STUDY MATERIAL FOR B.SC CHEMISTRY CHEMISTRY IN MEDICINE SEMESTER - IV, ACADEMIC YEAR 2020-21

UNIT CONTENT PAGE Nr

I FIRST AID 02

II CHEMICALS IN MEDICINE 20

III CAUSES AND TREATMENT OF SOME COMMON DISEASES 35

IV CLINICAL CHEMISTRY 58

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UNIT- I FIRST AID Introduction First aid is the first and immediate assistance given to any person suffering from either a minor or serious illness or injury, with care provided to preserve life, prevent the condition from worsening, or to promote recovery. It includes initial intervention in a serious condition prior to professional medical help being available, such as performing cardiopulmonary resuscitation (CPR) while waiting for an ambulance, as well as the complete treatment of minor conditions, such as applying a plaster to a cut. First aid is generally performed by someone with basic medical training. Mental health first aid is an extension of the concept of first aid to cover mental health,while psychological first aid is used as early treatment of people who are at risk for developing PTSD. Conflict First Aid, focused on preservation and recovery of an individual's social or relationship well-being, is being piloted. There are many situations which may require first aid, and many countries have legislation, regulation, or guidance specifies a minimum level of first aid provision in certain circumstances. This can include specific training or equipment to be available in the workplace (such as an automated external defibrillator), the provision of specialist first aid cover at public gatherings, or mandatory first aid training within schools. First aid, however, does not necessarily require any particular equipment or prior knowledge, and can involve improvisation with materials available at the time, often by untrained people. First aid can be performed on nearly all animals, such as first aid for pets, although this article relates to the care of human patients.

Early history and warfare Skills of what is known as first aid have been recorded throughout history, especially in relation to warfare, where the care of both traumatic and medical cases is required in particularly large numbers. The bandaging of battle wounds is shown on Classical Greek pottery from c. 500 BC, whilst the parable of the Good Samaritan includes references to binding or dressing wounds. There are numerous references to first aid performed within the Roman army, with a system of first aid supported by surgeons, field ambulances, and hospitals. Roman legions had the specific role of capsarii, who were responsible for first aid such as bandaging, and are the forerunners of the modern combat medic

First aid kits A first aid kit consists of a strong, durable bag or transparent plastic box. They are commonly identified with a white cross on a green background. A first aid kit does not have to be bought ready-made. The advantage of ready-made first aid kits is that they have well organized compartments and familiar layouts.

Contents There is no universal agreement upon list for the contents of a first aid kit. The UK Health and Safety Executive stress that the contents of workplace first aid kits will vary according to the nature of the work activities. As an example of possible contents of a kit, British Standard "BS 8599 First Aid Kits for the Workplace"

Lists the following items: Information leaflet Medium sterile dressings Tweezers Large sterile dressings Bandages Triangular dressing’s Safety pins Adhesive dressings Sterile wet wipes

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Micro porous tape Nitride gloves Face shield Foil blanket Burn dressings Clothing shears Conforming bandages Finger dressing Antiseptic cream Scissors

First Aid for accidents If someone is injured you should: ➢ First check that you and the casualty aren't in any danger, and, if possible, make the situation safe ➢ If necessary, call an ambulance when it's safe to do so carry out basic first aid

Assessing a casualty The three priorities when dealing with a casualty are commonly referred to as ABC, which stands for: ➢ Airway ➢ Breathing ➢ Circulation

Airway If the casualty appears unresponsive, ask them loudly if they're OK and if they can open their eyes. If they respond, you can leave them in the position they're in until help arrives. While you wait, keep checking their breathing, pulse and level of response: ➢ Are they alert? ➢ Do they respond to your voice? ➢ Do they respond to pain? ➢ Is there no response to any stimulus (are they unconscious)?

If there's no response, leave the casualty in the position they're in and open their airway. If this isn't possible in the position they're in, gently lay them on their back and open their airway.

To open the airway, place one hand on the casualty’s forehead and gently tilt their head back, lifting the tip of the chin using two fingers. This moves the tongue away from the back of the throat. Don't push on the floor of the mouth, as this will push the tongue upwards and obstruct the airway.

If you think the person may have a spinal injury, place your hands on either side of their head and use your fingertips to gently lift the angle of the jaw forward and upwards, without moving the head, to open the airway. Take care not to move the casualty’s neck. However, opening the airway takes priority over a neck injury. This is known as the jaw thrust technique.

Breathing To check if a person is still breathing: ➢ look to see if their chest is rising and falling ➢ listen over their mouth and nose for breathing sounds ➢ feel their breath against your cheek for 10 seconds

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If they're breathing normally, place them in the recovery position so their airway remains clear of obstructions and continue to monitor normal breathing. Gasping or irregular breathing is not normal breathing.

Circulation If the casualty isn't breathing normally, then you must start chest compressions immediately. Agonal breathing is common in the first few minutes after a sudden cardiac arrest (when the heart stops beating). Agonal breathing is sudden, irregular gasps of breath. This shouldn't be mistaken for normal breathing and CPR should be given straight away.

If someone is unconscious and breathing If a person is unconscious but breathing, and has no other injuries that would stop them being moved, place them in the recovery position until help arrives. Keep them under observation to ensure they continue to breathe normally, and don't obstruct their airway.

If someone is unconscious and not breathing If a person isn't breathing normally after an incident, call an ambulance and start CPR straight away. Use hands-only CPR if you aren't trained to perform rescue breaths.

Common accidents and emergencies Below, in alphabetical order, are some of the most common injuries that need emergency treatment in the UK and information about how to deal with them: ➢ anaphylaxis (or anaphylactic shock) ➢ bleeding ➢ burns and scalds ➢ choking ➢ drowning ➢ electric shock (domestic) ➢ fractures ➢ heart attack ➢ poisoning ➢ shock ➢ stroke

Important rules first aid Shout for help! Don't be afraid to use your lungs and shout for help as soon as you begin first aid measures. Keep shouting for help until you know you've been heard and action has been taken. Professional help can't come soon enough—if it's needed!

Assess the situation and scout the territory: If possible, ask the injured person what happened. Can she speak? Can she tell you how serious the accident is? Also, look around and make sure that performing first aid isn't going to be hazardous to your health. Are there any exposed wires near the injured person? Are there toxic fumes or flames? Is the ice hard enough for you to walk on or the water calm enough to jump in? In short, make sure you aren't in any danger before you start first aid. You won't be much help if you get injured, too.

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Determine if the accident warrants a visit to a hospital or simply a cleansing and a Band-Aid. If the injured person can talk, If the person simply needs stitches, don't call for an ambulance, just make a trip to the emergency room. But if he or she is unconscious, Check, Are the airways clear? Is he or she breathing? What about circulation? Is there a pulse? And, most importantly, it's up to you to decide whether or not to move the injured person. Sometimes this can't be helped. Once you've decided that you can safely walk on the ice or run past the flames, you might have to save the person in jeopardy by pulling or carrying them to safety, away from flames, thin ice, or toxic fumes. Here's a good rule to remember: don't move a person if there isn't a life-or-death reason to do so. You might cause more harm than good.

If you are trained and certified in CPR and a person is choking or cannot breathe, begin CPR right away. If you are not trained in CPR, do not attempt to resuscitate. You can break the ribs or puncture the lungs, for example, and if the person is choking, you can actually force the object further down his or her throat! If you don't know CPR, use mouth-to-mouth resuscitation techniques or for choking, use the Heimlich Maneuver. Also, take the injured person's pulse and loosen his or her clothes to make breathing easier.

Stop the bleeding: If the injured person is bleeding, apply direct, even pressure with a cloth and your hands to slow the flow. (To protect yourself against HIV and other infections while in direct contact with blood, don't forget to practice the universal guidelines for preventing infection.) Lift up a bleeding limb if it doesn't cause substantial additional pain. Make and apply a tourniquet only as a last resort.

Treat any symptoms of shock: If the victim is chilled, breathing harshly, nauseous, clammy, and pale, it is possible he or she is in shock and might become unconscious at any time. Vomiting can also be a sign of shock, and you want to keep airways clear. If no back or neck injury is suspected, gently roll the victim's whole body to the side to keep airways open and prevent vomit from pooling in the back of the throat (which can cause choking). Cover the victim with a blanket if you see any signs of shock. Use the universal guidelines to prevent transmittal of HIV or any other infection if you come in contact with bodily fluids.

Look for a Medic Alert bracelet or necklace The medic alert identification tag bears the name “Medic Alert” and displays the Greek symbol for medical care (a snake twisted around a staff). This bracelet provides medical and emergency personnel with life-sustaining information about the patient's medical history and special needs. The Medic Alert tag tells you if the victim is diabetic, epileptic, or allergic to any medications—all of which can make a tremendous difference in the course of treatment. If there is no Medic Alert bracelet or necklace, check the injured person's wallet. Sometimes medical warnings are written on an ID card or driver's license. Seek trained medical assistance: At this point, you can leave the injured person for a moment if necessary to summon help. In this world of cellular phones, it's nice to know we're only an arm's length away from emergency service. But what if an injury takes place where there isn't a portable phone? Or what if you don't own one yourself? Shout for help or as a last resort, run to the nearest phone. When you call for help, tell the police you want an ambulance with an EMT staff. Only trained

Page 5 of 65 STUDY MATERIAL FOR B.SC CHEMISTRY CHEMISTRY IN MEDICINE SEMESTER - IV, ACADEMIC YEAR 2020-21 personnel can help you with cardiac or respiratory problems, head traumas, poisoning, or fractures.

With or without medical alert information, you can make your call to emergency service more efficient if you begin with your name and location and the nature of the problem. If you've performed steps 1 through 7, you can also inform them of such additional things as potential dangers in the locale, whether or not the patient is breathing or bleeding or appears to have broken bones. All of these things help the EMTs prepare themselves before they arrive on the scene.

Never give an injured unconscious person anything by mouth: This means no pills, no liquids—nothing! When a person is unconscious, even water (which you might think will ease the pain) can interfere with breathing and choke him or her.

Wait: This is the hardest part of administering first aid care. When you've followed the steps above and done everything you can, all that's left is to wait for the ambulance to arrive. Unfortunately, minutes can feel like hours. While you're waiting, try to keep the injured person calm. You can provide comfort with a soothing voice or a gentle touch. The “Ssh. Don't worry. Help is almost here…” will help you cope as much as it will help the person you're treating.

First aid for cuts These guidelines can help you care for minor cuts and scrapes: 1. Wash your hands: This helps avoid infection.

2. Stop the bleeding: Minor cuts and scrapes usually stop bleeding on their own. If needed, apply gentle pressure with a clean bandage or cloth and elevate the wound until bleeding stops.

3. Clean the wound: Rinse the wound with water. Keeping the wound under running tap water will reduce the risk of infection. Wash around the wound with soap. But don't get soap in the wound. And don't use hydrogen peroxide or iodine, which can be irritating. Remove any dirt or debris with a tweezers cleaned with alcohol. See a doctor if you can't remove all debris.

4. Apply an antibiotic or petroleum jelly: Apply a thin layer of an antibiotic ointment or petroleum jelly to keep the surface moist and help prevent scarring. Certain ingredients in some ointments can cause a mild rash in some people. If a rash appears, stop using the ointment.

5. Cover the wound: Apply a bandage, rolled gauze or gauze held in place with paper tape. Covering the wound keeps it clean. If the injury is just a minor scrape or scratch, leave it uncovered.

6. Change the dressing: Do this at least once a day or whenever the bandage becomes wet or dirty.

7. Get a tetanus shot:

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Get a tetanus shot if you haven't had one in the past five years and the wound is deep or dirty.

8. Watch for signs of infection: See a doctor if you see signs of infection on the skin or near the wound, such as redness, increasing pain, drainage, warmth or swelling.

First aid for bruises A bruise forms when a blow breaks blood vessels near your skin's surface, allowing a small amount of blood to leak into the tissues under your skin. The trapped blood may cause a bruise that at first looks like a black-and-blue mark and then changes color as it heals.

You can enhance bruise healing with a few simple techniques. Remember RICE, for rest, ice, compress and elevate: ➢ Rest the bruised area, if possible. ➢ Ice the bruise with an ice pack wrapped in a towel. Leave it in place for 10 to 20 minutes. Repeat several times a day for a day or two as needed. ➢ Compress the bruised area if it is swelling, using an elastic bandage. Don't make it too tight. ➢ Elevate the injured area.

If your skin isn't broken, you don't need a bandage. Consider taking an over-the-counter pain reliever if needed.

Consult your doctor if you: ➢ Notice very painful swelling in the bruised area ➢ Are still experiencing pain three days after a seemingly minor injury ➢ Have frequent, large or painful bruises, particularly if your bruises appear on your trunk, back or face, or seem to develop for no known reasons ➢ Have easy bruising and a history of significant bleeding, such as during a surgical procedure ➢ Notice a lump (hematoma) form over the bruise ➢ Are experiencing abnormal bleeding elsewhere, such as from your nose or gums ➢ Suddenly begin bruising, but have no history of bruising ➢ Have a family history of easy bruising or bleeding

First aid for bleeding Injuries and certain medical conditions can result in bleeding. This can trigger anxiety and fear, but bleeding has a healing purpose. Still, you need to understand how to treat common bleeding incidents such as cuts and bloody noses, as well as when to seek medical help. Before you begin to treat an injury, you should identify its severity as best you can. There are some situations in which you shouldn’t try to administer any kind of first aid at all. If you suspect that there’s internal bleeding or if there’s an embedded object surrounding the site of the injury, immediately call emergency service or your local emergency services.

Also seek immediate medical care for a cut or wound if: ➢ it’s jagged, deep, or a puncture wound ➢ it’s on the face

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➢ it’s the result of an animal bite ➢ there’s dirt that won’t come out after washing ➢ the bleeding will not stop after 15 to 20 minutes of first aid If a person is bleeding profusely, be on the lookout for symptoms of shock. Cold, clammy skin, a weakened pulse, and loss of consciousness can all indicate that a person is about to go into shock from blood loss. Even in cases of moderate blood loss, the bleeding person may feel lightheaded or nauseous.

If possible, have the injured person lie down on the floor while you wait for medical care to arrive. If they are able, have them elevate their legs above their heart. This should help circulation to the vital organs while you wait for help. Hold continuous direct pressure on the wound until help arrives.

First aid for fractures A broken bone happens when one of your bones becomes cracked or broken into multiple pieces. It’s also known as a fracture. It can result from a sports injury, accident, or violent trauma. Broken bones usually aren’t life threatening, but they do require immediate medical care. Learn how to recognize the symptoms of a broken bone, provide first-aid treatment, and get professional help.

A broken bone can cause one or more of the following signs and symptoms: ➢ intense pain in the injured area that gets worse when you move it ➢ numbness in the injured area ➢ bluish color, swelling, or visible deformity in the injured area ➢ bone protruding through the skin ➢ heavy bleeding at the injury site

A fracture is a broken bone. It requires medical attention. If the broken bone is the result of major trauma or injury, call emergency service or your local emergency number.

Also call for emergency help if: ➢ The person is unresponsive, isn't breathing or isn't moving. Begin CPR if there's no breathing or heartbeat. ➢ There is heavy bleeding. ➢ Even gentle pressure or movement causes pain. ➢ The limb or joint appears deformed. ➢ The bone has pierced the skin. ➢ The extremity of the injured arm or leg, such as a toe or finger, is numb or bluish at the tip. ➢ You suspect a bone is broken in the neck, head or back.

Don't move the person except if necessary to avoid further injury. Take these actions immediately while waiting for medical help:

Stop any bleeding: Apply pressure to the wound with a sterile bandage, a clean cloth or a clean piece of clothing.

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Immobilize the injured area: Don't try to realign the bone or push a bone that's sticking out back in. If you've been trained in how to splint and professional help isn't readily available, apply a splint to the area above and below the fracture sites. Padding the splints can help reduce discomfort.

Apply ice packs to limit swelling and help relieve pain: Don't apply ice directly to the skin. Wrap the ice in a towel, piece of cloth or some other material.

Treat for shock: If the person feels faint or is breathing in short, rapid breaths, lay the person down with the head slightly lower than the trunk and, if possible, elevate the legs.

First aid for burns Burns and scalds are damage to the skin caused by heat. Both are treated in the same way. A burn is caused by dry heat – by an iron or fire, for example. A scald is caused by something wet, such as hot water or steam.

Burns can be very painful and may cause: ➢ red or peeling skin ➢ blisters ➢ swelling ➢ white or charred skin

The amount of pain you feel isn't always related to how serious the burn is. Even a very serious burn may be relatively painless.

To treat a burn, follow the first aid advice below: ➢ Immediately get the person away from the heat source to stop the burning ➢ Cool the burn with cool or lukewarm running water for 20 minutes – don't use ice, iced water, or any creams or greasy substances such as butter ➢ Remove any clothing or jewellery that's near the burnt area of skin, including babies' nappies - but don't move anything that's stuck to the skin ➢ Make sure the person keeps warm – by using a blanket, for example, but take care not to rub it against the burnt area ➢ Cover the burn by placing a layer of cling film over it – a clean plastic bag could also be used for burns on your hand ➢ Use painkillers such as paracetamol or ibuprofen to treat any pain ➢ If the face or eyes are burnt, sit up as much as possible, rather than lying down - this helps to reduce swelling

For All Burns 1. Stop Burning Immediately ➢ Put out fire or stop the person's contact with hot liquid, steam, or other material. ➢ Help the person "stop, drop, and roll" to smother flames. ➢ Remove smouldering material from the person. ➢ Remove hot or burned clothing. If clothing sticks to skin, cut or tear around it.

