TDR TB: ARE WE PREPARED

“The health is not all, but all without the health are no one.” Socrates. 

Totally drug resistant; Are we prepared for this?

Tuberculosis is one of the most serious infectious diseases of the developing world and it remains the leading cause of death from infectious disease globally. Tuberculosis (TB) is a contagious and potentially fatal disease that can affect almost any part of the body but manifests mainly as an infection of the lungs. It is caused by a bacterial microorganism, the tubercle bacillus or Mycobacterium.

 Totally drug-resistant tuberculosis (TDR-TB) is a generic term for tuberculosis strains that are resistant to a wider range of drugs than strains classified as extensively drug-resistant tuberculosis. TDR-TB has been identified in three countries; India, Iran, and Italy. The emergence of TDR-TB has been documented in four major publications. TDR-TB has resulted from further mutations within the bacterial genome to confer resistance, beyond those seen in XDR- and MDR-TB. Development of resistance is associated with poor management of cases. Drug resistance testing occurs in only 5% of TB cases worldwide. Without testing to determine drug resistance profiles, MDR- or XDR-TB patients may develop resistance to additional drugs. TDR-TB is relatively poorly documented, as many countries do not test patient samples against a broad enough range of drugs to diagnose such a comprehensive array of resistance. The United Nations' Special Programme for Research and Training in Tropical Diseases has set up a TDR Tuberculosis Specimen Bank to archive specimens of TDR-TB. Multi-drug-resistant tuberculosis (MDR-TB) is defined as tuberculosis that is resistant at least to isoniazid (INH) and rifampicin (RMP), the two most powerful first-line anti-TB drugs. Isolates that have multiple resistant to any other combination of anti-TB drugs but not to INH and RMP are not classed as MDR-TB. Extensively drug-resistant tuberculosis (XDR-TB) is a form of tuberculosis caused by bacteria that are resistant to some of the most effective anti-TB drugs. XDR-TB strains have arisen after the mismanagement of individuals with multidrug-resistant TB (MDR-TB).

Though terms likes such as “totally drug resistant” have not been clearly defined for tuberculosis by WHO. While the concept of “total drug resistance” is easily understood in general terms, in practice, in vitro drug susceptibility testing (DST) is technically challenging and limitations on the use of results remain: conventional DST for the drugs that define MDR and XDR-TB has been thoroughly studied and consensus reached on appropriate methods, critical drug concentrations that define resistance, and reliability and reproducibility of testing. Data on the reproducibility and reliability of DST for the remaining SLDs are either much more limited or have not been established, or the methodology for testing does not exist. 

To be remembered is the fact that the race by all medical practitioners to find a cure started since the existence of TB down to all its variants. Yet this mycobacterium seems to elude us as it keeps resisting each of our solution? Hence, it begs the question will these devastating disease take its leave? Will it be eradicated completely? Will our generation survive it? And if yes, will another strain of this mycobacterium exist?

Finally, I ask you all if our medical society of practitioners will survive these.

Fecal Incontinence

Fecal incontinence is the inability to control your bowel movements, causing stool (feces) to leak unexpectedly from your rectum. Also called bowel incontinence, fecal incontinence ranges from an occasional leakage of stool while passing gas to a complete loss of bowel control in someone who is older than 4 years old.

Common causes of fecal incontinence include constipation, diarrhea, and muscle or nerve damage. Fecal incontinence may be due to a weakened anal sphincter associated with aging or to damage to the nerves and muscles of the rectum and anus from giving birth.

Whatever the cause, fecal incontinence can be embarrassing. But don't shy away from talking to your doctor. Treatments are available that can improve, if not correct, fecal incontinence.

Treatments and drugs

A variety of treatments are available for fecal incontinence, depending on the severity of your symptoms. Treatment may include dietary changes, medications, special exercises that help you better control your bowels, or surgery.

