HYPERTENSION

 

OBJECTIVES OF THE SESSION:  By the end of our discussion here, the learner/reader/medical student will be able to;

1.  Differentiate between the normal and hypertensive blood pressures

2.  Explain the effects of increasing blood pressure on the body organs

3.  Describe the different types and stages of hypertension

INTRODUCTION: Hypertension is defined as a systolic blood pressure greater than 140 mmHg and a diastolic pressure greater than 90 mmHg, based on two or more measurements. Hypertension can be classified as follows:

a) Normal: systolic less than 120 mmHg; diastolic less than 80 mmHg

b) Prehypertension: systolic 120 to 139 mmHg; diastolic 80 to 89 mmHg

c) Stage 1: systolic 140 to 159 mm Hg; diastolic 90 to 99 mmHg

d) Stage 2: systolic 160 mmHg; diastolic 100 mmHg

CONSEQUENCES OF HYPERTENSION: Hypertension is a major risk factor for atherosclerotic cardiovascular disease, HF, stroke, and kidney failure. Hypertension carries the risk for premature morbidity or mortality, which increases as systolic and diastolic pressures rise. Prolonged blood pressure elevation damages blood vessels in target organs (heart, kidneys, brain, and eyes).

Essential (Primary) Hypertension: In the adult population with hypertension, between 90% and 95% have essential (primary) hypertension, which has no identifiable medical cause; it appears to be a multifactorial, polygenic condition. For high blood pressure to occur, an increase in peripheral resistance and/or cardiac output must occur secondary to increased sympathetic stimulation, sodium reabsorption, increased renin–angiotensin–aldosterone system activity, decreased vasodilation of the arterioles, or resistance to insulin action. Hypertensive emergencies and urgencies may occur in patients whose hypertension has been poorly controlled, whose hypertension has been undiagnosed, or in those who have abruptly discontinued their medications.

Secondary Hypertension: Secondary hypertension is characterized by elevations in blood pressure with a specific cause, such as narrowing of the renal arteries, renal parenchymal disease, hyperaldosteronism (mineralocorticoid hypertension), certain medications, pregnancy, and coarctation of the aorta. Hypertension can also be acute, a sign of an underlying condition that causes a change in peripheral resistance or cardiac output.

CLINICAL MANIFESTATIONS: Physical examination may reveal no abnormality other than high blood pressure. Changes in the retinas with hemorrhages, exudates, narrowed arterioles, and cotton–wool spots (small infarctions), and papilledema may be seen in severe hypertension. Symptoms usually indicate vascular damage related to organ systems served by involved vessels. Coronary artery disease with angina or myocardial infarction is the most common consequence. Left ventricular hypertrophy may occur; HF ensues. Pathologic changes may occur in the kidney (nocturia and increased BUN and creatinine levels). Cerebrovascular involvement may occur (stroke or transient ischemic attack [TIA] [ie, alterations in vision or speech, dizziness, weakness, a sudden fall, or transient or permanent hemiplegia]).

ASSESSMENT AND DIAGNOSTIC METHODS: History and physical examination, including retinal examination; laboratory studies for organ damage, including urinalysis, blood chemistry (sodium, potassium, creatinine, fasting glucose, total and high-density lipoprotein); ECG; and echocardiography to assess left ventricular hypertrophy. Additional studies, such as creatinine clearance, renin level, urine tests, and 24-hour urine protein, may be performed.

MEDICAL MANAGEMENT: The goal of any treatment program is to prevent death and complications by achieving and maintaining an arterial blood pressure at or below 140/90 mm Hg (130/80 mm Hg for people with diabetes mellitus or chronic kidney disease), whenever possible. Nonpharmacologic approaches include weight reduction; restriction of alcohol and sodium; regular exercise and relaxation. A DASH (Dietary Approaches to Stop Hypertension) diet high in fruits, vegetables, and low-fat dairy products has been shown to lower elevated pressures. Select a drug class that has the greatest effectiveness, fewest side effects, and best chance of acceptance by patient. Two classes of drugs are available as first-line therapy: diuretics and beta-blockers. Promote compliance by avoiding complicated drug schedules.

RELATED;

1. CONGESTIVE CARDIAC FAILURE  

2. CHAMBERS AND CIRCULATION THROUGH THE HEART  

3. CARDIAC CYCLE AND THE HEART SOUNDS  

4. ARTERIOSCLEROSIS

5.  MEDICAL CONDITIONS

REFERENCES

DIABETES MELLITUS

 

INTRODUCTION: Diabetes mellitus is a group of metabolic disorders characterized by elevated levels of blood glucose (hyperglycemia) resulting from defects in insulin secretion, insulin action, or both. INSULIN AS A CHEMICAL OF LIFE  Three major acute complications of diabetes related to short-term imbalances in blood glucose levels are hypoglycemia, diabetic ketoacidosis (DKA), and hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Long-term hyperglycemia may contribute to chronic microvascular complications such as kidney and eye disease, and neuropathic complications. Diabetes is also associated with an increased occurrence of macrovascular diseases, including coronary artery disease (myocardial infarction), cerebrovascular disease (stroke), and peripheral vascular disease. [coronaryartery disease]

TYPES OF DIABETES TYPE 1 (FORMERLY INSULIN-DEPENDENT DIABETES MELLITUS): About 5% to 10% of patients with diabetes have type 1 diabetes. It is characterized by destruction of the pancreatic beta-cells due to genetic, immunologic, and possibly environmental factors. In this medical condition, insulin injections are needed to control the blood glucose levels. Type 1 diabetes has a sudden onset, usually before the age of 30 years.

