Diabetes mellitus is a devastating metabolic disease caused by insufficient insulin synthesis, increased insulin disruption or ineffective insulin action. The pancreas is the organ where the Islets of Langerhans is located. The beta cells found in the islets of Langerhans aid the production of insulin. Diabetes mellitus is classified into two groups viz; Insulin Dependent Diabetes Mellitus (IDDM).and Non-insulin Dependent Diabetes Mellitus (NIDDM).
Insulin Dependent Diabetes Mellitus (IDDM) is also referred to as Type 1 diabetes or Juvenile onset diabetes. It affects people below 30years or age. Inadequate amount of insulin is secreted because the beta cells of the pancreas have been destroyed. Three factors have been implicated in this destructive process of the beta cells viz; genetics, viral infections and autoimmunity (i.e the body’s immune system destroys insulin.)
Non-insulin Dependent Diabetes Mellitus (NIDDM) is also called Type2 or maturity (adult) onset diabetes.It affects people above 35years of age. This type of diabetes is caused by the insensitivity of target tissues it insulin.It occurs mostly in obese people.
Symptoms of diabetes mellitus include hyperglycemia (high blood glucose level) caused by inadequate cellular uptake of glucose, glucosuria (i.e glucose in urine).osmotic dieresis,dehydration may affect patients despite consumption of large volumes of fluids in very severe cases, polydipsia (excessive thirst) and polyphagia(excessive hunger).
When there is insufficient insulin to regulate glucose, three principal target tissues and organs (i.e. liver , adipose tissue ,and muscles) don’t absorb nutrients adequately. In severe cases of diabetes, despite increased appetite and food consumption, the failure to utilize glucose effectively results in body weight reduction.
The following methods can be used to treat both types of diabetes mellitus;diet(should include high content dietary fibres),through the use of insulin pump,beta cell replacement therapy ,pharmacotherapy(i.e sulphonyiureas ,biguanides),
alternative medicine(plant extracts).Research has shown that extracts from Loranthus bengwensis (African mistletoe) and Indian almond and several others possess hypoglycemic properties.
Diabetes mellitus is a devastating metabolic disease and should be given adequate medical attention so that it can be effectively managed and treated.
Saturday, November 14, 2009
DIAGNOSTIC ENZYMES AND THEIR CLINICAL IMPORTANCE
Enzymes are substances which catalyse metabolic and biochemical reactions. They are also known as biological catalysts. They enable metabolic and biochemical reactions to occur by lowering the activation energy of such reactions. The following are examples of diagnostic enzymes viz,lactatedehydrogenase(LDH),
creatinekinase(CPK),alkaline phosphatase,aspartate aminotransferace(AST),
alanine aminotransferace(ALT),acid phosphatase,glucose-6-phosphate dehydrogenase
and so on.
It is pertinent to note that the rationale for assaying enzyme activities is based on the premise that changes in activities reflect changes that have occurred in aspecific tissue or organ. Lactate dehydrogenase is an important enzyme involved in glucose metabolism.It is a tetramer(has 2 different subunits).It has five isoenzymes which are designated LDH1(HHHH),LDH2(HHHM),LDH3(HHMM),LDH4(HMMM) and LDH5(MMMM) respectively.Isoenzymes catalyse similar reaction but migrate differently when subjected to electrophoresis.Hence,lactate dehydrogenase activity is found in cardiac muscles and red blood cells( i.e LDH1,LDH2 and LDH4),skeletal muscle(LDH5),Liver (LDH5),kidney and brain (LDH3).Hence,increased LDH activities can be used to detect myocardial infarction,leukaemia,liver cirrhosis,tumours of the central nervous system.
Creatinekinase(CPK) exists as a dimeric enzyme with three isoenzymes CPK1,CPK2, and CPK3.The subunits are designated BB,MB, and MM respectively.Total creatinekinase activity shows an increase following myocardial infarction.It is pertinent to note that it is only when CPK2(i.e MB subunit) contribute more than 6% of the total creatinekinase activity that creatinekinase is implicated in myocardial infarction.
