout in a large joint ( such as knee joint )

REMEMBER; ALWAYS CONSULT YOUR DOCTOR OR PHARMCIST BEFORE TAKING ANY TABLET OR MEDICINE.

NAZNEEN ZULFIQAR

PHARM-D, KU

LOWESTOFT, UNITED KINGDOM

By: Unknown On 8:39 PM

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MIGRAINE

 Many people are talking to social media sites such as twitter to share the agony of their migraine pain, sharing the agony with other sufferers on social media indicates a trend towards the cathartic sharing of physical pain as well as emotional pain . Migraine poses a huge public health problem, harming mood, productivity and overall quality of life. An estimated 12% of the western world population suffer migraine attacks and of those 75% see reduced functionally and 30% require bed rest.

Migraine is a chronic neurological disorder characterized by repeated attacks of several headaches. A migraine headache causes throbbing and pulsating pain, usually on only one side of the head. A migraine is not simply a bad headache. A migraine is an intense headache accompanied by other symptoms such as nausea (feeling sick), visual problems and an increased sensitivity to light or sound.

The intense throbbing , pulsating pain, and excruciating pain that accompanies a migraine can be so debilitating more than 90% of sufferers are unable to work or function normally during an attack. Around two-third of adults who experience migraine is women.  About one in five women and one in ten men in the united state have experienced a migraine or severe headache in the first three months and migraine ranks as one of the top 20 most disabling medical conditions worldwide. A migraine can last up to 72 hours and the 14 million people that suffer from chronic migraines live in fear of their next attack, knowing that it can happen at any time, without warning. Although, migraines are not life threatening and do not shortens people’s life expectancies. They can significantly damage the quality of people’s lives (Migraine Research Foundation, 2013).

Types of migraine:

There are 2 types of migraine:

1)    Hemiplegic migraine:

People with hemiplegic migraine experience paralysis or weakness on one side of the body, disturbance in speech and vision, symptoms can last for several days.

a)    Familial hemiplegic migraine (FHM ):

Is an inherited genetic migraine disorder that causes hemiplegic migraine. If parents, siblings or child has FHM, the chances you will have FHM are higher.

b)    Sporadic hemiplegic migraine (SHM ):

Occur in people without the genetic disorder and without a family history of hemiplegic migraine.

2)    Ophthalmic migraine:

Also sometime called ocular or retinal migraine are rare migraine variants characterized by repeated instances of visual disturbances such as blind spots or blindness on one side of the field of vision.

Migraine Aura:

Around one in five people who experience migraine experience an aura before their attack. An aura is a warning sign that a migraine is about to happen. People commonly experience an aura between 20 minutes and one hour before the headache stage of their migraine. The main symptoms of aura are visual problems such as blurred vision (difficulty focusing), blind spots, and flashes of light or a zigzag pattern moving from the central field of vision towards the edge. Other aura symptoms include tingling sensation ( pins & needles ) in the face, lips and tongue or in the arms and legs, speech problems such as slurred speech, dizziness, a stiff neck, and a very rarely loss of consciousness.

Symptoms of Migraine:

The main symptoms of migraine are an intense throbbing or headache often affecting the front or one side of the head, nausea (feeling sick), and vomiting and increased sensitivity to light and sound. The throbbing headache is often made worse by the person moving. Other symptoms of migraine might include poor concentration, feeling hot or cold, perspiration (sweating) and increased need to pass urine. People might also experience stomach and diarrhea. It is common for people t feel tired for up to two or three days after migraine.

Migraine causes:

The exact cause of migraine is still unknown; it seems to be an electrical disturbance in the brains of people who experience an aura before their attack, there appear to be change in the blood vessels in the brain. People with high blood pressure are at a high risk of experiencing migraine. Women are more than twice as likely as men to experience migraine. This is due to hormonal factors. Women might find that they experience a migraine just before or just after the start of their periods.

Some women find that oral contraception (the pills) can trigger migraine. It might be women experience migraine as they approach the menopause or that hormone replacement therapy (HRT) triggers migraine.

Migraine triggers:

There are various factors which might trigger a migraine. Each is different and you should try to identify which factor might apply to you and try to avoid them. Many people find that they are able to that one of the triggers o is own but a combination of more than one trigger can push them over their threshold and cause an attack.