Medications
Sometimes, doctors recommend medications to treat fecal incontinence, such as:

Anti-diarrheal drugs. Your doctor may recommend medications to reduce diarrhea and help you avoid fecal incontinence. A drug called loperamide (Imodium) may be used because it helps treat diarrhea.
Laxatives. If chronic constipation is to blame for your incontinence, your doctor may recommend the temporary use of mild laxatives, such as milk of magnesia, to help restore normal bowel movements.
Stool softeners. To prevent stool impaction, your doctor may recommend a stool-softening medication.
Other medications. If diarrhea is the cause of your fecal incontinence, your doctor may recommend drugs that decrease the spontaneous motion of your bowel (bowel motility) or medications that decrease the water content of your stool.
Therapies
A variety of therapies may improve fecal incontinence:

Dietary changes. What you eat and drink affects stool consistency. Your doctor may recommend changes to your diet to help improve your bowel movements.

For example, if chronic constipation is to blame for fecal incontinence, your doctor may recommend that you drink plenty of fluids and eat fiber-rich foods. A fiber supplement may also be recommended. If diarrhea is contributing to the problem, your doctor may recommend that you increase your intake of high-fiber foods to add bulk to your stools, making them less watery. In general, your doctor will recommend a diet that helps you gain good stool consistency for increased control of your bowels.

Bowel training. If fecal incontinence is due to a lack of anal sphincter control or decreased awareness of the urge to defecate, you may benefit from a bowel-training program and exercise therapies aimed at helping you restore muscle strength.

In some cases, bowel training means learning to go to the toilet at a specific time of day. For example, your doctor may recommend that you make a conscious effort to have a bowel movement after eating. This helps you gain greater control by establishing with some predictability when you need to use the toilet.

Biofeedback is another bowel-training treatment for fecal incontinence. It involves inserting a pressure-sensitive probe into your anus. This probe registers muscle strength and activity of your anal sphincter as it contracts around the probe. You can practice sphincter contractions and learn to strengthen your muscles by viewing the scale's display. These exercises can strengthen your rectal muscles.

Treatment for stool impaction. Your doctor may have to remove an impacted stool if taking laxatives or using enemas doesn't help you pass the hardened mass. To remove an impacted stool, your doctor inserts one or two gloved fingers into your rectum to break apart the impacted stool. These smaller pieces are easier to expel.
Sacral nerve stimulation. Another treatment for fecal incontinence is sacral nerve stimulation. The sacral nerves run from your spinal cord to muscles in your pelvis. These nerves regulate the sensation and strength of your rectal and anal sphincter muscles. Sacral nerve stimulation is carried out in stages. First, small needles are positioned in the muscles of your lower bowel, and these muscles are stimulated by an external pulse generator to identify which muscle stimulates anal contractions the most. The muscle response to the stimulation generally isn't uncomfortable. After a successful response, you may have a permanent pulse generator implanted. This treatment is usually done only if other treatments haven't worked.
Surgery
For some people, treatment of fecal incontinence requires surgery to correct an underlying problem. Surgical procedures to treat fecal incontinence aren't necessarily easy or free of complications. But, certain causes of fecal incontinence — anal sphincter damage caused by childbirth or rectal prolapse, for example — can often be effectively treated with surgery. Surgical options include:

Sphincteroplasty. This is surgery to repair a damaged or weakened anal sphincter. In this procedure, an injured area of muscle is identified and its edges are freed from the surrounding tissue. The muscle edges are then brought back and sewn together in an overlapping fashion. This strengthens the muscle, tightening the sphincter.
Treating rectal prolapse, a rectocele or hemorrhoids. If you have other problems, such as a condition in which a portion of your rectum protrudes through your anus (rectal prolapse), a protrusion of the rectum into the vaginal wall (rectocele) or hemorrhoids that are causing fecal incontinence, surgical correction of these problems will likely reduce or eliminate your fecal incontinence.
Sphincter replacement. An artificial anal sphincter can be used to replace a damaged anal sphincter. The device is essentially an inflatable cuff, which is implanted around your anal canal. When inflated, the device keeps your anal sphincter shut tight until you're ready to defecate. To go to the toilet, you use a small external pump to deflate the device and allow stool to be released. It then reinflates itself.
Sphincter repair. During a surgical procedure called a gracilis muscle transplant, a muscle is taken from your inner thigh and wrapped around your sphincter. This restores muscle tone to your sphincter.
Injection of biomaterials. Injection of a silicone-based material into the anal sphincter may improve incontinence by increasing the size of the anal sphincter. Other types of biomaterials are under study.
Colostomy. As a last resort, a colostomy may be the most definitive way to correct fecal incontinence. Colostomy is generally considered only after other treatments have failed. A colostomy is an operation that diverts stool through an opening in the abdomen. A special bag is attached to this opening to collect the stool.

