Acne herbal remedies (Ayurveda treatment for acne)

Acne is a condition which is difficult to treat but there are several ayurveda remedies available to treat acne. Aloe vera, Neem, Haldi (Turmeric) and Papaya are the leading herbs used in ayurveda to treat acne. Products from Rubia cordifolia, Curcuma longa (commonly known as Turmeric), Hemidesmus indicus (known as ananthamoola or anantmula), and Azadirachta indica (Neem) have been shown to have anti-inflammatory effects, but not aloe vera.

In ayurveda acne is called yauvan pidika. The mechanism of action of the ayurveda remedies of acne is to attack the root of the disease. While applying the following acne herbal remedies, there are several things that patients should practice;

1. keep the skin clean
2. keep the skin dry
3. avoid hot diets (chilies)
4. Massaging face regularly with the herbal oil

Followings are the ayurveda acne remedies;

1. application of paste prepared with Jamun/jambul (Syzgium cumini or Jambolan Plum) seeds over the pimples
2. Application of papaya paste (papaya+water) over the whole facial skin. Keep the paste for 20 minutes. Then clean the face with water and apply sesame or coconut oil on the face. This should be done once a day and continue at least one week.
3. Rubbing the face with the peel of an orange
4. Application of buttermilk at least twice a day for one week.
5. Make a paste of 10 grams of besan (flour of chickpea) and 10 grams of haldi (turmeric) in dahi (curds). Apply this paste on the face using massaging techniques. Let the paste dry on the face, and then wash it with plain water. This method provides relief within seven days of continuous application.
6. A paste of lodhra (Symplocos crataegoides), dhania (coriander) and vach (Acorus calamus) also promises results within seven days. This is one of the best acne treatments.
7. Extract the milk of the sharp thorns of the semal tree (cotton tree, Bombax ceiba). Apply this milk on the pimples directly and wash after it is dried off. Continue this process for just three days to get results.
8. Take powders of roasted mustard seeds, orange peels and chiraunji (Buchanania latifolia) in equal proportions. Grind them into a very fine constitution. This mixture is applied to the face.
9. Make a paste of jayphal (nutmeg) and red chandan (red sandalwood). Apply this on the face to reduce pimples.
10. Prepare a mixture of neembu (lemon), black kasondi (coffee pods or java beans) and extract of the tulsi (basil) and dry it in the sun. It will become more viscous when it is dried. Apply it on the face in this concentrated form. This is a sure method of reducing pimples. This acne remedy is helpful in acne cure.
11. A very simple remedy is to put the roots of the neem (Azadirachtha indica) in water and apply this concoction on the pimples. This method also gives fast relief from pimples.
12. Make a paste of masoor dal (red lentils) with milk, camphor and ghee. Apply this mixture on the face. This will not only reduce the pimples, but also take care of the pockmarks that can remain when the pimples are dried off. This is the best acne treatment
13. Make a paste of lemon juice, milk and kalaunji (seeds of fennel flower) in very fine powder form. Apply this paste on the face at night when retiring to bed. In the morning, wash the face with lukewarm water. This method is a quick way to eradicate pimples and can be used if you have to go to a party or a function.
14. Another method that can be employed if you have to socialize is to apply a paste of fine powder of dried orange peel in rose water. This will not only remove the pimples quickly but also improve the texture of the skin.
15. Mix a cup of milk with a cup of lemon juice. This mixture requires a time of ageing. Hence prepare it in the early morning and apply it when going to bed at night. Wash the face the next morning and wipe it with a rough towel. Continue this application for a couple of days until you see signs of relief. This acne remedy is helpful in acne cure.
16. Add a spoonful of salt in a bowl of hot water. Apply this with a rough towel on the face as though you are sponging the face. Remember to keep your eyes closed during this application. After each application, wring off the excess water from the towel. This is a mildly painful process as the salt will create a tingling sensation with the open areas of the pimples. However, you will obtain sure results in ten days.

Treated liquid milk and milk products

Milk is perishable. Being a nutritious liquid it is a good medium for the growth of micro-organisms either present in the milk (such as those of tuberculosis from infected cattle) or introduced during handling. Milk must therefore handle with care to keep it safe for consumption. Traditional milk has been preserved in different ways, such as the souring of milk by organisms harmless to man, concentrating to a solid or semisolid state by boiling, and by making cheese. Some of these products are valuable not only for their keeping qualities but also because they are more digestible. Modern technology has greatly improved on some of these methods and added to them the heat treatment of liquid milk.