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2. Remove Constrictive Clothing Immediately ➢ Take off jewellery, belts, and tight clothing. Burns can swell quickly.

For First-Degree Burns (Affecting Top Layer of Skin): 1. Cool Burn ➢ Hold burned skin under cool (not cold) running water or immerse in cool water until the pain subsides. ➢ Use compresses if running water isn't available.

2. Protect Burn ➢ Cover with sterile, non-adhesive bandage or clean cloth. ➢ Do not apply butter, oil, lotions, or creams (especially if they contain fragrance). Apply a petroleum-based ointment two to three times per day.

3. Treat Pain ➢ Give over-the-counter pain reliever such as acetaminophen (Panadol, Tylenol), ibuprofen (Advil, Motrin, Nuprin), or naproxen (Aleve, Naprosyn).

4. When to See a Doctor Seek medical help if: ➢ You see signs of infection, like increased pain, redness, swelling, fever, or oozing. ➢ The person needs tetanus or booster shot, depending on date of last injection. Tetanus booster should be given every 10 years. ➢ The burn blister is larger than two inches or oozes. ➢ Redness and pain last more than a few hours. ➢ The pain gets worse. ➢ The hands, feet, face, or genitals are burned.

5. Follow Up ➢ The doctor will examine the burn and may prescribe antibiotics

First aid for poisonous bites Not all bites or stings are the same. Different first aid treatment and medical care should be given depending on what type of creature has bitten or stung you. Some species can cause more damage than others. Some people also have allergies that raise the risk of a serious reaction.

Here’s how to recognize and treat the symptoms of bites and stings from insects, spiders, and snakes: Insects Nearly everyone has been bitten or stung by an insect at one time or another. Whether you’ve been attacked by a mosquito, fly, bee, wasp, ant, or other bug, insect bites and stings usually cause a mild reaction. Your body reacts to venom or other proteins that insects inject into you or transfer to your body through their saliva. This can result in symptoms at the site of the bite or sting, such as: ➢ redness ➢ swelling ➢ pain ➢ itching

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The severity of your symptoms can vary, depending on the type of insect that bites or stings you. Some people also develop a severe allergic reaction to insect stings or bites. Bee and wasp allergies are particularly common. A severe allergic reaction can cause: ➢ hives ➢ abdominal cramps ➢ nausea and vomiting ➢ swelling of your face, lips, or throat ➢ breathing problems ➢ shock

If you or someone you know begins to experience these symptoms shortly after being bitten or stung by an insect, call emergency service or local emergency services. A severe allergic reaction that affects multiple parts of your body is called anaphylaxis. It can be life- threatening if not treated promptly.

If you’ve ever had a severe reaction to an insect bite or sting, ask your doctor about allergy testing. If you’ve been diagnosed with a severe allergy, your doctor should prescribe a medication called epinephrine. You can use a preloaded epinephrine auto-injector (e.g., EpiPen®) to inject the medication in your outer thigh muscle. It acts quickly to raise your blood pressure, stimulate your heart, and reduce swelling of your airways. You should carry it with you at all times, especially when you’re outdoors in areas where you might encounter insects.

First aid treatment If someone shows signs of a severe allergic reaction, help them get emergency medical attention and follow the steps in the next section. If they show no signs of a severe reaction, treat the site of the bite or sting for minor symptoms: If the insect’s stinger is still embedded in their skin, remove it by gently scraping a flat- edged object, such as a credit card, across their skin. Avoid using tweezers to remove the stinger, since squeezing it may release more venom. Wash the area of the bite with soap and water. Place a cold compress or ice pack on the area for about 10 minutes at a time to help reduce pain and swelling. Wrap any ice or ice packs in a clean cloth to protect their skin. Apply calamine lotion or a paste of baking soda and water to the area several times a day to help relieve itching and pain. Calamine lotion is a type of antihistamine cream.

Common chemical poisoning Poisoning: Poisoning occurs when a certain amount of a toxic material (natural or processed) gets into the body; thus, harming the body.

Entry points of toxic material into the body: 1. Swallowing: Through one’s mouth and the digestive system

2. Inhalation: Through the respiratory system (such as poisonous fumes and gases, as well as invasive aesthetic drugs)

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3. Injection: Including insect bites, skin, under skin, intramuscular or intravenous injection.

4. Skin: By absorption (such as lotions and chemical substances)

Poisoning can be divided according to its causes into: 1. Poisoning by Medications. 2. Chemical Poisoning. 3. Food Poisoning.

Symptoms of Poisoning: Diagnosis is based on several factors which constitute the circumstances of the incident and observations of place where poisoning happened, in addition to symptoms and results of tests.

A. Circumstances of the Incident and Site Examination: It is only when people who share the same food and drink show similar acute signs and symptoms of poisoning that poisoning are highly suspected. Finding some toxic chemicals or medicinal substances in the room (notice a weird smell or liquid), empty bottles used for keeping such substances, a drug bottle near the victim (or pills scattered nearby).

B. Clinical Signs and Symptoms: 1. Gastrointestinal Symptoms: ➢ Nausea and vomiting - acute abdominal pains - diarrhea ➢ Vomiting smells like bitter almond - such as in the case of cyanide poisoning - and inorganic phosphorus (garlic odour)

2. Respiratory Symptoms: ➢ Cough - cyanosis - breathing difficulties in irritant gases and fume poisoning. ➢ The normal breathing rate for an adult is 16 times per minute.

3. Brain Symptoms: ➢ Victims show such signs due to infection of their central nerve system, including: ➢ Loss of consciousness ➢ Seizures (fits) ➢ Mental confusion

4. Corrosive Poisoning - such as concentrated acid and cleaners: Acute pharyngeal, chest and mouth pains due to oesophageal heartburn

Poisoning First Aid General Rules: Providing express first aid to the victim is meant to mitigate the toxic substance as fast as possible, while seeking medical assistance, maintaining breathing, blood circulation and other vital signs.

To correctly provide first aid, one should: 1. Make sure that there is no other risk - for you or the victim - due to administering first aid.

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2. If possible: ➢ Identify the poison, drug or food, and keep it vessel, remnants or cover. ➢ Identify the dosage or the intake of such substance. ➢ Verify the duration (since how long has the victim taken it). ➢ The Victim’s age and weight. 3. If poisoning is deliberate of by mistake. 4. Observe the symptoms (acute or mild). 5. If the victim vomits, keep the vomited material (for test purposes by the concerned authorities). 6. Call the Poison Control or hospital and get the first aid advice. 7. Call the ambulance or medical assistance, or carry the victim to the nearest hospital. 8. Make sure to have the toxic material and its bottle along with the victim to the hospital. 9. If the victim is unconscious: Check breath and provide C.P.R if needed.

Most Common Causes of Poisoning: 1. Poisons removed from original containers to bottles, such as household cleaners and bleaches. 2. Parents’ negligence leaving dangerous substances within children reach. 3. Improper storage of toxic substances. 4. Swallowing or inhaling toxic substances. 5. Leaving children unattended. 6. Suicidal thoughts

Poisonous Contamination of Skin and Eyes: First: First Aid in cases of Chemical and Household Cleaners Poisoning: 1. Check breath and provide C.P.R if needed. 2. Give cold milk and egg white. 3. Give strong pain reliever. 4. Do not force victim to vomit. 5. No gastric lavage. 6. No acids, such as vinegar and lime juice in case of acid poisoning. 7. Take victim immediately to hospital.

Second: ➢ Disinfectants and sterility (phenol, dettol and formalin) ➢ Excessive exposure to such toxic materials by touching or inhaling may cause poisoning, so ventilation is highly important after using these materials.

First Aid in cases of swallowing household disinfectants and sterilants: 1. For skin contamination, wash with plenty of water, then dilute with 10% alcohol; better use olive or castor oil. 2. In case of drinking disinfectants, better give ipecac to induce vomiting, only when victim is conscious. 3. Take victim immediately to hospital.

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Second: Inhalation Poisoning: Many poisoning cases occur due to inhaling toxic fumes or gases, where the toxin rapidly hits the bloodstream. So, administer first aid as fast as possible in these cases following these instructions: 1. Take the victim immediately away from the poisonous aerated milieu to clean air, while removing any tight clothes and untying the necktie. 2. Provide rescue breaths in case of respiratory failure of difficulty after removing anything inside the mouth as follows: ➢ Titling the head back to open the airway, while closing the nose trills with two fingers, taking a deep breath, blowing air into the victim’s lungs through the mouth; then watching the victim’s chest rise accordingly. ➢ Allow the victim to exhale which watching his chest fall. ➢ Repeat same procedure till the victim breathes normally. 3. Warm up victim if sign of cold or chill is found. 4. Calm down the victim if conscious. 5. Take patient immediately to hospital.

Third: Skin Poisoning: Skin may be contaminated by caustics which cause major skin damage, in which case such caustics must be removed as fast as possible as follows: 1. Wash skin with running water while removing the victim’s clothes, then wash the skin with water and dilute with soap. 2. Do not apply any medication or chemicals to the contaminated skin least they should aggravate the skin damage.

Fourth: Eye Poisoning: First aid for eye poisoning: 1. Open eyelids and wash with running water (at low pressure) for at least 10 minutes. 2. No eye drops. 3. Take patient immediately to hospital.

Soap, industrial cleaners and shampoos: Most soap used for household cleaning is not toxic due to neutralization of alkaline substances. As well, soap solution is used to induce vomiting instead of ipecac if not available. As for industrial cleaners (such as OMO, Persil, Tide...etc.), they contain both organic and non- organic substances, cloth softeners and enzymes to facilitate lavage. These cleaners are less toxic than other highly alkaline materials - like Flash and sewer unblockers where PH reaches up to 11. Other cleaners may contain bleaches, such Clorox with 3-6% sodium hypochlorite which - after mixing with hydrochloric acid - turns in the stomach into hypochlorous acid with its localized effects on the mucous membranes of the digestive system. It is not recommended to neutralize sodium hypochlorite with highly alkaline acids as chlorine gas or chloramine gas is formed alternately. Both gases irritate the mucous membranes and may cause asphyxiation. As for shampoos, they are less toxic, yet they have simple irritable effects on the mucous membranes. Other shampoos contain anti dandruff components such as selenium which could have some toxic signs due to excessive application or swallowing.

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Some disinfectants, deodorants and antibacterial substances contain compounds (quaternary ammonium), which are highly alkaline and toxic.

Alkaloid poisoning-symptoms-antidote Alkaloid poisoning is an illness associated with excess consumption of any specific type of green vegetable over an extended period of time. An alkaloid is a type of naturally occurring compound that has a least one nitrogen atom present in its structure. These substances are commonly found in plants and animals Removal of the animal from the pasture containing the possible toxicant is always a necessary first measure. In some cases, as with fescue toxic sis in pregnant mares, removal from pasture can clear the toxin from the animal’s system within days. Plant matter can clear the stomach in 24 hours and the entire digestive system in as little as 48 hours. However, in the case of some toxins such as pyrrolizidine alkaloids, chronic toxicity is cumulative, occurs with the ingestion of small amounts over weeks or months, and clinical signs may occur months or even years after ingestion of the plants.

Medications, treatments, and dietary supplements There are a number of medications that can alleviate some or all of the symptoms or discomfort of plant poisoning by certain toxins. Common treatments may include special diets including alfalfa and cereal grains, supplementation with protein concentrates, vitamins or minerals, intravenous fluids therapy, blood transfusions, surgery, medications such as Domperidone, sedation, intravenous vitamin K, injections of sodium nitrite or sodium thiosulfate, activated charcoal, potassium therapy, and respiratory stimulants, among others.

Antidotes or preventive medications are occasionally discovered that aid grazing animals in survival of toxic events. One of these is the use of Ivermectin, a medication used to treat internal parasites, as treatment for alkaloid toxicity. Alkaloid toxicity can also be counteracted with injections of physostigmine or a dopamine antagonist. Special diets or supplementation with grains or molasses may decrease nitrate toxic sis.

Alcohol poisoning-symptoms-antidote Diagnosis In addition to checking for visible signs and symptoms of alcohol poisoning, your doctor will likely order blood and urine tests to check blood alcohol levels and identify other signs of alcohol toxicity, such as low blood sugar.

Treatment Alcohol poisoning treatment usually involves supportive care while your body rids itself of the alcohol. This typically includes: ➢ Careful monitoring ➢ Prevention of breathing or choking problems ➢ Oxygen therapy ➢ Fluids given through a vein (intravenously) to prevent dehydration ➢ Use of vitamins and glucose to help prevent serious complications of alcohol poisoning

Adults and children who have accidentally consumed methanol or isopropyl alcohol may need haemodialysis — a mechanical way of filtering waste and toxins from your system — to speed the removal of alcohol from their bloodstream. Home remedies for alcohol poisoning won't work. This is an emergency situation.

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Dangerous myths You can't reverse the effects of alcohol poisoning, and you could actually make things worse through some actions. Here's what doesn't work: ➢ Sleeping it off - you can lose consciousness while asleep ➢ Black coffee or caffeine - this does not counteract the effects of alcohol poisoning ➢ A cold shower - the shock of cold can cause a loss of consciousness ➢ Walking it off - this does not increase the speed at which alcohol leaves your body

Mercury poisoning-antidote Mercury poisoning refers to toxicity from mercury consumption. Mercury is a type of toxic metal that comes in different forms within the environment. The most common cause of mercury poisoning is from consuming too much methyl mercury or organic mercury, which is linked to eating seafood.

Small amounts of mercury are present in everyday foods and products, which may not affect your health. Too much mercury, however, can be poisonous. Mercury itself is naturally occurring, but the amounts in the environment have been on the rise from industrialization. The metal can make its way into soil and water, and eventually to animals like fish.

Consuming foods with mercury is the most common cause of this type of poisoning. Children and unborn babies are the most vulnerable to the effects of mercury poisoning. You can help prevent toxicity by limiting your exposure to this potentially dangerous metal.

Symptoms of mercury poisoning Mercury is most notable for its neurological effects. In general, the U.S. Food and Drug Administration Trusted Source say that too much mercury can cause: ➢ anxiety ➢ depression ➢ irritability ➢ memory problems ➢ numbness ➢ pathologic shyness ➢ tremors

More often, mercury poisoning builds up over time. However, a sudden onset of any of these symptoms could be a sign of acute toxicity. Call your doctor right away if you suspect mercury poisoning.

Mercury poisoning symptoms in adults Adults with advanced mercury poisoning might experience: ➢ hearing and speech difficulties ➢ lack of coordination ➢ muscle weakness ➢ nerve loss in hands and face ➢ trouble walking ➢ vision changes

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Mercury poisoning symptoms in children and infants Mercury poisoning can also disrupt fetal and early childhood development. Infants and young children who’ve been exposed to high levels of mercury may have delays in: ➢ cognition ➢ fine motor skills ➢ speech and language development ➢ visual-spatial awareness

Complications of mercury poisoning High amounts of mercury can lead to long-term and sometimes permanent neurological changes. The dangers are especially notable in young children who are still developing. Mercury exposure can lead to developmental problems in the brain, which can also affect physical functions such as motor skills. Some children who are exposed to mercury at a young age may develop learning disabilities, according to the Environmental Defense Fund. Adults with mercury poisoning may have permanent brain and kidney damage. Circulatory failure is another possible type of complication.

Mercury poisoning from fish Methyl mercury (organic mercury) poisoning is largely linked to eating seafood, mainly fish. Toxicity from fish has two causes: ➢ eating certain types of mercury-containing fish ➢ eating too much fish

Fishes get mercury from the water they live in. All types of fishes contain some amount of mercury. Larger types of fishes can have higher amounts of mercury because they prey on other fishes that have mercury too.

Sharks and swordfish are among the most common of these. Bigeye tuna, marlin, and king mackerel also contain high levels of mercury.

It’s also possible to develop mercury poisoning from eating too much seafood. In small amounts, the following types of fish are okay to eat once or twice per week: ➢ albacore tuna ➢ anchovies ➢ catfish ➢ grouper ➢ pollock ➢ salmon ➢ shrimp ➢ snapper

Though these options contain less mercury overall, you’ll want to take care in how much you eat. If you’re pregnant, the March of Dimes recommends eating no more than 6 ounces of tuna per week and 8 to 12 ounces of other types of fish. This will reduce the risk of fetal mercury exposure.

You’ll also want to watch your fish consumption if you’re nursing, as mercury can be passed through breast milk.

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Other causes Other causes of mercury poisoning can be environmental or from exposure to other forms of the metal. These include: ➢ broken fever thermometers ➢ “silver” dental fillings ➢ certain types of jewellery ➢ mining for gold, and household gold extraction ➢ skin care products (Those made in the United States don’t usually contain mercury.) ➢ exposure to toxic air in industrialized communities ➢ CFL bulb breakage Trusted Source

Diagnosing mercury poisoning Mercury poisoning is diagnosed with a physical exam and a blood and urine test. Your doctor will ask about your symptoms when they start. They will also ask you about your dietary choices and other lifestyle habits. A blood or urine mercury test is used to measure levels in your body.