TYPE 2 (FORMERLY NON–INSULIN-DEPENDENT DIABETES MELLITUS): About 90% to 95% of patients with diabetes have type 2 diabetes. It results from a decreased sensitivity to insulin also known as insulin resistance, or from a decreased amount of insulin production. Type 2 diabetes is first treated with diet and exercise, and then with oral hypoglycemic agents as needed. Type 2 diabetes occurs most frequently in patients older than 30 years and in patients with obesity.

Gestational Diabetes Mellitus: Gestational diabetes is characterized by any degree of glucose intolerance with onset during pregnancy (second or third trimester). Risks for gestational diabetes include marked obesity, a personal history of gestational diabetes, glycosuria, or a strong family history of diabetes. High-risk ethnic groups include Hispanic Americans, Native Americans, Asian Americans, African Americans, and Pacific Islanders. It increases their risk for hypertensive disorders of pregnancy. 

Clinical Manifestations: Polyuria, polydipsia, and polyphagia. Fatigue and weakness, sudden vision changes, tingling or numbness in hands or feet, dry skin, skin lesions or wounds that are slow to heal, and recurrent infections. Onset of type 1 diabetes may be associated with sudden weight loss or nausea, vomiting, or stomach pains. Type 2 diabetes results from a slow (over years), progressive glucose intolerance and results in long-term complications if diabetes goes undetected for many years such as in case of eye disease, peripheral neuropathy, or peripheral vascular disease. Complications may have developed before the actual diagnosis is made.

Signs and symptoms of DKA: These include; abdominal pain, nausea, vomiting, hyperventilation, and a fruity breath odor. Untreated DKA may result in altered level of consciousness, coma, and death.

RELATED;

1.  DRUG ADMINISTRATION TECHNIQUES USED IN MEDICINE  

2.  DIABETES INSPIDUS

3.  INSULIN AND THE HUMAN BODY

4.  MEDICINE AND SURGERY 

REFERENCES

ALCOHOL AND THE HUMAN BODY

Introduction:  In our day to day life we tend to take in many stuff in our bodies some of which are helpful and others are harmful.  Whether intentional or accidentally taken, every chemical that we consume in our bodies has limits with in which it will be either useful or harmful and today, let us look at the comings and goings of alcohol in the human body and the effects both short term and long term of it's consumption.

Ethyl alcohol or simply alcohol has few clinical uses when given systemically, but is of great medical importance because of its pathological and psychological effects when used as a beverage in beers, wines, vodkas and other local and international alcoholic beverages.  Seasonal consumers of alcohol have some benefit from it and these are some of the few here; It is a sedative but not a perfect sedative-hypnotic.  I have discussed much about sedation and hypnosis and if you would like to read more about Sedative-hypnotics click here.  Alcohol in small quantities is capable of causing depressant states but it is not a perfect depressant.  So for that respect, many people tend to take it when they feel hyperactive to gain some feeling of depression especially following extraneous activities that require mental hassling.  Following ingestion of alcohol, there may be some feeling of pain killing or relief in some painful situations but it is not a perfect analgesic or what people literally call "pain killer" and it is never in any way intended for that purpose.  

Alcohol is one of the most important drug of dependence and abuse, and in many countries, the incidence of alcoholism is about 10% among the adult population.

Pharmacokinetics:  Ethyl alcohol is absorbed from the buccal, oesophageal, gastric and intestinal mucosae, and approximately 80% is absorbed from the small intestines.  In fact this makes it one of the most easily absorbable compounds when taken orally, and one of the drugs that can achieve maximum bioavailability in a short period of time.  I have discussed about the term bioavailability in relation to drug absorption and distribution recently and if you would like to read about that, you can click here. 

Alcohol delays gastric emptying and in high doses delays its own absorption. Following oral administration, alcohol can usually be detected in the blood within five minutes.  Alcohol is capable of crossing the placenta and the fetus can be exposed to it following drinking for pregnant mothers.  The effects of alcohol is so intense in pregnancy that when a mother drinks, the fetus will have almost the same concentration of alcohol in it's blood as that of the mother's blood per in mg/dl.  This is indicative of the degree with which it crosses the placenta compared to other compounds, and an alert on the possible initiation and development of teratogens or fetal malformations.

Peak concentrations occur between 30 minutes and two hours and during this period, the quantity taken and the amount reaching the body systems will be following a first order kinetics fashion. It should be noted that, Fats and carbohydrates delay absorption and therefore may affect. Alcohol is distributed throughout the body water. About 95% is metabolized mainly in the liver and the remainder is excreted unchanged in the breath, urine and sweat.

Effects of alcohol:  Alcohol has several effects on the different body systems as follows;

Nervous system: Alcohol decreases concentration, judgement, discrimination, and reasoning and increases self-confidence. Progressively increasing plasma concentrations are associated with sensations of relaxation followed by mild euphoria, incoordination, ataxia and loss of consciousness. 