Methods of processing or treatment of liquid milk

1. Pasteurization of milk
2. Sterilization of milk
3. evaporation and condensation of milk
4. sweetened condensed milk
5. dried milk

Pasteurization is undertaken to destroy the common pathogenic organisms which occur in raw milk. It consists in heating milk to sufficient high temperature for an appropriate length of time, so as to enable the product to be safely transported, distributed and consumed as liquid milk.

Sterilization of milk involves hating milk to a temperature of 120ºC for a few seconds, homogenized at 63 to 85ºC to prevent the separation of fat in the finished product, filled into bottles at 60 to 70ºC, the bottle hermetically sealed and heated at 120ºC for 20 to 60 minutes to ensure that the temperature inside the bottle is at least 115ºC for minutes. The milk tastes and keeps well.

In evaporation and condensation of milk, water from milk is removed partly and heat-treated to render it bacteriologically stable and safe.

Sweetened and condensed milk is that the milk is heated for 15 minutes at 80ºC, before or after addition of sucrose.

Dried milk powder may be made with whole milk or with milk from which a part of fat has been removed, or from which most of the fat has been removed during butter making. In this way one obtains full cream, half cream, skimmed or fat free milk powder respectively.

Streptococcus pyogenes

Streptococcus pyogenes is a bacterium which belongs to group A beta hemolytic streptococci. Streptococcus pyogenes is one of the most important human pathogens. It is the most frequent bacterial cause of pharyngitis and a very common cause of skin infections. Many of the streptococcus pyogenes strains have a hyaluronic acid capsule that is antiphagocytic.

Transmission of Streptococcus pyogenes

Streptococcus pyogenes as many other streptococci is a part of the normal flora of the human throat and skin. But the number of streptococci pyogenes is small when compared to other streptococci.

Enzymes produced by streptococcus pyogenes

These enzymes are inflammatory mediators and important in the pathogenesis of different diseases.
1. hyaluronidase (spreading factor)
2. streptokinase (fibrinolysin)
3. DNase (streptodornase)

Toxins and hemolysins produced by streptococcus pyogenes
1. erythrogenic toxin
2. streptolysin O
3. streptolysin S
4. pyogenic extotoxin A
5. exotoxin B

Diseases caused by streptococcus pyogenes

1. pyogenic diseases (pharyngitis and cellulites)
2. toxigenic diseases (scarlet fever and toxic shock syndrome)
3. immunologic diseases (rheumatic fever and acute glomerulonephritis)

Laboratory tests for streptococcus pyogenes

1. microbiologic tests (gram stain)
2. serological tests (elevated ASO titer)

Treatment for streptococcus pyogenes infections

Fortunately almost all streptococcus pyogenes strains are susceptible to penicillin G, but neither rheumatic fever nor acute glomerulonephritis patients benefit from penicillin treatment after onset of the diseases.

Prevention of streptococcus pyogenes infections

1. treatment for pharyngitis to prevent rheumatic fever
2. hand washing

SGOT / SGPT enzyme test

SGOT and SGPT are two enzymes found in the liver. SGOT / SGPT test is done to asses the state of the liver.

SGOT; serum glutamic oxaloacetic transaminase: Aspartate transaminase (AST)
SGPT; serum glutamic pyruvic transaminase: Alanine transaminase (ALT)

SGOT is basically a cytosolic enzyme where as SGPT is found in the mitochondria. Because of this mild and moderate liver damage gives high SGOT and normal SGPT (usually) value and sever liver damage gives high SGOT and SGPT test value. SGOT is also found in red blood cells and cardiac muscle, skeletal muscle, and kidney and brain tissue therefore damage and SGPT is found in cardiac and skeletal muscles therefore damage to these tissues can result in elevated SGOT/SGPT test value.

Normal SGOT/SGPT test value;

1. SGOT; Normal Adult Range: 0 - 48 U/L
2. SGPT; Normal Adult Range: 0 - 42 U/L

High SGOT/SGPT test values found in following conditions;

1. viral hepatitis
2. alcoholic liver diseases
3. non alcoholic liver disease
4. liver cell necrosis

Normal flora of the respiratory tract (nose, throat, trachea and bronchi)

Normal flora of the respiratory tract is usually same as the normal flora of the mouth. A wide spectrum of organisms colonizes the nose, throat and mouth, but the lower bronchi and alveoli typically contain few, if any, organisms. The nose is colonized by variety of streptococcal and staphylococcal species, the most significant of which is the pathogen staphylococcus aureus. Occasional outbreaks due to this organism, particularly in newborn nursery, can be traced to nasal, skin, or perianal carriage by personnel.