Alkaline phosphatase is an enzyme which transport phosphate groups across cell membranes of organs.It is found in the osteoblasts(bone cells),bile canali ( in the liver),small intestinal epithelium,proximal tubule(kidney) and placenta.Increase in alkaline phosphatase occurs mainly in bone diseases such as Paget disease,Osteogenic sarcoma,liver diseases and bilary tract.
Aspartate aminotransferase (AST) is an enzyme involved in transamination reactions. Transamination reactions produce keto and amino acids simultaneously in tissues where they occur.The assay of serum AST is particularly useful in the diagnosis of myocardial infarction.Elevated AST levels is indicative of damage to the myocardium. Although AST activity is still used in the diagnosis of myocardial infarction,it has been replaced to some extent by the assay of total creatinekinase activity(especially the isoenzyme CPK2).
Serum aminotransferase activities are sensitive indicators of parenchymal liver damage.Both alanine and aspartate aminotransferases have been implicated in infective hepatitis,infectious mononucleosis and hepatocellular damage.Exposure to toxic substances such as carbontetrachloride poisoning ,therapeutic substances such as chlormphenicol, cephalosporins and paracetamol overdose have also resulted in elevated AST and ALT activities.
The serum barely detectable glucose-6-phosphate dehydrogenase activity .An elevated activity is indicative of myocardial infarction .Red blood cells contain 120 – 240 units per 1012 cells. Defeciency of this enzyme can result in hemolytic anaemia through the use of antimalarials such as primaquine, aromatic compounds ,it has also been associated to Favism (resulting from Fava beans consumption).
Acid phosphatase is found in the prostate, red blood cells, small amounts are found in bone, liver, spleen and pancreas. The assay of serum acid phosphatase is mostly used to detect prostatic carcinoma and to monitor the treatment.
creatinekinase(CPK),alkaline phosphatase,aspartate aminotransferace(AST),
alanine aminotransferace(ALT),acid phosphatase,glucose-6-phosphate dehydrogenase
and so on.
It is pertinent to note that the rationale for assaying enzyme activities is based on the premise that changes in activities reflect changes that have occurred in aspecific tissue or organ. Lactate dehydrogenase is an important enzyme involved in glucose metabolism.It is a tetramer(has 2 different subunits).It has five isoenzymes which are designated LDH1(HHHH),LDH2(HHHM),LDH3(HHMM),LDH4(HMMM) and LDH5(MMMM) respectively.Isoenzymes catalyse similar reaction but migrate differently when subjected to electrophoresis.Hence,lactate dehydrogenase activity is found in cardiac muscles and red blood cells( i.e LDH1,LDH2 and LDH4),skeletal muscle(LDH5),Liver (LDH5),kidney and brain (LDH3).Hence,increased LDH activities can be used to detect myocardial infarction,leukaemia,liver cirrhosis,tumours of the central nervous system.
Creatinekinase(CPK) exists as a dimeric enzyme with three isoenzymes CPK1,CPK2, and CPK3.The subunits are designated BB,MB, and MM respectively.Total creatinekinase activity shows an increase following myocardial infarction.It is pertinent to note that it is only when CPK2(i.e MB subunit) contribute more than 6% of the total creatinekinase activity that creatinekinase is implicated in myocardial infarction.
Alkaline phosphatase is an enzyme which transport phosphate groups across cell membranes of organs.It is found in the osteoblasts(bone cells),bile canali ( in the liver),small intestinal epithelium,proximal tubule(kidney) and placenta.Increase in alkaline phosphatase occurs mainly in bone diseases such as Paget disease,Osteogenic sarcoma,liver diseases and bilary tract.
Aspartate aminotransferase (AST) is an enzyme involved in transamination reactions. Transamination reactions produce keto and amino acids simultaneously in tissues where they occur.The assay of serum AST is particularly useful in the diagnosis of myocardial infarction.Elevated AST levels is indicative of damage to the myocardium. Although AST activity is still used in the diagnosis of myocardial infarction,it has been replaced to some extent by the assay of total creatinekinase activity(especially the isoenzyme CPK2).
Serum aminotransferase activities are sensitive indicators of parenchymal liver damage.Both alanine and aspartate aminotransferases have been implicated in infective hepatitis,infectious mononucleosis and hepatocellular damage.Exposure to toxic substances such as carbontetrachloride poisoning ,therapeutic substances such as chlormphenicol, cephalosporins and paracetamol overdose have also resulted in elevated AST and ALT activities.