Mercury poisoning treatment There’s no cure for mercury poisoning. The best way to treat mercury poisoning is to stop your exposure to the metal. If you eat a lot of mercury-containing seafood, stop immediately. If toxicity is linked to your environment or workplace, you might need to take steps to remove yourself from the area to prevent further effects of poisoning. If your mercury levels reach a certain point, your doctor will have you do chelation therapy. Chelating agents are drugs that remove the metal from your organs and help your body dispose of them. Long term, you may need continuing treatment to manage the effects of mercury poisoning, such as neurological effects.

Outlook When detected early, mercury poisoning can be halted. Neurological effects from mercury toxicity are often permanent. If you suspect sudden mercury poisoning, call the Poison Control Centre at 800-222-1222.

Preventing mercury poisoning The best way to prevent dietary mercury poisoning is to take care with the amounts and types of seafood that you eat. You can also: ➢ Eat larger types of fish on an occasional basis. ➢ Avoid fish containing high levels of mercury if you’re pregnant. ➢ Follow fish and seafood serving guidelines for children: According to the FDATrusted Source, children younger than 3 years can eat 1 ounce of fish, while a serving size for children ages 4 to 7 is 2 ounces. ➢ Be choosy with your sushi choices. Many popular sushi rolls are made with mercury- containing fish. ➢ Be on the lookout for fish advisories in your area. This is especially useful if you fish for your own seafood. ➢ Take a blood or urine mercury test before conceiving. ➢ Wash your hands right away if you think you’ve been exposed to other forms of mercury.

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➢ Manage household spills of mercury (such as from CFL bulb breakage) ➢ Avoid activities with known mercury exposure risk, such as home gold extraction

Salicylate poisoning-antidote: Salicylate poisoning, also known as aspirin poisoning, is the acute or chronic poisoning with a salicylate such as aspirin. The classic symptoms are ringing in the ears, nausea, abdominal pain, and a fast breathing rate. Early on, these may be subtle, while larger doses may result in fever. Complications can include swelling of the brain or lungs, seizures, low blood sugar, or cardiac arrest.

Excess doses can be either on purpose or accidental. Small amounts of oil of wintergreen can be toxic. Diagnosis is generally based on repeated blood tests measuring aspirin levels and blood gases. While a type of graph has been created to try to assist with diagnosis, its general use is not recommended. In overdose maximum blood levels may not occur for more than 12 hours

Salicylate toxicity continues to be seen in the emergency department as a result of unintentional ingestions or suicide attempts. A high index of suspicion is necessary, with prompt recognition of clinical signs and symptoms of salicylate poisoning, such as tinnitus, hyperventilation, tachycardia, and metabolic acidosis. Early treatment can prevent organ damage and death.

Principles of treatment include stabilizing the ABCs as necessary, limiting absorption, enhancing elimination, correcting metabolic abnormalities, and providing supportive care. No specific antidote is available for salicylates.

Initial treatment of an acute overdose involves resuscitation followed by gastric decontamination by administering activated charcoal, which adsorbs the aspirin in the gastrointestinal tract. Stomach pumping is no longer routinely used in the treatment of poisonings, but is sometimes considered if the patient has ingested a potentially lethal amount less than one hour before presentation. Inducing vomiting with syrup of ipecac is not recommended. Repeated doses of charcoal have been proposed to be beneficial in cases of aspirin overdosing, although one study found that they might not be of significant value. Regardless, most clinical toxicologists administer additional charcoal if serum salicylate levels are increasing.

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UNIT – II CHEMICALS IN MEDICINE Alum-properties and uses: Potassium alum, potash alum, or potassium aluminium sulphate is a chemical compound: the double sulphate of potassium and aluminium, with chemical formula KAl(SO4)2. It is commonly encountered as the dodecahydrate, KAl(SO4)2·12H2O. It crystallizes in cubic structure with space group P a -3 and lattice parameter of 12.18 Å. The compound is the most important member of the generic class of compounds called alums, and is often called simply alum. Potassium alum is commonly used in water purification, leather tanning, dyeing, fireproof textiles, and baking powder as E number E522. It also has cosmetic uses as a deodorant, as an aftershave treatment and as a styptic for minor bleeding from shaving.

Potassium alum was known to the Ancient Egyptians, who obtained it from evaporates in the Western desert and reportedly used it as early as 1500 BCE to reduce the visible cloudiness (turbidity) in the water. Potassium alum was described under the name alumen or salsugoterrae by Pliny.

Types of Alum: Potassium Alum: Potassium alum is also known as potash alum or tawas. It is aluminium potassium sulfate. This is the type of alum that you find in the grocery store for pickling and in baking powder. It is also used in leather tanning, as a flocculant in water purification, as an ingredient in aftershave and as a treatment to fireproof textiles. Its chemical formula is KAl(SO4)2.

Soda Alum: Soda alum has the formula NaAl(S O4)2·12H2O. It is used in baking powder and as an acidulate in food.

Ammonium Alum: Ammonium alum has the formula N4Al(SO4)2·12H2O. Ammonium alum is used for many of the same purposes as potassium alum and soda alum. Ammonium alum finds applications in tanning, dyeing textiles, making textiles flame retardant, in the manufacture of porcelain cement and vegetable glues, in water purification and in some deodorants.

Chrome Alum: Chrome alum or chromium alum has the formula KCr(S O4)2·12H2O. This deep violet compound is used in tanning and can be added to other alum to grow lavender or purple crystals.

Selenate Alums: Selenate alums occur when selenium takes the place of sulphur so that instead of a 2- sulfate you get a selenate, (SeO4 ). The selenium-containing alums are strong oxidizing agents, so they can be used as antiseptics, among other uses.

Aluminium Sulphate: This compound is also known as papermaker's alum. However, it is not technically an alum.

Uses of Alum

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Alum has several household and industrial uses. Potassium alum is used most often, although ammonium alum, ferric alum, and soda alum may be used for many of the same purposes. ➢ purification of drinking water as a chemical flocculant ➢ in styptic pencil to stop bleeding from minor cuts ➢ the adjuvant in vaccines ( a chemical that enhances the immune response) ➢ deodorant "rock" ➢ pickling agent to help keep pickles crisp ➢ flame retardant ➢ the acidic component of some types of baking powder ➢ an ingredient in some homemade and commercial modeling clay ➢ an ingredient in some depilatory (hair removal) waxes ➢ skin whitener ➢ ingredient in some brands of toothpaste

Culinary Uses: 1. It is used as a water purifier since it makes solid impurities settle at the bottom of the container. 2. Alum is used as the acidic component of some commercial baking powders. 3. Alum powder, found in the spice section of grocery stores, may be used in pickling recipes and as a preservative to maintain fruit and vegetable crispness. 4. It can also be used to curdle milk for recipes like "Milk Cake" where the milk, sugar and alum mixture is cooked till it thickens and resembles khoya. Use ¼ tsp alum for 2 litres full fat milk when preparing Milk Cake

Health Benefits: 1. Alum, in its various forms, is commonly used as an astringent and antiseptic. This is the main reason why it is used to inhibit body odour when used as natural deodorant. 2. The astringent and antiseptic properties in Potash Alum also help in reducing bleeding in minor abrasions and cuts, nosebleeds etc. 3. Alum in powder or crystal form, or in styptic pencils, is sometimes applied to cuts to prevent or treat infection. 4. Alum is used in vaccines as an adjuvant to enhance the body's response to immunogens. 5. Powdered alum is commonly cited as a home remedy for ulcers.

Aluminium hydroxide gel-uses Aluminium is a naturally occurring mineral. Aluminium hydroxide is an antacid. Aluminium hydroxide is used to treat heartburn, upset stomach, sour stomach, or acid indigestion. Aluminium hydroxide is also used to reduce phosphate levels in people with certain kidney conditions. Aluminium hydroxide may also be used for purposes not listed in this medication guide.

This medication is used to treat the symptoms of too much stomach acid such as stomach upset, heartburn, and acid indigestion. Aluminium hydroxide is an antacid that works quickly to lower the acid in the stomach. Liquid antacids usually work faster/better than tablets or capsules. This medication works only on existing acid in the stomach. It does not prevent acid production. It may be used alone or with other medications that lower acid production (including H2 blockers such as cimetidine/ranitidine and proton pump inhibitors such as omeprazole).

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How to use Aluminium Hydroxide Take this medication by mouth between meals and at bedtime. Follow all the directions on the product package or use as directed by your doctor. If you are uncertain about any of this information, consult your doctor or pharmacist.

Shake the bottle well before each dose. Refrigerating the suspension may improve the flavour. Do not freeze. This medication works best if taken without other fluids. You can mix your dose with a little water if needed.

This product contains aluminium, which may react with other medications (including digoxin, iron, tetracy clineantibiotics, pazopanib, quinolone antibiotics such as ciprofloxacin), preventing them from being fully absorbed by your body. Talk with your doctor or pharmacist about how to schedule your medications to prevent this problem.

If your acid problems persist or worsen after you have used this product for 1 week, or if you think you have a serious medical problem, seek immediate medical attention. If you are using this medication regularly on a daily basis for more than 2 weeks, you may have a medical problem that needs different treatment. Ask your doctor if this is the right medication for you.

Before taking this medicine Heartburn can mimic early symptoms of a heart attack. Get emergency medical help if you have chest pain that spreads to your jaw or shoulder and you feel anxious or light-headed. Ask a doctor or pharmacist if it is safe for you to take this medicine if you have: ➢ kidney disease, a history of kidney stones; ➢ severe constipation; ➢ if you are dehydrated; or ➢ if you drink alcohol frequently.

Aluminium hydroxide side effects Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using the medicine and call your doctor at once if you have: ➢ severe stomach pain or constipation, loss of appetite; ➢ pain when you urinate; ➢ muscle weakness, tiredness; ➢ extreme drowsiness; or ➢ bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds. ➢ Less serious side effects may be more likely, and you may have none at all.

Aluminium acetate-uses In the solid state, three salts exist under this name: 1. Neutral aluminium triacetate, Al(CH3CO2)3, which is formally called aluminium acetate under IUPAC rules, with CAS RN 139-12-8 2. Basic aluminium dictate, HOAl(CH3CO2)2, also known as basic aluminium acetate, and formally named hydroxyl aluminium dictate, with CAS RN 142-03-0 3. Basic aluminium mono acetate, (HO)2AlCH3CO2, also known as dibasic aluminium acetate and formally named dihydroxy aluminium acetate, with CAS RN 7360-44-3

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In aqueous solution, aluminium triacetate hydrolyses to form a mixture of the other two, and all solutions of all three can be referred to as "aluminium acetate" as the species formed co-exist and inter-convert in chemical equilibrium.

Aluminium acetate is a special topical preparation that contains the element aluminium. If you’ve ever had a rash, insect bite, or other skin irritation, you may have used aluminium acetate to reduce the itching and irritation. While it has several uses for topical skin irritation, aluminium acetate itself can sometimes cause allergic skin reactions. That’s why it’s important to know when it can be helpful and when to avoid using it and see a doctor.

Aluminium acetate is a salt that is used as a topical astringent. When applied to the skin, it helps to shrink the body tissues, which can have a protective effect on irritated and inflamed skin. It is sold as powder to mix with water or as topical gel. You don’t need a doctor’s prescription to use aluminium acetate solutions. The medication is available over-the-counter in most drugstores. You can buy it under names like aluminium acetate solution, Burow’s solution, Domeboro, or Star-Otic.

Aluminium acetate can be used to treat skin irritations from: ➢ poison ivy ➢ poison oak ➢ poison sumac ➢ substances such as soaps and cosmetics ➢ insect bites ➢ jewelry

It may also be helpful for foot problems, including athlete’s foot, swelling, and excessive sweating, and as treatment for ear canal infections.

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect: Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat. Very bad skin irritation.

Ferrous fumigate-uses Ferrous fumarate is a type of iron. You normally get iron from the foods you eat. iron becomes a part of your hemoglobin (HEEM o glo bin) and myoglobin (MY o glo bin). Hemoglobin carries oxygen through blood to tissues and organs. Myoglobin helps muscle cells store oxygen.

Ferrous fumarate is used to treat iron deficiency anemia (a lack of red blood cells caused by having too little iron in the body).This medication is an iron supplement used to treat or

Page 23 of 65 STUDY MATERIAL FOR B.SC CHEMISTRY CHEMISTRY IN MEDICINE SEMESTER - IV, ACADEMIC YEAR 2020-21 prevent low blood levels of iron (such as those caused by anemia or pregnancy). Iron is an important mineral that the body needs to produce red blood cells and keep you in good health.

You should not use ferrous fumarate if you are allergic to it, or if you have: ➢ iron overload syndrome; ➢ anemia (a lack of red blood cells); or ➢ thalassemia (a genetic disorder of red blood cells).

Ferrous Fumarate Side Effects Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have: ➢ bright red blood in your stools; or ➢ pain in your chest or throat when swallowing a ferrous fumarate tablet.

Common side effects may include: ➢ constipation, diarrhea; ➢ nausea, vomiting, heartburn; ➢ loss of appetite; or ➢ black or dark-colored stools or urine. To make sure ferrous fumarate is safe for you, tell your doctor if you have: ➢ liver or kidney disease; ➢ porphyria (a genetic enzyme disorder that causes symptoms affecting the skin or nervous system); ➢ if you are an alcoholic; or ➢ if you receive regular blood transfusions.

It is not known whether ferrous fumarate will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. Your dose needs may be different during pregnancy.

It is not known whether ferrous fumarate passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby. Do not give ferrous fumarate to a child without the advice of a doctor.

Ammonium ferric citrate It has the formula (NH4)5[Fe(C6H4O7)2]. A distinguishing feature of this compound is that it is very soluble in water, in contrast to ferric citrate which is not very soluble.

In its crystal structure each citric acid moiety has lost four protons. The deprotonated hydroxyl group and two of the carboxylate groups ligate to the ferric center, while the third carboxylate group coordinates with the ammonium

Ammonium ferric citrate has a range of uses, including: ➢ As a food additive, where it has the E number E381, and is used as an acidity regulator. Most notably used in the Scottish beverage Irn-Bru. ➢ Water purification. ➢ As a reducing agent of metal salts of low activity like gold and silver. ➢ With potassium ferricyanide as part of the cyanotype photographic process.

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➢ Used in Kligler iron deeps to determine hydrogen sulfide production in microbial metabolism. ➢ In medical imaging, ammonium ferric citrate is used as a contrast medium. ➢ As a hematinic

Ferric Ammonium Citrate is used in the treatment of: ➢ Anemia, Hypochromic ➢ Pregnancy Complications, Hematologic ➢ Ferric Ammonium Citrate is used in the prevention of: ➢ Anemia, Iron-Deficiency

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information

Ferrous gluconate-uses Ferrous gluconate is a type of iron. You normally get iron from the foods you eat. In your body, iron becomes a part of your hemoglobin (HEEM o glo bin) and myoglobin (MY o glo bin). Hemoglobin carries oxygen through your blood to tissues and organs. Myoglobin helps your muscle cells store oxygen. Ferrous gluconate is used to treat or prevent iron deficiency anemia (a lack of red blood cells caused by having too little iron in the body). Ferrous gluconate may also be used for purposes not listed in this medication guide.

You should not use ferrous gluconate if you are allergic to it, or if you have: ➢ iron overload disorder (hemochromatosis, hemosiderosis); or ➢ hemolyticanemia (caused by the breakdown of red blood cells). ➢ To make sure ferrous gluconate is safe for you, tell your doctor if you have ever had: ➢ ulcerative colitis; ➢ stomach ulcers or similar stomach problems; ➢ thalassemia (a genetic disorder of red blood cells); or ➢ if you receive regular blood transfusions.

Ferrous gluconate: Pronunciation: FER us GLOO koenate Brand: Ferate, Fergon What is the most important information I should know about ferrous gluconate? You should not use this medicine if you have hemochromatosis, hemosiderosis, or hemolyticanemia.

What is ferrous gluconate? Ferrous gluconate is a type of iron. You normally get iron from the foods you eat. In your body, iron becomes a part of your hemoglobin (HEEM o glo bin) and myoglobin (MY o glo bin). Hemoglobin carries oxygen through your blood to tissues and organs. Myoglobin helps your muscle cells store oxygen. Ferrous gluconate is used to treat or prevent iron deficiency anemia (a lack of red blood cells caused by having too little iron in the body). Ferrous gluconate may also be used for purposes not listed in this medication guide.

What should I discuss with my healthcare provider before taking ferrous gluconate?

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You should not use ferrous gluconate if you are allergic to it, or if you have: ➢ iron overload disorder (hemochromatosis, hemosiderosis); or ➢ hemolyticanemia (caused by the breakdown of red blood cells). ➢ To make sure ferrous gluconate is safe for you, tell your doctor if you have ever had: ➢ ulcerative colitis; ➢ stomach ulcers or similar stomach problems; ➢ thalassemia (a genetic disorder of red blood cells); or ➢ if you receive regular blood transfusions.