1)    Emotional triggers:

Include stress, anxiety, excitement and shock.

2)    Physical triggers:

Include tiredness, irregular sleep, tension in the neck & shoulder, eye stress (for example after using a computer screen) and dental problem (for example teeth grinding).

3)    Dietary trigger:

Include lack of food (dieting), irregular meals, dehydration, alcohol, caffeine, certain food such as chocolate, cheese, citrus fruits, certain food additives such as monosodium glutamate ( MSG ), aspartame ( a sweetener ), nitrates.

4)    Environmental triggers:

Include bright light, loud noise, and smoky environment.

5)    Other triggers:

Other triggers include smoking and some sleeping tablets.

Treatment of migraine:

1)    Most people find that lying down in a quite dark room reduces the pain of migraine.

2)    Sleeping (If you are able) can also help to treat migraine.

3)    Some people find that symptoms die down after they have vomited.

4)    Some people find that pain relief medications like paracetamol, aspirin, and anti-inflammatory drug like ibuprofen are effective, especially if they take them at the very first sign of an attack.

5)    People might also benefit from anti-sickness medications.

6)    People might be prescribed general strong pain relief medication such as Triptan which is a specific migraine medication. If situation does not improve after treatment than you might referred to a specialist migraine clinic.

 

Who is at risk for a Migraine headache?

The risk factors for migraine headache include:

1)    Age:

Most people will experience their first migraine headache before or during adolescence

2)    Family history:

Migraine headache can be hereditary. More than 75% of people who suffer from migraine headache have a parent or sibling who has migraine.

3)    Gender:

Women are three times more likely to have migraine headaches than men. Women who have migraine headaches have more frequent migraine compared to men who experience migraine.

.

      Tips to prevent Migraine:

1)    Stay on a regular sleep schedule

2)    Eat regularly

3)    Drink plenty of water to keep hydrated & trying to avoid stress

4)    Avoid food triggers such as caffeine, chocolate, cheese, alcohol, red wine.

5)    Exercise regularly

6)    Avoid stressful situations

            

NAZNEEN ZULFIQAR, PHARM-D, KU

LOWESTOFT, SUFFOLK, UNITED KINGDOM

By: Unknown On 12:01 PM

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FDA Advisory Panel Endorses Inhaled-Insulin Product Afrezza

A US Food and Drug Administration (FDA) advisory panel has voted in favorof MannKind's Afrezza (Technosphere insulin-inhalation system) for the treatment of both type 1 and type 2 diabetes in adults.

Votes of the Endocrinologic and Metabolic Drugs Advisory Committee in favor of Afrezza were 13-1 for type 1 diabetes and 14-0 for type 2 diabetes. One panel member left early and did not vote.

Afrezza consists of a premeal insulin powder loaded into a cartridge for oral inhalation. The company is seeking an indication as an ultrarapid-acting insulin for adults with type 1 or 2 diabetes. In type 1 patients, the indication would be for use with injected basal insulin.

Panel members cited the advantages of more rapid onset of insulin action and shorter duration, resulting in a lower risk for hypoglycemia, as well as the potential for greater acceptance of inhaled-insulin therapy for patients with type 2 diabetes who might otherwise refuse or be unable to self-inject insulin.

However, the panel did express concern about data suggesting lower glucose-lowering efficacy compared with injected short-acting insulin (aspart) in type 1 patients and about lack of long-term lung-function data beyond 2 years, as well as a possible signal for lung cancer.

Panel members presented the agency with a long list of recommendations for postmarketing studies and labeling requirements to address those issues, among others.

Risks vs Benefits

Technosphere insulin begins working within 12 to 15 minutes, peaks by 30 minutes, and is essentially cleared by 180 minutes. Current rapid-acting insulins, in contrast, peak at about 1 hour and remain in the circulation up to 5 hours.

In a pivotal trial involving 353 patients with type 2 diabetes inadequately controlled on 1 or more oral agents, Afrezza was superior to placebo in lowering HbA_1c at 24 weeks, with a week-24 treatment difference of -0.40 (P< .0001). However, in a pivotal study of 344 patients with type 1 diabetes, Afrezza had significantly inferior HbA_1c reduction compared with premeal injections of insulin aspart, although the difference remained within the prespecified noninferiority margin.