The serum barely detectable glucose-6-phosphate dehydrogenase activity .An elevated activity is indicative of myocardial infarction .Red blood cells contain 120 – 240 units per 1012 cells. Defeciency of this enzyme can result in hemolytic anaemia through the use of antimalarials such as primaquine, aromatic compounds ,it has also been associated to Favism (resulting from Fava beans consumption).
Acid phosphatase is found in the prostate, red blood cells, small amounts are found in bone, liver, spleen and pancreas. The assay of serum acid phosphatase is mostly used to detect prostatic carcinoma and to monitor the treatment.
Saturday, October 3, 2009
ACNE : A FACIAL DISORDER WITH ITS TREATMENT
Acne, commonly referred to as pimples is an inflammatory skin disorder which affects the face of humans. Acne is more common in males because androgens stimulate the production of keratin and sebum which leads to clogged pores. Most women suffer premenstrual flare-ups that are prompted by the release of progesterone after ovulation. During puberty, both sexes have increased androgen levels and this makes girls to be vulnerable to acne.
The exact cause of acne is idiopathic (unknown origin),but factors that contribute include; heredity, oily skin, androgens, steroids, oral contraceptives, consumption of junk foods, saturated fats, use of cosmetics and monthly menstrual cycles.
The sebaceous gland is a very important gland found in the skin. Studies have shown that increased activity of this gland has been implicated in acne. The sebaceous gland secrete sebum, an oily substance.
The panacea for acne or pimples include the following; consumption of diet rich in fibre is encouraged so as to remove toxins from the body. Eat foods rich in zinc such as soybeans, whole grains, shellfish, avoid alcohol and caffeine intake, butter. Avoid all forms of sugar since excess sugar affects the immune system. Eliminate all processed foods from diet, keep the affected area free from oil by washing with an all-natural soap with sulfur that is designed for acne. Use natural, water-based cosmetics.
The use of drug therapy in severe acne is also relevant. Drugs like Isotretinoin (Accutne) disrupts plug formation and shrinks the overactive sebaceous glands. Topical tretinon (Retin-A)can be used in moderate cases of acne by preventing the pores from being clogged .Benzyl peroxide is also used to treat mild cases. Anti-acne lotion such as neo-cresol, ten-o –six can be used.
The need to maintain facial beauty cannot be overemphasized. Pimples can be effectively treated and averted if the above-mentioned dietary and health habits are strictly obeyed.
The exact cause of acne is idiopathic (unknown origin),but factors that contribute include; heredity, oily skin, androgens, steroids, oral contraceptives, consumption of junk foods, saturated fats, use of cosmetics and monthly menstrual cycles.
The sebaceous gland is a very important gland found in the skin. Studies have shown that increased activity of this gland has been implicated in acne. The sebaceous gland secrete sebum, an oily substance.
The panacea for acne or pimples include the following; consumption of diet rich in fibre is encouraged so as to remove toxins from the body. Eat foods rich in zinc such as soybeans, whole grains, shellfish, avoid alcohol and caffeine intake, butter. Avoid all forms of sugar since excess sugar affects the immune system. Eliminate all processed foods from diet, keep the affected area free from oil by washing with an all-natural soap with sulfur that is designed for acne. Use natural, water-based cosmetics.
The use of drug therapy in severe acne is also relevant. Drugs like Isotretinoin (Accutne) disrupts plug formation and shrinks the overactive sebaceous glands. Topical tretinon (Retin-A)can be used in moderate cases of acne by preventing the pores from being clogged .Benzyl peroxide is also used to treat mild cases. Anti-acne lotion such as neo-cresol, ten-o –six can be used.
The need to maintain facial beauty cannot be overemphasized. Pimples can be effectively treated and averted if the above-mentioned dietary and health habits are strictly obeyed.
