What some medical personnels do not know about LORATIDINE.

    Loratidine is a piperidine derivative related to azatadine..
  It is a long-acting,non sedating tricyclic antihistamine with selective peripheral H1-receptor antagonist activity,with no significant sedative or anti-muscarinic activity.
  Loratidine is rapidly absorbed from the G.I.T after administration.
  Peak plasma concentrations are beign attained at about one hour.
  Loratidine is 98% bound to plasma protein and undergoes extensive metabolism,maily to decarboethyloratidine,which has less ootent anti-histamine activity.
 Loratidine has an half-life of 8.4 hours.

 INDICATIONS
 Loratidine is indicated for relief of symptoms with allergic rhinitis such as sneezing,nasal discharge (rhinorrhea) and itching, ocular itching and burning.

 It is also indicated for relief of symptoms of chronic urticaria and other dermatological disorders.


  CONTA-INDICATIONS
 Loratidine is contra-indicated  in :
-Bladder obstruction
-Protastic hypertrophy
-Urinary retention,
-glaucoma or sensitivity to loratidine.

 

 USE IN PREGNANCY AND LACTATION
The safe use of loratidine in pregnancy has not been established because small amounts of it are excreted in breast milk and therefore,risk benefits should be considered due to increased risk of antihistamines in infants.


    DOSAGE
Usual dose for adults and children weighing 30 and above  is 10mg dly.

 For children less than 30kg,a dose of 5mg dly is recommended.

 

   DRUG INTERACTION
Increased plasma concentration has been reported when loratidine is used concomitantly with buscopan,erythromycin,ketokonazole and cimetidine.

See what you should know about the drug, FLUCONAZOLE!

     

    Flucinazole is an antifungi drug active        against the following:

-Treatment of cryptococcal meningitis in patients who are unable to tolerate amphorericin B.

-Maintenance therapy to prevent relapse of cryptococcal meningitis in Px. with AIDS.

- Treatment of oropharyngeal and oesophageal candidiasis in AIDS and other immunosuppressed px.

- Secondary prophylasis of oropharyngeal candidiasis in px with HIV infection.

- Serious and life threatening candida infections in px. unable to tolerate amphoteric B.

- Vagina Candidiasis on failure of topical therapy.

- Treatment of extensive tinea corporis,tinea curis,tinea pedis infection in immunocompetent px. in whom topical therapy is not a practical treatment option.


        Dosage and Administration
Fluconazole is normally administered orally. If possible,it may be administered through I.V.F at a rate not exceeding 200mg/hr.
  Since the oral absorption is rapid and almost complete,there is no need to change the daily dosage and tranferring from I.V.F to oral or vice versa.
   The daily dose of fluconazole should be based on the infectiing organism and the px. response to therapy and treatment should continue until clinical parameters or laboratory test shows that the fungal infection has subsided.

**The IVF is compatible with Ringers Solution and normal saline.

 Adult:

-Cryptococcal meningitis in patients who are unable to take or tolerate amohotericin B: the usual dose is 400mg stat ;followed by 200mg daily.
 A dosage of 400mg daily may be used,based on medical judgement of the px's response to treatment.
 For px. not responding to treatment for uo to 60 days would appear unlikely to respnd to Fluconazole.
 The treatment duration for for cryptococcal infections depend on the clinical and mycological response,but should continue 10-12 wks after CSF culture becomes negative .

- Prevention of relapse of cryptococcal meningitis in AIDS px:
 After the pxreceives a full course of primary therapy,flucinazole may be administered at a daily dose of 100-200mg.

- Oropharyngeal Candidiasis:
 The recommended dose is 100mg stat;followed by 50mg daily.
 For oesophageal candidiasis,the recommended dose is 200mg stat;then 100mg daily.
  Clinical evidence of candidiasis usually resolves in few days,but treatment should continue for 2-3 wks at least,especially in px. with severely compromised immune system.

-Secondary prophylasis against oropharyngeal candidiasis in px. with HIV infection: the recommended dose is 150mg as a single dose once weekly.

