COVID - 19 cases

Corona Virus Cases.

COVID - 19 cases

New York
Week 1 - 2
Week 2 - 105
Week 3 - 613

France
Week 1 - 12
Week 2 - 191
Week 3 - 653
Week 4 - 4499

Iran
Week 1 - 2
Week 2 - 43
Week 3 - 245
Week 4 - 4747
Week 5 - 12729

Italy
Week 1 - 3
Week 2 - 152
Week 3 - 1036
Week 4 - 6362
Week 5 - 21157

Spain
Week 1 - 8
Week 3 - 674
Week 4 - 6043

Pakistan

Week 1 - 1
Week 2 - 10
Week 3 - 15
Week 4 -  300

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COVID-19 | Tips to Strengthen Your Immunity Naturally | Corona Outbreak

COVID-19 | Immunity boosters | Corona Outbreak

People affected by coronavirus are mostly immunocompromised patients.

Immunity can be boosted by:

Vitamin C

Vitamin D

Vitamin E

Vitamin A 

Vitamin B6 

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Covid_19 Coronavirus latest updates #CoronavirusPandemic

BREAKING: The World Health Organization has declared that COVID-19 "can be characterized as a pandemic."
#CoronavirusPandemic

Covid_19 Coronavirus latest updates

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INSULIN | High Alert Medicines | What Pharmacists should know?

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Corona virus | what not to do .

Corna Virus | what not to Do

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Meloxicam inj Approved by FDA for treatment of moderate to severe pain.

• 

• Meloxicam inj Approved by FDA for treatment of moderate to severe pain.

The US Food and Drug Administration (FDA) has approved meloxicam injection (Anjeso, Baudax Bio) for the treatment of moderate to severe pain in adults, either by itself of with other nonsteroidal anti-inflammatory drug (NSAID) analgesics, according to a company news release.

Meloxicam injection will be given as a once-daily intravenous bolus push.

Meloxicam is a long-acting, preferential cyclooxygenase type 2 (COX-2) pathway inhibitor with analgesic, anti-inflammatory, and antipyretic properties that are thought to result from inhibition of the COX-2 pathway and reduced prostaglandin biosynthesis.

The onset of analgesia with meloxicam injection is delayed, and the drug should not be used when rapid onset of analgesia is needed.

"The approval of Anjeso marks an important achievement for the medical community given the unmet need for non-opioid options in the pain treatment landscape," Keith Candiotti, MD, chair of the Department of Anesthesiology, Perioperative Medicine and Pain Management at the University of Miami, Florida, said in the news release.

"While traditional opioid medications have proven effective at providing pain relief, the associated adverse side effects, including sedation and respiratory depression, have driven physicians to employ a multi-modal approach to treating post-operative pain. With 24-hour, durable pain relief and a safety profile comparable to placebo, Anjeso has the potential to serve as a meaningfully differentiated analgesic alternative," he continued.

The approval follows consideration of data from two phase 3 efficacy trials and one phase 3 safety study. The new drug application also included data from four phase 2 clinical trials and other safety studies.

"The safety and efficacy of Anjeso have been well-established through several mid- and late-stage clinical studies," Stewart McCallum, MD, chief medical officer of Baudax Bio, said in the news release. "Moreover, data from our Phase III safety trial demonstrated that Anjeso is well tolerated and impacted opioid consumption compared to placebo, further highlighting its value to patients, providers and health systems."

Phase 3 Efficacy Trials

The first efficacy trial was a multicenter, randomized, double-blind, placebo-controlled study that included 201 patients who had undergone bunionectomy. Patients were randomly assigned in a 1:1 ratio to receive up to three 30-mg meloxicam injections or placebo once every 24 hours after surgery.

Those who received meloxicam experienced a statistically significant reduction in sum of the pain intensity differences over 48 hours (SPID48) (P = .0034) compared with those who received placebo.