Ask a doctor before using this medicine if you are pregnant or breast-feeding: Your dose needs may be different during pregnancy or while you are nursing. Ferrous gluconate is not approved for use by anyone younger than 18 years old.

How should I take ferrous gluconate? Use this medication exactly as directed on the label, or as prescribed by your doctor. Do not use it in larger amounts or for longer than recommended. Take ferrous gluconate on an empty stomach, at least 1 hour before or 2 hours after a meal.

Ferrous gluconate may be taken with food if it upsets your stomach. Take this medicine with a full glass of water or juice. Measure liquid medicine with the dosing syringe provided, or with a special dose- measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one. Do not crush, chew, or break an extended-release tablet. Swallow the pill whole. Ferrous gluconate can stain your teeth, but this effect is temporary. To prevent tooth staining, mix the liquid form of ferrous gluconate with water or fruit juice (not with milk) and drink the mixture through a straw. You may also clean your teeth with baking soda once per week to treat any tooth staining.

Ferrous gluconate may be only part of a complete program of treatment that also includes a special diet. Follow the diet plan created for you by your doctor or nutrition counselor. Get familiar with the list of foods you should eat to make sure you get enough iron in your diet. Store at room temperature, away from moisture and heat

Biological importance of sodium In humans, sodium plays a key role in the regulation of blood volume, blood pressure, osmotic balance and maintains a constant pH. Renin–angiotensin system - hormone system that regulates blood pressure and fluid balance influences the amount of sodium in the body. Lowering blood pressure and serum sodium in the kidneys leads to the formation of renin. Renin is an enzyme that is known as angiotensin-converting-enzyme and mediates the regulation of extra cellular fluid volume (plasma, lymph, intestinal fluid), and arterial vasoconstriction. In this way, regulate blood pressure. Renin causes the production of aldosterone and angiotensin (hormones) that cause sodium excretion in the urine.

Increasing the concentration of sodium decreases renin formation and sodium returns to normal. Sodium is also essential for the functioning of neurons and osmoregulation between cells and the extracellular fluid. In humans, this process is regulated by the Na+/K+ pump.

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Human water and salt balance Although the system for maintaining optimal salt and water balance in the body is a complex one, one of the primary ways in which the human body keeps track of loss of body water is that osmoreceptors in the hypothalamus sense a balance of sodium and water concentration in extracellular fluids. Relative loss of body water will cause sodium concentration to rise higher than normal, a condition known as hypernatremia. This ordinarily results in thirst. Conversely, an excess of body water caused by drinking will result in too little sodium in the blood (hyponatremia), a condition which is again sensed by the hypothalamus, causing a decrease in vasopressin hormone secretion from the anterior pituitary, and a consequent loss of water in the urine, which acts to restore blood sodium concentrations to normal.

Urinary sodium Because the hypothalamus/osmoreceptor system ordinarily works well to cause drinking or urination to restore the body's sodium concentrations to normal, this system can be used in medical treatment to regulate the body's total fluid content, by first controlling the body's sodium content. Thus, when a powerful diuretic drug is given which causes the kidneys to excrete sodium, the effect is accompanied by an excretion of body water (water loss accompanies sodium loss). This happens because the kidney is unable to efficiently retain water while excreting large amounts of sodium. In addition, after sodium excretion, the osmoreceptor system may sense lowered sodium concentration in the blood and then direct compensatory urinary water loss in order to correct the hyponatremic (low blood sodium) state.

Potassium in biology Potassium is the main intracellularion for all types of cells, while having a major role in maintenance of fluid and electrolyte balance. Potassium is necessary for the function of all living cells, and is thus present in all plant and animal tissues. It is found in especially high concentrations within plant cells, and in a mixed diet, it is most highly concentrated in fruits. The high concentration of potassium in plants, associated with comparatively very low amounts of sodium there, historically resulted in potassium first being isolated from the ashes of plants (potash), which in turn gave the element its modern name. The high concentration of potassium in plants means that heavy crop production rapidly depletes soils of potassium, and agricultural fertilizers consume 93% of the potassium chemical production of the modern world economy.

The functions of potassium and sodium in living organisms are quite different. Animals, in particular, employ sodium and potassium differentially to generate electrical potentials in animal cells, especially in nervous tissue. Potassium depletion in animals, including humans, results in various neurological dysfunctions. Characteristic concentrations of potassium in model organisms are: 30-300mM in E. coli, 300mM in budding yeast, 100mM in mammalian cell and 4mM in blood plasma

The U.S. Institute of Medicine (IOM) sets Estimated Average Requirements (EARs) and Recommended Dietary Allowances (RDAs), or Adequate Intakes (AIs) for when there is not sufficient information to set EARs and RDAs. Collectively the EARs, RDAs, AIs and ULs are referred to as Dietary Reference Intakes. The current AI for potassium for women and men ages 14 and up is 4700 mg. AI for pregnancy equals 4700 mg/day. AI for lactation equals 5100 mg/day. For infants 0–6 months 400 mg, 6–12 months 700 mg, 1–13 years increasing

Page 27 of 65 STUDY MATERIAL FOR B.SC CHEMISTRY CHEMISTRY IN MEDICINE SEMESTER - IV, ACADEMIC YEAR 2020-21 from 3000 to 4500 mg/day. As for safety, the IOM also sets Tolerable upper intake levels (ULs) for vitamins and minerals, but for potassium the evidence was insufficient, so no UL established.

Food sources Eating a variety of foods that contain potassium is the best way to get an adequate amount. Foods with high sources of potassium include kiwifruit, orange juice, potatoes, bananas, coconut, avocados, apricots, parsnips and turnips, although many other fruits, vegetables, legumes, and meats contain potassium.

Common foods very high in potassium: ➢ beans (white beans and others), dark leafy greens (spinach, Swiss chard, and others), baked potatoes, dried fruit (apricots, peaches, prunes, raisins; figs and dates), baked squash, yogurt, fish (salmon), avocado, and banana; ➢ nuts (pistachios, almonds, walnuts, etc.) and seeds (squash, pumpkin, sunflower)

The most concentrated foods (per 100 grams) are:[25] ➢ dried herbs, sun dried tomatoes, dark chocolate, whey powder, paprika, yeast extract, rice bran, molasses, and dry roasted soybeans

Deficiency Hypokalemia: A severe shortage of potassium in body fluids may cause a potentially fatal condition known as hypokalemia. Hypokalemia typically results from loss of potassium through diarrhea, diuresis, or vomiting. Symptoms are related to alterations in membrane potential and cellular metabolism. Symptoms include muscle weakness and cramps, paralytic ileus, ECG abnormalities, intestinal paralysis, decreased reflex response and (in severe cases) respiratory paralysis, alkalosis and arrhythmia. In rare cases, habitual consumption of large amounts of black licorice has resulted in hypokalemia. Licorice contains a compound (Glycyrrhizin) that increases urinary excretion of potassium

Biological importance of calcium Calcium ions (Ca2+) contribute to the physiology and biochemistry of organismscell. They play an important role in signal transduction pathways, where they act as a second messenger, in neurotransmitter release from neurons, in contraction of all muscle cell types, and in fertilization. Many enzymes require calcium ions as a cofactor, including several of the coagulation factors. Extracellular calcium is also important for maintaining the potential difference across excitable cell membranes, as well as proper bone formation.

Plasma calcium levels in mammals are tightly regulated, with bone acting as the major mineral storage site. Calcium ions, Ca2+, are released from bone into the bloodstream under controlled conditions. Calcium is transported through the bloodstream as dissolved ions or bound to proteins such as serum albumin. Parathyroid hormone secreted by the parathyroid gland regulates the resorption of Ca2+ from bone, reabsorption in the kidney back into circulation, and increases in the activation of vitamin D3 to calcitriol. Calcitriol, the active form of vitamin D3, promotes absorption of calcium from the intestines and bones. Calcitonin secreted from the parafollicular cells of the thyroid gland also affects calcium levels by opposing parathyroid hormone; however, its physiological significance in humans is dubious.

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Intracellular calcium is stored in organelles which repetitively release and then re accumulate Ca2+ ions in response to specific cellular events: storage sites include mitochondria and the endoplasmic reticulum.[3]

Characteristic concentrations of calcium in model organisms are: in E. coli 3mM (bound), 100nM (free), in budding yeast 2mM (bound), in mammalian cell 10-100nM (free) and in blood plasma 2mM

Dietary recommendations concerns of long-term adverse side effects such as calcification of arteries and kidney stones, the IOM and EFSA both set Tolerable Upper Intake Levels (ULs) for the combination of dietary and supplemental calcium. From the IOM, people ages 9–18 years are not supposed to exceed 3,000 mg/day; for ages 19–50 not to exceed 2,500 mg/day; for ages 51 and older, not to exceed 2,000 mg/day. The EFSA set UL at 2,500 mg/day for adults but decided the information for children and adolescents was not sufficient to determine ULs

Health claims Although as a general rule, dietary supplement labeling and marketing are not allowed to make disease prevention or treatment claims, the FDA has for some foods and dietary supplements reviewed the science, concluded that there is significant scientific agreement, and published specifically worded allowed health claims. An initial ruling allowing a health claim for calcium dietary supplements and osteoporosis was later amended to include calcium and vitamin D supplements, effective January 1, 2010. In order to qualify for the calcium health claim, a dietary supplement much contain at least 20% of the Reference Dietary Intake, which for calcium means at least 260 mg/serving. ➢ "Adequate calcium throughout life, as part of a well-balanced diet, may reduce the risk of osteoporosis." ➢ "Adequate calcium as part of a healthful diet, along with physical activity, may reduce the risk of osteoporosis in later life." ➢ "Adequate calcium and vitamin D throughout life, as part of a well-balanced diet, may reduce the risk of osteoporosis." ➢ "Adequate calcium and vitamin D as part of a healthful diet, along with physical activity, may reduce the risk of osteoporosis in later life.

Measurement in blood The amount of calcium in blood (more specifically, in blood plasma) can be measured as total calcium, which includes both protein-bound and free calcium. In contrast, ionized calcium is a measure of free calcium. An abnormally high level of calcium in plasma is termed hypercalcemia and an abnormally low level is termed hypocalcemia, with "abnormal" generally referring to levels outside the reference range.

Biological importance of iodine Iodine is an essential trace element in biological systems. It has the distinction of being the heaviest element commonly needed by living organisms as well as the second-heaviest known to be used by any form of life (only tungsten, a component of a few bacterial enzymes, has a higher atomic number and atomic weight). It is a component of biochemical pathways in organisms from all biological kingdoms, suggesting its fundamental significance throughout the evolutionary history of life.

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Iodine is critical to the proper functioning of the vertebrate endocrine system, and plays smaller roles in numerous other organs, including those of the digestive and reproductive systems. An adequate intake of iodine-containing compounds is important at all stages of development, especially during the fetal and neonatal periods, and diets deficient in iodine can present serious consequences for growth and metabolism.

In vertebrate biology, iodine's primary function is as a constituent of the thyroidhormones, thyroxine (T4) and triiodothyronine (T3). These molecules are made from addition - condensation products of the amino acidtyrosine, and are stored prior to release in an iodine-containing protein called thyroglobulin. T4 and T3 contain four and three atoms of iodine per molecule, respectively; iodine accounts for 65% of the molecular weight of T4 and 59% of T3. The thyroid gland actively absorbs iodine from the blood to produce and release these hormones into the blood, actions which are regulated by a second hormone, called thyroid-stimulating hormone (TSH), which is produced by the pituitary gland. Thyroid hormones are phylogenetically very old molecules which are synthesized by most multicellularorganisms, and which even have some effect on unicellular organisms. Thyroid hormones play a fundamental role in biology, acting upon gene transcription mechanisms to regulate the basal metabolic rate. T3 acts on small intestine cells and adipocytes to increase carbohydrate absorption and fatty acid release, respectively. Deficiency of thyroid hormones can reduce basal metabolic rate up to 50%, while an excessive production of thyroid hormones can increase the basal metabolic rate by 100%. T4 acts largely as a precursor to T3, which is (with minor exceptions) the biologically active hormone.

Via the thyroid hormones, iodine has a nutritional relationship with selenium. A family of selenium-dependent enzymes called deiodinases converts T4 to T3 (the active hormone) by removing an iodine atom from the outer tyrosine ring. These enzymes also convert T4 to reverse T3 (rT3) by removing an inner ring iodine atom, and also convert T3 to 3,3'- Diiodothyronine (T2) by removing an inner ring atom. Both of the latter products are inactivated hormones which have essentially no biological effects and are quickly prepared for disposal. A family of non-selenium-dependent enzymes then further deiodinates the products of these reactions.

Selenium also plays a very important role in the production of glutathione, the body's most powerful antioxidant. During the production of the thyroid hormones, hydrogen peroxide is produced in large quantities, and therefore high iodine in the absence of selenium can destroy the thyroid gland (often described as a sore throat feeling); the peroxides are neutralized through the production of glutathione from selenium. In turn, an excess of selenium increases demand for iodine, and deficiency will result when a diet is high in selenium and low in iodine

Dietary recommendations The U.S. Institute of Medicine (IOM) updated Estimated Average Requirements (EARs) and Recommended Dietary Allowances (RDAs) for iodine in 2000. For people age 14 and up, the iodine RDA is 150 μg/day; the RDA for pregnant women is 220 μg/day and the RDA during lactation is 290 μg/day. For children 1–8 years, the RDA is 90 μg/day; for children 8–13 years, 130 μg/day. As a safety consideration, the IOM sets tolerable upper intake levels (ULs) for vitamins and minerals when evidence is sufficient. The UL for iodine for adults is 1,100 μg/day. This UL was assessed by analyzing the effect of supplementation on thyroid-stimulating

Page 30 of 65 STUDY MATERIAL FOR B.SC CHEMISTRY CHEMISTRY IN MEDICINE SEMESTER - IV, ACADEMIC YEAR 2020-21 hormone. Collectively, the EARs, RDAs, AIs and ULs are referred to as Dietary Reference Intakes (DRIs).

Deficiency Worldwide, iodine deficiency affects two billion people and is the leading preventable cause of mental retardation. Mental disability is a result which occurs primarily when babies or small children are rendered hypothyroidic by a lack of dietary iodine (new hypothyroidism in adults may cause temporary mental slowing, but not permanent damage).

In areas where there is little iodine in the diet, typically remote inland areas and semi- arid equatorial climates where no marine foods are eaten, iodine deficiency also gives rise to hypothyroidism, the most serious symptoms of which are epidemic goitre (swelling of the thyroid gland), extreme fatigue, mental slowing, depression, weight gain, and low basal body temperatures.

The addition of iodine to table salt (so-called iodized salt) has largely eliminated the most severe consequences of iodine deficiency in wealthier nations, but deficiency remains a serious public health problem in the developing world. Iodine deficiency is also a problem in certain areas of Europe; in Germany, an estimated one billion dollars in healthcare costs is spent each year in combating and treating iodine deficiency.

Hypersensitivity reactions to iodine-containing compounds Some people develop a hypersensitivity to compounds of iodine but there are no known cases of people being directly allergic to elemental iodine itself.[50] Notable sensitivity reactions that have been observed in humans include: ➢ The application of tincture of iodine may cause a rash. ➢ Some cases of reaction to povidone-iodine (Betadine) have been documented to be a chemical burn. ➢ Eating iodine-containing foods, especially seafood products such as shellfish, may cause hives.

Medical use of iodine compounds (i.e. as a contrast agent) can cause anaphylactic shock in highly sensitive patients, presumably due to sensitivity to the chemical carrier. Cases of sensitivity to iodine compounds should not be formally classified as iodine allergies, as this perpetuates the erroneous belief that it is the iodine to which patients react, rather than to the specific allergen. Sensitivity to iodine-containing compounds is rare but has a considerable effect given the extremely widespread use of iodine-based contrast media

Biological importance of copper Copper is an important component of many enzymes in the body and play an important role in cell energy production. Activity of these enzymes is highest in the heart, brain, liver and kidney.

In addition, enzymes that are responsible for connective tissue proteins formation (collagen and elastin) require copper. Copper is necessary for the development and maintenance of blood vessels, skin, bones and joints. It helps in preserving cells of the nervous system. Also has a beneficial effect on osteoporosis.

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Copper is involved in the release of iron from their depot, the creation of bone marrow and maturation of red blood cells.

Copper is essential for the synthesis of phospholipids of cell membranes and thus maintain myelin that separates the nerve cell from the environment and regulates the levels of the neuro transmitters.

Copper is a component of the enzyme copper-zinc superoxide dismutase (Cu / Zn SOD), which serves as an antioxidant essential to preserve the body from damage caused by free radicals. Matching the copper and zinc is important for the normal functioning of the body.

Copper is very important in creating the immune response to infection. During the inflammatory process or infection, the mobilization of the two compounds in their structure include ion copper superoxide dismutase and ceruloplasmin. Copper is also necessary for the maturation and function of T cells.

It also plays an important role in the contraction of the heart muscle, as well as in the healthy functioning of small blood vessels that control blood flow, nutrients and waste products. It affects the normal functioning of muscles and blood vessels involved in the lining of blood vessels.