At high blood concentrations, the gag reflex is impaired, vomiting may occur and death may result from aspiration of gastric contents. The importance of alcohol as a factor in road traffic accidents is well known. 

The central depressant actions of alcohol greatly enhance the effects of other central depressant drugs. In patients with organic brain damage, alcohol may induce unusual aggression and destructiveness, known as pathological intoxication.

Medical uses of alcohol:  Alcohol may seem to be a universal poison because of it's hazardous effects on the human body when consumed in large quantities and for a long time however, there times when it can be used as a medicine.  Alcohol is used topically as an antiseptic and many antiseptic solutions have some alcoholic component in them. In fact the smell of alcohol can be detected by exposed individual on use of sanitizing solutions.  Systemic alcohol is used in poisoning by methanol or ethylene glycol, since it competes with these for oxidation by alcohol dehydrogenase, slowing the production of toxic metabolites such as formaldehyde, oxalic acid.  We shall late be discussing the toxicities that result form alcohols including methanol in a separate discussion.

Conclusion:  Health experts say that is good to have some sort of alcoholic beverage in a day with a daily recommendation of 2 bottles of bear for men and 1 bottle for women.  The recommendation however may be different depending on the region and someone's health status.  Small quantities of alcohol are shown to increase the efficiency and normal functioning of the cardiovascular system and Gastrointestinal tract.  The problem however comes that once taken, alcohol tends to make an individual develop tolerance and dependance to it.  Increasing intake of large quantities of alcohol is associated with Nervous system, Cardiovascular and GIT related medical conditions as seen above. 

RELATED;

1.  ADDICTION, TOLERANCE AND DEPENDENCY

2.  ALCOHOL BREAKDOWN BY THE LIVER

3.  FUNCTIONS OF THE LIVER

4.  ALCOHOL LIVER FAILURE

5.  ALTERED LEVEL OF CONSCIOUSNESS

6.  SEDATIVES AND HYPNOTICS

7.  CENTRALLY ACTING DRUGS

8.  BIOAVAILABILITY

REFERENCES

PHYSICAL VERSUS PSYCHOLOGICAL DEPENDENCE

 

INTRODUCTION:  Whether a substance is addictive is related to how easily an individual can stop taking the agent on a repetitive basis. When a person has an overwhelming desire to take a drug and cannot stop, this condition is referred to as substance dependence. Substance dependence is classified into two categories, physical dependence and psychological dependence. 

PHYSICAL DEPENDENCE:  This refers to an altered physical condition caused by the adaptation of the nervous system to repeated substance use. Over time, the body’s cells become accustomed to the presence of the unnatural substance.  With physical dependence, uncomfortable symptoms known as withdrawal result when the agent is discontinued. Alcohol, sedatives, nicotine, and CNS stimulants are examples of substances that with extended use may easily cause physical dependence. Repeated doses of opioids, such as morphine and heroin, may produce physical dependence rather quickly, particularly when the drugs are taken intravenously.

PSYCHOLOGICAL DEPENDENCE:  In contrast, psychological dependence refers to a condition in which no obvious physical signs of discomfort are observed after the agent is discontinued. The user, however, will have an overwhelming desire to continue drug-seeking behavior despite obvious negative economic, physical, or social consequences. Associated intense craving may be connected with the patient’s home or social environment. Strong psychological craving may continue for months or even years and can be responsible for relapses during therapy. For psychological dependence to occur, relatively high doses of drugs are usually taken for a prolonged period. Examples are marijuana and antianxiety drugs. On the other hand, psychological dependence may develop quickly after only one use, as with crack cocaine, a potent, rather inexpensive, form of the drug. 

WITHDRAWAL SYNDROME:  Once a person becomes physically dependent and the substance is discontinued, withdrawal syndrome may occur. Prescription drugs are often used to reduce the severity of withdrawal symptoms. For example, alcohol withdrawal might be treated with the short-acting benzodiazepine oxazepam; opioid withdrawal might be treated with methadone. Symptoms of nicotine withdrawal might be relieved with replacement therapy in the form of nicotine patches or chewing gum. 

For withdrawal from CNS stimulants, hallucinogens, marijuana, or inhalants, specific pharmacologic intervention is generally not indicated. Symptoms of withdrawal may be particularly severe for those who are dependent on alcohol or sedatives. Because of the severity of the symptoms, the process of withdrawal from these agents is probably best accomplished in a substance abuse treatment facility.  

With chronic substance abuse, people will often associate use of the substance with their conditions and surroundings, including social contacts with other users who are also taking the drug. Users tend to revert to drug-seeking behavior when they return to the company of other substance abusers. Counselors often encourage users to refrain from associating with past social contacts or having relationships with other substance abusers to lessen the possibility for relapse.

RELATED;

1.  PHARMACOKINETICS  

2.  DRUG METABOLISM

3.  CENTRALLY ACTING MEDICATIONS

4.  SEDATIVE-HYPNOTICS

REFERENCES 

NAUSEA AND VOMITING

 

INTRODUCTION: Nausea is an unpleasant, subjective sensation that is accompanied by weakness, diaphoresis, and hyperproduction of saliva. It is sometimes accompanied by dizziness. Intense nausea often leads to vomiting, or emesis.