The study met 15 of the 19 secondary outcomes, "including statistically significant differences in SPID6 (p = 0.0153), SPID12 (p = 0.0053), SPID24 (p = 0.0084), SPID24-48 (p = 0.0050), time to first use of rescue medication (p = 0.0076), and several other rescue use and pain relief metrics during the first 48 hours, compared to placebo," the company noted in the news release.

The second study was a multicenter, randomized, double-blind, placebo-controlled clinical trial that enrolled 219 patients who had undergone abdominoplasty. The patients were randomly assigned in a 1:1 ratio to receive meloxicam injection 30 mg or placebo once every 24 hours. Those in the meloxicam group experienced a statistically significant decrease in SPID24 (P = .0145) compared with those in the placebo group.

The trial met "statistical significance for 10 of the secondary endpoints, including statistically significant differences in SPID12 (p = 0.0434), time to perceptible pain relief (p = 0.0050), subjects with ≥ 30% improvement at 24 hours (p = 0.0178), number of times patients required rescue in the first 24 hours after randomization (p = 0.0275), as well as number of times rescued from 24 to 48 hours (p = 0.0009), and several other pain relief metrics, compared to placebo," according to the news release.

In both efficacy studies, meloxicam injection was well tolerated, and rates of serious adverse events related to bleeding did not differ between the meloxicam and placebo groups.

Safety Study

The safety study was a multicenter, randomized, double-blind, placebo-controlled phase 3 clinical trial that included patients who underwent major elective surgeries and were expected to remain hospitalized for at least 24 to 48 hours. The procedures included total hip and knee replacements, spinal surgeries, hernia repairs, gynecologic surgeries, and others.

Of the study participants, 40% were men, and 23% were older than 65 years. The safety trial did not require minimum pain scores for treatment. Study sites were allowed to use opioids and other pain management modalities, in accordance with their standard of care, with meloxicam or placebo added.

The study randomly assigned patients in a 3:1 ratio to receive either meloxicam or placebo intravenously once daily up to seven doses; 721 patients received one or more doses of the study medication.

In those aged 65 years or older, approximately 7% fewer patients in the meloxicam group experienced at least one adverse event compared with the placebo group. The percentage of study participants who experienced one or more serious adverse events was lower in the meloxicam group (2.6%) than in the placebo group (5.5%).

Two serious adverse events were considered to be possibly related to the study treatment. Both occurred in one patient in the placebo group. There were no deaths in either of the treatment groups. Approximately 3% of those in each study group discontinued the study.

Among the most frequent adverse effect experienced by at least 2% of patients who received meloxicam injection and that occurred at a higher frequency compared with placebo were constipation, increased gamma-glutamyl transferase, and anemia.

The product label includes warnings about an increased risk for serious and possibly fatal cardiovascular thrombotic events. It states that meloxicam injection is contraindicated in patients who are to undergo coronary artery bypass graft (CABG) surgery. Patients taking meloxicam injection also have an increased risk for potentially fatal serious gastrointestinal adverse events, such as "bleeding, ulceration, and perforation of the stomach or intestines."

These risks can be increased early in treatment and may increase as treatment goes on.

Meloxicam injection should not be used in those who are known to be hypersensitive to meloxicam or to any of the product's components; those with a history of asthma, urticaria, or other allergic reaction after using aspirin or other NSAIDs; those with moderate to severe renal insufficiency who are at risk for renal failure related to volume depletion; and in patients who are to undergo CABG surgery.

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coronavirus, Citibanamex postpones plenary meeting of its Advisory Council

coronavirus, Citibanamex postpones plenary meeting of its Advisory Council

For coronavirus, Citibanamex postpones plenary meeting of its Advisory Council

President Andrés Manuel López Obrador was confirmed to close the meeting next Friday at the Hotel Presidente Inter-Continental México.
To prevent the spread of the coronavirus in the country, Citibanamex announced last night that it decided to “postpone until further notice” the plenary meeting of the Consultative Council, to be held Thursday and next Friday at the Hotel Presidente Inter-Continental México. President Andrés Manuel López Obrador was confirmed to close the meeting at lunch on Friday, March 6.

