Diabetic Neuropathy

Diabetic Neuropathy is a neurometabolic disorder that is found in diabetic patients.

• About 60-70% of people with diabetes have mild to severe forms of nervous system damage, including:                                                                                                                                                                -Impaired sensation or pain in the feet or hands                                                                          -Slowed digestion of food in the stomach                                                                                        -Carpal tunnel syndrome                                                                                                                   -Other nerve problems

• More than 60% of nontraumatic lower-limb amputations in the United States occur among people with diabetes.

Risk Factors
-Glucose control
-Duration of diabetes
-Damage to blood vessels
-Mechanical injury to nerves
-Autoimmune factors
-Genetic susceptibility
-Lifestyle factors
-Smoking
-Alcohol
-Increased Height
-Pathogenesis of Diabetic Neuropathy
Metabolic factors
-High blood glucose
-Advanced glycation end products
-Sorbitol
-Abnormal blood fat levels
-Ischemia
-Nerve fiber repair mechanisms
Pathophysiology-biochemical and vascular factors

Ways of Diagnosis
-Assess symptoms - muscle weakness,
-muscle cramps, prickling, numbness or pain, vomiting, diarrhea,
- poor bladder control and sexual dysfunction
-Comprehensive foot exam
-Skin sensation and skin integrity
-Quantitative Sensory Testing (QST)
-X-ray
-Nerve conduction studies
-Electromyographic examination (EMG)
-Ultrasound

Classification of Diabetic Neuropathy
-Symmetric polyneuropathy
-Autonomic neuropathy
-Polyradiculopathy
-Mononeuropathy
-Symmetric Polyneuropathy

Most common form of diabetic neuropathy 
Affects distal lower extremities and hands (“stocking-glove” sensory loss) 
Symptoms/Signs
-Pain
-Paresthesia/dysesthesia
-Loss of vibratory sensation
Complications:
-Ulcers
-Charcot arthropathy
-Dislocation and stress fractures
-Amputation

Foot Ulceration

Treatment of Symmetric Polyneuropathy

-Glucose control
-Pain control
-Tricyclic antidepressants
-Topical creams
-Anticonvulsants
-Foot care
                                                                             -Visual inspection of feet at every visit with a health care professional
-Use lotion to prevent dryness and cracking
-Cut toenails weekly or as needed
-Always wear socks and well-fitting shoes
-Notify their health care provider immediately if any foot problems occur

Autonomic neuropathy

Affects the autonomic nerves controlling internal organs
-Peripheral
-Genitourinary
-Gastrointestinal
-Cardiovascular
Symptoms/Signs:
-Neuropathic arthropathy (Charcot foot)
Aching, pulsation, tightness, cramping, dry skin, pruritus, edema, sweating abnormalities
Weakening of the bones in the foot leading to fractures
-Treatment: Symptomatic therapy due to have foot ulceration, pain, edema and so on.

Polyradioculopathy
-Lumbar polyradiculopathy (diabetic amyotrophy)
-Thigh pain followed by muscle weakness and atrophy
-Thoracic polyradiculopathy
-Severe pain on one or both sides of the abdomen, possibly in a band-like pattern
-Diabetic neuropathic cachexia
-Polyradiculopathy + peripheral neuropathy
-Associated with weight loss and depression
-Polyradiculopathies are diagnosed by electromyographic (EMG) studies
Treatment
-Foot care
-Glucose control
-Pain control

Mononeuropathy
-Peripheral mononeuropathy
-Single nerve damage due to compression or ischemia
-Occurs in wrist (carpal tunnel syndrome), elbow, or foot (unilateral foot drop)
-Cranial mononeuropathy
-Affects the 12 pairs of nerves that are connected with the brain and control sight, eye movement, hearing, and taste
Symptoms/Signs
-paratesia
-Edema
-unilateral pain near the affected eye
-paralysis of the eye muscle
-double vision
So we should concern about diabetes

Article Written By: Md. Enamul Hoque Khan
Student of MPharm,Department of Pharmacy,
East West University,Dhaka.

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Posted in: Clinical Pharmacy,Diseases Information

What is a Disease?

What is a disease?
–   Abnormal condition of an organism’s cells, body systems, or processes.
–   Evidence: specific symptoms and signs
–   They cause an immune response in complex organisms
–   This is the body’s attempt to rid itself of the disease and stay healthy.