Melanin (natural pigment located in the hair and skin) includes enzymes that contain copper. Enzyme histaminase that metabolizes the amino acid histamine, requires copper for its functioning. Copper is also involved in the metabolism of fat and cholesterol, as well as the normal functioning of insulin (which regulates the metabolism of sugar). Is involved in the synthesis of prostaglandins (substances that regulate many functions such as heart rate, blood pressure and wound healing)

Essentiality Copper is an essential trace element (i.e., micronutrient) that is required for plant, animal, and human health. It is also required for the normal functioning of aerobic (oxygen- requiring) microorganisms.

Copper is incorporated into a variety of proteins and metalloenzymes which perform essential metabolic functions; the micronutrient is necessary for the proper growth, development, and maintenance of bone, connective tissue, brain, heart, and many other body organs. Copper is involved in the formation of red blood cells, the absorption and utilization of iron, the metabolism of cholesterol and glucose, and the synthesis and release of life-sustaining proteins and enzymes. These enzymes in turn produce cellular energy and regulate nerve transmission, blood clotting, and oxygen transport.

Copper stimulates the immune system to fight infections, to repair injured tissues, and to promote healing. Copper also helps to neutralize "free-radicals", which can cause severe damage to cells.

Copper's essentiality was first discovered in 1928, when it was demonstrated that rats fed a copper-deficient milk diet were unable to produce sufficient red blood cells

Fetuses, infants, and children

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Copper is essential for the normal growth and development of human fetuses, infants, and children. The human fetus accumulates copper rapidly in its liver during the third trimester of pregnancy. At birth, a healthy infant has four times the concentration of copper than a full- grown adult. Human milk is relatively low in copper, and the neonate's liver stores falls rapidly after birth, supplying copper to the fast-growing body during the breast feeding period. These supplies are necessary to carry out such metabolic functions as cellular respiration, melanin pigment and connective tissue synthesis, iron metabolism, free radical defense, gene expression, and the normal functioning of the heart and immune systems in infants.

Infants have special biochemical mechanisms for adequately managing copper in their bodies while permanent lifelong mechanisms develop and mature.

Severe deficiency of copper in pregnant mothers increases the risk of health problems in their fetuses and infants. Health effects noted include low birth weights, muscle weaknesses, and neurologic problems. However, copper deficiencies in pregnant women can be avoided with a balanced diet.

Since copper availability in the body is hindered by an excess of iron and zinc intake, pregnant women prescribed iron supplements to treat anemia or zinc supplements to treat colds should consult physicians to be sure that the prenatal supplements they may be taking also have nutritionally-significant amounts of copper.

Homeostasis Copper is absorbed, transported, distributed, stored, and excreted in the body according to complex homeostatic processes which ensure a constant and sufficient supply of the micronutrient while simultaneously avoiding excess levels. If an insufficient amount of copper is ingested for a short period of time, copper stores in the liver will be depleted. Should this depletion continue, a copper health deficiency condition may develop. If too much copper is ingested, an excess condition can result. Both of these conditions, deficiency and excess, can lead to tissue injury and disease. However, due to homeostatic regulation, the human body is capable of balancing a wide range of copper intakes for the needs of healthy individuals.Many aspects of copper homeostasis are known at the molecular level

Supplementation Copper supplements can prevent copper deficiency, but supplements should be taken only under a doctor's supervision. Different forms of copper supplementation have different absorption rates. For example, the absorption of copper from cupric oxide supplements is lower than that from copper gluconate, sulfate, or carbonate.

Supplementation is generally not recommended for healthy adults who consume a well- balanced diet which includes a wide range of foods. However, supplementation under the care of a physician may be necessary for premature infants or those with low birth weights, infants fed unfortified formula or cow's milk during the first year of life, and malnourished young children.

Copper deficiency There are conflicting reports on the extent of deficiency in the U.S. One review indicates approximately 25% of adolescents, adults, and people over 65, do not meet the Recommended Dietary Allowance for copper. Another source states less common: a federal survey of food

Page 33 of 65 STUDY MATERIAL FOR B.SC CHEMISTRY CHEMISTRY IN MEDICINE SEMESTER - IV, ACADEMIC YEAR 2020-21 consumption determined that for women and men over the age of 19, average consumption from foods and beverages was 1.11 and 1.54 mg/day, respectively. For women, 10% consumed less than the Estimated Average Requirement, for men fewer than 3%. Other conditions linked to copper deficiency include osteoporosis, osteoarthritis, rheumatoid arthritis, cardiovascular disease, colon cancer, and chronic conditions involving bone, connective tissue, heart and blood vessels. nervous system and immune system.

Populations susceptible to copper deficiency include those with genetic defects for Menkes disease, low-birth-weight infants, infants fed cow's milk instead of breast milk or fortified formula, pregnant and lactating mothers, patients receiving total parenteral nutrition, individuals with "malabsorption syndrome" (impaired dietary absorption), diabetics, individuals with chronic diseases that result in low food intake, such as alcoholics, and persons with eating disorders.

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UNIT - III CAUSES AND TREATMENT OF SOME COMMON DISEASES

Insect borne diseases Insect-borne diseases are viral and bacterial illnesses from insect (bug) bites. The most common insects that pass on disease are mosquitoes, sand flies, ticks, and fleas. For example, mosquitoes are known for spreading the Zika virus, Yellow Fever, and Malaria. Ticks are known to spread Lyme disease.

Symptoms of insect-borne diseases Symptoms vary depending upon the type of insect that has bitten you. Common symptoms of insect borne diseases can include: ➢ fever ➢ chills ➢ headache ➢ sore muscles ➢ skin rash ➢ nausea ➢ Stomach pain

More serious symptoms can include: ➢ difficulty breathing ➢ the feeling that your throat is closing ➢ swelling of your lips, tongue, or face ➢ chest pain ➢ a racing heartbeat that lasts more than a few minutes ➢ dizziness ➢ vomiting

What causes insect-borne diseases? The diseases are caused by blood-sucking insects that infect humans or animals when they bite. You increase your risk of being infected by an insect when you are in areas where they gather. This would include tall grass, bushes, spots near still water (ponds), and places around the globe with heavy outbreaks.

How are insect-borne diseases diagnosed? Your doctor can typically diagnose an insect-borne disease with a physical exam, a review of your symptoms, and a look at your recent travel destinations. Lab tests (blood and urine) can diagnose certain insect-borne diseases.

Known Insect-Borne Disease ➢ Dengue Fever ➢ Leishmaniasis ➢ Lyme Disease ➢ Malaria ➢ Rocky Mountain Spotted Fever ➢ West Nile Virus ➢ Yellow Fever

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Malaria is a mosquito-borne infectious disease that affects humans and other animals. Malaria causes symptoms that typically include fever, tiredness, vomiting, and headaches. In severe cases it can cause yellow skin, seizures, coma, or death. Symptoms usually begin ten to fifteen days after being bitten by an infected mosquito. If not properly treated, people may have recurrences of the disease months later. In those who have recently survived an infection, reinfection usually causes milder symptoms. This partial resistance disappears over months to years if the person has no continuing exposure to malaria.

It is caused by single-celled microorganisms of the Plasmodium group. The disease is most commonly spread by an infected female Anopheles mosquito. The mosquito bite introduces the parasites from the mosquito's saliva into a person's blood. The parasites travel to the liver where they mature and reproduce. Five species of Plasmodium can infect and be spread by humans. Most deaths are caused by P. falciparum because P. vivax, P. ovale, and P. malariae generally cause a milder form of malaria. The species P. knowlesi rarely causes disease in humans. Malaria is typically diagnosed by the microscopic examination of blood using blood films, or with antigen-basedrapid diagnostic tests. Methods that use the polymerase chain reaction to detect the parasite's DNA have been developed, but are not widely used in areas where malaria is common due to their cost and complexity.

The risk of disease can be reduced by preventing mosquito bites through the use of mosquito nets and insect repellents, or with mosquito control measures such as spraying insecticides and draining standing water.

Signs and symptoms

Main symptoms of malaria The signs and symptoms of malaria typically begin 8–25 days following infection, but may occur later in those who have taken antimalarial medications as prevention. Initial manifestations of the disease—common to all malaria species—are similar to flu-like symptoms, and can resemble other conditions such as sepsis, gastroenteritis, and viral diseases. The presentation may include headache, fever, shivering, joint pain, vomiting, hemolyticanemia, jaundice, hemoglobin in the urine, retinal damage, and convulsions.

The classic symptom of malaria is paroxysm—a cyclical occurrence of sudden coldness followed by shivering and then fever and sweating, occurring every two days (tertian fever) in P. vivax and P. ovale infections, and every three days (quartan fever) for P. malariae.

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P. falciparum infection can cause recurrent fever every 36–48 hours, or a less pronounced and almost continuous fever. Although it kills nearly one million people every year, malaria is preventable and curable.

Some of the main methods of prevention are: ➢ Insecticide-treated bed nets. Most malaria-carrying mosquitoes bite at night, so insecticide-treated mosquito nets can be a life-saving barrier. It is important that nets are easy to get hold of – either offered at a subsidised price or given away for free – and that they are designed in a way that is suitable for the local context. Awareness campaigns are also important to make sure that they are used effectively. ➢ Treating women during pregnancy. Pregnant women have lower immunity. Doses of anti-malarials during pregnancy can protect both mother and child. ➢ Health education. An important part of preventing malaria and malaria deaths is improving people’s understanding of the disease. This includes how to use nets properly to avoid being bitten, awareness of the symptoms, how to get treatment, the importance of getting treatment quickly (particularly for children), and the need to finish a full course of drugs and not stop when you feel better. ➢ Environmental methods. Getting rid of pools of stagnant water, clearing bushes from around houses and planting lemon grass can all reduce the number of mosquitoes nearby.

How is malaria treated? There are a number of effective drugs available to treat malaria but speedy diagnosis and immediate treatment are essential. The majority of deaths from severe malaria in children are caused by not getting to a clinic in time. Some forms of malaria can be fatal within days or even hours once they develop, but malaria can usually be cured if treated quickly. Those who survive may still suffer lasting health problems.

For people living in remote areas with little or no access to health services, more mobile staff and health outposts would reduce the time between diagnosis and treatment, and save lives.

How big a problem is drug resistance? Resistance to the cheapest and most widely used anti-malarial drug, chloroquine, is now common across Africa. New treatments have been developed but they come at a high cost. An adult dose of a newer drug may be 10 to 20 times more expensive than older anti-malarials.

One reason for the rise of drug resistance is that people do not finish their course of treatment but stop when they start to feel better. Poorly trained pharmacists and store owners may also allow patients to buy just a portion of a course of drugs, as that is all they can afford, which contributes to dangerous drug resistance.

What is the cost of treatment? Cost varies enormously, but in many of the countries most affected, the cost of treatment is unmanageable for poor and marginalised communities. In Sierra Leone, for example, the cost of treating a child with malaria has been estimated as the equivalent of half a month’s average salary.

Filariasis

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Filariasis is a parasitic disease caused by an infection with roundworms of the Filarioidea type. These are spread by blood-feeding insects such as black flies and mosquitoes. They belong to the group of diseases called helminthiases.

Eight known filarial worms have humans as definitive hosts These are divided into three groups according to the part of the body the effect: ➢ Lymphatic filariasis is caused by the worms Wuchereriabancrofti, Brugiamalayi, and Brugiatimori. These worms occupy the lymphatic system, including the lymph nodes; in chronic cases, these worms lead to the syndrome of elephantiasis. ➢ Subcutaneous filariasis is caused by Loa loa (the eye worm), Mansonellastreptocerca, and Onchocerca volvulus. These worms occupy the layer just under the skin. L. loa causes Loa loafilariasis, while O. volvulus causes river blindness. ➢ Serous cavity filariasis is caused by the worms Mansonellaperstans and Mansonellaozzardi, which occupy the serous cavity of the abdomen. Dirofilariaimmitis, the dog heartworm, rarely infects humans.

The adult worms, which usually stay in one tissue, release early larval forms known as microfilariae into the person's blood. These circulating microfilariae can be taken up during a blood meal by an insect vector; in the vector, they develop into infective larvae that can be spread to another person.

Individuals infected by filarial worms may be described as either "microfilaraemic" or "amicrofilaraemic", depending on whether microfilariae can be found in their peripheral blood. Filariasis is diagnosed in microfilaraemic cases primarily through direct observation of microfilariae in the peripheral blood. Occult filariasis is diagnosed in amicrofilaraemic cases based on clinical observations and, in some cases, by finding a circulating antigen in the blood.

Signs and symptoms The most spectacular symptom of lymphatic filariasis is elephantiasis – edema with thickening of the skin and underlying tissues—which was the first disease discovered to be transmitted by mosquito bites. Elephantiasis results when the parasites lodge in the lymphatic system.

Elephantiasis affects mainly the lower extremities, while the ears, mucous membranes, and amputation stumps are affected less frequently. However, different species of filarial worms tend to affect different parts of the body; Wuchereriabancrofti can affect the legs, arms, vulva, breasts, and scrotum (causing hydrocele formation), while Brugiatimori rarely affects the genitals. Those who develop the chronic stages of elephantiasis are usually free from microfilariae (amicrofilaraemic), and often have adverse immunological reactions to the microfilariae, as well as the adult worms. The subcutaneous worms present with rashes, urticarial papules, and arthritis, as well as hyper- and hypopigmentation macules. Onchocerca volvulus manifests itself in the eyes, causing "river blindness" (onchocerciasis), one of the leading causes of blindness in the world. Serous cavity filariasis presents with symptoms similar to subcutaneous filariasis, in addition to abdominal pain, because these worms are also deep-tissue dwellers.

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TREATMENT The approach to treatment of lymphatic filariasis requires an understanding of antimicrobial agent mechanisms as well as attention to the possibility of coinfection. The clinical approach is described below, followed by a discussion of data related to individual antimicrobial agents.

Clinical approach: The treatment of choice for lymphatic filariasis is diethylcarbamazine (DEC), although this agent is contraindicated in patients coinfected with onchocerciasis and must be used with caution in patients with loiasis, since severe adverse events can occur in individuals with high microfilarial loads.

Prevention & Control The best way to prevent lymphatic filariasis is to avoid mosquito bites. The mosquitoes that carry the microscopic worms usually bite between the hours of dusk and dawn . If you live in an area with lymphatic filariasis: ➢ At night Sleep in an air-conditioned room or Sleep under a mosquito net ➢ Between dusk and dawn Wear long sleeves and trousers and Use mosquito repellent on exposed skin.

Another approach to prevention includes giving entire communities medicine that kills the microscopic worms — and controlling mosquitoes. Annual mass treatment reduces the level of microfilariae in the blood and thus, diminishes transmission of infection. This is the basis of the Global Programme to Eliminate Lymphatic Filariasis.

Experts consider that lymphatic filariasis, a neglected tropical disease (NTD), can be eliminated globally and a global campaign to eliminate lymphatic filariasis as a public health problem is under way. The elimination strategy is based on annual treatment of whole communities with combinations of drugs that kill the microfilariae. As a result of the generous contributions of these drugs by the companies that make them, hundreds of millions of people are being treated each year . Since these drugs also reduce levels of infection with intestinal worms, benefits of treatment extend beyond lymphatic filariasis. Successful campaigns to eliminate lymphatic filariasis have taken place in China and other countries.

Air borne diseases You can catch some diseases simply by breathing. These are called airborne diseases.

Airborne disease can spread when people with certain infections cough, sneeze, or talk, spewing nasal and throat secretions into the air. Some viruses or bacteria take flight and hang in the air or land on other people or surfaces.

When you breathe in airborne pathogenic organisms, they take up residence inside you. You can also pick up germs when you touch a surface that harbors them, and then touch your own eyes, nose, or mouth.

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Because these diseases travel in the air, they’re hard to control. Keep reading to learn more about the common types of airborne diseases and what you can do to protect yourself from catching them.

The common cold Millions Trusted Source of cases of the common cold occur each year in the United States. Most adults get two or three colds a year. Children tend to get them more frequently.

The common cold is the top reason for absences at school and work. There are many viruses that can cause a cold, but it’s usually a rhinovirus.

Influenza Most of us have some experience with the flu. It spreads so easily because it’s contagious about a day before you notice the first symptoms. It remains contagious for another 5 to 7 days. If you have a weakened immune system for any reason, you can spread it to others longer than that.

There are many strains of the flu, and they are constantly changing. That makes it difficult for your body to develop immunities.

Chickenpox Chickenpox is caused by the varicella-zoster virus. If you have chickenpox, you can spread it for a day or two before you get the telltale rash. It takes up to 21 days after exposure for the disease to develop.

Most people get chickenpox only once, and then the virus goes dormant. Should the virus reactivate later in life, you get a painful skin condition called shingles.

If you haven’t had chickenpox, you can contract it from someone with shingles.

Mumps Mumps is another very contagious viral disease. You can spread it before symptoms appear and for up to 5 days after. Mumps used to be quite common in the United States, but rates have declined by 99 percent Trusted Source due to vaccination.

From January 1 to January 25, 2020, 70 cases in the United States were reported to the CDC. Outbreaks tend to occur in densely populated environments.

Measles Measles is a very contagious disease, particularly in crowded conditions. The virus that causes measles can remain active in the air or on surfaces for up to 2 hours. You’re able to transmit it to others up to 4 days before and 4 days after the measles rash appears. Most people get the measles only once. Measles is a leading cause of death among children worldwide and was responsible for 140,000 deaths Trusted Source in 2018. It’s estimated that the measles vaccine prevented around 23 million deaths from 2000 to 2018.