The central reason for the suspension is the application of the Citi protocol for “internal and external meetings” in this type of circumstances. "The health and safety of those attending this event are the highest priority for Citibanamex," according to information obtained by MILLENNIUM. We recommend: By Covid-19, air tickets to Europe are 15% cheaper This meeting is the most important of the US bank in Mexico, which is attended by more than 600 global and national investors, among which is the CEO BlackRock, Larry Flink, the world's largest fund manager, as well as federal government officials and private sector leaders. https://www.milenio.com/negocios/coronavirus-citibanamex-pospone-reunion-consejo-consultivo

This meeting is the most important of the US bank in Mexico, attended by more than 600 global and national investors, among which is the general director of BlackRock, Larry Flink, the most important fund manager in the world, as well as officials from the federal government and private sector leaders. The decision was made one week after the 83 Banking Convention of the Association of Banks of Mexico, which is scheduled to take place on the 12th and 13th of this month in Acapulco, Guerrero, the most important financial event of the year, and which could continue same way. 

We recommend you: Due to a national women's strike on March 9, Citibanamex expects to close branches There were many work meetings to take a definition from Michael Corbat, CEO of Citi; Valentín Diez Morodo, president of Citibanamex; Manuel Romo, general director of Citibanamex, and Ernesto Torres Cantú, general director of Citi for Latin America, among other officials.

 Among the planned analysis topics were the T-MEC and the bilateral agenda, the private sector and the next stage in energy reform, women's challenges in the business world, job security in Mexico, corporate citizenship, digital commerce challenges, Mexico in the face of geopolitical risks in the world. As special guests, in addition to President López Obrador, were the governor of the Bank of Mexico (Banxico), Alejandro Díaz de León, as well as the Secretaries of Finance and Foreign Affairs, Arturo Herrera and Marcelo Ebrard, respectively https: //www.milenio .com / business / coronavirus-citibanamex-postpone-meeting-advisory council

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Coronavirus, covered by insurers like any disease: AMIS

Coronavirus, covered by insurers like any disease: AMIS

corona virus

Recaredo Arias, Director of AMIS, said Covid-19 falls under the Health and Medical Expense insurance policies
In particular, insured persons are advised to read the conditions of the policy and, if necessary, consult their agent to know the extent of the coverage acquired.

“It is important to emphasize that, being a respiratory illness, the coronavirus is covered like any illness within the Health and Medical Expenses insurance policies. In case the level of pandemic or epidemic is reached, most insurers cover this type of illness, ”said Recaredo Arias, AMIS Director General.
Association figures detail that in 2019 the insurers paid around 60 billion pesos for the care of diseases, of which, about 5%, that is, 3 billion pesos, corresponded to respiratory ailments.

"It is important that, like ten years ago, we all follow the prevention measures that have been recommended to us, to reduce the risk of contagion," he said.

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Protocol for treatment of confirmed COVID-19 Infection

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How to stop gaining weight | Does Depression Cause Weight Gain or Weight Loss?

How to stop gaining weight plus depression weight gain

How to stop gaining weight

WEIGHT GAIN Obesity Definition:

Obesity refers to an increase in total body fat.

Obesity is also known as weight gain and it occurs when we take more calories in our diet than the body uses up. if the which eat provides more calories than our body needs than an excess of food is converted into fat, so the fat cells start increases in size, and when they can no longer expand they start increases in number.

Point to remember:

If we lose weight, the size of fat cells decreases but its number can't decrease.

Cause of Weight Gain:

There are many factors that contribute to obesity but if these factors are control we can easily control yourselves from becoming obese.

~GENES:

Genes may contribute to obesity i.e obesity tends to run in families.

~LIFE STYLE:

Obesity is also caused by a shared diet. Most of our eating habits and activities are learned from people around us.so it is concluded that overeating and inactive lifestyle can cause obesity.

~AGE FACTOR:

Age can also contribute to obesity because as people grow elder they tend to lose muscle and gain fat because their metabolism becomes slow as compared to a younger age.so slow metabolism lower down their calorie requirements.

