Medicine Hack

Ingestion of alcohol makes you feel warm because it causes cutaneous vasodilation. Increased blood flow to the skin coupled with a low environmental temperature means that there is a more rapid loss of heat from the body. Furthermore, consumption of a large amount of ethanol leads to depression of the central temperature regulating mechanism. Thus drinking alcohol excessively in cold climates can lead to hypothermia and even death if appropriate measures are not taken.

1) First detected AF - It is the designation given when diagnosis has only recently been made. 2) Recurrent AF - When patient has experienced two or more episodes of AF. 3) Paroxysmal AF - Self terminating episodes that generally last less than 7 days (mostly <24 hr) 4) Persistent AF - Last more than 7 days and requires electrical or pharmacologic cardioversion. 5) Permanent AF - It has failed cardioversion and has been sustained for more than a year.

This is a continuation of the main article  Diabetes insipidus . It shows the effect of desmopressin in a case of central D.I. The changes seen are: 1) decrease in urine output, 2) increase in urine osmolarity, 3) decrease in plasma osmolarity and 4) slight increase in body weight. Desmopressin is 12 times more potent antidiuretic than ADH. It has a duration of action of around 8 hours and thus can be given in 3 divided doses per day. The intranasal route is preferred though the bioavailability is only 10-20%. Treatment is life long.

Definition: It is a syndrome characterized by the production of abnormally large volumes of dilute urine due to the decreased secretion or decreased action of AVP (arginine vasopressin). AVP is also commonly known as ADH i.e. Anti Diuretic Hormone. Cause: 1) Central D.I - aka pituitary D.I or neurohypophyseal D.I. 2) Nephrogenic D.I Central D.I occurs because of an inadequate release of ADH from the posterior pituitary. The usual causes are idiopathic, traumatic, iatrogenic (surgery,radiation), neoplastic, infective, granulomatous (TB,sarcoidosis) and congenital being a rarer cause. Nephrogenic D.I is due to the resistance to ADH at the level of the collecting duct cell. The most common cause of resistance is the use of drugs like lithium (bipolar disorders) and amphotericin. But it can rarely be due to a congenital cause. Pathogenesis: The antidiuretic effect of ADH is achieved by increasing the hydroosmotic permeability of cells that line the distal tubule and medullary

Application: 1) Production of recombinant proteins like factor VIII, insulin and tissue plasminogen activator, 2) Transgenic organisms also called as genetically modified organisms like herbicide resistant crops, 3) Gene therapy to correct a genetic disorder or an acquired disease, though there has only been limited success in this field till now.

Group: macrolide Antimicrobial activity: Good against Gram positive and Gram negative organisms. Slightly less active than erythromycin against staphylococci and streptococci but more active against H.influenzae. It is also highly active against chlamydia, Mycobacterium avium complex and Toxoplasma gondii. Mechanism of action: It binds to the 50s ribosome subunit and hinders the translocation of the elongated peptide chain from the acceptor site to the peptidyl site. Thus the ribosome does not move along the mRNA to expose the next codon and peptide synthesis is prematurely terminated. Pharmacokinetic properties: Acid stability and more active in alkaline medium, rapid oral absorption but better given 1 hour before meals or 2 hours after meals, marked tissue distribution especially intracellular penetration (macrophages and fibroblasts), Half life : 2-4 days, therefore can be given as once a day dosing Clinical uses: 1) Legionnaire's pneumonia - 500 mg O.D for 2 wee

The use of I.V morphine in dyspnea from pulmonary edema due to left ventricular failure produces remarkable relief. The proposed mechanisms include:  1) reduced anxiety ( decreased perception of shortness of breath ),  2) reduced cardiac preload ( reduced venous tone ) and  3) decreased cardiac afterload (decreased peripheral resistance ).  However frusemide remains the treatment of choice.  Side effect is respiratory depression at a higher dosage which occurs because of inhibition of the brainstem respiratory mechanism.