PATHOPHYSIOLOGY: Vomiting is a defense mechanism used by the body to rid itself of toxic substances. Vomiting is a reflex primarily controlled by the vomiting center of the medulla of the brain, which receives sensory signals from the digestive tract, the inner ear, and the chemoreceptor trigger zone (CTZ) in the cerebral cortex. Interestingly, the CTZ is not protected by the blood–brain barrier, as is the vast majority of the brain; thus, these neurons can directly sense the presence of toxic substances in the blood. Once the vomiting reflex is triggered, wavelike contractions of the stomach quickly propel its contents upward and out of the body.

OBJECTIVES OF THE TREATMENT: The treatment outcomes for nausea or vomiting focus on removal of the cause, whenever feasible.

CAUSES OF NAUSEA AND VOMITING: Nausea and vomiting are common symptoms associated with a wide variety of conditions such as GI infections, food poisoning, nervousness, emotional imbalances, motion sickness, and extreme pain. Other conditions that promote nausea and vomiting are general anesthetics, migraine headache, trauma to the head or abdominal organs, inner ear disorders, and diabetes. Psychological factors play a significant role, as patients often become nauseated during periods of extreme stress or when confronted with unpleasant sights, smells, or sounds. The nausea and vomiting experienced by women during the first trimester of pregnancy is referred to as morning sickness. If this condition becomes acute, with continual vomiting, it may lead to hyperemesis gravidarum, a situation in which the health and safety of the mother and developing baby can become compromised. Pharmacotherapy is initiated after other antinausea measures have proved ineffective. Nausea and vomiting are the most frequently listed adverse effects for oral medications.

CONSEQUENCES OF NAUSEA AND VOMITING: Nausea and vomiting is a common reason for patients’ lack of adherence to the therapeutic regimen and for discontinuation of drug therapy. When large amounts of fluids are vomited, dehydration and significant weight loss may occur. Because the contents lost from the stomach are strongly acidic, vomiting may cause a change in the pH of the blood, resulting in metabolic alkalosis. With excessive loss, severe acid–base disturbances can lead to vascular collapse, resulting in death if medical intervention is not initiated. Dehydration is especially dangerous for infants, small children, and older adults and is evidenced by dry mouth, sticky saliva, and reduced urine output that is dark yellow-orange to brown.

RELATED;

1.  ANTIEMETIC AGENTS  

2.  THE ENTERIC NERVOUS SYSTEM

3.  MEDICAL CONDTIONS

REFERENCES

DYSMENORRHEA

INTRODUCTION: Dysmenorrhea is defined as painful menstruation. This is often sufficiently severe that it prevents a woman from performing normal activities. It may also be accompanied by other symptoms, including diarrhea, nausea, vomiting, headache, and dizziness. Dysmenorrhea may be because of a clinically identifiable cause and in that case we call it secondary dysmenorrhea, or by an excess of prostaglandins, leading to painful uterine muscle activity in which case we call it primary dysmenorrhea.

THE CASCADE OF DYSMENORRHEA: Primary and secondary dysmenorrhea are a source of recurrent disability for a significant number of women in their early reproductive years. It is uncommon for primary dysmenorrhea to occur during the first three to six menstrual cycles, when regular ovulation is not yet well established. The incidence of primary dysmenorrhea is greatest in women in their late teens to early twenties and it tends to declines with age. On the other hand, secondary dysmenorrhea becomes more common as a woman ages, because it accompanies the rising prevalence of causal factors. Childbearing does not affect the occurrence of either primary or secondary dysmenorrhea.

ETIOLOGY AND PATHOPHYSIOLOGY

Primary Dysmenorrhea: Primary dysmenorrhea is caused by excess prostaglandin F2α (PGF2α) produced in the endometrium. Prostaglandin production in the endometrium normally increases under the influence of progesterone, reaching a peak at, or soon after, the start of menstruation. With the onset of menstruation, formed prostaglandins are released from the shedding endometrium. In addition to the increase in prostaglandins from endometrial shedding, necrosis of endometrial cells provides increased substrate arachidonic acid from cell walls for prostaglandin synthesis.

Prostaglandins are potent smooth muscle stimulants that cause intense uterine contractions, resulting in intrauterine pressures to increase. PGF2α also causes contractions in smooth muscle elsewhere in the body, resulting in nausea, vomiting, and diarrhea. Besides PGF2α, prostaglandin E2 (PGE2) is also produced in the uterus. PGE2, a potent vasodilator and inhibitor of platelet aggregation, has been implicated as a cause of primary menorrhagia.

Secondary Dysmenorrhea: Secondary dysmenorrhea is caused by structural abnormalities or disease processes that occur outside the uterus, within the uterine wall, or within the uterine cavity. Common causes of secondary dysmenorrhea include endometriosis described as; the presence of endometrial glands and stroma outside of the uterus, adenomyosis also described as; the presence of ectopic endometrial tissue within the myometrium, adhesions, pelvic inflammatory disease (PID), and leiomyomata (uterine fibroids).