Endocrinology Posting

Hey people, guess you have all been wondering how distant i have been from this blog. Yeah i was MIA.

It was endocrinology posting  and i will say it took much of my time. Well it was interesting as well as boring.

During my first few days in this rotation, i sat still trying to remember types of inflammation and which one occurs in different autoimmune scenarios, i was taken back to my knowledge of biochemistry  the many metabolic pathways: PPP(Pentose phosphate pathway), glycolytic, gluconeogenesis, glyconeogenesis, glycogenolysis, beta oxidation and Krebs cycle. Anatomical knowledge wasn't left out cos you have to know location of the endocrine organs and how they function from there location.Every Physiological detail about these organs, their reception, transport and function were also all needed to make studying pathology of the endocrine system a success.

I learnt there was no fast-forward button in med-school because for every skipped learning, you will have to press the rewind  to move on in medical career successfully.

During cu ration, i had opportunity to examine a diffuse  toxic nodular goiter patient and it was fun getting to learn from the illness and how to maintain it. i mean the anti-thyroid drugs, beta adrenoblockers and sedatives majorly calms it off.

So if you are looking forward to the cycle be sure you  enjoy it as Diabetes mellitus ad mist  others will catch your attention.

And now i am of to ENT........... 

MNEMONIC OF THE DAY

 

"Screw The Lawyer Save A Patient": branches of axillary artery

Superior thoracic
Thoracoacromiol
Lateral thoracic
Subscapular
Anterior circumflex humeral
Posterior circumflex humeral

Alternatively: "Some Times Life Seems A Pain".

THE CRIMSON TONGUE

There are five main medical reasons for the appearance of strawberry tongue. Some of these reasons can even be life threatening, especially for toddlers or pre teen children. Their immune systems are not yet able to fully handle the diseases related to this condition.

Scarlet fever is an illness that is related to strawberry tongue. This disease happens when the bacteria streptococcus invades the body. But every child that comes in contact with the bacteria may not be affected. For example, if two children from the same families are infected with streptococcus, one may come down with Scarlett fever but the other may just get a normal strep throat. The strep throat can be easily treated with an antibiotic. For some children the strep bacteria turns into toxic poison within the body. Along with the red tongue, these children also get a rash that appears to look like sunburn and can be itchy. Small blisters can also form. The rash starts on the neck and face and quickly spreads to other areas of the body. A fever and swollen lymph nodes can also be seen. If properly treated with antibiotics, Scarlett fever can be cured in around a week.

Deficiencies of certain vitamins can be a contributing factor to strawberry tongue. Folic acid and B-12 deficiencies can make a person anemic. This affects red blood cell production by reducing the cells efficiency. This opens the body up to more than a few health problems, like difficulty breathing and intestinal issues. Incorporating more vitamins into your diet can help clear up this condition. Along with pills that have to be taken for a full four months.

Kawasaki syndrome is a condition that mostly affects children under the age of five. It isn't clear what causes this disease but some of the symptoms include a high fever, swollen lymph nodes, a rash on the abdominal area and a swollen red tongue. This disease can be cleared up with the proper medication but only if it is identified immediately. If it goes unnoticed, it can cause serious heart valve damage.

Geographic tongue is a condition that can be irritating. White or bald patches appear on the tongue and although it is not a serious problem, if it persists for two weeks or longer you must see a physician. It is not known what exactly causes geographic tongue but it mostly affects women and people with compromised immune systems. It also has a genetic background because most people who acquire it have siblings with the same problem.

Bacterial toxic shock syndrome has been associated with strawberry tongue. This condition may be fatal if not immediately diagnosed. It is caused by toxins produced by staphylococcus bacteria and has many symptoms. A high fever, extreme headache, sore throat and rashes are seen with this disease. Most cases of toxic shock syndrome are related to women and tampon use but anyone can get the disease. The treatments for the disease include an intravenous drip with anti resistant antibiotics and maybe even dialysis, to remove the bacteria from the blood.

