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Antimalarial
What is malaria?
Malaria is an infection caused by the protozoan (single cell) parasitic organism Plasmodium that is transmitted by an infected mosquito and enters the blood from a mosquito bite. The plasmodium parasite has a complex life cycle, which begins in the mosquito and continues through several stages in humans. When inject into the blood through a mosquito bite, the sporozoite stage of the plasmodium parasite migrates to the liver where it multiplies and is then released back into the blood stream developing into merozoites. The merozoites infect red blood cells, where they multiply and develop into trophozoites and schizonts, which cause destruction of red blood cells. Some merozoites develop into gametocytes, the sexual form of the parasite, which are taken up by a mosquito when feeding on blood and develop into sporozoites in the salivary gland of the mosquito, ready to begin a new life cycle.
Symptoms of malaria usually appear within 10 to 15 days of the mosquito bite and include fever, shivering, headache, vomiting, muscle pain, and joint pain. If malaria is not treated, it can quickly become life-threatening, causing anaemia and brain damage and disrupting the blood supply to vital organs.
Treatment for malaria
Treatment for malaria depends on breaking the life cycle of the plasmodium as well as preventing further destruction of red blood cells. Treatment is often hampered by the ability of the plasmodium to develop resistance to drugs such as chloroquine.
Quinine is a natural antimalarial that is found in the bark of the cinchona tree. And belongs to the quinoline group of drugs. Quinine sulphate is a synthetic form of natural quinine and is used to treat malaria by acting as blood schizontocide that kills the schizont stage of the plasmodium parasite. Quinine sulphate also causes the accumulation of haem, a product of red blood cell production that is toxic to plasmodium and causes its death; this also prevents spread of infection.
Atovaquone and proguanil are both antimalarials that work by blocking nucleic acid synthesis and thereby inhibiting the replication of the schizont phase of the plasmodium parasite once inside the red blood cells. This prevents further destruction of red blood cells and also prevents spread of the parasite. Atovaquone and proguanil are usually combined in a single medication as they act synergistically to enhance the antimalarial effect.
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Womens / HRT
Female hormones
Throughout a woman’s fertile period the two hormones estrogen and progesterone (produced by the ovaries), work together to control the menstrual cycle. Estrogen stimulates ovulation and progesterone prepares the endometrium or lining of the uterus for implantation of a fertilised egg. If pregnancy occurs progesterone continues to be produced by the placenta to maintain the pregnancy, if not levels of progesterone falls, which initiates menstruation. The production of estrogen and progesterone is regulated by hormones produced by the pituitary gland - Follicle Stimulating Hormone (FSH) and Luteunising Hormone (LH), which in turn are under the control of Gonadotropin Releasing Hormones (GnRH) produced by the hypothalamus in the brain.
Androgens are generally considered to be male hormones but they also have several functions in the female body, including puberty related changes like pubic hair growth, preventing bone loss, libido and for the production of oestrogen.
Conditions caused by hormonal imbalance
An hormonal imbalance in women can cause a range of hormonal disorders:
- Lack of progesterone can result in menstrual disorders like, secondary amenorrhoea (menstrual periods that have stopped, are absent or irregular), dysmenorrhoea or painful periods, premenstrual syndrome and abnormal uterine bleeding, which occurs during the menstrual cycle instead of at the end. Medication containing a form of progesterone can help treat these menstrual disorders. Endometriosis, a condition where the endometrium grows outside the uterus and causes pain and bleeding can also be treated with progesterone.
- Overproduction of androgen or androgenisation causes hirsutism or production of unwanted hair, androgenic alopecia (hair loss) and polycystic ovary syndrome (PCOS), which is usually accompanied by acne and hirsutism and is related to insulin resistance and type-2 diabetes. These conditions can be treated using anti-androgen drugs.
Treating symptoms of menopause
As menopause approaches, the production of the female hormones estrogen and progesterone ceases, which brings to an end to the regular cycle of ovulation and menstruation. A lack of estrogen causes the of symptoms including, hot flushes, night sweats, sleeplessness, vaginal dryness, headaches, mood swings, lack of concentration and loss of energy. Estrogen also has several other actions in various metabolic processes including maintaining bone mass, which is why a lack of estrogen at menopause increases risk of osteoporosis.
Hormone replacement therapy (HRT) is used to help relieve symptoms of menopause by replacing female hormones that the body has stopped making naturally. HRT is generally in the form of an estrogen and can be delivered systemically as oral tablets or patches, or as topical creams for local vaginal symptoms like atrophic vaginitis. Combination HRT includes a form of progesterone to reduce the risk of developing endometrial cancer due to estrogen alone.
Other menopausal symptom relief medications available include clonidine, an alpha blocker and some dietary supplements that help reduce hot flushes.