~SEX FACTOR:

Sex can also cause obesity because men have more muscle than women and also muscle burns more calories than any other tissues so men use more calories than women even at rest so if women are taking the same amount of calories as men take then women are likely to gain weight than men on same calorie intake.

~EMOTIONS:

Many people gain weight because of their emotions i.e depression, hopelessness, anger and many other reasons. Their feelings and emotions affect their eating habits causing them to overheat which results in obesity.

~MEDICATIONS:

Some medicines also contribute to obesity but it is also observed that medicines are not a very common cause of obesity as compare to overeat and an inactive lifestyle. Examples are antidepressants medicines.

~MEDICAL CONDITIONS:

Some medical conditions can also cause obesity which includes hypothyroidism, Cushing syndrome, and depression, etc.

The best method to Reduce weight gain

~EXERCISE:

Exercise is the main factor due which we overcome from the problem of obesity so taking exercise for 30 minutes on most days od week or daily walking to certain miles can solve the problem of obesity.

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Advantages of using Medical Equipments

Medical Equipmemts

There are many important Medical Equipment used in Hospitals 

they are

Advantages Of Using Medical Equipments

Medical devices to be used severally reception, with the assistance of that is feasible to treat diseases and injuries, or the utilization of that prevents the progression of the unwellness.

The medical devices to be stipendiary for embody glucometer check strips necessary for measurement the blood glucose of diabetics, lancets, hypoglycemic agent needles, totally different stoma care appliances, orthoses, catheters, wound dressings and patches for treatment of various wounds, the devices used for the treatment of sleep disorders and therefore the masks therefrom.

The insurance Fund reimburses medical devices either at ninetieth or five hundredth discount rate. consequently, 100 percent or five hundredth of the device worth should be paid by the patients themselves.

The doctor providing treatment establishes the necessity for a medical device and prepares the digital card of the medical device for acquisition therefrom on favorable terms. For purchase of the device, the patient should address the pharmacy or a vender WHO has entered into a contract with the insurance Fund associated presents an identity document. If you purchase the device for somebody else, then it's necessary that the identification code of the person for WHO you purchase the device is enclosed. The list of medical devices is updated annually on the idea of the proposals of makers and skilled associations, and therefore the worth agreements ended with the makers.

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An overview of Diabetes mellitus DM Classification, Pathophysiology

Diabetes mellitus DM

Etiology of type Type 1 Diabetes

1.Autoimmunity:

It is caused by the production of antibodies called islets cell Antibodies(ICA) which car the destruction of pancreatic Beta cells.

In more than 70% patient after. Circulating ICA are found.

2.Idiopathic cause:

Sometimes Type 1 Diabetes mellitus can occur due to unknown cause.

3.Genetic factors:

 it is more important in type 2 then in Type 1.

4. Other factors:

A.Environmental factors

B.viral infections 

such as mumps measle influence the viral pneumonia

In some instances there maybe is heriditary tendency for beta cell degeneration even without viral infection or autoimmune disorder.

B. Etiology of type 2 Diabetes mellitus:

 it occurs due to insulin and sensitivity and answers of insulin resistance and aging secondary life style an abnormal visceral obesity beta cell destruction there is selective defect and beta cell secretory mechanism that prevent it from responding normally to glucose the impaired beta cell response to glucose are further aggravated buy increase hyperglycemia and this defect improve with decreased hyperglycemia patient with type 2 Diabetes mellitus retain approximately 50% of Beta cells Mass.