WARFARIN

Warfarin (coumadin) is an anticoagulant drug, which means it works by preventing the blood from clotting (secondary homeostasis), it's considered as vitamin K reductase inhibitor, so what is vitamin K reductase to begin with! it's basically an enzyme that is responsible to return vitamin K from it's "INACTIVE" form to the "ACTIVE" one, because vitamin K works in the clotting process by converting the clotting factor "X, IX, VII, II" from their "INACTIVE" form to the "ACTIVE" one, so when we inhibit the vitamin K reductase enzyme, the consumed vitamin K will not return to it's active form, and that will decrease the clotting factors which are dependent on it (X, IX, VII, II), in other words the clotting mechanism will stop.

It's worth mentioning that the clotting mechanism involves three pathways, the extrinsic, the intrinsic, and the common pathway, the extrinsic involves factor VII, the intrinsic involves factors XII, XI, IX, VIII, and the common involves factors X, II, the intrinsic and the extrinsic pathways stimulates the common pathway which in turn converts the the unstable fibrinogen to the stable fibrin, and as you saw earlier warfarin works by inhibiting the factors X, IX, VII, II, which means it will affect all of the three pathways, and ultimately will prevent clotting.

We should not begin with warfarin alone! but WHY? for the first three days we should start the patient on heparin, then we should discontinue heparin and continue with warfarin, once again but WHY? Well, it's because of two main reasons...
The first reason is that warfarin will prevent the formation of new activated clotting factors, but it will NOT have any effect on the ALREADY activated clotting factors.
The second reason reason is that it will cause hypercoagulable state, because vitamin K is also responsible of converting PROTEIN C from the inactive to the active form, and the function of protein C in the body is to prevent clotting, so when it's absent, it will lead to clotting and the subsequent necrosis of body tissues.

Side effects include, bleeding, clotting (when given alone), teratogenic (fetotoxicity, NOT to be given to pregnant women).

The antidote for it is vitamin K, or we can just give fresh frozen plasma (FFP) because they contain already activated clotting factors.

P.S When we give warfarin we should keep an eye on the INR, the target is 2 - 3, if it's less than 2 then the patient is at risk for clotting (low dose), but if it's higher than 3 then the patient is at risk for bleeding (high dose) and in either way we should correct the dose, and also you should know that warfarin was first used as a pesticide for rats in 1948, and only in 1954 it was used on humans as anticoagulant.

KEEP FIT

Statistically, moving towards a plant-based diet is associated with weight loss. One Oxford University study of nearly 38,000 adults found that meat-eaters had the highest BMIs for their ages and vegans the lowest, with vegetarians and semi-vegetarians in between; and there are several explanations for this trend.
Plant-based meals tend to be richer in antioxidants and fiber, which are both tied to weight loss, and researchers have seen an increase in calorie burn after vegan meals. But in order to reap the benefits, you need to do vegan right. In other words, a diet of processed vegan donuts and fake meat isn’t going to transform you into Sasha Fierce. Here are five steps for building nutritionally balanced plant-based meals that will slim and satisfy:
Start with produce
Currently about 75% of Americans fall short of the recommended daily minimum of two fruit and three vegetable servings. When produce serves as the foundation of a plant-based meal, it’s easy to fill that gap, or exceed the target, and this alone can help shrink your fat cells. Recently University of Florida researchers developed an index that ranks the phytochemical index, or PI score of meals, which is essentially a measure of antioxidant consumption. A vegan diet (excluding liquor and refined sugars) could have a perfect score of 100, whereas a typical American diet, heavy in animal and processed foods and low in produce, would score below 20. Scientists found that even when two groups consumed the same number of daily calories, those with higher PI scores had smaller waist measurements, and lower body fat percentages. In other words, the quality of your calories counts–a lot. That said, by going veg, you’ll likely slash calories. For example, a snack of eight cheese cubes and eight club crackers provides 260 calories, compared to 165 in a dozen baby carrots and a quarter cup of hummus.
Add a whole grain
Whole grains are super hot, because of research linking them to a lower risk of not only obesity, but a number of chronic diseases, including type 2 diabetes and heart disease. In one study researchers randomly assigned volunteers into one of two groups. The first was asked to consume whole grains exclusively, and the second was instructed to select only refined grains. Over twelve weeks, both groups were advised to exercise and follow identical diets. At the end of the study, body weight decreased in both groups–between 8 to 11 pounds on average. But the whole grain group lost more belly inches, and experienced nearly a 40% drop in a blood marker for inflammation, a known trigger of aging and disease. In a plant-based meal, a small serving of whole grain provides bonus antioxidants, additional fiber, and slow-burning carbs that keep blood sugar and insulin levels regulated. Great choices include oats, barley, quinoa, corn, and brown, red, and black rice.
Pick your protein
Protein revs up metabolism and supports muscle mass, so it’s important to include a source in every vegan meal. Just trade meat, poultry or seafood for a small scoop of beans or lentils in a taco salad, stir fry, or whole grain pasta primavera. Or, use pureed beans as a sandwich spread or pizza topping (check out my vegan white bean pizza). Like whole grains, these hearty alternatives provide additional antioxidants and filling fiber, so they’ll keep you fuller longer and delay the return of hunger.