Rates of severe hypoglycemia were 43% lower among the type 1 patients with premeal Afrezza compared with aspart injections.

Cough was the most common adverse event, occurring in 27% of all the study subjects and leading to discontinuation in 3%. Small decrements in forced expiratory volume in 1 second (FEV1) of about 40 to 60 mL were noted within the first 3 months and persisted for the 2 years of follow-up, although there wasn't further progression.

Because of the risk for bronchospasm in patients with underlying lung disease, including chronic obstructive pulmonary disease (COPD) and asthma, the product would be contraindicated in those groups, and the label would include recommendations for screening of patients for these conditions before starting them on Afrezza and possibly for periodic ongoing monitoring of lung function as well.

A total of 4 cases of lung cancer occurred in patients who had used Afrezza, 2 during the trial in smokers, and 2 others, both squamous-cell tumors, at 2.6 and 3.8 years after the end of the trial in nonsmokers. An oncologist on the panel, Liz Szabo, MD, from the National Cancer Institute, called that "unusual" and advised that more data be collected.

Pulmonologist James K. Stoller, MD, of the Cleveland Clinic Foundation, voted yes for both type 1 and type 2 because he was "extremely impressed by the unmet need and the advantages of this drug for subsets of individuals." Nonetheless, he said he remained concerned about the potential for the product's use in patients with unrecognized COPD and expressed skepticism about the extent of adherence to a label recommendation for spirometry.

"I think we sometimes take solace that the labeling indications will inform against risk, but I am highly concerned that would not be the case in clinical practice, regardless of what it says in the label." Because of that, he advised that the contraindication include ever-smokers as well as current smokers.

Acting committee chair Robert J. Smith, MD, an endocrinologist at Brown University, Providence, Rhode Island, raised the concern that MannKind had not done a study in which Afrezza was added to basal insulin in type 2 patients, whereas basal insulin is typically introduced first in clinical practice.

Nonetheless, he also voted yes for both type 1 and type 2 patients. "Perhaps the strongest motivation for me is that an inhaled form of insulin represents a drug that will serve some patients who are not effectively served by currently available forms of insulin. I am convinced enough by the efficacy data to believe that there are at least some subgroups of patients that will substantially benefit."

However, Dr. Smith added, "I think it's quite possible that there are other subgroups, and perhaps even a majority of type 1 diabetes patients, who would do better in terms of glucose control on injected rather than this form of insulin."

He also said he voted yes because "the data about potentially serious adverse events are not strong enough that I feel it's imperative to resolve those questions before the drug might be marketed, but I think there are a number of potential concerns about adverse effects that are very, very important to follow up postmarket."

FDA advisory panel members are vetted for conflicts of interest and are given temporary waivers for participation if necessary. No waivers were issued for this meeting

Source:

Tanveer Hussain MS, IRPH

Clinical Pharmacist, VA HVHCS

Castle Point, NY

By: Unknown On 10:32 PM

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Urinary Tract Infection (UTI) IN ELDERLY

A Urinary bladder infection places stress on the body. That stress can result in confusion, and abrupt changes in behaviour in older adult results in an “Elderly Urinary Tract Infection”.

A sudden change in behaviour is, in fact, one of the best indicators of a urinary tract infection in older adults. Some common warning signs might include the onset of elderly urinary incontinence, confusion or not being able to do tasks the patient could easily do a day or two before. Anytime there's a change in an older adult. If one day they're able to dress themselves or feed themselves and then there's a sudden change, a red flag should go up. If a 30-year old woman experiences painful burning when she urinates, it's almost certain she has a urinary tract infection (UTI). But an elderly urinary tract infection rarely causes such clear symptoms and might not involve pain or discomfort at all. As you get older your immune response changes; it's part of normal aging. Half of all women will develop a urinary tract infection in their lifetimes. Typically, UTIs, also known as bladder infections, are easy to cure. But REMEMBER if left untreated, the infection can spread and develop into far more serious conditions.

