Benefits of Vitamin F

Vitamin F is made up of unsaturated fatty acids (linoleic acid (LA) and alpha-linoleic acid (LNA)). Wheat germ, peanut oil, sunflower seeds, safflower, soybean, peanuts, walnuts, pecans, almonds and even avocados are the common foods rich in vitamin F.

Main benefit of vitamin F is the prevention of LDL plaque (bad cholesterol) formation in the arteries. In addition to that vitamin F helps healthy skin and hair as well.

Eczema, acne, and other skin or hair problems and diarrhea are the main results of vitamin F deficiency. Since vitamin F is nontoxic, supplements in the form of tablets can be taken. The excess amount of vitamin f can lead to weight gain.

Too much saturated fatty acids, oxygen and heat are the inhibitors of vitamin F.

Hormonal therapy for acne vulgaris

Development of acne depends on follicular hyperkeratinization, sebum production, P. acnes growth, and inflammation. Hormones like androgens (male hormones) also play a part in the development of acne. Androgens increase the sebum production, which is one of the major determinants of acne development. Conditions like polycystic ovarian syndrome, congenital adrenal hyperplasia, and adrenal or ovarian tumors can result in increased level of androgen.
During prepubertal period, androgen production rises. Therefore prepubertal boys and girls can show evidence of increased acne.

Because of above reasons, hormonal therapy has a place in treatment of acne. Oral contraceptives and spironolactone are the commonest medications prescribed.Though the androgens play a role in development of acne, most of the patients with acne do not have increased levels of androgens in their blood. Still hormonal therapies are useful for the treatment of acne.

An oral contraceptive or anti-androgen can be used for women with moderate to severe acne who are not trying to become pregnant. Women with milder acne who choose oral contraceptives for the purpose of pregnancy prevention can also experience the ancillary benefit of improvement in their acne.

Hormonal therapy can be used as an adjuvant for moderate to severe acne. It can be combined with topical retinoid, topical and oral antimicrobial agent.Oral contraceptives preparations with a low androgenic progestin can be used for women with excessive ovarian androgen production (eg, polycystic ovarian syndrome) whereas Glucocorticoids are indicated for those with excessive adrenal androgen production, such as in classical congenital adrenal hyperplasia.

CULEX mosquitoes

These mosquitoes are importance as vectors of Filariasis and arboviruses. Culex quinquefasciatus, Culex fatigans, Culex tritaeniorhynchus, Culex gelidus, Culex fuscocephala and Culex pseudovishnui are some importance members of this group.

Culex quinquefasciatus
Other Culex species

AEDES mosquitoes

Aedes are world wide distribution extending up to the Arctic Circle where they are a serious biting nuisance to man during summer months. However their major medical importance is as vector of arboviruses. Aedes aegipti and Aedes albopictus are members of this family.

Aedes aegypti & Aedes albopictus

CULICINE MOSQUITOES

Length of the palps of the females are much shorter than that of proboscis and palps of male are pointed ( not clubbed).Adults usually rests with body parallel to resting surface. Larvae hang down from water surface and have siphon tubes. Eggs may be in clusters or singly but do not have floats.
Culicine mosquitoes include around 30 genera of which the medically important ones are

1. Aedes
2. Culex
3. Mansonia
4. Armigeres

ANOPHELINES mosquitoes

MORPHOLOGY

Length of the Palps of the females is equal to the length of the proboscis whereas palps of the male are clubbed in shape. Adults usually rest with body forming an angle to the resting surface. Larvae lie parallel to the surface of water with the help of palmate hairs on the abdomen. They do not have siphon tubes. Eggs are laid singly and usually have floats.

THE GENUS ANOPHELES

The genus Anopheles is the only mosquitoes that are medically important among Anophelines. Anopheles is the only known vectors of human malaria. In some countries they transmit Filariasis (Africa and SE Asia), and viruses as well (Africa).

Anopheles has world wide distribution. The genus contains about 400 species, but only about 30 species are efficient natural vectors of human malaria. Natural susceptibility of Anopheles to human malaria is largely unexplained. The frequency of feeding on man, mosquito density and longevity are some features of importance in determining the efficiency of a vector in nature. Further, the habits of a given species vary from country to country. Thus a particular species may be an important vector in one area and not in another.