Don’t forget the fat
Fats from plant foods are critical for weight control because they add the satisfaction factor to each meal. Fats delay stomach emptying, and they’re needed to absorb antioxidants, which hitch a ride as fats are shuttled from the digestive tract into the bloodstream. There are many delectable plant-based options, including nuts, seeds, and natural nut butters, ripe avocado, Mediterranean olives, and a variety of plant oils, from extra virgin olive oil to sesame, sunflower, and coconut oil.
Season it up
Including herbs and spices in each meal is a fantastic way to add aroma and flavor without sodium or sugar, and studies show that these plant-based ingredients pack a powerful weight loss punch. Natural seasonings like cinnamon, ginger, garlic, and crushed red pepper have been shown to boost calorie burning, improve satiety, and they’re much more potent in antioxidants than even fruits and veggies. In one Penn State University study, consuming two tablespoons of herbs and spices within a meal, specifically rosemary, oregano, cinnamon, turmeric, black pepper, cloves, garlic powder and paprika, resulted in higher blood antioxidant levels and a 30% reduction in blood fats compared to subjects who ate the same meals without seasonings.
I call this meal building approach the ‘5 piece puzzle,’ and there are dozens of delicious ways to solve it. Vegan meals that incorporate each key component include:
Asian veggies stir fried with fresh grated ginger and chili pepper over a bed of wild rice topped with edamame and sliced almonds
Mediterranean veggies sautéed in extra virgin olive oil with garlic, tossed with fresh basil, whole grain penne and cannellini beans
Fresh greens tossed with cilantro and lime seasoned pico de gallo, topped with black beans, roasted corn, and fresh avocado
Sound yummy? More vegan options can add some variety and excitement to your meal portfolio, and by using the puzzle, you won’t be stuck with a simple salad.
Many of my clients are amazed at the lack of hunger and boundless energy they experience after vegan meals, and feel inspired to experiment with their own plant-based puzzle combinations, even if they don’t want to become vegan.
How about you? Are you a part-time vegan? If so have you seen weight loss results? And what are your favorite ways to veganize a meal? Please tweet your thoughts to @CynthiaSass and @goodhealth.
Cynthia Sass is a registered dietitian with master’s degrees in both nutrition science and public health. Frequently seen on national TV, she’s Health’s contributing nutrition editor, and privately counsels clients in New York, Los Angeles, and long distance. Her latest New York Times best seller is S.A.S.S! Yourself Slim: Conquer Cravings, Drop Pounds and Lose Inches.

Quote of the day

“There are only two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle.” 

― Albert Einstein

Stay Positive and Move Forward: Avoid Dealing with Mistakes the Wrong Way

Everyone makes mistakes and the busier you are, the more mistakes you will make. The only question is “Do you stay positive and move forward from life’s inevitable ups and downs?”

Here’s how you can learn to maintain positive thinking and benefit from your mistakes in the face of adversity.