Causes of type 2 Diabetes mellitus

These are

Mainly associated with hyperinsulinemia:

 the visceral obesity correlate with insulin resistance where is substance that seems to have less of an association decrease and number of insulin receptors

Family history: (genetic factor)

Genetically beta cell destructionphone
 type 2 has much stronger genetic relationship then type one
there are no circulating antibodies.
Other factors age more than 40 years hypertension high cholesterol level history of a normal fasting Glucose level excess growth hormone(acromegaly) pregnancy gestational diabetes ,
Polycystic ovary disease,
 lipodystrophy (acquired of genetic lipids accumulation)
autoantibodies to insulin receptor
mutation of insulin receptor
mutation of paroxism proliferator-activated receptor (pparg)
 mutation that causes genetic audacity for example melano receptor mutatioi

Pathophysiology of diabetes mellitus:

The pathophysiology of diabetes mellitus is related to the hormone insulin which is secreted by the Beta cells of pancreas. this hormone is responsible for maintaining Glucose level in the blood. It allows the body cells to use glucose is a main energy source, however in diabetic person due to abnormal insulin metabolism the body cells and tissues do not make use of glucose from the blood, resulting in an elevated of glucose or hyperglycemia over a period of time, high glucose level in the bloodstream can lead to severe complication such as I disorder cardiovascular diseases renal diseases kidney damage nerve problems.

Type 1 Diabetes mellitus:

 in Type 1 Diabetes mellitus DM the pancreas cannot synthesise enough amount of insulin hormone as required by the body. Pathophysiology of Type 1 Diabetes mellitus suggest that it is an autoimmune disease and which the body on immune system generate secretions of substances that attack the Beta cells of pancreas consequently the pancreas secrete little or no insulin.

Type 1 Diabetes mellitus DM is more common among children and young adults around 20 years since it is the common among young individual and insulin hormone is used for the treatment. Type 1 Diabetes is also referred to as insulin dependent Diabetes mellitus or Juvenile diabetes.

Type 2 Diabetes mellitus:

In case of type 2 Diabetes mellitus there is normal production of insulin hormone but the body cells are resistant to insulin since the body cells and tissues are non responsive to insuline, glucose remains in the bloodstream. It is commonly manifested by middle age adult about 40 years is insulin is not necessary for the treatment of type 2 Diabetes mellitus it is known as non insulin Diabetes mellitus NIDDM or adult onset diabetes.

Gestational diabetes 

on the other hand occurs among pregnant women it is caused by due to the fluctuation of hormonal level during pregnancy usually the blood glucose level return to the normal after the baby is born.

General mechanism related to pathophysiology of diabetes mellitus DM:

Insulin is the principal hormone that regulate uptake of glucose from the blood and to the most cell therefore deficiency of insulin or the insensitivity of its receptors play a central role and all form of diabetes.
Much of the carbohydrate in the food is converted within a few hours to the monosaccharide glucose the principal carbohydrate found in the blood and is used by the body as a fuel. Insulin is released into the blood by Beta cells found in the pancreas In response to rising level of blood glucose after eating. Insulin is used by about two third of the body cells to absorb glucose from the blood for the used as a fuel for conversion to other needed molecules or for storage and insulin is also principle control signal for conversion of glucose to glycogen for internal storage and level and muscle cells.

Lower Glucose level result both and reduce release of insulin from the Beta cells and the rivers conversion of glycogen to glucose occur when Glucose level Falls. This is mainly controlled by the hormone glucagon which act and an opposite manner to insulin. Glucose discovered by the liver Re enter the bloodstream muscle cells lack the necessary export mechanism.

Higher insulin level increases some anabolic processes such as cell growth and duplication Protein synthesis and fat storage. Insulin is the principal signal and converting many of the bidirectional process of metabolism from a catabolic to and anabolic direction and vice versa. In particular a low insulin level is trigger for entering or Living ketosis the fat burning metabolic phase.

If the amount of insulin available is insufficient if the self respond poorly to the effect of insulin or if the answering itself is defective then glucose will not be absorbed properly buy those body cells that require it will be stored appropriately in the liver and muscles. The net effect is persistent high level of blood glucose poor Protein synthesis and other metabolic the arrangement searches acidosis.

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Diabetes | Type 1 Diabetes | Type 2 Diabetes | DM

Diabetes DM:

Diabetes DM

Definition of Diabetes:

Diabetes mellitus DM is a group of metabolic disorder characterized by hyperglycemia and abnormality is in carbohydrate fat and protein metabolism. It result from the defect and insulin secretion, insulin sensitivity for both.
Or
Diabetic is chronic incurable disease.
Or
Diabetes mellitus is heterogeneous group of disorder characterized by varing degree of insulin hyposecretion or insulin in sensitivity regardless of it is associated with hyperglycemia.