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The disease is less common in the United States and occurs mostly in people who haven’t been vaccinated. There were 1,282 cases Trusted Source reported in 2019. As of March 2, 2020, there have been 12 confirmed cases in 2020.

Whooping cough (pertussis) This respiratory illness causes swelling of the airways that results in a persistent hacking cough. It’s at the height of contagiousness for about 2 weeks after the coughing starts.

Worldwide, there are about 24.1 million Trusted Source cases of whooping cough every year, resulting in 160,700 deaths.

In 2018Trusted Source, there were 15,609 reported cases in the United States.

Tuberculosis (TB) TB, also known as consumption, is an airborne disease. This is a bacterial infection that doesn’t spread easily. You generally have to be in close contact with a person who has it for a long time.

You can contract TB without becoming ill or transmitting it to others.

About 1.4 billion people worldwide have TB. Most aren’t sick. About 10 million people worldwide have active TB.

People with a weakened immune system have the greatest risk of developing the disease. Symptoms can appear within days of exposure. For some, it takes months or years to activate.

When the disease is active, bacteria rapidly multiply and attack the lungs. It can spread through your bloodstream and lymph nodes to other organs, bones, or skin.

Diphtheria Once a major cause of sickness and death in children, diphtheria is now rare in the United States. Due to widespread vaccination, fewer than five cases have been reported in the past decade. Worldwide, there were about 7,100 cases Trusted Source of diphtheria in 2016, but it may be underreported. The disease injures your respiratory system and can damage your heart, kidneys, and nerves.

Symptoms Airborne diseases usually result in one or more of the following symptoms: ➢ inflammation of your nose, throat, sinuses, or lungs ➢ coughing ➢ sneezing ➢ congestion ➢ runny nose ➢ sore throat ➢ swollen glands ➢ headache

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➢ body aches ➢ loss of appetite ➢ fever ➢ fatigue

Chickenpox causes an itchy rash that usually starts on your chest, face, and back before spreading over the rest of your body. Within a few days, fluid-filled blisters form. The blisters burst and scab over in about a week.

The measles rash can take as long as 7 to 18 days to appear after you’ve been exposed. It generally starts on your face and neck, and then spreads over the course of a few days. It fades within a week. Serious complications of measles include: ➢ ear infections ➢ diarrhea ➢ dehydration ➢ severe respiratory infection ➢ blindness ➢ swelling of the brain, or encephalitis

Whooping cough gets its name from its main symptom, a severe hacking cough, which is usually followed by a forceful intake of air.

Symptoms of TB vary depending on which organs or body systems are affected and may include coughing up sputum or blood.

Diphtheria can cause marked swelling in your neck. This can make it difficult to breathe and swallow.

Complications from airborne diseases are more likely to affect the very young, the very old, and people with a compromised immune system.

Treatment for common airborne diseases For most airborne diseases, you’ll need plenty of rest and fluids. Further treatment depends on your specific illness.

Some airborne diseases, such as chickenpox, have no targeted treatment. However, medications and other supportive care can help relieve symptoms.

Some, such as the flu, can be treated with antiviral drugs. Treatment for infants with whooping cough can include antibiotics, and hospitalization is often needed.

There are drugs to treat and cure TB, although some strains of TB are drug resistant. Failure to complete the course of medicine can lead to drug resistance and return of symptoms.

If caught early enough, diphtheria can be successfully treated with antitoxins and antibiotics.

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What you can do to prevent spreading an airborne disease Although it’s impossible to completely avoid airborne pathogens, there are some things you can do to lower your chances of getting sick: ➢ Avoid close contact with people who have active symptoms of disease. ➢ Stay home when you’re sick. Don’t let vulnerable people come in close contact with you. ➢ If you must be around others, wear a face mask to prevent spreading or breathing in germs. ➢ Cover your mouth when you cough or sneeze. Use a tissue or your elbow to cut down on the possibility of transmitting germs on your hands. ➢ Wash your hands thoroughly (at least 20 seconds) and often, especially after sneezing or coughing. ➢ Avoid touching your face or other people with unwashed hands.

Vaccines can reduce your chances of getting some airborne diseases. Vaccines also lower the risk for others in the community.

Airborne diseases that have vaccines include: ➢ chickenpox ➢ diphtheria ➢ influenza: vaccine updated every year to include strains most likely to spread in the coming season ➢ measles: usually combined with vaccine for mumps and rubella, and is known as the MMR vaccine ➢ mumps: MMR vaccine ➢ TB: not generally recommended in the United States ➢ whooping cough

In developing countries, mass immunization campaigns are helping to lower the transmission rates of some of these airborne diseases.

Cholera Cholera is an infection of the small intestine by some strains of the bacteriumVibrio cholerae. Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhea that lasts a few days. Vomiting and muscle cramps may also occur.Diarrhea can be so severe that it leads within hours to severe dehydration and electrolyte imbalance. This may result in sunken eyes, cold skin, decreased skin elasticity, and wrinkling of the hands and feet. Dehydration can cause the skin to turn bluish.[8] Symptoms start two hours to five days after exposure.

Cholera is caused by a number of types of Vibrio cholerae, with some types producing more severe disease than others. It is spread mostly by unsafe water and unsafe food that has been contaminated with human feces containing the bacteria.Undercooked seafood is a common source.Humans are the only animal affected.Risk factors for the disease include poor sanitation, not enough clean drinking water, and poverty. There are concerns that rising sea levels will increase rates of disease. Cholera can be diagnosed by a stool test. A rapid dipstick test is available but is not as accurate.

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Cholera Symptoms Symptoms of cholera can begin as soon as a few hours or as long as five days after infection. Often, symptoms are mild. But sometimes they are very serious. About one in 20 people infected have severe watery diarrhea accompanied by vomiting, which can quickly lead to dehydration. Although many infected people may have minimal or no symptoms, they can still contribute to spread of the infection.

Signs and symptoms of dehydration include: ➢ Rapid heart rate ➢ Loss of skin elasticity (the ability to return to original position quickly if pinched) ➢ Dry mucous membranes, including the inside of the mouth, throat, nose, and eyelids ➢ Low blood pressure ➢ Thirst ➢ Muscle cramps If not treated, dehydration can lead to shock and death in a matter of hours.

Cholera Treatment and Prevention There is a vaccine for cholera. Both the CDC and the World Health Organization have specific guidelines for who should be given this vaccine. You can protect yourself and your family by using only water that has been boiled, water that has been chemically disinfected or bottled water. Be sure to use bottled, boiled, or chemically disinfected water for the following purposes ➢ Drinking ➢ Preparing food or drinks ➢ Making ice ➢ Brushing your teeth ➢ Washing your face and hands ➢ Washing dishes and utensils that you use to eat or prepare food ➢ Washing fruits and vegetables

To disinfect your own water, boil it for one minute (or 3 minutes at higher elevations) or filter it and use a commercial chemical disinfectant. You should also avoid raw foods, including the following: ➢ Unpeeled fruits and vegetables ➢ Unpasteurized milk and milk products ➢ Raw or undercooked meat or shellfish ➢ Fish caught in tropical reefs, which may be contaminated

If you develop severe, watery diarrhea and vomiting -- particularly after eating raw shellfish or traveling to a country where cholera is epidemic -- seek medical help immediately. Cholera is highly treatable, but because dehydration can happen quickly, it's important to get cholera treatment right away.

Hydration is the mainstay of treatment for cholera. Depending on how severe the diarrhea is, treatment will consist of oral or intravenous solutions to replace lost fluids. Antibiotics, which kill the bacteria, are not part of emergency treatment for mild cases. But they can reduce the duration of diarrhea by half and also reduce the excretion of the bacteria, thus helping to prevent the spread of the disease.

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Treatment Anyone who has been in a high-risk region within the previous 5 days and develops severe vomiting and diarrhoea should seek urgent medical assessment. Although cholera can be life-threatening, it is easily treated by immediate rehydration, that is, replacement of the fluid and salts lost through diarrhoea. Oral rehydration fluid is recommended. This can be obtained from pharmacies. Patients with severe dehydration or who are unable to keep oral fluids down require hospitalisation and intravenous fluid replacement. Antibiotics shorten the duration of the illness and lessen the severity, but they are not as important as rehydration.

Typhoid fever Typhoid fever, also known simply as typhoid, is a bacterial infection due to a specific type of Salmonella that causes symptoms. Symptoms may vary from mild to severe, and usually begin 6 to 30 days after exposure. Often there is a gradual onset of a high fever over several days. This is commonly accompanied by weakness, abdominal pain, constipation, headaches, and mild vomiting. Some people develop a skin rash with rose colored spots. In severe cases, people may experience confusion. Without treatment, symptoms may last weeks or months. Diarrhea is uncommon. Other people may carry the bacterium without being affected; however, they are still able to spread the disease to others. Typhoid fever is a type of enteric fever, along with paratyphoid fever.

The cause f typhoid is the bacterium Salmonella enterica subsp. entericaserovarTyphi growing in the intestines and blood. Typhoid is spread by eating or drinking food or water contaminated with the feces of an infected person. Risk factors include poor sanitation and poor hygiene. Those who travel in the developing world are also at risk. Only humans can be infected. Symptoms are similar to those of many other infectious diseases. Diagnosis is by either culturing the bacteria or detecting their DNA in the blood, stool, or bone marrow. Culturing the bacterium can be difficult. Bone-marrow testing is the most accurate.

Signs and symptoms Classically, the progression of untreated typhoid fever is divided into four distinct stages, each lasting about a week. Over the course of these stages, the patient becomes exhausted and emaciated. In the first week, the body temperature rises slowly, and fever fluctuations are seen with relative bradycardia (Faget sign), malaise, headache, and cough. A bloody nose (epistaxis) is seen in a quarter of cases, and abdominal pain is also possible. A decrease in the number of circulating white blood cells (leukopenia) occurs with eosinopenia and relative lymphocytosis; blood cultures are positive for Salmonella enterica subsp. entericaserovarTyphi. The Widal test is usually negative in the first week.

In the second week, the person is often too tired to get up, with high fever in plateau around 40 °C (104 °F) and bradycardia (sphygmothermic dissociation or Faget sign), classically with a dicrotic pulse wave. Delirium can occur, where the patient is often calm, but sometimes becomes agitated. This delirium has led to typhoid receiving the nickname "nervous fever". Rose spots appear on the lower chest and abdomen in around a third of patients. Rhonchi (rattling breathing sounds) are heard in the base of the lungs. The abdomen is distended and painful in the right lower quadrant, where a rumbling sound can be heard. Diarrhea can occur in this stage, but constipation is also common. The spleen and liver are enlarged

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(hepatosplenomegaly) and tender, and liver transaminases are elevated. The Widal test is strongly positive, with antiO and antiH antibodies. Blood cultures are sometimes still positive at this stage. The major symptom of this fever is that it usually rises in the afternoon up to the first and second week.

In the third week of typhoid fever, a number of complications can occur: ➢ Intestinal haemorrhage due to bleeding in congested Peyer's patches occurs; this can be very serious, but is usually not fatal. ➢ Intestinal perforation in the distal ileum is a very serious complication and is frequently fatal. It may occur without alarming symptoms until septicaemia or diffuse peritonitis sets in. ➢ Encephalitis ➢ Respiratory diseases such as pneumonia and acute bronchitis ➢ Neuropsychiatric symptoms (described as "muttering delirium" or "coma vigil"), with picking at bedclothes or imaginary objects ➢ Metastatic abscesses, cholecystitis, endocarditis, and osteitis ➢ The fever is still very high and oscillates very little over 24 hours. Dehydration ensues, and the patient is delirious (typhoid state). One-third of affected individuals develop a macular rash on the trunk. ➢ Platelet count goes down slowly and the risk of bleeding rises. ➢ By the end of third week, the fever starts subsiding

Vaccination Two typhoid vaccines are licensed for use for the prevention of typhoid: the live, oral Ty21a vaccine (sold as Vivotif by Crucell Switzerland AG) and the injectable typhoid polysaccharide vaccine (sold as Typhim Vi by Sanofi Pasteur and Typherix by GlaxoSmithKline). Both are efficacious and recommended for travellers to areas where typhoid is endemic. Boosters are recommended every five years for the oral vaccine and every two years for the injectable form. An older, killed whole-cell vaccine is still used in countries where the newer preparations are not available, but this vaccine is no longer recommended for use because it has a higher rate of side effects (mainly pain and inflammation at the site of the injection).

To help decrease rates of typhoid fever in developing nations, the World Health Organization (WHO) endorsed the use of a vaccination program starting in 1999. Vaccinations have proven to be a great way at controlling outbreaks in high incidence areas. Just as important, it is also very cost-effective. Vaccination prices are normally low, less than US$1 per dose. Because the price is low, poverty-stricken communities are more willing to take advantage of the vaccinations. Although vaccination programs for typhoid have proven to be effective, they alone cannot eliminate typhoid fever. Combining the use of vaccines with increasing public health efforts is the only proven way to control this disease.

Antibiotics Where resistance is uncommon, the treatment of choice is a fluoroquinolone such as ciprofloxacin. Otherwise, a third-generation cephalosporin such as ceftriaxone or cefotaxime is the first choice. Cefixime is a suitable oral alternative.

Typhoid fever, when properly treated, is not fatal in most cases. Antibiotics, such as ampicillin, chloramphenicol, trimethoprim - sulfamethoxazole, amoxicillin, and ciprofloxacin,

Page 46 of 65 STUDY MATERIAL FOR B.SC CHEMISTRY CHEMISTRY IN MEDICINE SEMESTER - IV, ACADEMIC YEAR 2020-21 have been commonly used to treat typhoid fever. Treatment of the disease with antibiotics reduces the case-fatality rate to about 1%.

Without treatment, some patients develop sustained fever, bradycardia, hepatosplenomegaly, abdominal symptoms, and occasionally, pneumonia. In white-skinned patients, pink spots, which fade on pressure, appear on the skin of the trunk in up to 20% of cases. In the third week, untreated cases may develop gastrointestinal and cerebral complications, which may prove fatal in up to 10–20% of cases. The highest case fatality rates are reported in children under 4 years. Around 2–5% of those who contract typhoid fever become chronic carriers, as bacteria persist in the biliary tract after symptoms have resolved

Diarrhoeal diseases: Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin with loss of the normal stretchiness of the skin and irritable behaviour. This can progress to decreased urination, loss of skin color, a fast heart rate, and a decrease in responsiveness as it becomes more severe. Loose but non-watery stools in babies who are exclusively breastfed, however, are normal.

The most common cause is an infection of the intestines due to either a virus, bacteria, or parasite—a condition also known as gastroenteritis. These infections are often acquired from food or water that has been contaminated by feces, or directly from another person who is infected. The three types of diarrhea are: short duration watery diarrhea, short duration bloody diarrhea, and persistent diarrhea (lasting more than two weeks, which can be either watery or bloody). The short duration watery diarrhea may be due to cholera, although this is rare in the developed world. If blood is present, it is also known as dysentery. A number of non- infectious causes can result in diarrhea. These include lactose intolerance, irritable bowel syndrome, non-celiac gluten sensitivity, celiac disease, inflammatory bowel disease such as ulcerative colitis, hyperthyroidism, bile acid diarrhea, and a number of medications. In most cases, stool cultures to confirm the exact cause are not required.

Prevention Sanitation Numerous studies have shown that improvements in drinking water and sanitation (WASH) lead to decreased risks of diarrhoea. Such improvements might include for example use of water filters, provision of high-quality piped water and sewer connections.

In institutions, communities, and households, interventions that promote hand washing with soap lead to significant reductions in the incidence of diarrhea. The same applies to preventing open defecation at a community-wide level and providing access to improved sanitation. This includes use of toilets and implementation of the entire sanitation chain connected to the toilets (collection, transport, disposal or reuse of human excreta).

Hand washing Basic sanitation techniques can have a profound effect on the transmission of diarrheal disease. The implementation of hand washing using soap and water, for example, has been experimentally shown to reduce the incidence of disease by approximately 42–48%. Hand washing in developing countries, however, is compromised by poverty as acknowledged by the CDC: "Hand washing is integral to disease prevention in all parts of the world; however, access

Page 47 of 65 STUDY MATERIAL FOR B.SC CHEMISTRY CHEMISTRY IN MEDICINE SEMESTER - IV, ACADEMIC YEAR 2020-21 to soap and water is limited in a number of less developed countries. This lack of access is one of many challenges to proper hygiene in less developed countries." Solutions to this barrier require the implementation of educational programs that encourage sanitary behaviours.

Water Given that water contamination is a major means of transmitting diarrheal disease, efforts to provide clean water supply and improved sanitation have the potential to dramatically cut the rate of disease incidence. In fact, it has been proposed that we might expect an 88% reduction in child mortality resulting from diarrheal disease as a result of improved water sanitation and hygiene. Similarly, a meta-analysis of numerous studies on improving water supply and sanitation shows a 22–27% reduction in disease incidence, and a 21–30% reduction in mortality rate associated with diarrheal disease. Chlorine treatment of water, for example, has been shown to reduce both the risk of diarrheal disease, and of contamination of stored water with diarrheal pathogens.