This is achieved through the simple exercise of self-disclosure. For you to truly understand yourself and to move forward from the troubling things that may have happened in your past, you must be able to disclose yourself to at least one person. You have to be able to get those things off your chest. You must rid yourself of those thoughts and feelings by revealing them to someone who won’t make you feel guilty or ashamed for what has happened.

Stay Positive

There are two ways to look at the world: the benevolent way or the malevolent way. People with a malevolent or negative worldview take a victim stance, seeing life as a continuous succession of problems and a process of unfairness and oppression. They can’t move forward, don’t expect a lot and don’t get much. When things go wrong, they shrug their shoulders and passively accept that this is the way life is and there isn’t anything they can do to make it better.

On the other hand, people who practice positive thinking see the world around them as filled with opportunities and possibilities. They believe that everything happens as part of a great process designed to make them successful and happy. They approach their lives, their work, and their relationships with optimism, cheerfulness, and a general attitude of positive thinking and expectations. They stay positive, expect a lot and are seldom disappointed.

Flex Your Mental Muscles with Positive Thinking

When you develop positive thinking and the skill of learning from your mistakes, you become the kind of person who welcomes obstacles and setbacks as opportunities to flex your mental muscles and move forward. You look at problems as rungs on the ladder of success that you grab onto as you pull your way higher.

Two of the most common ways to deal with mistakes are invariably fatal to high achievement. The first common but misguided way to handle a mistake is the failure to accept it when it occurs. According to statistics, 70 percent of all decisions we make will be wrong. That’s an average. This means that some people will fail more than 70 percent of the time, and some people will fail less. It is hard to believe that most of the decisions we make could turn out to be wrong in some way. In fact, if this is the case, how can our society continue to function at all?

Cut Your Losses and Move Forward

The fact is that our society, our families, our companies, and our relationships continue to survive and thrive because intelligent people tend to cut their losses, stay positive and minimize their mistakes. It is only when people refuse to accept that they have made a bad choice or decision—and prolong the consequences by sticking to that bad choice or decision—that mistakes become extremely expensive and hurtful.

Learn From Your Mistakes

The second common approach that people take with regard to their mistakes, one that hurts innumerable lives and careers, is the failure to use your mistakes to better yourself and to improve the quality of your mind and your thinking.

Learning from your mistakes is an essential skill that enables you to move forward, stay positive, and develop the resilience to be a master of change rather than a victim of change. The person who recognizes that he has made a mistake and changes direction the fastest is the one who will win in an age of increasing information, technology and competition.

By remaining fast on your feet, you will be able to out-play and out-position your competition. You will become a creator of circumstances rather than a creature of circumstances.

Thank you for reading this post on how to stay positive and move forward by avoiding common mistakes in handling life’s adversities. How do you apply positive thinking in your life? Please comment and share below!

PHENYTOIN AS A DRUG FOR EPILEPSY.

The use of phenytoin in patients with epilepsy dates back to 1938. The main mechanism of action of phenytoin is believed to be inactivation of the voltage-dependent sodium channels, resulting in suppression of repetitive firing. The absorption occurs primarily in the duodenum, and its rate is highly variable, depending on the specific oral preparation, the amount ingested and on different factors affecting solubility of the drug in the gastrointestinal tract. For example, complete-nutrition formulas co-administered through nasogastric tube with phenytoin may cause a dramatic decrease in its serum concentrations. The bioavailability of both intramuscularly and rectally administered phenytoin is poor, therefore these routes are not recommended for use in clinical practice.

In healthy individuals, phenytoin is around 90% bound to plasma proteins, only the free portion being pharmacologically active. However, the percentage of binding varies according to changes in albumin concentration, in renal failure, hepatic failure, AIDS and in the presence of concomitant highly protein bounded medications (such as valproic acid).

Total phenytoin plasma concentrations (established therapeutic range of 10-20 mg/ml) may, therefore, be a misleading test in the above-mentioned conditions. Thus, measurement of unbound concentrations may be of clinical value, especially in patients experiencing toxic reactions despite therapeutic concentrations. Phenytoin is almost completely metabolized in the liver, 80% by the cytochrome p450 system, and has nonlinear pharmacokinetics due to enzyme saturation at the usual therapeutic plasma concentrations. Therefore age, genetic profile, pregnancy, concomitant illnesses and medications (enzyme inducers and inhibitors, such as many of the AEDs) may significantly affect the dose/concentration ratio of phenytoin. On the other hand, since phenytoin is an inducer of the liver enzymes, it may affect the concentration of other drugs (such as warfarin and many AEDs).