Let’s know how vegetables control diabetes

Epidemiology of Diabetes:

a) Type 1 insulin dependent Diabetes mellitus:

 occurs mainly in 10 to 14 years old but may occur in adult especially when hyperglycemia first appear and non obese or elderly.

The Global incidence is increasing with the annual increase of up to 3%.

An estimated 18.2 million American have diabetes mellitus of whom 1 million have Type 1 Diabetes mellitus.

b) type 2 non insulin dependent Diabetes mellitus:

More than 90% of all diabetes have type 2 diabetes.

Usually occur in person with of age more than 70 years.

Incident of type 2 increases with the agent obesity.

Types of Diabetes:

There are too many types of diabetes mellitus depend upon insulin secretion.
1.Type 1 diabetes mellitus
2.Type 2 diabetes mellitus

Type 1 Diabetes mellitus in type 2 Diabetes mellitus represent two distinct diseases from epidemiological point of view, but clinical distinction can sometime be difficult varing degree of insulin secretary failure may be present in both form of diabetes.

For example:

Some patient with immune mediated diabetes Mein not at first required insulin where is many with type 2 diabetes will eventually do so.

1.Type 1 diabetes mellitus:( Insuline dependent Diabetes mellitus):

Type 1 Diabetes mellitus is also called insulin dependent Diabetes mellitus (IDDM) NS caused by lack of insulin secretion by Beta cells of pancreas. It is often called Juvenile diabetes. This usual onset of Type 1 Diabetes occur at about 14 years of age and for this reason it is often called Juvenile Diabetes mellitus.

2. Type 2 Diabetes mellitus: ( non insulin dependent Diabetes mellitus):

Type 2 diabetes is also called non insulin Diabetes mellitus (NIDDM) and it and is caused by decree sensitivity of target tissue to metabolic effect of insulin. This reduced sensitivity to insulin aspart insulin resistance.

Type 2 diabetes occur after age 30 often between the ages of 50 and 60 years. Therefore, this syndrome is often referred to as adult onset Diabetes.

3.Other Specific Types of Diabetes mellitus DM:

Other specific types of diabetes known as secondary diabetes, describe diabetes that is associated with certain other condition and syndrome such as diabetes can occur with pancreatic disease are the removal of pancreatic tissue and with endocrine diseases such as acromegaly cushing's syndrome or pheochromocytoma.
Endocrine disorders they produce hyperglycemia do so by increasing the hepatic production of glucose and decreasing the cellular use of glucose.

Several diuretics such as thiazide diuretics and loop diuretics elevate blood glucose level. This diabetic increases potassium loss which thought to impair insulin release.

Other Drugs known to cause hyperglycemia are glucocorticoids levodopa ,oral contraceptives ,sympathomimetics ,phenothiazines ,,Phenytoin and
 total parenteral nutrition (hyperalimination)

4. Gestational diabetes:

Gestational Diabetes mellitus refer to any degree of glucose intolerance that is detected first during pregnancy. It occurs to various degree in 1% to 14% of all pregnancies, depending on the population and Diagnostic tests used. It most frequently affect women with family history of diabetes with glucosuria, with the history of stillbirth or continuous abortion, fetal abnormalities and previous pregnancy, our previous large or heavy for date baby and who are obese, of Advanced maternal age or have had five IMO pregnancies.

Women with average risk should be tested at 24 to 28 weeks of gestation. Women with fbg of more than one 20 mg per DL are casual glucose of more than 200 mg per DL meet the threshold for diabetes, if confirmed on subsequent day and do not need to undergo oral glucose tolerance test.

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Rabies - Symptoms and causes Diagnosis Treatment

Rabies:

Rabies infected animal

Rabies Synonym: 

hydrophobia

Rabies Definition:

Viral infectious disease of CNS and is highly lethal viral infection caused by specific type of virus clinically characterized by a variable incubation period from 2 weeks to 16 weeks or longer and for a very short illness i.e. 2-3  days.