THE EFFECTS, MANAGEMENT AND TREATMENT OF HYPERTENSION
The adverse effects of hypertension principally involve the blood vessels, the central nervous system, the retina, the heart and the kidneys respectively. Structural changes in blood vessels via arteriosclerosis often promote and aggravate hypertension by increasing peripheral vascular resistance and reducing renal function. Stroke is a common complication of hypertension and may be due to cerebral haemorrhage or cerebral infraction. The excessive cardiac mortality and morbidity associated with hypertension is largely attributed to a higher incidence of coronary artery disease. Studies have shown that long standing hypertension may cause proteinuria and progressive renal failure by damaging the renal vasculature or blood vessels.
Management of hypertension requires a detailed understanding of the aetiology and pathogenesis, mechanism of control of elevated blood pressure. Such mechanisms include the baroceptor feedback mechanism, chemoreceptor mechanism,rennin-angiotensin-aldosterone mechanism, and the killikrein-kinin mechanism.
Treatment of hypertension involves the use of two approaches viz; the non-drug approach and the drug approach. Non-drug approach include dietary discipline such as salt restriction, less consumption of fatty foods, avoid smoking ,weight reduction therapy fro obese persons, reduced alcohol intake, partaking in exercises and adequate rest from strenuous activities. Drug approach should be utilized with caution since hypertension is a disease of decades. The drug regimen should have minimal side effect and well tolerated, must cause no organ damage at therapeutic doses, and have a gradual effect on decreasing elevated blood pressure. Examples of such drugs include indapamide, amiloride, clonidine, adomet (α methyldopa), hydralazine, captopril, trandolapril, losartan and so on.
Conclusively, hypertension is a deadly killer disease which can be effectively managed and treated, and prevented if healthy lifestyle and dietary discipline is practiced.
Management of hypertension requires a detailed understanding of the aetiology and pathogenesis, mechanism of control of elevated blood pressure. Such mechanisms include the baroceptor feedback mechanism, chemoreceptor mechanism,rennin-angiotensin-aldosterone mechanism, and the killikrein-kinin mechanism.
Treatment of hypertension involves the use of two approaches viz; the non-drug approach and the drug approach. Non-drug approach include dietary discipline such as salt restriction, less consumption of fatty foods, avoid smoking ,weight reduction therapy fro obese persons, reduced alcohol intake, partaking in exercises and adequate rest from strenuous activities. Drug approach should be utilized with caution since hypertension is a disease of decades. The drug regimen should have minimal side effect and well tolerated, must cause no organ damage at therapeutic doses, and have a gradual effect on decreasing elevated blood pressure. Examples of such drugs include indapamide, amiloride, clonidine, adomet (α methyldopa), hydralazine, captopril, trandolapril, losartan and so on.
Conclusively, hypertension is a deadly killer disease which can be effectively managed and treated, and prevented if healthy lifestyle and dietary discipline is practiced.
HYPERTENSION:THE SILENT AND POTENT KILLER
The Advanced Learners Dictionary by A.S. Hornby defines hypertension as ‘abnormally high blood pressure’. Research has shown that a sustained diastolic pressure greater than 90mmHg or a sustained systolic pressure in excess of 140mmHg is considered to constitute hypertension.
Hypertension could be primary or essential, secondary, salt-induced respectively. Between 90-95% of hypertensive cases are idiopathic (of unknown origin).Secondary hypertension occurs in a small percentage of patients (between 5-10%) and also caused by renal disease. Detailed studies on single gene disorder have been interpreted to favour the hypothesis that defects in renal-sodium homeostasis are the primary cause of hypertension. Rise in blood pressure is directly correlated with increasing levels of sodium intake. Genetically predisposed animals given sodium loads develop hypertension. Sodium restriction lowers blood pressure in hypertensive humans.
Aetiology of hypertension can be successfully established in only 10-15% of patients. However, a meticulous investigation of autonomic nervous system function, rennin-angiotensin system and failure of the kidney to identify a primary abnormality resulting in elevated peripheral vascular resistance in hypertensive cases. The probability of offspring inheriting hypertension has been put at 30%.
Pathogenesis of hypertension has been associated to two factors viz; genetic influences and environmental factors. Mutations occurring in genes found in enzymes controlling aldosterone metabolism ultimately result in hypertension. Examples include aldosterone synthase, 11β-hydroxylase, 17α-hydroxylase and so on.