Vaccination Immunization against the pathogens that cause diarrheal disease is a viable prevention strategy, however it does require targeting certain pathogens for vaccination. In the case of Rotavirus, which was responsible for around 6% of diarrheal episodes and 20% of diarrheal disease deaths in the children of developing countries, use of a Rotavirus vaccine in trials in 1985 yielded a slight (2–3%) decrease in total diarrheal disease incidence, while reducing overall mortality by 6–10%. Similarly, a Cholera vaccine showed a strong reduction in morbidity and mortality, though the overall impact of vaccination was minimal as Cholera is not one of the major causative pathogens of diarrheal disease. Since this time, more effective vaccines have been developed that have the potential to save many thousands of lives in developing nations, while reducing the overall cost of treatment, and the costs to society.

A rotavirus vaccine decrease the rates of diarrhea in a population. New vaccines against rotavirus, Shigella, Enterotoxigenic Escherichia coli (ETEC), and cholera are under development, as well as other causes of infectious diarrhea.

Nutrition Dietary deficiencies in developing countries can be combated by promoting better eating practices. Zinc supplementation proved successful showing a significant decrease in the incidence of diarrheal disease compared to a control group. The majority of the literature suggests that vitamin A supplementation is advantageous in reducing disease incidence. Development of a supplementation strategy should take into consideration the fact that vitamin A supplementation was less effective in reducing diarrhea incidence when compared to vitamin A and zinc supplementation, and that the latter strategy was estimated to be significantly more cost effective.

Breastfeeding Breastfeeding practices have been shown to have a dramatic effect on the incidence of diarrheal disease in poor populations. Studies across a number of developing nations have shown that those who receive exclusive breastfeeding during their first 6 months of life are better protected against infection with diarrheal diseases. One study in Brazil found that non- breastfed infants were 14 times more likely to die from diarrhea than exclusively breastfed infants.[72] Exclusive breastfeeding is currently recommended for the first six months of an infant's life by the WHO, with continued breastfeeding until at least two years of age

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Treatment Mild cases of acute diarrhea may resolve without treatment. Persistent or chronic diarrhea will be diagnosed and any underlying causes will be treated in addition to the symptoms of diarrhea.

Dehydration For all cases of diarrhea, rehydration is key: ➢ Fluids can be replaced by simply drinking more fluids, or they can be received intravenously in severe cases. Children and older people are more vulnerable to dehydration. ➢ Oral rehydration solution or salts (ORS) refers to water that contains salt and glucose. It is absorbed by the small intestine to replace the water and electrolytes lost in the stool. In developing countries, ORS costs just a few cents. The World Health Organization (WHO) says ORS can safely and effectively treat over 90 percent of non-severe diarrhea cases. ➢ Oral rehydration products, such as Oralyte and Rehydralyte, are available commercially. Zinc supplementation may reduce the severity and duration of diarrhea in children. Various products are available to purchase online.

Antidiarrheal medication Over-the-counter (OTC) antidiarrheal medicines are also available: ➢ Loperamide, or Imodium, is an antimotility drug that reduces stool passage. Loperamide and Imodium are both available to purchase over-the-counter or online. ➢ Bismuth subsalicylate, for example, Pepto-Bismol, reduces diarrheal stool output in adults and children. It can also be used to prevent traveler’sdiarrhea. The can be bought online as well as over-the-counter.

There is some concern that antidiarrheal medications could prolong bacterial infection by reducing the removal of pathogens through stools.

Antibiotics Antibiotics are only used to treat diarrhea caused by a bacterial infection. If the cause is a certain medication, switching to another drug might be possible.

Diet Nutritionists from Stanford Health Care offer some nutritional tips for diarrhea: ➢ Sip on clear, still liquids such as fruit juice without added sugar. ➢ After each loose stool, replace lost fluids with at least one cup of liquid. ➢ Do most of the drinking between, not during meals. ➢ Consume high-potassium foods and liquids, such as diluted fruit juices, potatoes without the skin, and bananas. ➢ Consume high-sodium foods and liquids, such as broths, soups, sports drinks, and salted crackers. ➢ Other advice from the nutritionists is to: ➢ eat foods high in soluble fiber, such as banana, oatmeal and rice, as these help thicken the stool ➢ limit foods that may make diarrhea worse, such as creamy, fried, and sugary foods ➢ Foods and drinks that might make the diarrhea worse include: ➢ sugar-free gum, mints, sweet cherries, and prunes

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➢ caffeinated drinks and medication ➢ fructose in high amounts, from fruit juices, grapes, honey, dates, nuts, figs, soft drinks, and prunes ➢ lactose in dairy products ➢ magnesium ➢ olestra, or Olean, a fat substitute

Probiotics There is mixed evidence for the role of probiotics in diarrhea. They may help prevent traveler’s diarrhea. In children, there is evidence that they might reduce diarrheal illness by 1 day. Antibiotic-associated diarrhea might be reduced by the use of probiotics, as may diarrhea related to Clostridium difficile, although the evidence is mixed.

People should ask their doctor for advice, as there are numerous strains. The strain most studied for antibiotic-associated diarrhea are probiotics based on Lactobacillus rhamnosus and Saccharomyces boulardii.

Probiotics to help with Clostridium difficile and antibiotic diarrheas were investigated in a trial published in The Lancet. They found no evidence that a multi-strain preparation of bacteria was effective in preventing these conditions, calling for a better understanding of the development of antibiotic-associated diarrhea.

Asthma Asthma is a clinical syndrome of chronic airway inflammation characterized by recurrent, reversible, airway obstruction. Airway inflammation also leads to airway hyper re activity, which causes airways to narrow in response to various stimuli. Asthma results from complex interactions between an individual's inherited genetic makeup and interactions with the environment. The factors that cause a genetically predisposed individual to become asthmatic are poorly understood.

The following are risk factors for asthma: ➢ Family history of allergic conditions ➢ Personal history of hay fever (allergic rhinitis) ➢ Viral respiratory illness, such as respiratory syncytial virus (RSV), during childhood ➢ Exposure to cigarette smoke ➢ Obesity ➢ Lower socioeconomic status ➢ Exposure to air pollution or burning biomass

Different types of asthma Asthma may not be the same in different affected individuals. Asthma specialists currently use a variety of clinical data to categorize a patient's asthma. This data includes the age of asthma onset, the presence or absence of environmental allergies, the presence or absence of elevated blood or sputum levels of eosinophils (a type of white blood cell), lung function testing (spirometry and fractional excretion of nitric oxide), obesity, and cigarette smoke exposure.

Types: T2 high or non T2 (T2 low)

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Your doctor may refer to asthma as being "allergic" or "eosinophilic." One or both of these characteristics make up a "T2 high" phenotype of asthma, which is the term for the type of immune inflammation associated with asthma. The allergic type typically develops in childhood and is associated with environmental allergies, which approximately 70%-80% of children with asthma have. Typically, there is a family history of allergies. Additionally, other allergic conditions, such as food allergies or eczema, are often also present. Allergic asthma often goes into remission in early adulthood. However, in many cases, the asthma reappears later. Sometimes allergic asthma can appear with elevated blood or sputum eosinophils. Asthma that develops in adulthood may be associated with sputum or blood eosinophils but without environmental allergies. Sometimes patients in this category also have nasal polyps, which are eosinophil-rich growths in the nasal lining.

Non T2 asthma, or T2 low asthma, comprises a smaller yet difficult to treat proportion of asthma that is not associated with allergies or eosinophils. This type of asthma is sometimes called "neutrophilic asthma" and may be associated with obesity.

Asthma symptoms and signs The classic signs and symptoms of asthma are shortness of breath, cough (often worse at night), and wheezing (high-pitched whistling sound produced by turbulent airflow through narrow airways, typically with exhalation). Many patients also report chest tightness. It is important to note that these symptoms are episodic, and individuals with asthma can go long periods without any symptoms.

Common triggers for asthmatic symptoms include exposure to allergens (pets, dust mites, cockroach, molds, and pollens), exercise, and viral infections. Other triggers include strong emotion, odor exposure, and temperature extremes. Tobacco use or exposure to secondhand smoke complicates asthma management.

Many of the symptoms and signs of asthma are nonspecific and can be seen in other conditions as well. Symptoms that might suggest conditions other than asthma include new symptom onset in older age, the presence of associated symptoms (such as chest discomfort, lightheadedness, palpitations, and fatigue), and lack of response to appropriate medications for asthma.

The physical exam in asthma is often completely normal. Occasionally, wheezing is present. In an asthma exacerbation, the respiratory rate increases, the heart rate increases, and the work of respiration increases. Individuals often require accessory muscles to breathe, and breath sounds can be diminished. It is important to note that the blood oxygen level typically remains fairly normal even in the midst of a significant asthma exacerbation. Low blood oxygen level is therefore concerning for impending respiratory failure.

Asthma treatment options The treatment goals for asthma are to: ➢ adequately control symptoms, ➢ minimize the risk of future exacerbations, ➢ maintain normal lung function, ➢ maintain normal activity levels, and ➢ take the least amount of medication possible with the least amount of potential side effects.

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Inhaled corticosteroids (ICS) are the most effective anti-inflammatory agents available for the chronic treatment of asthma and are first-line therapy per most asthma guidelines. It is well recognized that ICS are effective in decreasing the risk of asthma exacerbations. Furthermore, the combination of a long-acting bronchodilator (LABA) and an ICS has a significant additional beneficial effect on improving asthma control. Short-acting rescue inhalers are the standard of care for break through symptoms.

The most commonly used asthma medications include the following: ➢ Short-acting bronchodilators (albuterol [Proventil, Ventolin, ProAir, ProAirRespiClick, Maxair, Xopenex]) provide quick relief for symptoms occurring despite controller medications. These may also be used alone in patients with occasional symptoms or patients experiencing symptoms with exercise only. Inhaled steroids (budesonide [PulmicortTurbuhaler, PulmicortRespules], fluticasone [Flovent, ArnuityEllipta, Armon Air RespiClick], beclomethasone [Qvar], mometasone[Asmanex], ciclesonide [Alvesco], flunisolide [Aerobid, Aerospan]) are first-line anti-inflammatory therapies. ➢ Long-acting bronchodilators (salmeterol [Serevent], formoterol [Foradil], vilanterol) can be added to ICS as additive therapy. LABAs should never be used alone for the treatment of asthma. ➢ ICS/LABA combination agents combine corticosteroids and long-acting bronchodilators. Fluticasone/salmeterol (Advair, AirDuo, Wixela), budesonide/formoterol (Symbicort), fluticasone/vilanterol (Breo), mometasone/formoterol (Dulera). ➢ Leukotriene modifiers (montelukast [Singulair], zafirlukast [Accolate], zileuton [Zyflo]) can also serve as anti-inflammatory agents. ➢ Anticholinergic agents or antimuscarinic agents (ipratropium [Atrovent, Atrovent HFA], tiotropium [Spiriva], umeclidinium [IncruseEllipta]) can help decrease sputum production. ➢ There is one triple combination agent of an inhaled corticosteroid, long-acting bronchodilator, and anti-muscarinic agent: fluticasone/vilanterol/umeclidium (Trelegy) that is most often used for asthma/COPD overlap. ➢ Anti-IgE treatment (omalizumab [Xolair]) can be used in allergic asthma. ➢ Anti-IL5 treatment (mepolizumab [Nucala], reslizumab [Cinqair], and benralizumab [Fasenra]) can be used in eosinophilic asthma. ➢ Anti IL-4 receptor antagonist (dupilumab, Dupixent) is approved for moderate to severe eosinophilic asthma. It is also approved for atopic dermatitis and nasal polyposis.

There is often concern about potential long-term side effects of inhaled corticosteroids. Numerous studies have repeatedly shown that even long-term use of inhaled corticosteroids has very few if any sustained, clinically significant side effects, including changes in bone health, growth, or weight. However, the goal always remains to treat all individuals with the least amount of medication that is effective. Patients with asthma should be routinely reassessed for any appropriate changes to their medical regimen.

Epilepsy Epilepsy is a chronic disorder that causes unprovoked, recurrent seizures. A seizure is a sudden rush of electrical activity in the brain. There are two main types of seizures. Generalized seizures affect the whole brain. Focal, or partial seizures, affect just one part of the brain. A mild seizure may be difficult to recognize. It can last a few seconds during which you lack awareness.

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Stronger seizures can cause spasms and uncontrollable muscle twitches, and can last a few seconds to several minutes. During a stronger seizure, some people become confused or lose consciousness. Afterward you may have no memory of it happening.

There are several reasons you might have a seizure. These include: ➢ high fever ➢ head trauma ➢ very low blood sugar ➢ alcohol withdrawal Epilepsy is a fairly common neurological disorder that affects 65 million people around the world. Anyone can develop epilepsy, but it’s more common in young children and older adults. It occurs slightly more in males than in females. There’s no cure for epilepsy, but the disorder can be managed with medications and other strategies.

Symptoms of epilepsy Seizures are the main symptom of epilepsy. Symptoms differ from person to person and according to the type of seizure.

Focal (partial) seizures A simple partial seizure doesn’t involve loss of consciousness. Symptoms include: ➢ alterations to sense of taste, smell, sight, hearing, or touch ➢ dizziness ➢ tingling and twitching of limbs

Complex partial seizures involve loss of awareness or consciousness. Other symptoms include: ➢ staring blankly ➢ unresponsiveness ➢ performing repetitive movements

Generalized seizures Generalized seizures involve the whole brain. There are six types:

Absence seizures, which used to be called “petit mal seizures,” cause a blank stare. This type of seizure may also cause repetitive movements like lip smacking or blinking. There’s also usually a short loss of awareness.

Tonic seizures cause muscle stiffness.

Atonic seizures lead to loss of muscle control and can make you fall down suddenly.

Clonic seizures are characterized by repeated, jerky muscle movements of the face, neck, and arms.

Myoclonic seizures cause spontaneous quick twitching of the arms and legs.

Tonic-clonic seizures used to be called “grand mal seizures.” Symptoms include: ➢ stiffening of the body

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➢ shaking ➢ loss of bladder or bowel control ➢ biting of the tongue ➢ loss of consciousness

Following a seizure, you may not remember having one, or you might feel slightly ill for a few hours.

Epileptic seizure Some people are able to identify things or situations that can trigger seizures. A few of the most commonly reported triggers are: ➢ lack of sleep ➢ illness or fever ➢ stress ➢ bright lights, flashing lights, or patterns ➢ caffeine, alcohol, medicines, or drugs ➢ skipping meals, overeating, or specific food ingredients

Identifying triggers isn’t always easy. A single incident doesn’t always mean something is a trigger. It’s often a combination of factors that trigger a seizure.

A good way to find your triggers is to keep a seizure journal. After each seizure, note the following: ➢ day and time ➢ what activity you were involved in ➢ what was happening around you ➢ unusual sights, smells, or sounds ➢ unusual stressors ➢ what you were eating or how long it had been since you’d eaten ➢ your level of fatigue and how well you slept the night before

You can also use your seizure journal to determine if your medications are working. Note how you felt just before and just after your seizure, and any side effects. Bring the journal with you when you visit the doctor. It may be useful in adjusting your medications or exploring other treatments.

Causes of epilepsy For 6 out of 10 people with epilepsy, the cause can’t be determined. A variety of things can lead to seizures.

Possible causes include: ➢ traumatic brain injury ➢ scarring on the brain after a brain injury (post-traumatic epilepsy) ➢ serious illness or very high fever ➢ stroke, which is a leading cause of epilepsy in people over age 35 ➢ other vascular diseases ➢ lack of oxygen to the brain ➢ brain tumor or cyst ➢ dementia or Alzheimer’s disease

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➢ maternal drug use, prenatal injury, brain malformation, or lack of oxygen at birth ➢ infectious diseases such as AIDS and meningitis ➢ genetic or developmental disorders or neurological diseases

Heredity plays a role in some types of epilepsy. In the general population, there’s a 1 percent chance of developing epilepsy before 20 years of age. If you have a parent whose epilepsy is linked to genetics, that increases your risk to 2 to 5 percent. Genetics may also make some people more susceptible to seizures from environmental triggers. Epilepsy can develop at any age. Diagnosis usually occurs in early childhood or after age 60.

How is epilepsy treated? Most people can manage epilepsy. Your treatment plan will be based on severity of symptoms, your health, and how well you respond to therapy. Some treatment options include:

Anti-epileptic (anticonvulsant, antiseizure) drugs: These medications can reduce the number of seizures you have. In some people, they eliminate seizures. To be effective, the medication must be taken exactly as prescribed.

Vagus nerve stimulator: This device is surgically placed under the skin on the chest and electrically stimulates the nerve that runs through your neck. This can help prevent seizures.

Ketogenic diet: More than half of people who don’t respond to medication benefit from this high fat, low carbohydrate diet.

Brain surgery: The area of the brain that causes seizure activity can be removed or altered.

Research into new treatments is ongoing. One treatment that may be available in the future is deep brain stimulation. It’s a procedure in which electrodes are implanted into your brain. Then a generator is implanted in your chest. The generator sends electrical impulses to the brain to help decrease seizures.