The throat contains a mixture of viridans streptococci, Neisseria species, and streptococci epidermidis. These nonpathogens occupy attachment sites on the pharyngeal mucosa and inhibit the growth of the pathogens streptococcus pyogenes, neisseria meningitiids and staphylococcus aureus respectively.

In the mouth, viridans streptococci make up about half of the bacteria. Streptococcus mutans, a member of the viridans group is of special interest since it is found in large numbers in dental plaque, the precursor of caries. The plaque on the enamel surface is composed of gelatinous, high molecular weight glucans secreted by bacteria.

pictures-images of medically important mosquitoes

Anopheles stephensi

Culiseta longiareolata

Asian tiger mosquito forest day mosquito (Aedes (Stegomyia) albopictus)

Anopheles albimanus mosquito a vector of malaria

Aedes aegypti vector of dengue fever and yellow fever

Clopidogrel and aspirin combination for MI

Clopidogrel and aspirin combination is very effective in the management of MI (myocardial infarction). Clopidogrel is licensed for the prevention of ischemic events in patients with a history of symptomatic ischemic disease. Clopidogrel, in combination with low dose aspirin, is also licensed for acute coronary syndrome (myocardial infarction, MI) without ST segment elevation; in these circumstances the combination is given for at least 1 month but usually no longer than 9-12 months. However, long term routine use of clopidogrel with aspirin increases the risk of bleeding and the evidence of benefit of such use is not compelling. A low dose of aspirin is used for the secondary prevention of cardiovascular diseases.

Aspirin is an irreversible inhibitor of platelet cyclooxygenase activity and thereby interferes with platelet activation. Chronic administration of 75 to 325 mg orally per day has been shown to reduce coronary events in asymptomatic adult men, patients with chronic stable angina, and patients with or who have survived unstable angina and myocardial infarction. Administration of this drug should be considered in all patients with IHDin the absence of gastrointestinal bleeding, allergy, or dyspepsia. Clopidogrel (300 mg loading and 75 mg/d) is an oral agent that blocks ADP receptor–mediated platelet aggregation. It provides the same benefits as aspirin, if not better, particularly if aspirin causes the side effects listed above. Clopidogrel with aspirin can improve coronary outcomes when given to patients for 1 year after an episode of unstable angina but with some increase in the risk of bleeding. This increased risk is improved when the dose of aspirin is reduced.
Side effects of clopidogrel and aspirin combination are bleeding manifestations, nausea, vomiting, hypotension, bradycardia, chest pain, etc.

Sodium (Na+) restriction in heart failure

Sodium (Na+) restriction in heart failure is one of the important steps in the management of heart failure. Depending on the stage of the heart failure, sodium (Na+) restriction can give a good out come. Patients In mild heart failure (NYHA stage 1) can have a complete symptomatic improvement with sodium (Na+) restriction. Average sodium consumption is 6-10 gram (as sodium chloride) per day. This sdium comes from salt added to food and from salty food (fast food). 50% sodium restriction in heart failure can be achieved by avoiding salty food consumption and 75% sodium restriction can be achieved by further reduction of table salt. If the heart failure is severe (NYHA stage 3 and 4), intake of NaCl should be reduced to 1 g/d. to achieve a reasonable sodium restriction, food containing high sodium level (milk, cheese, bread, cereals, canned vegetables and soups, some salted cuts of meat, spinach, celery, and beets) should be reduced. If the patient finds it difficult to restrict sodium, sodium chloride substitutes can be used. Potassium chloride, maltodextrin and potassium bitartrate are some of the substitutes available for sodium chloride. But these are at the research level. Autolysed yeast can be used to preserve the salty taste of the food while sodium restriction is applied.

Metabolic acidosis case discussion

Case discussion on the metabolic acidosis enables the proper understanding of the pathophysiology, mechanisms, precipitating factors, complications and treatment of metabolic acidosis.