Phenytoin was proved to be effective in the acute treatment of SE and repetitive seizures and as a seizure-prevention agent against generalized tonic-clonic and partial seizures. However, only limited efficacy was observed in absence, myoclonic, tonic and atonic seizure types. The most common concentration-related side effects of phenytoin are drowsiness, ataxia, incoordination, diplopia and nystagmus. Serum concentrations above 30 mg/ml can cause encephalopathy (even as severe as coma), aggravation of seizures, more severe cerebellar symptoms and signs and movement disorders. Idiosyncratic reactions include rash, fever, lymphadenopathy, abnormal LFTs, blood dyscrasias and renal failure.

Long-term treatment with phenytoin has been associated with gingival hyperplasia, acne, hirsutism, cerebellar atrophy, peripheral neuropathy, enhanced osteopenia, decreased folate level, macrocytosis and changes in the concentration of thyroid hormones. When administred to pregnant women, phenytoin has been associated with an increase in the rate of birth defects. Intravenously administered, phenytoin can cause sometimes very severe local reactions, as well as cardiovascular adverse effects, such as arrhythmias and hypotention. Substituting phenytoin for an equivalent dose of phosphenytoin (a water-soluble phenytoin prodrug) may reduce the adverse events rate, especially for intravenous administration.

The recommended loading dose of phenytoin is 15-20 mg/kg. When given intravenously, phenytoin should be diluted in normal saline (not in dextrose-containing fluids), and the infusion should not exceed 50 mg/min or 25 mg/min in patients with history of cardiovascular disease. In cases of oral loading, it should be divided into three doses, given two to three hours apart for better absorption.

For maintenance therapy, the regimen should be individualized according to the plasma concentrations, which should be closely monitored. Due to the phenytoin nonlinear pharmacokinetics, especially low increments in the dose should be made once the minimal therapeutic level had been reached.

The face as a signpost to Good living

It is a widely known fact that the color of facial skin reflects the overall health of the body. Here you will learn how to determine what is behind the change of color and hue.

The grayish undertone is a result of fatigue and continuous lack of sleep. If wholesome rest and cosmetic procedures for fatigue relief do not help in improving the condition of your face, you will have to consult a doctor.

A yellow hue is often indicative of disturbances in the area of the liver, pancreas and spleen. It may also mean that you are at risk of kidney stone formation.

Bronzing of the skin, also known as mock-tan often arises from lack of hormones in the adrenal glands. This is a serious illness which has to be treated by an endocrinologist!

The white or pale face is a result of low blood pressure. It can also be an indication of heart or lung problems, as well as hormonal lack in the thyroid gland.

A red face is most likely due to an increase in the erythrocytes in the blood, high blood pressure or problems in the cardiovascular system.

Graying of facial skin is often seen in people with gastrointestinal issues. If digestion is normal, then the reason for greying of the skin can be found in smoking or constant stress.

A bluish hue can be caused by heart conditions or respiratory problems.

A dark blackening of the face is a hint that it’s high time to visit the urologist. Such a dark hue is usually indicative of kidney or bladder disease.

Giving Love A Second Chance - Short Story

“Eyamba?” He called.

I didn’t respond. I wanted to scream, hit him – anything to dispel the raging emotions I was feeling. How could he come back after all this time and ask this of me. Just when I was picking up the pieces of my broken heart, just as I was getting my life back on track. In that moment I considered all the hurtful things I could say to him – to give him a taste of how I felt and what I thought of him and his stupid request. In a flash my mind went over the course of events that had led us to this place- the threshold of divorce; the death of our beautiful baby boy.

The night he left, I remember sitting at the dining table thinking about how much he had changed. About how in the 3 years we’d been married or in the 2 years we’d dated I’d never seen this side of my husband. It’d been 8 months since we lost our son and I still didn’t know what my husband was thinking or how he was feeling; in all that time I’d tried to reach out to him, but he treated me like the enemy, like it was my fault our little boy was gone. I knew I couldn’t stop trying, so I walked up to where he sat on the couch and stroked his head, like I used to do when we first got married.