Environmental factors that could lead to hypertension include increased salt intake (sodium), obesity, occupation, serum cholesterol levels, cigarette smoking and so on. There is a correlation between obesity and arterial pressure. Obese persons usually have elevated arterial pressure which results in hypertension. Fundamental haemodynamic variables such as cardiac output and peripheral vascular resistance play key roles in the pathogenesis of hypertension.
Hypertension is a silent, potent killer disease which can adequately be cured by a qualified medical officer through the use of antihypertensive drugs and dietary discipline. The need to be adequately informed is very essential in treating and averting hypertension.
Hypertension could be primary or essential, secondary, salt-induced respectively. Between 90-95% of hypertensive cases are idiopathic (of unknown origin).Secondary hypertension occurs in a small percentage of patients (between 5-10%) and also caused by renal disease. Detailed studies on single gene disorder have been interpreted to favour the hypothesis that defects in renal-sodium homeostasis are the primary cause of hypertension. Rise in blood pressure is directly correlated with increasing levels of sodium intake. Genetically predisposed animals given sodium loads develop hypertension. Sodium restriction lowers blood pressure in hypertensive humans.
Aetiology of hypertension can be successfully established in only 10-15% of patients. However, a meticulous investigation of autonomic nervous system function, rennin-angiotensin system and failure of the kidney to identify a primary abnormality resulting in elevated peripheral vascular resistance in hypertensive cases. The probability of offspring inheriting hypertension has been put at 30%.
Pathogenesis of hypertension has been associated to two factors viz; genetic influences and environmental factors. Mutations occurring in genes found in enzymes controlling aldosterone metabolism ultimately result in hypertension. Examples include aldosterone synthase, 11β-hydroxylase, 17α-hydroxylase and so on.
Environmental factors that could lead to hypertension include increased salt intake (sodium), obesity, occupation, serum cholesterol levels, cigarette smoking and so on. There is a correlation between obesity and arterial pressure. Obese persons usually have elevated arterial pressure which results in hypertension. Fundamental haemodynamic variables such as cardiac output and peripheral vascular resistance play key roles in the pathogenesis of hypertension.
Hypertension is a silent, potent killer disease which can adequately be cured by a qualified medical officer through the use of antihypertensive drugs and dietary discipline. The need to be adequately informed is very essential in treating and averting hypertension.
MYOCARDIAL INFARCTION AND ITS TREATMENT
Myocardial infarction, more commonly known as a heart attack is a process which results when blood supply to the heart is reduced or cut off thereby depriving the cardiac muscles of oxygen which ultimately results in their death.
Studies have shown that there are three basic scenarios that can produce heart attack viz; partial or complete blockage of one of the arteries that supply the heart with oxygen, the setting up of an abnormal rhythm that affects cardiac output and development of a weak spot in a blood vessel. Partial or complete blockage of one of the arteries can be caused by a blood clot, formation of plaque as a result of high consumption of rich fatty foods (source of ‘bad’ cholesterol or low density lipoproteins).The narrowing and hardening of the arteries(arteriosclerosis) impede blood flow to the heart and this affects cardiac output. The blockage of the coronary artery result in coronary artery disease. The development of a weak spot in a blood vessel called aneurysm can rupture resulting in internal bleeding and disrupting normal blood flow.
Humans considered to be at greater risk of having a heart attack include; smokers, those who abuse drugs, diabetics, hypertensives, those with hypercholestoremia, high triglyceride levels, those with elevated lactate dehydrogenase, aminotransferases and creatinekinase enzyme levels, and those passing through stress. It is pertinent to note that one-third of all heart attacks occur without warning while the rest are preceded by months or even years of symptoms. Such symptoms include angina pectoris chest pain, intermittent angina, constant sensation of heartburn that persist for days and from which antacids provide no relief.
The following guidelines are necessary for ameliorating and averting heart attack; eat foods rich in dietary fibre, do not eat red meat, highly spiced foods, salt, fried and fatty foods, avoid smoking and alcohol intake, minimize your intake of vitamin D, a fat-soluble vitamin, and dairy products with high fat content. Drugs such as vassoprin can be used to avert heart attack. Proper management of hypertension and diabetes through the use of drugs such as adomet, captopril, Indapamide, Hydralazine, Clonidine, sulphonylurea and biguanides, monitoring cholesterol/triglyceride levels, levels of marker enzymes such as creatinekinase (CK), Lactate dehydrogenase,(LDH),aminotranferases(AST and ALT) can help to avert heart attack.