DIAGNOSIS: Patients with primary dysmenorrhea present with recurrent, month-aftermonth, spasmodic lower abdominal pain that occurs on the first 1 to 3 days of menstruation. Dyspareunia is generally not found in patients with primary dysmenorrhea and, if present, should suggest a secondary cause. Symptoms In patients with primary dysmenorrhea, the pain is often diffusely located in the lower abdomen and suprapubic area, with radiation around or through to the back. The pain is described as “coming and going,” or similar to labor. This pain is frequently accompanied by moderate-to-severe nausea, vomiting, and diarrhea. Fatigue, low backache, and headache are also common.

In patients with secondary dysmenorrhea, the pain often lasts longer than the menstrual period. It may start before menstrual bleeding begins, become worse during menstruation, then persist after menstruation ends. Secondary dysmenorrhea often starts later in life than primary dysmenorrhea.

THERAPY: Patients with primary dysmenorrhea generally experience exceptional pain relief through the use of nonsteroidal anti-inflammatory drugs (NSAIDs), which are prostaglandin synthetase inhibitors. Other useful components of therapy for primary dysmenorrhea include the application of heat; exercise; psychotherapy and reassurance; and, on occasion, endocrine therapy; that is to say, oral contraceptives to induce anovulation and pain relief.

Combined Oral Contraceptives: Combined oral contraceptives can be useful in patients who do not desire childbearing and who do not have contraindications to their use. They work by suppressing ovulation and stabilizing estrogen and progesterone levels, with a resultant decrease in endometrial prostaglandins and spontaneous uterine activity. Oral contraceptives may be taken in the traditional 28-day cycle, or in an extended fashion that increases the interval between menses. The continuous use of oral contraceptives to eliminate menses can often eliminate dysmenorrhea altogether.

Therapy for Secondary Dysmenorrhea: For secondary dysmenorrhea, when a specific diagnosis is possible, therapy directed at the underlying condition is most likely to succeed.

RELATED;

1.  Endometriosis

2.  Pelvic inflammatory disease

3.  Infertility

4.  Ectopic pregnacy

REFERENCES

PHASES OF METABOLISM

 

INTRODUCTION: The degradation of foodstuffs occurs in three stages. (1) In the first stage, digestion in the gastrointestinal tract converts the macromolecules into small units. For example, proteins are digested to amino acids. This is called primary metabolism. Physiology of the gastrointestinal tract

(2) Then these products are absorbed, catabolized to smaller components, and ultimately oxidized to CO₂. Carbondioxide

(3) The reducing equivalents are mainly generated in the mitochondria by the final common oxidative pathway, citric acid cycle. The citric acid cycle

In this process, NADH or FADH₂ are generated. This is called secondary or intermediary metabolism. Then these reduced equivalents enter into the electron transport chain (ETC, or Respiratory chain), where energy is released. This is the tertiary metabolism or Internal respiration or cellular respiration.

Carbohydrates enter the glycolysis pathway, converted to acetyl CoA and are oxidized in the citric acid cycle. Carbohydrate metabolism is centered on glucose, and is mainly used for provision of energy to the body. Lipid metabolism is centered on fatty acids, which are also used for provision of energy. Amino acids are mainly meant for body building purpose. However, most of the amino acids are eventually transaminated, the carbon skeletons are oxidized. This will provide some energy. But energy production is not the main purpose of amino acid metabolism.

RELATED;

1. GLYCOLYSIS

2. THE CITRIC ACID CYCLE

3. PROTEIN ENERGY MULNUTRITION

REFERENCES

UGANDAN GOSPEL MUSIC

UGANDAN GOSPEL MUSIC

JUDITH BABIRYE

1.  Butonotono

Download mp3

2.  Nzijukira

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3.  Judith Babirye non-stop music 2015

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JOSEPH SEGAWA

1.  Nina omubeezi

2.  Nze ngumye

3.  Aligabanaki

4.  Omuntu kyasiga

5.  Biyinzika

SILVER KYAGULANYI

1.  Ekisa ekinondoola

Download mp3

RELATED;

1.  GOSPEL MUSIC DOWMLOADS

2.  NON-STOP MUSIC DOWNLOAD LINKS

3.  ANDROID APPS DOWNLOAD

NORMAL LABOR AND VAGINAL DELIVERY

INTRODUCTION: Labor and birth are natural human processes and for most women, minimal interventions are required. Uncomplicated labor occurs at term which is taken to be completion of 38 weeks of gestation, with a single fetus in a vertex presentation, with labor initiated by spontaneous, effective contractions, and with birth completed within 24 hours.

BEGINNING OF LABOR: Initiation of labor is a complex process involving a combination of factors that work in conjunction to stimulate myometrial activity and in turn initiate the onset of labor. These factors may include oxytocin release from the posterior pituitary, uterine distention or stretching, increasing uterine pressure due to the term fetus, increased maternal prostaglandin and fetal cortisol levels, placental aging, and changes in estrogen and progesterone ratios. The exact mechanism(s) that initiate spontaneous labor have been researched but are not completely understood.

TRUE VERSUS FALSE LABOR: Premonitory signs of labor such as lightening, urinary frequency, a change in vaginal discharge including bloody show, the loss of the mucus plug, and irregular contractions are often reported before true labor begins. True labor is distinguished from false labor by contractions that become progressively more frequent and regular, discomfort beginning in the back and radiating toward the abdomen causing cervical dilation, cervical effacement, and fetal descent. Duration of labor will depends on fetal presentation, fetal size, position of the fetus, and a multitude of factors including pelvic structure, the woman’s body mass, and birthing position.

