Impetigo contagiosa: therapeutic aspects

In tropical countries pyoderma is a common problem particularly in summer and monsoon. Causative organisms are Staphylococcus aureus, Streptococcus pyogens, Bacillus proteus, pseudomonas and coliform bacilli. Infection of the skin is characterized by discrete thin walled vesicles and bullae which rapidly become pustular then rupture. Impetigo occurs mainly on exposed parts of the body. Lesions occurring on scalp are mostly associated with pediculosis capitis. On rupture of these lesions a thin straw coloured seropurulent discharge is noticed. Sometimes group A beta-haemolyticus infections may follow acute glomerulonephritis. Impetigo occurs most frequently in early childhood. It may simulate different superficial skin conditions like circinate patches of ringworm. It is a common but simple problem, which can be easily cured by topical therapy and if needed systemic antibiotics can be given. Topical corticosteroid ointments should not be used, they worsen the infection

Metoclopramide a drug with versatile therapeutic uses

Metoclopramide a benzamide acts centrally by blocking dopamine D2 receptors in the CTZ and peripherally by enhancing the action of acetylcholine at muscarinic nerve endings in the gut. It increases gastric peristalsis while relaxing the pylorus and first part of the duodenum. It has no action on gastric secretions. It is the prokinetic of choice. The drug is effective in diabetic gastroparesis. Metoclopramide is effective and polar drug for many types of vomiting, postoperative, drug induced, disease associated [especially migraine], radiation sickness, it is less effective in motion sickness. It is also effective in vomiting induced by highly emetic anticancer drugs. Female patients who undergo operative procedures develop nausea which can be controlled by metoclopramide. Postoperative nausea and vomiting can be controlled with the drug. It is also effective in drug induced nausea and vomiting. It is also effective in the treatment of migraine. It has also been advised for hyperemesis gravidarum. Regarding use of metoclopramide during pregnancy to determine its use further studies are required. Its adverse effects include extra pyramidal symptoms. Antimuscarinic drugs; benzteropine given I/v can abolish the reaction. Prolonged use in elderly may produce tardive dyskinesia. Metoclopramide induced pseudotetanus has been reported, methemoglobinemia and sulfhemoglobinemia have also been reported. It is effective in nausea and vomiting induced in various conditions, like postoperative, gynaecological procedures, cytotoxic drugs. It is also effective in migraine it is a good prokinetic agent

Ibuprofen: Adverse Effects

Ibuprofen is the first member of the class propionic acid introduced in 1969. It is better-tolerated analgesic as compared to aspirin. All members belonging to propionic acid group inhibit prostaglandins, easily absorbed on oral administration, enter brain, synovial fluid and cross placenta, largely metabolized in liver by hydroxylation and glucuronic conjugation excreted in urine as well as in bile. It has analgesic, antipyretic and anti-inflammatory effects. It is commonly used in rheumatoid arthritis, osteoarthritis, and other musculoskeletal disorders. It is useful drug but cannot be considered free of adverse effects, the side effects comprise of milder gastric discomfort, nausea and vomiting, headache, dizziness, blurring of vision, tinnitus, depression, rashes, itching and other hypersensitive phenomena. Anaphylactic shock has also been reported, salt retention and hypertension has also been reported in elderly patients. In our study we noticed 10 male and 25 female patients developing gastric discomfort on prolonged use of ibuprofen. Two females patients have been noted developing analgesic headache. 5 male and 2 female observed nausea. 3 males and 2 females reported dizziness. 2 male patients were observed to have fixed drug eruptions

Vitamin, E: therapeutic uses

Alphatochopherol has vitamin E activity, wheat green oil is the richest source, it is also present in cereals, nuts, spinach and egg yolk. It was de clared that female rats required an unrecognized substance essential to sustance normal pregnancy. Some times during pregnancy death of the foetuses occurred in animals who were deficient of that substance later on vitamin E was referred to as antisterility vitamin. Vitamin E acts as antioxidant protecting unsaturated lipids in cell membrane. In animals vitamin E deficiency shows structural and functional abnormalities of many organs. Morphological alterations reveal biochemical defects involving fatty acid metabolism. Though it is called the antisterility factor but it does not have any value in treatment of sterility and habitual abortions in humans. There is interest of vitamin E in neurological diseases in humans. Vitamin E is essential nutrient necessary for the optimal development and maintenance of integrity and function of human nervous system and skeletal muscles. Clinical vitamin E deficiency has been implicated only in certain neuromuscular diseases in children. Vitamin E has been found to enhance the absorption of Vitamin A, found useful in intermittent claudication, fibrocystic breast disease and nocturnal muscle cramps, vitamin E has been promoted in menopausal syndrome, toxemia of pregnancy, ischaemic heart disease, several skin diseases, post herpetic neuralgia and scleroderma. It has also been found useful in retinopathy Higher levels of Vitamin E have lower risk of breast cancer. It is useful in athero sclerosis, cerebrovascular disorders, anaemia of premature infants, retrolental fibroplasias, bronchopulmonary dysplasia and intraventricular haemorrhages It inhibits aggregation of blood platelets. Vitamin E needs further and more trials to achieve its benefits. This is a review article

Treatment of miliaria rubra with ascorbic acid: an open pilot study

Miliaria rubra [prickly heat] is one of the most common and quite distressing skin disease of the tropics. It produces burning and itching. The condition is well recognized both by the patients and the physicians. It presents in the form of pruritic, erythematous papulovesicles on the skin. The primary treatment is to keep the patient in cold and airy atmosphere which unfortunately, is not easily practicable in tropical settings. Ascorbic acid in the dose of 1G daily for one week was tried on eighty cases of various age groups ranging from 10-50 years. Severe symptomatic cases turned to moderate and moderate to slight. Further studies to ascertain the role of ascorbic acid in the management of miliaria rubra are recommended

Scabies: a common skin problem often misdiagnosed

Scabies is a common skin problem and is caused by a parasite sarcoptes scabiei. The affected patient develops pruritic papules. The sites of predilection are chiefly the inter digital webs of the hands, the wrist, the flexures, of the arms, the axillae, the nipples, area around the umbilicus, lower abdomen, genitals and the buttocks. The disease spreads in epidemics and is transmitted from one person to another, unhygienic situations are basic factors for the spread of this infestation. Delayed treatment of the primary cases may flare-up the problem. Sufficient survey of the epidemiological problem is necessary. Very important matter is misdiagnosis of the disease, it has been misdiagnosed as eczema, allergic dermatitis, pyogenic infections etc. Irrational use of corticosteroids have contributed in flaring-up of the disease. The disease can be easily treated with crolamiton cream, Benzyl benzoate emulsion, and sulphur ointment. There are many other drugs topical available for its treatment. Only oral drug available is ivermectin single dose of which gives good results. All preventive and Therapeutic measures are necessary, good diagnostic acumen is needed in practitioners of medicine