How do diseases differ?
      The causes can be different
–    Pathogens cause some diseases.
–    Biological causes
–    Often called microbes (microscopic)
–    Protists, bacteria, or viruses
–    Microbes can be:
•    carried by mosquitoes, flies, pigs, or other animals
–    Transmitted to humans
•    Found in water, soil, and sneezes

Why aren’t we sick all the time?
Other causes
–   Genetics
–    Inherited conditions - related to chromosomes
     Biochemical or environmental factors
–    Second hand smoke
–    Air pollution
     Individual organism
–    Problems or failure in normal functioning of an organ or organ system

Body’s defense systems
     Preventing microbes from entering the body - first lines of defense
–    Hairs lining mucus membranes
–    Skin
–    Acids in the stomach
     White blood cells are second line of defense
     Third line of defense: lymphocytes and leukocytes - white blood cells
     Antibodies - immunities
–    natural or by vaccination

Managing Non Pathogenic Diseases
     Repair the damaged system
–    Medicines
–    Surgery
–    Combination
     Behavioral changes
–    Remove causative behaviors

Communicable Diseases
     Influenza
     Meningitis
     Rabies
     Tetanus
     Polio
     Whooping cough
     Shingles
     Tuberculosis
     Traveler’s diseases
     Chicken pox
     Measles
     Mumps

Non communicable diseases
     Asthma
     Multiple Sclerosis
     Diabetes
     Epilepsy
     Allergies
     Osteoarthritis
     Restless Leg Syndrome

What are the differences?
     Think about the causes.
     Which diseases can be transmitted from person to person?
     Which can be treated (or prevented) with medicines?
     Which will go away?  Which are likely to continue for the remainder of the individual’s life?

Article Written by Dr. Sufia Islam
Head, Department of Pharmacy
East West University

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Posted in: Diseases Information

What Is Gastritis?

What Is Gastritis?

Gastritis is an inflammation, irritation, or erosion of the lining of the stomach. It can occur suddenly (acute) or gradually (chronic).

What Causes Gastritis?

Gastritis can be caused by irritation due to excessive alcohol use, chronic vomiting, stress, or the use of certain medications such as aspirin or other anti-inflammatory drugs. It may also be caused by any of the following:

·   Helicobacter pylori (H. pylori): A bacteria that lives in the mucous lining of the stomach. Without treatment the infection can lead to ulcers, and in some people, stomach cancer. 

·   Pernicious anemia: A form of anemia that occurs when the stomach lacks a naturally occurring substance needed to properly absorb and digest vitamin B12. 

·     Bile reflux: A backflow of bile into the stomach from the bile tract (that connects to the liver and gallbladder). 

·   Infections caused by bacteria and viruses

If gastritis is left untreated, it can lead to a severe loss in blood, or in some cases increase the risk of developing stomach cancer.

What Are the Symptoms of Gastritis?

Symptoms of gastritis vary among individuals, and in many people there are no symptoms. However, the most common symptoms include:

·         Nausea or recurrent upset stomach

·         Abdominal bloating

·         Abdominal pain

·         Vomiting

·         Indigestion

·   Burning or gnawing feeling in the stomach between meals or at night

·         Hiccups

·         Loss of appetite

·         Vomiting blood or coffee ground-like material

·         Black, tarry stools 

How Is Gastritis Diagnosed?

To diagnose gastritis, your doctor will review your personal and family medical history, perform a thorough physical evaluation, and may recommend any of the following tests.

·        Upper endoscopy. An endoscope, a thin tube containing a tiny camera, is inserted through your mouth and down into your stomach to look at the stomach lining. The doctor will check for inflammation and may perform a biopsy, a procedure in which a tiny sample of tissue is removed and then sent to a laboratory for analysis. 

·         Blood tests. The doctor may perform various blood tests such as checking your red blood cell count to determine whether you have anemia, which means that you do not have enough red blood cells. He or she can also screen for H. pylori infection and pernicious anemia with blood tests. 

·         Fecal occult blood test (stool test). This test checks for the presence of blood in your stool, a possible sign of gastritis. 

What Is the Treatment for Gastritis?

Treatment for gastritis usually involves:

·  Taking antacids and other drugs to reduce stomach acid, which causes further irritation to inflamed areas.

·         Avoiding hot and spicy foods.

·         For gastritis caused by H. pylori infection, your doctor will prescribe a regimen of several antibiotics plus an acid blocking drug (used for heartburn).

·         If the gastritis is caused by pernicious anemia, B12 vitamin shots will be given.

Once the underlying problem disappears, the gastritis usually does, too. Then should talk to your doctor before stopping any medicine or starting any gastritis treatment on your own.

Article Written by Paul Chen
Student of M.Pharm
Department of Pharmacy
Primeasia University  

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Posted in: Diseases Information