Case 01

A 25 year old woman with diabetes mellitus type 1 presented in coma state. On admission following biochemical tests were done

Serum electrolytes

electrolytes	Test value	Reference
Sodium (Na+)	135mmol/l	132-144
Potassium (K+)	5.7mmol/l	3.2-4.8
Chloride (Cl-)	101mmol/l	98-108
Bicarbonate (HCO3-)	10mmol/l	23-33
urea	9mmol/l	3-8
RBS	30.5mmol/l	3-5.5
Urinary ketone bodies	Positive

Blood gas analysis

pH	7.09	7.35-7.45
H+	80nmol/l	35-45
Pco2	20mmhg	35-45

1. Identify the biochemical derangements of this patient.
2. explain the pathophysiology of these abnormalities
3. Serum electrolyte levels were done 6 hours after commencement of insulin and normal saline therapy and it revealed following results.

Sodium (Na+)	143mmol/l	132-144
Potassium (K+)	2.8mmol/l	3.2-4.8

i.What is the probable cause for this change?

ii.What precautions should you take to avoid this situation?

Answer case 01

1. biochemical derangements

hyperkalemia

acidosis (reduced pH, reduced Pco2, reduced HCO3-)

uremia

severe hyperglycemia

2. explanation

Severe insulin deficiency occurs in type I diabetes mellitus leads to increased lypolysis as the body cannot utilize the glucose in the absence of insulin. Lypolysis results more free fatty acids which are used to produce energy. This process will result ketone bodies such as acetone, acetoacetone and hydroxybutyrate. Because of the deficiency of insulin, hyperglycemia will result. Due to the accumulation of ketone bodies, acidity of the blood goes up. Bicarbonate is a buffer and it will come into the action therefore bicarbonate level goes down due to the consumption. Excess ketone bodies will appear in urine.

3. i. with insulin therapy glucose starts entering to the cells. This is accompanied with potassium as well. Therefore potassium level goes down.

ii. to avoid this KCl has to be infused with IV fluids with frequent monitoring of the serum electrolytes.

Health issues of eating chicken eggs

What are the Health issues of eating chicken eggs? This is one of the frequent questions ask from nutritionists. Chicken egg is a good nutrients source as it contains proteins, minerals, vitamin and cholesterol. Therefore there can be both bad and good Health issues of eating chicken eggs.

Followings are the main health issues of eating chicken eggs;

1. health problems associated with cholesterol and fat
2. increased risk of type 2 diabetes
3. health issues related to consumption of contaminated eggs
4. food allergy

Health issues of eating chicken eggs; Cholesterol and fat

10% of whole egg is composed of fat and it represents the caloric value of the egg. More than half the calories found in eggs come from the fat in the yolk about 30% of egg fat are saturated (Palmitic,Stearic and Myristic acids) which contains LDL cholesterol.egg white contains little amount of fat. Consumption of egg yolk and increased health risk is a debatable question as some studies show that consumption of 2-3 egg per day cause no harm whereas some studies show that egg yolk can alter the cholesterol level in the blood. Therefore patients with high cholesterol profile may avoid the excess consumption of egg. Some studies show that moderate egg consumption (6 per week) can increase the risk of cardiovascular disease or strokes


Health issues of eating chicken eggs; Type 2 diabetes

Several studies have shown that there is an increased risk of developing type 2 diabetes with the consumption of egg. This is common for both male and female.

Health issues of eating chicken eggs; Contamination

There can be health issues related to the consumption of contaminated egg. This is mainly due to the contamination of eggs with feces. Salmonella enteritidis is one of the commonest infections related to consumption of contaminated eggs. The risk of infection from raw or undercooked eggs is dependent in part upon the sanitary conditions under which the hens are kept.

Health issues of eating chicken eggs; Food allergy

One of the most common food allergies in infants is eggs.Infants usually have the opportunity to grow out of this allergy during childhood, if exposure is minimized. The egg allergy is prevalent enough in the United States that food labeling practices now include eggs, egg products and the processing of foods on equipment that also process foods containing eggs in a special allergen alert section of the ingredients on the labels.

Egg yolk nutrients composition

30% of the whole egg is egg yolk. Egg yolk proteins serve mainly as a food reserve for young chick. The main components are lipovitellin, lipovitellinin, phosphovitin (a phosphoprotein) and livetin, a water soluble fraction. Lipovitellin is the major yolk protein and is rich in lysine and lucine. The ratio of lipovitellin to livetin in hen’s egg is 4:1.

Egg yolk is used extensively as an emulsifier in mayonnaise, cake butter and confectionary. Its color is mainly due to the presence of xanthophylls pigments. An egg laid by a hen kept in deep litter tends to have a paler yolk than one from free-run poultry unless greens are fed or pigments added to the diet. A darker yolk does not necessarily mean a higher concentration of vitamin A or of carotene.