STAGES OF LABOR: Labor is divided into four stages; 

Stage 1: The first stage of labor, which is cervical dilation to 10 cm, is divided into latent (0-3 cm dilation), active (4-7 cm dilation), and transitional (8-10 cm dilation) phases.

Stage 2: Stage two is measured from compete dilation to the birth of the baby and may have a latent or passive phase.

Stage 3: Stage three is from the birth of the baby to the expulsion of the placenta.

Stage 4: Stage four is the immediate postpartum recovery phase occurring from the delivery of the placenta and encompassing the first 2 hr postdelivery.

RELATED;

1.  PRETERM LABOR AND BIRTH

2.  DRUGS USED DURING LABOR AND DELIVERY

3.  ECTOPIC PREGNANCY

4.  PARTURITION AND LABOR

REFERENCES

COMMON TYPES OF ANTIBIOTICS AND THEIR MECHANISM OF ACTION

 

1. PENICILLINS: Penicillin is one of the oldest and most commonly used antibiotics in many countries because of it's effectiveness and affordability. It is effective against a wide range of bacterial infections and is often used to treat strep throat, pneumonia, and other respiratory infections. In the past before the coming of newer and more effective antibiotics, it was also one of the first lines in treatment of syphilis and gonorrheal infection.  Some of the examples of penicillins include but not limited to; Amoxicillin, Cloxacillin, Penicillin V, and Penicillin G.

Mechanism of action: Penicillin and derivatives are taken in a broad class of antibiotics known as Beta-lactam antibiotics; they work by inhibiting the synthesis and development of the bacterial cell wall.

Drawbacks: Although penicillin is still used in many countries due to it’s affordability and spectrum of activity, the on-going emergence of antimicrobial drug resistance limits their use in many scenarios. In addition, there are many individuals who develop allergic reactions to penicillin compared to new and safer antibiotics.  I already discussed penicillin and it's use in medicine in details and if you would like to read more about it you can follow the link below;  Use of penicillin and it's derivatives in clinical medicine.

2. FLOROQUINOLONES: Some of the drugs in this sub class of antibiotics include; Ciprofloxacin, Levofloxacin among others. Ciprofloxacin which is one of the most commonly available and prescribed, is a powerful antibiotic that is effective against a wide range of bacteria. It is often used to treat urinary tract infections, respiratory infections, and skin infections.

Mechanism of action: These drugs produce their effects by interfering with the DNA replication process and we shall therefore collectively term them; DNA synthesis inhibitors or in other wards, antimetabolites.  I made a detailed discussion on the pharmacology of this class of drugs and you can read more about the from the link below; Fluroquinolones and their use in clinical medicine.

3. TETRACYCLINES: Some of the drugs in this sub class of antibiotics include; Tetracycline, Oxytetracycline, Doxycycline and others. Doxycycline one of the most common, is an antibiotic that is used to treat a variety of bacterial infections, including acne, respiratory infections, and sexually transmitted diseases.

Mechanism of action:  These drugs act by inhibiting the process of protein synthesis in the bacterial cell.

Drawbacks: Because of their spectrum of activity which is broad, irrational use of these drugs can read to clearance of part of the human microbiome, something that can lead to opportunistic infection and super infections or even rendering other antibiotics ineffective. 

Their use is known to cause development of pseudomembranous colitis by Clostridium deficile and some fungal manifestations for that purpose. They are also discouraged from usage in young children due to their teeth discoloration effects and may lead to borne development problems.

4. MACROLIDES: In this class of antibiotics we have examples such as Azithromycin, Erythromycin and Clarithromycin. Azithromycin one of the most common is often used to treat respiratory infections, skin infections, and sexually transmitted diseases. The dosage and formulation of Azithromycin allows good compliance because of a three days regimen and a single tablet daily.  I discussed Azithromycin in a separate discussion in details you can read more about it from the link below;  Use of Azithromycin in clinical medicine.

5. VANCOMYCIN: Vancomycin is a glycopeptide antibiotic that is used to treat serious bacterial infections, including sepsis and endocarditis. Although it’s self is not a beta lactam antibiotic like penicillin and cephalosporines, it shares the mechanism of action with them; Inhibits the synthesis and development of the bacterial cell wall.

6. METRONIDAZOLE - Metronidazole is an antibiotic that is effective against a wide range of bacterial and parasitic infections, including vaginal infections, skin infections, and gastrointestinal infections. In brief we shall say; it is both antibacterial and antiprotozoal and therefore can be used as a prophylaxis for bacteremia and treatment of amebiasis. It is one of the most effective antibiotics against Entamoeba histolitica.

Mechanism of action: Metronidazole when used against protozoa, is DNA synthesis inhibitor and therefore we can say; it is an antimetabolite. In bacteria it acts as a proton sink, depriving the bacteria cell of oxidative equivalents

Drawbacks: Metronidazole have several side effects including but not limited to; Nausea and vomiting, a metallic taste, and it also has a disulfiram-like effect when taken together with alcohol.  I discussed about Metronidazole alone and it's use in details you can read about it from  here;  Use of metronidazole in clinical medicine.