Hormone based treatments for other conditions
This category also provides hormone based treatment for other women’s conditions, including:
- Some breast cancers and endometrial cancer, which are both estrogen-dependent tumours and can be treated with anti-estrogen drugs.
- Infertility due to lack of ovulation using an estrogen receptor modulator
- Osteoporosis or loss of bone mass is a common problem in postmenopausal women, which can be treated with medications that regulate bone turnover.
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Abdi Ibrahim
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Men's Health
About androgens
Androgens are steroid sex hormones produced mainly in the testes that control the development of the male sex organs, the testes, penis, seminal vesicles and prostate gland. They also regulate and maintain secondary male characteristics like the development of body and facial hair, increase in bone and muscle mass and deepening of the voice at puberty. Females also produce small amounts of androgens in the ovaries, but in some cases over production causes androgenisation with characteristics like unwanted body hair.
The main androgens are the male hormone testosterone and its active metabolite dihydrotestosterone (DHT), which is much more potent than testosterone. Both testosterone and DHT bind to the androgen receptor within responsive cells, including brain, bone, hair follicles, testes and prostate cells.
Increased production of or sensitivity to testosterone is thought to be involved in conditions like hypersexuality and aggression in male sex offenders. Also increased sensitivity to DHT and increased conversion of testosterone to DHT is thought to contribute to the hair loss process in male pattern baldness.
The prostate gland
The prostate gland is a small organ that lies just below the bladder and surrounds the top of the urethra, which is the tube that carries urine from the bladder. The prostate gland contributes to the seminal fluid made mainly by the seminal vesicles and the small amount made by the testes, which also contains sperm. Seminal fluid is transported by the urethra through the penis during ejaculation.
Growth and development of the prostate gland is controlled by testosterone, which binds to androgen receptors inside prostate cells. Conditions of the prostate gland include:
- Prostatitis, which is inflammation of the prostate usually due to an infection.
- Benign Prostatic Hyperplasia (BPH), which is an enlarged prostate but is not cancerous.
- Prostate cancer, which is an androgen-dependent tumour and needs testosterone for the cancer cells to grow.
Erectile dysfunction
Erectile dysfunction (ED) is also known as impotence in men and is the inability to achieve or maintain a hard erect penis suitable for sexual activity, which is normally the natural response to sexual stimulation. ED is due to decreased blood flow into the penis and can be treated by specific medication taken at the time of planned sexual activity.
Treatments for men’s health problems
Medications available for treating specific men’s health problems include:
- Anti-androgens that block the production of testosterone and its effects on cells containing androgen receptors, and are used to treat prostate cancer; also hypersexuality in male sex offenders.
- Inhibitors of the enzyme 5α-reductase that converts testosterone to DHT, and is used to treat BPH and male pattern baldness.
- Alpha blockers or alpha-adrenergic antagonists that relax muscle cells in the prostate gland and are used to treat symptoms of BPH.
- Inhibitors of the enzyme phosphodiesterase type 5 (PDE5) that widen blood vessels allowing blood flow into penis, and are used to treat ED.
- Prostaglandins that relax smooth muscle and are used to treat ED.
- Dietary supplements containing a naturally occurring 5α-reductase inhibitor, used to support prostate health and to treat BPH and male pattern baldness.
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Haemorrhoids
What are haemorrhoids?
Haemorrhoids are swollen veins in the lining of the lower part of the rectum and anus. They are caused by an increase in pressure within the rectum and anus such as during pregnancy, due to pressure of the enlarged uterus, and straining due to constipation.
This causes the swollen veins to become permanently dilated, swollen and inflamed. Haemorrhoids can be internal within the lining of the lower rectum and anal canal, or external, which surround the anus. Internal haemorrhoids are made up of blood vessels, supporting connective tissue and smooth muscle. They are usually pain free but can cause bleeding and may also become prolapsed when protrude into the anal canal and can cause problems. External haemorrhoids may also bleed if they become thrombosed, which is when there is bleeding within the haemorrhoid and the blood clots. External haemorrhoids may cause itching due to irritation of the surrounding skin, but this may also be due to rectal or anal fissures, which are small tears or cuts in the anal or rectal canal through which stools are passed. Muscle spasm is also a symptom of haemorrhoids, which can be painful.
Treatment for haemorrhoids
Treatments for haemorrhoids are available as an ointment applied to the anal area or as a suppository that is inserted into the rectum. Haemorrhoid treatments usually combine a corticosteroid anti-inflammatory, like fluocortolone or hydrocortisone, with a local anaesthetic, like cinchocaine, to treat the inflammation and pain associated with haemorrhoids. The corticosteroid inhibits the formation of inflammatory chemicals like interleukins that stimulate the formation of other inflammatory chemicals like prostaglandins. This reduces pain and swelling, associated with inflammation. The anaesthetic component acts locally to reduce pain, discomfort and itching.
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