Studies have shown that there are three basic scenarios that can produce heart attack viz; partial or complete blockage of one of the arteries that supply the heart with oxygen, the setting up of an abnormal rhythm that affects cardiac output and development of a weak spot in a blood vessel. Partial or complete blockage of one of the arteries can be caused by a blood clot, formation of plaque as a result of high consumption of rich fatty foods (source of ‘bad’ cholesterol or low density lipoproteins).The narrowing and hardening of the arteries(arteriosclerosis) impede blood flow to the heart and this affects cardiac output. The blockage of the coronary artery result in coronary artery disease. The development of a weak spot in a blood vessel called aneurysm can rupture resulting in internal bleeding and disrupting normal blood flow.
Humans considered to be at greater risk of having a heart attack include; smokers, those who abuse drugs, diabetics, hypertensives, those with hypercholestoremia, high triglyceride levels, those with elevated lactate dehydrogenase, aminotransferases and creatinekinase enzyme levels, and those passing through stress. It is pertinent to note that one-third of all heart attacks occur without warning while the rest are preceded by months or even years of symptoms. Such symptoms include angina pectoris chest pain, intermittent angina, constant sensation of heartburn that persist for days and from which antacids provide no relief.
The following guidelines are necessary for ameliorating and averting heart attack; eat foods rich in dietary fibre, do not eat red meat, highly spiced foods, salt, fried and fatty foods, avoid smoking and alcohol intake, minimize your intake of vitamin D, a fat-soluble vitamin, and dairy products with high fat content. Drugs such as vassoprin can be used to avert heart attack. Proper management of hypertension and diabetes through the use of drugs such as adomet, captopril, Indapamide, Hydralazine, Clonidine, sulphonylurea and biguanides, monitoring cholesterol/triglyceride levels, levels of marker enzymes such as creatinekinase (CK), Lactate dehydrogenase,(LDH),aminotranferases(AST and ALT) can help to avert heart attack.
ERECTILE DYSFUNCTION AND ITS TREATMENT
Impotence or erectile dysfunction is the inability of a man to obtain and sustain an erection. If a man does not have the ability to achieve or maintain an erection adequate for normal sexual intercourse, he is said to be impotent. Erection result from a complex combination or synergy of brain stimuli, blood vessels, nerve function and action of hormones.
Many factors that can result to erectile dysfunction or impotence include; use of certain drugs (antidepressants, diuretics, sedatives, and antihistamines),alcohol consumption, cigarettes, a history of sexually transmitted infections, diabetes mellitus and hypertension. Hormonal imbalance of fluctuations such as testosterone levels, elevated prolactin productions, and so on. Diabetes mellitus, a metabolic disease is probably the most common physical cause of impotence.
Studies have shown that impotence may be chronic or recurring. The age bracket of men suffering from impotence is between 30 – 60 years. Many therapists and physicians believe that 85% of cases of impotence have some physical origin while the remaining 15% can be attributed to psychological problems.
The appropriate treatment for erectile dysfunction is dependent on whether the cause is physical or psychological. A man whose impotence is psychologically based can still have erection during sleep unlike the man experiencing a physically based impotence.
The following health practices can be used to treat impotence. viz; eating a healthy, well balanced diet, avoid alcohol especially before sexual intercourse, consult a urologist for testing to determine whether impotence is caused by an underlying illness that require treatment. A therapist can be consulted to explore psychological factors that may contribute to impotence especially repressed anger, hate or a fear of intimacy. The use of drugs to treat erectile dysfunction should be under the strict supervision of a qualified medical officer since these drugs have side effects. Drugs include Regitine, Alprostadil, Sidernaphil(Viagra),Yohimbine and so on. Vacuum devices can also be employed to promote erection.
The measure of a man is his ability to copulate and satisfy the woman sexually and if necessary to impregnate the woman. Most men would prefer infertility to impotence. Impotence or erectile dysfunction has a very strong relevance in the socio-sexual life of every man and must be tackled thoroughly.
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