7. SALFONAMIDES: Some of the most common examples of sulfonamides include; sulfamethoxazole and salfadoxine.  These drugs are frequently combined with non-salfonamide molecules with which they share some mechanism of action including but not limited to; Pyrimethamine and Trimethoprim.  Such combinations has greater synergistic effects and they can be used in treatment of a wide range of infections.

Trimethoprim-sulfamethoxazole, is one of such combination antibiotic that is often used to treat urinary tract infections, respiratory infections, and gastrointestinal infections.  This combination has been used widely in immunocompromised and HIV/AIDS patients for prophylactic prevention of opportunistic infections especially related to protozoa.  

The other common application of such combinations is the use of a combination of Pyrimethamine and salfadoxine in brand names like "Fansidar", one of the current malarial prophylaxis therapy in pregnant mothers.  I have recently discussed more about sulfonamides and you can read about them from  the link below; Sulfonamides and their use in clinical medicine

In our next discussion, I will be looking at the rest of the antibiotic classes I have not discussed briefly here including but not limited to; Cephalosporines such as Ceftrioxone, Carbapems such as Imepenem, Rifamycins such as Rifampicin and Rifampin and many others.  You can also feel free to subscribe to my YouTube channel where I discuss some of these pharmacotherapy from the link below;  Mega Mover Empire on YouTube.

RELATED;

1.  PNEUMONIA

2.  ANTIMICROBIAL DRUG RESISTANCE

3.  THE ORIGIN OF ALLERGIC REACTIONS IN THE HUMAN BODY

4.  PHARMACOLOGY OF PENICILLIN AND IT'S DERIVATIVES

5.  FLOROQUINOLONES AND THEIR USE IN CLINICAL MEDICINE

6.  THE HUMAN MICROBIOME

7.  USE OF AZITHROMYCIN IN CLINICAL MEDICINE

8.  USE OF METRONIDAZOLE IN CLINICAL MEDICINE

REFERENCES

TEN RULES OF BEING FREE FROM STRESS AT THE WORKPLACE

TEN RULES OF BEING FREE FROM STRESS:  

Stress is one disorder that affects the young and old, single and married, employees and employers, ladies and gentlemen.  Stress is a state of worry or mental tension that happens on a daily basis in all working individuals.  From unfinished tasks of the office at the workplace, to the family disputes of going back home late, stress can tear you up into pieces and if not managed in time, things can go the wrong way.  Technically being stressed can sometimes increase productivity especially when it comes to multi-tasking however, long term stress can lead to development of chronic illnesses including but not limited to; Hypertension, Mental disorders, Diabetes mellitus among others.  

Apart from the possibility of developing complicated illnesses related to stress, this monster situation can lead to job and family neglect and increasing imperfection and performances if not managed and or treated immediately.  Although there are medical and several irrational ways people manage stress, the best way to be safe is prevention of the situation.  In this article, we are going to look at Mega Mover Empire's ten rules of being free from stress at the workplace.  Feel free to subscribe to this channel and please send in you comments, additions and many more.

1.  BE PRO-LIFE:  The overall intention of anyone to work is to generate income for themselves and their families and it is the line I too, get up every morning and go to work.  It should however be noted that before you over think about work, think about you being alive and healthy first putting it in mind that, a dead body can not work and your life is the most precious gift you have ever got.  

In the medical field we have a principle known as "The sanctity of life" and this applies more to the Nursing professionals although it can apply to the rest of medical and non personnel.  It generally looks at the health worker being able to save life in any conditions as much as they can.  It does not however means that they should put their life at risk, or get exposed to life threatening events as long as the rest who are intended are saved.  And the same feeling should apply for any other potential worker.  Think about your life being safe and secure before thinking about work.

Man's greatest fear is what to eat and it is something one should think about to be provided by any employer although there some organizations and employers that may never mind the way their workers get what to eat.  This is one of my worst saying ever but don't misquote me please, "If your employer can not provide you with what to eat in time, your are not working for a human being but a robot instead".  There is a way our intestines are so demanding that in almost after every 4 hours, there will be a need to eat something and it is unfortunate the humans don't consume electricity and there is no replacement for food therefore.  Otherwise I wish some of us were rechargeable, China would have already made for us some of the most long lasting rechargeable batteries but that is not the case.  It therefore turns out that food is one of the things that maintains life and should be available for any worker to avoid stress related to that matter.  I have discussed much about the relationship of food and our survival in my article named "Wonders of the human body" you can read more about it here.

2.  KNOW HOW TO WRITE THE ABCDE AT YOUR WORKPLACE:  One of the most challenging and root causes of confusion at work is randomization of tasks.  Let us say you have more than 12 tasks to accomplish in the 5 day of the week, and these are having different submission time frames including those that requires 24 hours, 36 hours, 3 days a week and more than a week for there deadlines.  It is wise that you accomplish the task that requires more attention first and it will be more wise to start with those that require emergency, and in short, this is called prioritization.  For a medical professional whether on Out-patient Department (OPD) or on Emergency Unit be able to attend to someone very prone to death from hemorrhage, cardiac arrest and respiratory failure first compared to those that have delayed administration of medications because of patient and attendants negligence if that is what it dictates.