Rabies Etiology:

Rabies Causative agent:

lyssa virus type-1
Family: Ribo viradae
Sub-family: rhabdo viradae

Morphological characteristics of Rabies Virus:

It is single strand RNA genome
One end is round and other is flat
Length is 18nm, diameter is 75nm

Types of Rabies virus:

There are two types of rabies virus

• Street virus 
• Fixed virus

Rabies Street virus:

• It is naturally occurring cause of rabies
• Very lethal 
• Nor used in vaccine product
• Incubation period is long.

Rabies Fixed virus:

• Artificially produced by tissue culture technique
• It is not lethal 
• Used in vaccine product
• Incubation period is 4-6 days.

Reservoir / habitat of infection of Rabies virus:

In urban areas, rabies reservoir is rabid dog
In case of wild life, bats, jackal, fox etc.

 Rabies Source of infection:

All warm blooded animals are responsible for zoonotic infection
Saliva (highly infected with virus) is a source of infection of rabid animals.

Rabies Mode of transmission:

• Bite of rabid animal
• 
  
• Licking of abraded/traumatic skin 
• 
  
• mucosal membrane by rapid animal

Incubation period Rabies virus:

 2-16 weeks or longer.

Factors effecting incubation period of Rabies virus:

Site of bite:

If site of bite is towards from CNS then incubation period is short and if away from CNS then incubation period is long.

Severity of bite:

• Mild 
• Moderate
• Deep 
• Superficial

Number of bites

• Nature of rabid animal
• First aid facility

Pathophysiology of Rabies:

• Inoculation of virus to any other healthy animal
• Locally multiply or replicated of that virus in connective/muscular tissues.
• Attachment of virus to inorre ending of peripheral neuron
• Start moving towards and away from CNS.
• In CNS it will cause encerptialilits
• Centrifugally moving towards various areas of the body i.e. skeletal muscles, myocardial muscles and different glands i.e. salivary glands attack on salivary gland is very crucial and a source of infection cause zoonotic infection of CNS and result in death.

Clinical features of Rabies:

• Prodromal phase/stage
• Headache, low grade fever and sore throat
• Pain and tingling at the site of bite
• Malaise and fatigue
• Excitation stage:
• Sensory system involvement
• Motor system involvement
• Autonomic system involvement
• Mental involvement

 Sensory system involvement:

• Hydrophobia
• Aerophobia
• Rigidity and spasticity of muscle 
• Intolerance of light

Motor system involvement:

• Rigidity and spasticity of muscles.
• Autonomic system involvement:
• Excessive salivation and lacrimation
• Mental changes/fear of death
• Depression and anxiety

Convulsion stage:

• Convulsion/paralysis
• Coma
• Death

Diagnosis of Rabies:

• Neigri body identificatio
• History of rabid bite
• Clinical features
• Immune fluorescent technique.

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Current Medical Management of Peptic Ulcer Disease

Current Medical Management of Peptic Ulcer Disease

Summary Of peptic ulcer Disease:

 Gastric ulceration occurs due to increased gastric secretion or due to any microbial infection. The therapeutic management include the use of antibiotics and the drugs which reduces the gastric secretion .Minor ulcers are treated by drug therapy although long term treatment is required to avoid the chances of reoccurrences .Drug induced gastric ulcer is the main focusing problem however efficacious drugs are now used for this.

Pathophysiology of Peptic ulcer:

The peptic ulcer is a disease in the gastric lining mostly occurred from the combine effect of secreted acid and pepsin. Pepsin is a proteolytic enzyme which require acidic medium for its action. Increased pepsin and acid secretion is found in gastric and duodenal ulcer patients and appear to play an active role in ulcer formation.  Not all ulcers, however, are accompanied by excessive gastric secretion. Gastric ulcers may occur in normal or even low gastric secretion.
The cytoprotective action is responsible for the treatment of ulcers without any decrease in pepsin or acid secretion. This mechanism is not well known but it shows the regeneration of epithelial cells, mucosal bicarbonate secretion, mucosal prostaglandin and upper mucous coat. The gastric or duodenal ulcer is treated as quickly as the ulcer in any part of body.