The kidneys, ureters, bladder and urethra work together to rid the body of urine:

1.      The kidneys remove extra liquid and waste from the blood in the form of urine.

2.      The ureters carry the urine from the kidneys to the bladder.

3.      And, the bladder stores the urine until it is emptied through the urethra.

UTIs are thought to be much more common in women because the urethra is shorter in women than in men, giving bacteria-which live in the rectal area and also on a person's skin-an easier route into the body.

·        Cystitis:

The most common diagnosis is cystitis, (the infection and inflammation of the Urinary Bladder), which causes frequent and painful urination. However, other parts of the lower and upper urinary tract system can become infected. As a general rule of thumb, the higher up the infection in the urinary tract system, the worse it is.

·        Urethritis:

Burning urination is often the result of urethritis, the infection of the urethra.

·        Pyelonephritis:

Pyelonephritis occurs when a bladder infection spreads to the kidneys. It can cause:

1.      Upper back and flank pain,

2.      Shaking, chills,

3.      Nausea and vomiting.

·        Prostatitis:

 UTIs in men can lead to prostatitis, or enlargement of the prostate gland, the male organ that produces semen, which is located just below the bladder.

Symptoms of a UTI include:

1.      General discomfort.

2.      A feeling of being over-tired.

3.      Blood in the urine and pain even when not urinating.

4.      Men might feel fullness in the rectum. Back and side pain can indicate the infection has reached the kidneys.

5.      An elderly person will rarely get a fever, but if an older patient has one it is considered an emergency. "It shouldn't be taken lightly. If they do have a fever, it's a serious infection.

Who's at risk?

1.      Older adults at greater risk for getting an elderly urinary tract infection.

2.      Those who require a catheter in the urethra and bladder.

3.      Those who are diabetics.

4.      Anyone with kidney stones.

5.      Women who've gone through menopause.

After menopause, women experience a change in the lining of the vagina and also produce less estrogen, which helps protect against UTIs. Hormone replacement therapy (HRT) can help protect postmenopausal women from UTIs, according to the American Urological Association, but HRT may increase other health risks and so may not be appropriate for all women.

Diagnosis & Treatment:

In most cases, diagnosing and treating an elderly urinary tract infection is relatively straightforward. A simple urinalysis can confirm the infection's presence and, for someone in good health, antibiotics are the first choice of treatment. UTIs often clear up in only a few days. The course of treatment can take weeks and perhaps involve hospitalization for the administration of intravenous antibiotics.

1.      Home tests: A dipstick is held in the urine stream. Home tests are a convenient way for chronic UTI sufferers to quickly diagnose whether they have an infection. But they should only be used with the support and guidance of a patient's physician.

2.      Ultrasound exam:  Ultrasounds can help evaluate bladder and kidney problems as doctors are able to see whether there are abnormalities in the bladder that could be contributing to the infections.

3.      X-rays: Using a series of x-rays and a contrast dye to highlight abnormalities in the urinary tract can help pin-point abnormalities.

4.      CAT scan: A CAT scan provides a detailed three-dimensional picture of the urinary tract.

Patient suffering from UTIs must drink plenty of fluids to flush the bacteria from their systems. Proper fluid intake makes it harder for bacteria to live and multiply in the urinary tract. Older adults drink four to six 8-ounce glasses of water a day. Drinking cranberry juice or taking cranberry tablets can also make urine less inviting for bacteria.

Patient should keep the urine clear.

·        Drinking plenty of water is an important prevention tactic.

·        Urinating promptly after the urge arises

·        Wiping front to back

·        Emptying the bladder shortly before and after intercourse

·        Avoiding use of feminine products such as deodorant sprays, douches and powders in the genital area that could irritate the urethra

·        Taking showers instead of baths

·        Noticing a Change In Behaviour

REMEMBER; ALWAYS CONSULT YOUR DOCTOR OR PHARMACIST BEFORE TAKING ANY TABLET OR MEDICINE.

Dr. Imtiaz Syed

M.B, B.S, MBA, CRA, PCQI, CPC

LinkedIn: http://uk.linkedin.com/pub/imtiaz-syed/13/89/841

OpenDoor Team member.  www. OpenDoor.cc

Redditch, Gloucestershire. UK.

By: Unknown On 10:47 AM

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