- Serious and Life threatening Candidal infections in px. with Amphoteric B intolerance: The usual dose is 400mg stat; then, 200mg daily, depending on the clinical response.

-Vaginal Cadidiasis on failure of topical therapy:  A single oral dose of 150mg should be administered.

-For extensive tinea corporis,tinea curis or severe tinea pedis in immunocompetent px. in whom topical therapy is not practical: The recommended dose is 150mg weekly for 4 weeks.


Children

 As with similar infections in adult,the duration of treatment is based on the clinical and mycological response .
 The recommended child dose is 3-6mg/kg.

Elderly
 Dosage should be reduced for elderly px with renal impairment.


              Conta-indications
Fluconazole is contra-indicated for pxs. with known sensitivity to Fluconazole or related azole compounds or it's esipients.

ALL YOU NEED TO KNOW ABOUT THE USE OF CEFUROXIME

    Clinical Particulars:

    Cefuroxime is a cephalosporine antibiotics,which is resistant against most Beta-Lactamase and its active against a wide range of Gram-Positive and Gram-Negative organisms.

   It is an atibiotics indicated for the treatment of infections caused by susceptible bacteria.
 
   Susceptibility of cefurixime may vary with geography,time and local susceptibility data should be conducted where available.



  Indications:

 - Upper Respiratory Tract infections e.g ENT infections;  such as Otitis media, Sinusities,Tonsilitis and Pharyngitis.

- Lower Respiratory Tract infections e.g Pneumonia, Acute bronchitis, Acute exacerbation of acute chronic bronchitis.

- Genito-urinary Tract Infection e.g Pyelonephritis, Cystitis , Urethritis

- Skin and soft tissue Infections e.g Impetigo, Pyoderma ...

- S.T.I e.g Gonorrhea.

- Treatment of early Lyme disease and subsequent prevention of late Lyme disease.


 Dosage:

 The usual course of treatment is 7 days ; however , course of treatment may range from 5-10 days.
 And for optimal absorption,Cefuroxime should always be taken with food.

• Adult:
Most Infections            = 250 mg twice daily.
UTI.                                = 125 mg  twice daily.
Mild to moderate LRTI = 250 mg twice daily.
Severe LRTI                    = 500 mg twice daily.
Gonorrhea.                    = 500 mg twice daily.
Pyelonephritis.             =  250 mg twice daily.

••Children:
When prescription of fixed dose is preferred,the recommended dose for most infections is 125 mg twice daily. In children aged two years or older with Otitis media,or where appropriate,with more severe infections,the dose dose is 250 mg twice daily,to a max of 500 mg daily.

* For paediatric use; a course of 10 mg/kg daily for mild to moderate infection and 15 mg/kg  daily in divided doses for severe infection should be given.


    Overdose:
Cephalosporine overdose can cause cerebral irritation,which can lead to convulsion.

  Treatment: Overdose can be treated with haemo dialysis and peritoneal dialysis.



  Absorption:
On administration,Cefuroxime are absorbed from the G.I.T and rapidly hydrolysed in the intestinal mucosa and blood;thus released into the body's circulation.
  Its absorption is well enhanced with food.

Followning administration, cefurixime peak serum level (2.9 mg/ l for a 125 mg dose, 4.4 mg/l for a 250 mg dose ,7.7 mg/l for a 500 mg dose and 13.6 mg/l for a 1g dose) occurs approximately 2.r hrs after dosing ,when taken with food.



   Interaction:
 Drugs which reduces gastric acididty ,e.g antacids,may result in a lower bioavalability of cefurixime compared with that of fasting state and tend to cancel the effect of of enhanced absorption after food.

Like other antibiotics, cefuroxime may affect gut flora, leading to lower oestrogen re- absorption and reduced efficacy of combined oral contraceptives.


 Use in Pregnancy and Lactation:
The use of Cefuroxime is safe in pregnancy/lactation,because there has been no historical/experimental evidence of teratogenic effect.

 But,like every other antibiotics,it should be administered with care in the early trimesters of pregnancy.

                 

MALE INVOLVEMENT IN REPRODUCTIVE HEALTH

     

     While considering male involvement in Reproductive health,there is need to consider the role of men in Family planning.