3.  BE CAREFUL WITH YOUR COMMUNICATION PORTALS:  Communication is one very important aspect in any work settings, and it is one of the root causes of conflicts at the workplace.  In most cases when a message in sent from one person through a series of other individuals it tends to get diluted or even fading away.  I know in your workplace you have office assistants that can convey messages from your office but it will be more efficient for you take many of the messages by yourself to the respective individuals as long as you are not that too busy.  Every message sent via a third part generates another third party and the more third parties become numerous, your message will become an open secret, subjecting you to become a topic within the organization and generation of subsequent stress situation related to the way you have to address the situation.  Therefor by controlling the way you communicate alone, you can avoid some of the most stressful situations you would encounter at your workplace.

4.  RESPECT HUMAN EVOLUTION AND THE EXISTANCE OF LIKES AND DISLIKES:  The topic of evolution is seen as both a science and a fiction but the issue is, we have developed in such a way that we have what we like and what we dislike basing on our genetic predisposition and evolutionary trends.  Try you level best to know what you like and what you dislike at your workplace as this will help alleviate anxiety that may trigger any stressful situation.  I am one guy who actually does not want food and sauce mixed on the same plate however because in public places that is how food is served, I will mind about separating the two when I am home.  And my friend James is funny in the same regard, he does not want to eat in public and he will enjoy eating from some private room.

5.  THOUGHLY STUDY THE STRENGTH OF BOTH YOUR MUSCLES AND MINDS:  One very important aspect of work is that we normally tend to forget or never mind about our different capacity to carryout the intended work.  But the thing is, there is always a level beyond which we can not perform either mentally or physically.  This is more to do with time and multitasking where if you try to work for extended time, there is a way your body may not be able to accomplish the tasks as desired.  On the other hand if there are very many tasks and you want all of them done in one day, again things may end up in imperfections.  Therefore the balance will be working within the allocated time frame and doing just enough of what your body can afford.  Always remember this precious thinking and idea "Rome was not built in one day"  This reminds me of the time I was working in the stone quarry and my obligation was to make it to 2 trucks of gravel per day.  But because 3 truck would generate more money for me I could sometimes end up working for 3 extra hours of the day to make it to that and sometime things would end up into mess and excessive tiredness to wake up early the next day.  So please mind much on not building a tower to heaven.

6.  MIND MUCH ABOUT PROFFESSIONAL ETHICS AND CODES OF CONDUCT:  Every time I talk about this, it reminds of my best Friend, mentor and Lecturer in Mbarara University Dr. Francis Bajunirwe.  That gentleman was my teacher of Community and Public health way back in 2011 but most of all, he taught me the way a professional health worker can handle stressful situations.  Later 5 years down the road I started seeing the examples that he had given me in our private discussions.  Every time you have a misconduct at the workplace there is a way it tends to stress you up and everyone will be looking at you like a monster.

7.  RESPECT THE EDUCATED:  In most cases we tend to work with people with higher level and some with lower level than ours just because we have different roles.  It may not be evident or easily understandable but usually depending on the level of organization in the organography, you will be able to tell whether someone holds a higher level of education than yours.  Such people will have more experience, tactics and knowledge of the way things are done and they are the right people to consult.  Actually try not to argue with them too much because you may end up restricting the information you can get from them.  One Professor friend of mine once told me these words "...always try to respect the educated because, knowledge can flow from elites to ignorant by passive diffusion".

8.  BE AWARE OF THE INDIVIDUAL DIFFERENCES:  It should be clear with you that we do not come from the same family, we grew up in different communities and we have been exposed to totally different situations in our life.  At least if that is the thinking, then it turns out that even our behaviors are totally different.  Never at any point should you get surprise when someone do something that is not usual.  Even if it is your best friend, they were not created the same way like you and somewhere somehow they may have a boot loops when it comes to doing several tasks.  So keep in mind that at any point the person next to you at the workplace is not the best nor the worst with certain tasks.

9.  TRY TO AVOID TRAFFIC JAM AND GIVE RESPECT TO TIME:  Doing things in time gives a lot of relief and you notice you can even help others do theirs better as you become less fixed. One simple idea I have also bought from myself in the last 10 years is that I like doing things my own way, follow my own order and be unique from the rest of co-workers.  It doesn't mean I try to deviate from my job description or work alone and ignore teamwork but instead, do the task as instructed but using unique and special tactics.  Every time I tried doing something exactly the same way my friends did, I got a lot of critics that raised my cortisol levels subjecting me to development of stress.  Well for some activities can be done in one way but I mean, I may change and do the task at a later time or earlier time compared to my friends as long as the time will be finished in the allocated time frame.

10.  LISTEN TO SOME MUSIC:  Not just music but favorite music, is capable of relieving stress at work as long as it will not obstruct you and other colleagues.  There is a way I have considered stress a walkover by listening to Gospel music for the last 15 years.  And this is especially true when it came to Hillsong album of "North point worship".  Every time I listen to it I kind of feeling like I am in Georgia.  I know your favorite may not be Gospel but whatever it is, as long as it makes you calm and comfortable please, it is one of the non pharmacological ways of relieving stress.

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