An egg yolk is rich in cholesterol, about 250 mg per egg. For this reason nutritionists recommend a reduction in egg intake to 2 or 3 per week for older children and adults. Egg yolk protein binds iron, forming an insoluble chelate, preventing iron absorption. The absorption of medicinal iron is also reduced if given with egg yolk. Therefore medicinal iron should not be taken with or immediately after a meal containing egg yolk.

Egg white nutrients composition

The white of the egg contains 365 of water, 13% of protein, and 0.25% of fat and mineral salts. The yolk contains 51% of water, 16.65 protein, 31.7% fat, 1% mineral and vitamins A, D, thiamine and riboflavin and nearly all the cholesterol in the egg. The diet of the hen has no effect on the amino acid composition of the egg.

Egg white proteins differ markedly fro the proteins of the egg yolk in biological function and structure. Egg white is almost a pure solution of protein, almost all proteins of egg white being active as enzymes, inhibitors or antibodies. Their main function is to protect the embryo from microbial factors. The most abundant proteins in the avian egg white are ovalbumin (54%), conalbumin (13%), ovomucoid (11%) and lysozyme (3.5%). Conalbumin is an antibacterial factor which binds metal ions, including iron. Ovomucoid is a glycoprotein which inhibits the proteolytic action of trypsin and lysozyme is an enzyme that causes lysis of microorganisms by breaking down carbohydrates polymer in their cell wall.

Egg white has the ability to form stable foams. Egg white proteins are easily denatured, and the foaming capacity is impaired as a result of heating, freezing and dehydration. Avidin, an egg white protein, is inactivated by heating. It prevents the absorption of biotin. The consumption of large amount of egg can cause biotin deficiency.

Egg nutrients composition allergy

The egg forms a complete food for the embryo chick and is rich in most of the nutrients. About 12% of hen’s egg is shell, 58% egg white and 30% egg yolk. An average egg weighing about 60 g provides 7 g protein, 6g fat, 30g calcium, 1.5mg iron, about 250mg cholesterol and 335 kj energy. An egg has about 12% protein on fresh-weight basis and 35% on dry basis.

The white of the egg contains 365 of water, 13% of protein, and 0.25% of fat and mineral salts. The yolk contains 51% of water, 16.65 protein, 31.7% fat, 1% mineral and vitamins A, D, thiamine and riboflavin and nearly all the cholesterol in the egg. The diet of the hen has no effect on the amino acid composition of the egg.

Whole egg proteins are very well balanced with respect to all the essential amino acids and are particularly rich in arginine and the sulphur containing acids. Egg proteins are very digestible even when raw. In vivo studies reveal a digestibility of 95% for raw egg, although in vitro studies indicate that raw egg is less digestible. Egg proteins have a higher biological value than milk, meat or soya bean proteins.

Egg is rich in minerals and is a good source of calcium. Although egg yolk is rich in iron it is a poor source of iron. Egg yolk protein binds iron, forming an insoluble chelate, preventing iron absorption. The absorption of medicinal iron is also reduced if given with egg yolk. Therefore medicinal iron should not be taken with or immediately after a meal containing egg yolk.

Some people develop allergic reaction to egg. Most of the time, the protein containing in the egg are the causative factor. These people should avoid the egg consumption.

Staphylococcal scalded skin syndrome (SSSS) treatment

Staphylococcal scalded skin syndrome (SSSS) is a disease of children. Scalded skin syndrome occurs due to the epidermolytic toxin of minor Staphylococcus aureus infection. The characteristics feature of Staphylococcal scalded skin syndrome (SSSS) is the acute exfoliation of the skin following erythematous cellulites. Pemphigus neonatorum or Ritter's disease are the other names give to staphylococcus scalded skin syndrome (SSSS)

Oral or nasal cavities, throat, or umbilicus are the commonest sites that are affected by Staphylococcal scalded skin syndrome (SSSS). Bullae form, and diffuse sheet like desquamation occurs.Mortality rate due to SSSS is very low as it is a self limited disease. Even though, if SSSS is associated with sepsis, it can increase the mortality rate.

Clinical features of Staphylococcal scalded skin syndrome (SSSS)

• presents as a red rash followed by diffuse epidermal exfoliation
• General malaise
• Fever
• Irritability
• Skin tenderness

Staphylococcal scalded skin syndrome (SSSS) treatment

• drainage of pus from localized lesions
• antibiotics according to the sensitivity pattern
• control of cross infection (hand washing, treatment of carriers, exclusion of carriers in outbreaks)