Another avenue of research involves a pacemaker-like device. It would check the pattern of brain activity and send an electrical charge or drug to stop a seizure.

Minimally invasive surgeries and radiosurgery are also being investigated.

Medications for epilepsy The first-line treatment for epilepsy is antiseizure medication. These drugs help reduce the frequency and severity of seizures. They can’t stop a seizure that’s already in progress, nor is it a cure for epilepsy.

The medication is absorbed by the stomach. Then it travels the bloodstream to the brain. It affects neurotransmitters in a way that reduces the electrical activity that leads to seizures.

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Antiseizure medications pass through the digestive tract and leave the body through urine. There are many antiseizure drugs on the market. Your doctor can prescribe a single drug or a combination of drugs, depending on the type of seizures you have.

Common epilepsy medications include: ➢ levetiracetam (Keppra) ➢ lamotrigine (Lamictal) ➢ topiramate (Topamax) ➢ valproic acid (Depakote) ➢ carbamazepine (Tegretol) ➢ ethosuximide (Zarontin)

These medications are generally available in tablet, liquid, or injectable forms and are taken once or twice a day. You’ll start with the lowest possible dose, which can be adjusted until it starts to work. These medications must be taken consistently and as prescribed. Some potential side effects may include: ➢ fatigue ➢ dizziness ➢ skin rash ➢ poor coordination ➢ memory problems

Rare, but serious side effects include depression and inflammation of the liver or other organs. Epilepsy is different for everybody, but most people improve with antiseizure medication. Some children with epilepsy stop having seizures and can stop taking medication.

Peptic ulcers Peptic ulcers are open sores that develop on the inside lining of your stomach and the upper portion of your small intestine. The most common symptom of a peptic ulcer is stomach pain.

Peptic ulcers include: ➢ Gastric ulcers that occur on the inside of the stomach ➢ Duodenal ulcers that occur on the inside of the upper portion of your small intestine (duodenum)

The most common causes of peptic ulcers are infection with the bacterium Helicobacter pylori (H. pylori) and long-term use of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) (Advil, Aleve, others). Stress and spicy foods do not cause peptic ulcers. However, they can make your symptoms worse

Treatment Treatment for peptic ulcers depends on the cause. Usually treatment will involve killing the H. pylori bacterium, if present, eliminating or reducing use of NSAIDs, if possible, and helping your ulcer to heal with medication.

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Medications can include: Antibiotic medications to kill H. pylori. If H. pylori is found in your digestive tract, your doctor may recommend a combination of antibiotics to kill the bacterium. These may include amoxicillin (Amoxil), clarithromycin (Biaxin), metronidazole (Flagyl), tinidazole (Tindamax), tetracycline (Tetracycline HCL) and levofloxacin (Levaquin).

The antibiotics used will be determined by where you live and current antibiotic resistance rates. You'll likely need to take antibiotics for two weeks, as well as additional medications to reduce stomach acid, including a proton pump inhibitor and possibly bismuth subsalicylate (Pepto-Bismol).

Medications that block acid production and promote healing. Proton pump inhibitors — also called PPIs — reduce stomach acid by blocking the action of the parts of cells that produce acid. These drugs include the prescription and over-the-counter medications omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), esomeprazole (Nexium) and pantoprazole (Protonix).

Long-term use of proton pump inhibitors, particularly at high doses, may increase your risk of hip, wrist and spine fracture. Ask your doctor whether a calcium supplement may reduce this risk.

Medications to reduce acid production. Acid blockers — also called histamine (H-2) blockers — reduce the amount of stomach acid released into your digestive tract, which relieves ulcer pain and encourages healing.

Available by prescription or over-the-counter, acid blockers include the medications ranitidine, famotidine (Pepcid), cimetidine (Tagamet HB) and nizatidine (Axid AR).

Antacids that neutralize stomach acid. Your doctor may include an antacid in your drug regimen. Antacids neutralize existing stomach acid and can provide rapid pain relief. Side effects can include constipation or diarrhea, depending on the main ingredients. Antacids can provide symptom relief, but generally aren't used to heal your ulcer.

Medications that protect the lining of your stomach and small intestine. In some cases, your doctor may prescribe medications called cytoprotective agents that help protect the tissues that lines your stomach and small intestine.

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UNIT - IV CLINICAL CHEMISTRY Composition of blood

When a sample of blood is spun in a centrifuge, the cells and cell fragments are separated from the liquid intercellular matrix. Because the formed elements are heavier than the liquid matrix, they are packed in the bottom of the tube by the centrifugal force. The light yellow colored liquid on the top is the plasma, which accounts for about 55 percent of the blood volume and red blood cells is called the hematocrit, orpacked cell volume (PCV). The white blood cells and platelets form a thin white layer, called the "buffy coat", between plasma and red blood cells.

Plasma The watery fluid portion of blood (90 percentwater) in which the corpuscular elements are suspended. It transports nutrients as well as wastes throughout the body. Various compounds, including proteins, electrolytes, carbohydrates, minerals, and fats, are dissolved in it.

Formed Elements The formed elements are cells and cell fragments suspended in the plasma. The three classes of formed elements are the erythrocytes (red blood cells), leukocytes (white blood cells), and the thrombocytes (platelets).

Erythrocytes (red blood cells) Erythrocytes, or red blood cells, are the most numerous of the formed elements. Erythrocytes are tiny biconcave disks, thin in the middle and thicker around the periphery. The shape provides a combination of flexibility for moving through tiny capillaries with a maximum surface area for the diffusion of gases. The primary function of erythrocytes is to transport oxygen and, to a lesser extent, carbon dioxide.

Leukocytes (white blood cells) Leukocytes, or white blood cells, are generally larger than erythrocytes, but they are fewer in number. Even though they are considered to be blood cells, leukocytes do most of their work in the tissues. They use the blood as a transport medium. Some are phagocytic, others produce antibodies; some secrete histamine and heparin, and others neutralize histamine. Leukocytes are able to move through the capillary walls into the tissue spaces, a process called diapedesis.In the tissue spaces they provide a defense against organisms that cause disease and either promote or inhibit inflammatory responses.

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There are two main groups of leukocytes in the blood. The cells that develop granules in the cytoplasm are called granulocytes and those that do not have granules are called agranulocytes. Neutrophils, eosinophils, and basophils are granulocytes. Monocytes and lymphocytes are agranulocytes.

Neutrophils, the most numerous leukocytes, are phagocytic and have light-colored granules. Eosinophils have granules and help counteract the effects of histamine. Basophils secrete histomine and heparin and have blue granules. In the tissues, they are called mast cells. Lymphocytes are agranulocytes that have a special role in immune processes. Some attack bacteria directly; others produce antibodies.

Thrombocytes (platelets): Thrombocytes, or platelets, are not complete cells, but are small fragments of very large cells called megakaryocytes. Megakaryocytes develop from hemocytoblasts in the red bone marrow. Thrombocytes become sticky and clump together to form platelet plugs that close breaks and tears in blood vessels. They also initiate the formation of blood clots.

Blood grouping There are four main blood groups (types of blood) – A, B, AB and O. Your blood group is determined by the genes you inherit from your parents. Each group can be either RhD positive or RhD negative, which means in total there are eight main blood groups.

Antibodies and antigens Blood is made up of red blood cells, white blood cells and platelets in a liquid called plasma. Your blood group is identified by antibodies and antigens in the blood. Antibodies are proteins found in plasma. They're part of your body's natural defences. They recognise foreign substances, such as germs, and alert your immune system, which destroys them. Antigens are protein molecules found on the surface of red blood cells.

The ABO system There are four main blood groups defined by the ABO system: ➢ blood group A – has A antigens on the red blood cells with anti-B antibodies in the plasma ➢ blood group B – has B antigens with anti-A antibodies in the plasma ➢ blood group O – has no antigens, but both anti-A and anti-B antibodies in the plasma ➢ blood group AB – has both A and B antigens, but no antibodies

Blood group O is the most common blood group. Almost half of the population (48%) has blood group O. Receiving blood from the wrong ABO group can be life threatening. For example, if someone with group B blood is given group A blood, their anti-A antibodies will attack the group A cells. This is why group A blood must never be given to someone who has group B blood and vice versa. As group O red blood cells don't have any A or B antigens, it can safely be given to any other group.

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The NHS Blood and Transplant (NHSBT) website has more information about the different blood groups.

The Rh system Red blood cells sometimes have another antigen, a protein known as the RhD antigen. If this is present, your blood group is RhD positive. If it's absent, your blood group is RhD negative.

This means you can be one of eight blood groups: ➢ A RhD positive (A+) ➢ A RhD negative (A-) ➢ B RhD positive (B+) ➢ B RhD negative (B-) ➢ O RhD positive (O+) ➢ O RhD negative (O-) ➢ AB RhD positive (AB+) ➢ AB RhD negative (AB-)

About 85% of the UK population is RhD positive (36% of the population has O+, the most common type).

In most cases, O RhD negative blood (O-) can safely be given to anyone. It's often used in medical emergencies when the blood type isn't immediately known.

It's safe for most recipients because it doesn't have any A, B or RhD antigens on the surface of the cells, and is compatible with every other ABO and RhD blood group. The NHS Blood and Transplant (NHSBT) website has more information about the RH system.

Blood group test To work out your blood group, your red cells are mixed with different antibody solutions. If, for example, the solution contains anti-B antibodies and you have B antigens on your cells (you're blood group B), it will clump together.

If the blood doesn't react to any of the anti-A or anti-B antibodies, it's blood group O. A series of tests with different types of antibody can be used to identify your blood group.

If you have a blood transfusion – where blood is taken from one person and given to another – your blood will be tested against a sample of donor cells that contain ABO and RhD antigens. If there's no reaction, donor blood with the same ABO and RhD type can be used.

Determination of blood groups and matching Red cell compatibility It is a general principle that red cell components of identical ABO group and RhD type as the recipient should be used for transfusion. As shown in the table below, O Rh negative is the universal red cell donor blood that can be given to all patients. This is common practice when a patient’s blood group is unknown and in emergency situations especially for women of child-bearing age.

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Plasma compatibility Plasma contains anti-A and anti-B antibodies depending upon the blood group. Our body also has antibodies to A and/or B antigens according to our blood group. Patients should only receive plasma that does not contain an antibody which could attack the antigens present on their own red cells. Group A recipients have A antigen on their red cells, so they can’t receive group O or group B plasma as the anti-A will attack their red cells. Group B recipients have B antigen on their red cells, so they can’t receive group O or group A plasma as the anti-B will attack their red cells.

Group AB recipients can only receive group AB plasma. Group O recipients do not have either A or B antigen, so can safely receive plasma of any blood group type.

Blood pressure – hypertension High blood pressure, or hypertension, occurs when your blood pressure increases to unhealthy levels. Your blood pressure measurement takes into account how much blood is passing through your blood vessels and the amount of resistance the blood meets while the heart is pumping.

Narrow arteries increase resistance. The narrower your arteries are, the higher your blood pressure will be. Over the long term, increased pressure can cause health issues, including heart disease.

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Hypertension is quite common. In fact, since the guidelines have recently changed, it’s expected that nearly half of American adults will now be diagnosed with this condition.

Hypertension typically develops over the course of several years. Usually, you don’t notice any symptoms. But even without symptoms, high blood pressure can cause damage to your blood vessels and organs, especially the brain, heart, eyes, and kidneys.

Early detection is important. Regular blood pressure readings can help you and your doctor notice any changes. If your blood pressure is elevated, your doctor may have you check your blood pressure over a few weeks to see if the number stays elevated or falls back to normal levels. Treatment for hypertension includes both prescription medication and healthy lifestyle changes. If the condition isn’t treated, it could lead to health issues, including heart attack and stroke.

Symptoms of hypertension Hypertension is generally a silent condition. Many people won’t experience any symptoms. It may take years or even decades for the condition to reach levels severe enough that symptoms become obvious. Even then, these symptoms may be attributed to other issues.

Symptoms of severe hypertension can include: ➢ headaches ➢ shortness of breath ➢ nosebleeds ➢ flushing ➢ dizziness ➢ chest pain ➢ visual changes ➢ blood in the urine

These symptoms require immediate medical attention. They don’t occur in everyone with hypertension, but waiting for a symptom of this condition to appear could be fatal.

The best way to know if you have hypertension is to get regular blood pressure readings. Most doctors’ offices take a blood pressure reading at every appointment.

If you only have a yearly physical, talk to your doctor about your risks for hypertension and other readings you may need to help you watch your blood pressure.

For example, if you have a family history of heart disease or have risk factors for developing the condition, your doctor may recommend that you have your blood pressure checked twice a year. This helps you and your doctor stay on top of any possible issues before they become problematic.

Causes high blood pressure There are two types of hypertension. Each type has a different cause.

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Primary hypertension Primary hypertension is also called essential hypertension. This kind of hypertension develops over time with no identifiable cause. Most people have this type of high blood pressure. Researchers are still unclear what mechanisms cause blood pressure to slowly increase. A combination of factors may play a role. These factors include:

Genes: Some people are genetically predisposed to hypertension. This may be from gene mutations or genetic abnormalities inherited from your parents.

Physical changes: If something in your body changes, you may begin experiencing issues throughout your body. High blood pressure may be one of those issues. For example, it’s thought that changes in your kidney function due to aging may upset the body’s natural balance of salts and fluid. This change may cause your body’s blood pressure to increase.

Environment: Over time, unhealthy lifestyle choices like lack of physical activity and poor diet can take their toll on your body. Lifestyle choices can lead to weight problems. Being overweight or obese can increase your risk for hypertension.

Secondary hypertension Secondary hypertension often occurs quickly and can become more severe than primary hypertension. Several conditions that may cause secondary hypertension include: ➢ kidney disease ➢ obstructive sleep apnea ➢ congenital heart defects ➢ problems with your thyroid ➢ side effects of medications ➢ use of illegal drugs ➢ alcohol abuse or chronic use ➢ adrenal gland problems ➢ certain endocrine tumors

Two numbers create a blood pressure reading: Systolic pressure: This is the first, or top, number. It indicates the pressure in your arteries when your heart beats and pumps out blood.

Diastolic pressure: This is the second, or bottom, number. It’s the reading of the pressure in your arteries between beats of your heart.

Five categories define blood pressure readings for adults: Healthy: A healthy blood pressure reading is less than 120/80 millimeters of mercury (mm Hg). Elevated:

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The systolic number is between 120 and 129 mm Hg, and the diastolic number is less than 80 mm Hg. Doctors usually don’t treat elevated blood pressure with medication. Instead, your doctor may encourage lifestyle changes to help lower your numbers.

Stage 1 hypertension: The systolic number is between 130 and 139 mm Hg, or the diastolic number is between 80 and 89 mm Hg.

Stage 2 hypertension: The systolic number is 140 mm Hg or higher, or the diastolic number is 90 mm Hg or higher.

Hypertensive crisis: The systolic number is over 180 mm Hg, or the diastolic number is over 120 mm Hg. Blood pressure in this range requires urgent medical attention. If any symptoms such as chest pain, headache, shortness of breath, or visual changes occur when blood pressure is this high, medical care in the emergency room is needed. A blood pressure reading is taken with a pressure cuff. For an accurate reading, it’s important you have a cuff that fits. An ill-fitting cuff may deliver inaccurate readings. Blood pressure readings are different for children and teenagers. Ask your child’s doctor for the healthy ranges for your child if you’re asked to monitor their blood pressure.

Blood pressure determination Measuring Blood Pressure Blood pressure is measured with an instrument called a sphygmomanometer. First, a cuff is placed around your arm and inflated with a pump until the circulation is cut off. A small valve slowly deflates the cuff, and the doctor measuring blood pressure uses a stethoscope, placed over your arm, to listen for the sound of blood pulsing through the arteries. That first sound of rushing blood refers to the systolic blood pressure; once the sound fades, the second number indicates the diastolic pressure, the blood pressure of your heart at rest.

Blood pressure is measured in millimeters of mercury (mm Hg) and recorded with the systolic number first, followed by the diastolic number. For example, a normal blood pressure would be recorded as something under 120/80 mm Hg.

Blood pressure readings can be affected by factors like: ➢ Smoking ➢ Coffee or other caffeinated drinks ➢ A full bladder ➢ Recent physical activity

Blood pressure is also affected by your emotional state and the time of day. Since so many factors can affect blood pressure readings, you should have your blood pressure taken several times to get an accurate measurement.

What Is Normal Blood Pressure? Experts consider normal blood pressure to be less than 120/80 mm Hg. Based on population data, about 42 percent of American adults have normal blood pressure. At one point, blood pressure at or above 120/80 and less than 140/90 was considered normal to high;

Page 64 of 65 STUDY MATERIAL FOR B.SC CHEMISTRY CHEMISTRY IN MEDICINE SEMESTER - IV, ACADEMIC YEAR 2020-21 these numbers are now considered pre-hypertensive. Blood pressure consistently at or above 140/90 is considered high blood pressure or hypertension.

Blood pressure normally rises as you age and grow. Normal blood pressure readings for children are lower than for adults, while blood pressure measurements for adults and older teenagers are similar.

Blood pressure can also be too low, a condition called hypotension. Hypotension refers to blood pressure lower than 90/60. Symptoms of hypotension include dizziness, fainting, and sometimes shock.

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