  In many African countries,men are the providers and heads of households and therefore,the decision makers of in the fanily.

  Men in their capacity as heads of families and decision makers exert a lot of influence on their family especially their wives,on reproductive health decisions.

  Men's support and participation will therefore make a big difference in the family's reproductive health matters.

 
   Importance of Male Involvement  
         In  Family Planning

 1.  Men are also at risk of reproductive health problems linked with puberty,lack of access to family planning services,substance abuse,sexual and domestic violence and several sexual partners ,resulting in contracting and transmitting infections,including HIV/AIDS.

 2.   For better under of gender role:- there are now changes in traditional inequalities between men and women;;Hence,gender roles may be beneficial if men are involved.

 3. Increase contraceptive prevalence and aceptance.

 4.  Find solution to common health problems.

 5. Men/boys are often not equiped with sufficient information and knowledge on sexual and reproductive health and are often marginalized by health services.

 6. For better understanding of sexuality and different ways in which men and women experience sexual pleasures.

 7.  Improve greater access to high quality reproductive health care / services.

 8.  Increase greater male involvement with children and contributiins to parenting.

 9.  Enhance better under of domestic violence and ways to enhance men's abilitg to communicate in non-violent ways.

SEXUAL DYSFUNCTIONS

 
    Sexual dysfunction or sexual mal-formation refers to a difficulty experienced by an individual or a couple during any stage of a normal sexual activity,including Desire,Preference,Arousal or orgasm.
   
   Sexual Dysfunction can have a profound impact on an idividuals perceived quality of sexual life.
  A thorough sexual history and assessment of general health and other sexual problems (if any) are very important.
 

   Classification

Sexual dysfunction may be classified into 4 main categories;namely:

 - Sexual desire disorders e.g low libido.
 - Arousal Disorder e.g Erectile Dysfunction.
 - Orgasm Disorder e.g Premature                      ejaculation.
 - Pain Disorder e.g                                                  dysparenia,Priapism,Vaginismus.

     
       Sexual Desire Disorders 
  Sexual desire disorders are characterised by a lack or absence for some period of time for sexual desire or libido for sexual activity or of sexual fantasies.

  This condition ranges from from a general lack of sexual desire to a lack of sexual desire for the current partner .

  The condition may have started after a period of normal sexual functioning or the person may always have had no or low sexual desire.

 The cause varies considerably,but include a possible decrease in the production of normal oestrogen in women or testosterone in men;
  Other causes may be:
- Ageing
- Fatigue
-Pregnancy
-Effect of medication
-Depression/anxiety or any other      phychiatric  condition

 **Loss of libido from the use of certain medication usually reverses after the medication stops;but in some cases,it doesn't.



         Sexual Arousal Disorders
  Sexual arousal disorders were previously known as frigidity in women or impotence in men ;but it has been replaced with less judgemental terms ; e.g impotence,now erectile dysfunction and frigidity has a number of terms describing specific problems ;;e.g 'desire /arousal.

   For both men and women,these conditions can manifest as an aversion to or avoidance of  sexual contact with a partner .
  In men, there may be partial or total failure to to attain or maintain erection or there may be lack of sexual excitement and pleasure in Sexual activity.

  There may be medical causes to these disorders such as decreased blood flow or lack of vagina lubrication.
  Chronic desease e.g type ii diabetis can also contribute,as well as the nature of the relationship between the parners.
  The side effect of some hypertensive drugs, e.g methyldopa can also be a cause.



         Erectile Dysfunction (Impotence)
  Erectile dysfunction  is a sexual dysfunction characterised by the inability to develope or maintain an erection of the penis.

     There are various underlined casuses, such as damaged nerve endings,which prevents or delays erction, medical conditions like diabetis ,as well as cardiovascular diseases which decreases blood flow to the tissues in the penis.

  These above listed cause can be psychological or physiological.
 Physiological damage is more severe,but psychological erctile dysfunction can often be helped by anything the px believes in.




           Orgasm Disorder
This is a type of sexual disorder whereby ejaculation occurs before the oartner achieves orgasm or a mutual satisfactory length of time has passed during intercourse.