“Hey baby, how are you doing?”

He looked at me with so much irritation I physically withdrew. This was not my husband; this was not the man I married.

“Nnena, you keep asking me that question like you actually expect to hear anything different from what I’ve been telling you.”

“You say you are fine, but I know….”

“Has it not occurred to you that after everything that’s happened you are the last person I would want to talk to?”

Tears welled up in my eyes

“What can I do? What do you want me to do?”

Turning away from me

“Nothing. The truth is I just can’t do this anymore”

My heart raced. “You can’t do what any more?”

Just like that, in just a few words the love of my life placed the final brick on the wall that he’d been building between us. He wanted a divorce.

It’s been 14 months since that night, now he sits here, telling me he’s had a change of heart and wants me back? He must be having a laugh. Maybe he started weeding when he left, or maybe crack cocaine, or maybe…..

“Eyamba.”

There he goes again. Eyamba is my middle name; he’s the only one that calls me that.

“Don’t call me that. You lost the right to call me Eyamba the day you decided to stop fighting for our marriage.”

I regretted the words the moment they came out of my mouth.

“I’m sorry I didn’t mean to sound so…”

“No, no, no you are right. I gave up that right when I gave up on you- on us. Please give me another chance." He stretched his hand across the table. "That’s all I ask, just 1 more chance.”

I don’t want a divorce, but I also don’t want the constant insecurity that comes with not knowing if he will throw me off the ship again when the next storm comes. I know I have to take all these fears and insecurities to God until my husband’s actions prove that I can trust him to stick around no matter what comes our way.

“We’ll see how it goes.”

I extended my hand across the table to put it in his over the untouched platter of chicken wings he’d ordered, and his audible sigh of relief brought a half smile to my face.

Talia in black marking her six year anniversary since her diagnosis. ♥

Talia is a 13 year old girl who loves makeup, fashion, dancing, her family, doggie Bella and has been fighting cancer now for nearly 6 years.

Talia Castellano was diagnosed with stage 4 Neuroblastoma on February 14, 2007. She was cancer free for 13 months but relapsed in Sept. 2008. Again she was cancer free for almost 2 years, but sadly relapsed a second time on August 13, 2010 and has now relapsed again for a third time on April 8, 2011. She will never give up and does not let multiple surgeries, hospital stays, lab tests, chemo treatments, experiemental treatments or anything else get in her way of being simply AMAZING. She loves makeup and has her own YouTube channel, TaliaJoy18 and is an inspiration to many.

Update 08/06/12: Talia's cancer has spread and is now in her bone. In addition, she has developed pre-leukemia. Talia has not given up, but is not going to go through any more painful and toxic treatments and just prolong and enjoy the rest of her life. She is a strong and very brave young woman and we are so very proud of her.

I found out about her a while ago and i am quite surprised at her enthusiasm for life even in her situation. I admire her and her popular word  MAKEUP IS MY WIG. She does this as she is almost bald all year long from chemotherapy treatments and today she marks her sixth year struggling and all i can say is thank God for her cos she has inspired so many with her view of life.
She isn't letting go thou she is aware of her chances at life.

The Single Valentine Story.

Happy Val Celebration.

         

Let us remember in this day the real meaning of Love, the Originator of Love and what It takes to love.
Do not misuse the opportunity.
One Love pals.
Thanks for coming by............

We Are Nigerians - Journey to Amalgamation Documentary

We need to learn our History
We have to know our roots
We have to know what we have been through
We have to be true daughters and son
If we intend to make things better
We need This Knowledge

"Don't wait to buy real estate, buy real estate and wait."

A five bedroom flat with 2 living rooms on a 2plots of land,well furnished kitchen, well fenced and with boys quarters. Along with the house are 2 stand by generators( Diesel and petrol consuming). It cost #35 million along with agency fee. It can be negotiated upon. Its located at Olokuta Estate, Idi Aba, Abeokuta.





"Don't wait to buy real estate, buy real estate and wait."