TREATMENT OF PEPTIC ULCER:

Placebo Therapy

It is shown that about 80% of peptic ulcer is treated with placebo treatment with in one month.2 they are generally lower than that. However there is a chance of healthiness even with a placebo therapy .The placebo therapy become responsible for the popularity of ineffective therapy.

Clinical trials with routine endoscopic follow up also found another unexpected fact: many active ulcers are asymptomatic this may not be wonderful because many ulcerative patients did not have any signs earlier. endoscopic evaluation described that gastric ulcer repetition will be asymptomatic in the clients who have symptoms earlier.5'6 this shows that finding signs of peptic ulcer is very difficult.

Antacid Therapy

A strongly acidic environment is required for the proteolytic action of pepsin enzyme. Even very small amount of alkalinity in medium finishes its activity and also the degenerative activity of the acids. Therefore antacid therapy is very beneficial .In control study it found that antacid therapy treat the ulcer as beneficial as the other therapies.7Then why people not taken it mostly.

it is because of its uneasiness in use as the other treatments. Clients must take one and three doses after each meal and also before sleep. Some clients does not like it while some patients stop its administration before healing the ulcer just on relieving of symptoms. Magnesium presence may causes diarrhea while calcium carbonate may stimulate gastric secretion after therapy. That is why its use has been stopped.

H2-Antagonists

Cimetidine (Tagamet et al.) is a competitive antagonist of histamine, which blocks its attachment to
H2-receptors and inhibits acid secretion.8 its treating activity is faster than the placebo therapy. Cimetidine is the most famous drug in gastric ulcer as well as in peptic syndrome not related to peptic ulcer. Many patients took the drug for short courses on demand. Its use in non-ulcer dyspepsia is debatable and beyond the scope of this paper. Although 300 mg q.i.d. was initially administered for minor therapy, 600 mg b.i.d. was soon known to be as efficacious and best accepted by patients. Cimetidine treatment is related to many uncommon but effective side effects.

Drowsiness and reversible confusion may occur specifically in older ones. Cimetidine co-administration can prolong metabolism and excretion of some drugs and significantly raise their blood levels in the body. Co-administration of cimetidine with warfarin should be closely monitored because of inhibition of warfarin metabolism. Without these cimetidine is most acceptable by the patients and because of cost effectiveness it has most potential for market led to the development of other H2 antagonists. Ranitidine was released second after the cimetidine

Coating Agents

Sucralfate released most quickly after the cimetidine for the ulcer therapy. It bind to the ulcerative area and form a jelly like substances which protect the acid, pepsin, and bile acid to bind with diseased area. Sucralfate actions superficially and shows some side effects without for constipation in some patients. Drug should be given one hour before meal and at sleep time also.

Concomitant use may interfere with absorption of some drugs and is not available in generic form. Concomitant use of sucralfate with NSAIDS is useful in the treatment of ulcer .However not the sucralfate nor the H2-antagonist is effective in the treatment of ulcer disease.10

Prostaglandins

Misoprostol (Cytotec), a prostaglandin E1 analogue, combines anti secretory and cytoprotective actions. Diarrhea is the first amendable in many clients, but if we keep maintain our therapy then improve the health. However it is very difficult for the constipative patients. Misoprostol should be prohibited in pregnancy because it do abortion.

It is currently approved for treatment of duodenal ulcer at a dose of 200ug q.i.d after meals and at bedtime misoprostol reduces the chances of ulcer with NSAIDS use .That is why the drug is given in steps of 400 to 800microgm/day and also for NSAIDS INDUCED ulcer. NSAIDS induced ulcerative patients are treated with prostaglandins.

Miscellaneous Agents

Pirenzepine (Gastrozepin) is because of its anti-secretory activity is given for the ulcer disease. However it is not as much as effective as that of H2 receptor blocker.

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