  There is no calculated length of time for intercourse to last,but generally, premature ejaculation is said to occur under 2 minutes from the time of insertion of penis.

 For a diagnosis,the px must have chronic hx of premature ejaculation,poor ejaculatory control and problem of 'feeling of disatisfaction' as well as distress in the px,partner or both.
 
 Historically,it was attributed to psycological causes,but new theories suggest that premature ejaculation may have an underlying neuro-biological cause,which may lead to rapid ejaculation.

 


          Sexual pain disorders
 This affect women,almost exclusively and are also known as vaginismus (an involuntary spasm of the muscles of the vagina wall) or dysparenia (painful sexual intercourse).
  In men,it ovcurs as *priapism.

 Dysparenia may be caused by insufficient vagina lubrication (vagina dryness). Poor lubrication may result from insufficient excitemebt or sexual stimulation or from hormonal changes caused by menopause,pregnancy or breastfeeding.

 Irritation from contaceptive creams and foams may also be a cause,as can fear and axiety about sex.

  It is unclear exactly,the casuses of vaginismus,but it is thought that passed sexual trauma,such as rape or sexual abuse  may play a role.

  *Priapism :- This is a painful penile erection that occurs for several hours,without sexual stimulation.
  This condition developes when blood get trapped in the penis. If the condition is not promptly treated, it can lead to severe dcaring and permanrnt loss of erectile function.
 It occurs in young men and children; as well as adults who misuse certain medication.
  Individuals with sickle Cell Disease may also suffer this type of pain disorder.

       

THE MENSTRUAL CYCLE

 

   
   
     Menstruation by definition,is the monthly 
discharge of blood from the endometrium of the uterus,which comences at puberty and ends at menopause;

  *The first mesntrual cycle is called menarche. 

     The cycle

       The menstrual cycle refers to the harmonous,regular cyclic changes that occurs in the ovaries and uterus from the time of menarchy to menopause.

  

These changes are usually under the control of the follicle stimulating hormone (FSH), from the anterior pictuitary gland,which actvon the ovaries to produce oestrogen and progesterone;

 Then normal cycle is 28 days and each cycle has three stages/phases:

  1. The Poliferative Phase:-This is when the the endometrium of the uterus is under the influence of the F.S.H by the anterior pictuitary gland.

   

    It is the the phase that follows immediately after menstruation and lasts till ovulation.

    During this phase,the endometrium is reformed  and regenerated;There is re-qrowth and thickening of the endomentrial lining that has been shared during menstruation.

   This phase undergoes the re-generative changes when the F.S.H causes one premodial follicle to ripen to a graffian follicle.

   The ripened graffian follicle produces the female sex hormone,oestrogen in large quantities. The effect of oestrogen brings about the poliferation (bursting) of the endomentrium.

  There is thickenibg of the endomentrial  lining when the level of oestrogen rises in the blood,stimulating the release of lieutenising hormone (L.H) by the anterior pictuitary gland (A.P.G).

 The release of the of the L.H causes the mature graffian follicle to rupture and release an egg; and this is process is called Ovulation.

  2. The Secretary Phase :-  This is when the the endometrium is under the control of progesterone.

  

In this phase, level of progesterone rises and helps to stimulate the building of the uterine lining; The endometrial glands grows and become more tortous.

The layers thickens to about 3.5mm and becomes spongy in appearance .The lining shows evidence of of secretions in readiness for the reception of a possibly fertilizes ovum ;;thus,begins its journey towards the uterus from the fallopian tube.

  3. The Menstrual Phase:- This phase occurs at about the 22nd day after the begining of the previous mesnstrual period.

 If the ovum is not fertilised,the  corpus liteum disintegrates and causes a decrease in the level of oestrogen and progesterone in the blood.

 By day 28,there are not enough of these two hormones to keep the lining of the uterus going,the endometrium now lacking hormonal support,breaks down and it's shed in form of menstruation.

 This explains why the Menstrual flow usually lasts 5 days on the average in 1 month;but there are wide variations depending on the cycle.
 At the end of the 5th day, F.S.H is again secreted by the A.P.G and the cycle begins again.

SIGNS AND SYPTOMS OF PREGNANCY

       

     When pregnancy occurs,menstruation ceases and returns to some weeks or months after delivery.
 Amenorrhoea,ceasation of menstruation and breast changes are the foremost signs the woman sees that shows pregnancy.

            Signs and symptoms

 1. Presumptive Signs:
    • Early breast Changes around 3-4 weeks         in primi-gravida but not significant in           multi-gravida.

   • Amenorrhoea, Ceasation of                              menstruation at 4 weeks.

  • Morning Sickness;i.e nausea with or without vomitting between 4-14 weeks.

   • Bladder irritability between 6-12 weeks.

   • Frequent micturition,but without pain.

   • Quickening: movement of the foetus first recongnised by the mother between 16-12 weeks.

 
2. Probable signs:
   Majority of these signs are elicited by the health Professional mainly by Vagina examination and laboratory investigatio,such as the presence of Human Choronic Gonaldotropic hormone(H.C.G) in blood and urine at around 9-14 days.
   Other signs include;

  •Hegars Sign (Softened Isthmus)-a sensation felt by the finger when a bi-manual vagina examination is done.

  •Osiander's Sign (Pulsation of the furnices)

 • Uterine Souffles.

 •  Chadwicks Sign (blueish coloration of the vagina)

 • Braxton Hick's Contraction at the 16th week.

3. Positive Signs:
  • Hearing of the foetal heart rate when checked with a foetal stetoscope at about the 20th week.

  • Palpation of foetal part at 24th week.

  •  Visualisation of the foetus through Ultrasonography at about the 4-6th week or X-Ray at the 16th week of gestation.

PICTORIAL AID ON DIAGNOSING SOME COMMON SKIN INFECTIONS

Most times,Health professionals are presented with some skin/soft tissue infection(s),and diagnosis may be un-easy for him/her based on some certain iota of similarity(ies) that goes with diverse skin problems.

But with Proper physical examination done on the patient,based on the physical presentation of infection,the Health Professional would be able to give accurate diagnosis of the dermatological case presented;thus helping to find a matching medication for the patient.

Below are pictorial presentation of some common skin infections, with accompanying signs and symptoms, which will enhance the Health Professional's knowledge on giving proper diagnosis to dermatological cases presented to the Health facility:

THE PROCESS OF CONCEPTION

  To begin,let's know what conception is;

** Conception,also called Pregnancy starts with the fusion of the male spermatozoa with the female ovum during or after sexual coitus(sexual intercourse).

The fusion of the ovum and spermatozoa takes place at the ampullae of the falopian tube and it is called fertilisation,while the fertilised ovum is called a zygot

N:B :: At sexual intercourse,between 200 to 500 million sperm cells are ejaculated into the vagina,but the acididty of the vagina is not favorable for their survival,so many of the sperms die there.

The remainder of the sperm(about 10'000) moves towards the cervix and only about a few hundred may be all that finally complete the journey to the falopian tube,where fertilisation takes place.

The egg is capable of fertilisation up to 48 hours after its release from the from the ovary and the sperm has a maximum lifespan of 72 hours.

The Process

At Ovulation,the egg is is picked up by the fibriam Ovarica, some finger-like projections of the fallopian tube and then swept by cilliary action toelwards the ampullae,where the fusion takes place.

The sperm penetrates the egg cytoplasm;thus a fusion of egg and sperm to form a zygote.

When one sperm penetrates the jelly-luke coat and cellulose membrane of the egg,other sperms are prevented from fertilising the same egg through an immediate thickening of the cell membrane.

This fertilisation, in humans is complete 20hrs after coitus,resulting in the formation of a Diploid number of 46 chromosomes in the embrayo(zygote),contributed by the donation of 23 chromosomes each by the egg and spermatozoa;

                     

IDENTIFYING MEDICAL INSTRUMENTS AND THEIR USES.

  There are a million instruments  used in medical practice today.
  This article gives a  picture based identification,description and uses of some medical instruments used both in the Primary,Secondary and Tetiary Levels of Health.