Anopheles is crepuscular (around sunset) or nocturnal in habits such as mating, blood feeding and ovipositioning. They are generally not found at altitude above 2000-2500 m.

Anopheles culicifacies, Anopheles subpictus, Anopheles minimus, Anopheles vagus, Anopheles maculates and Anopheles annularis are some members of the genus Anopheles. They all are vectors of human malaria but distribution varies. Anopheles culicifacies is the only malarial vector in Sri Lanka whereas others are found as vectors in Africa.

MEDICALLY IMPORTANT MOSQUITOES

INTRODUCTION

Mosquitoes are the most important group of insects. They are important as vectors of human diseases. In addition they cause a considerable biting nuisance to man. Mosquitoes are found world wide with over 3000 species included in 34 genera, distributed from the tropics to the arctic regions. However, the medically important species belong to only a few of these genera.

MORPHOLOGY

These are small slender flies with one pair of wings; forwardly projecting mouth parts; scales covered the body, legs and wings. The body is divisible to head, thorax and abdomen. The head bears the characteristic mouth pars suited for piercing and sucking. The mouth parts are collectively called the proboscis. It consists of a labium (lower lip), a labrum (upper lip) enclosing two pairs of cutting apparatus (mandibles and maxillae) and a stylet (hypopharynx) through which the salivary duct opens. The food channel is formed the labrum and the hypopharynx. The head bears a pair of palps and long segmented antennae. In the female the antennae have only few hairs, while in the males they are bushy and feathery. Internally trilobed salivary gland is situated ventrally in the thorax. Powerful flight muscles are also present in the thorax. The body cavity (hemocele) is bathed in fluid.

LIFE CYCLE
Only female mosquitoes suck blood, while the males thrive on plant and fruit juices. The blood meal is essential in providing nutrients for the maturation of eggs. The time taken from the blood meal to oviposition is referred to as the gonotrophic cycle (2-3 days in the tropic). The life cycle has a complete metamorphosis with egg, larva, pupa and adult stage.

• EGG: A female mosquito carefully selects the breeding site, each species having its own preferred habit, 100-200 eggs are laid at a time on water or moist surface, either singly or in batches. Eggs hatch in around 2-5 days.
• LARVA: Larvae are legless with prominent thorax. It is actively feeding with four larval stages (7-14 days). Larvae breathe air through spiracles found in the posterior ends. In general almost any collection of permanent or temporary water can be a larval habit, but larvae are not found in large expanses of water such as lakes and in fast flowing rivers (except at margins).
• PUPA: They are ‘comma’ shaped with a large cephalothorax (fused head and thorax). Although non-feeding, they show active movements. Pupal stage lasts 2-3 days.
• ADULT: They emerge by splitting the pupal skin. In the tropics adults live for 2-3 weeks but in colder climates they live much longer.

ADULT BEHAVIOUR

Mosquitoes are rather selective in their choice of hosts for their blood meals. Some species prefer human blood to animal and are called anthropophilic while others feeding only on animals are termed zoophilic. The biting and resting behavior of adults are important in the epidemiology of disease transmission.

Medically important mosquitoes can be divided into two groups;

1. Anophelines
2. Culicines

What are the phytohaemagglutinins?

Introduction

Haemagglutinins are proteins capable of agglutinating red blood cells. Such substances present in plants are called phytohaemagglutinins. They are present in all legumes. About 25% of the growth inhibition produced in rats (experiment level) by Soya beans is due to haemagglutinins. Significant level of haemagglutinins occur also in black beans and kidney beans (varieties of Phaseolus vulgaris).purified hemagglutinins from these two pulses, when fed to rats at a level0.5 to 1% result in 100% mortality within two weeks.

Mechanism of toxicity

Phytohaemagglutinins bind with the red cell membrane and make them more vulnerable to the hemagglutination

Common food items containing phytohaemagglutinins

Soya bean
Black beans and
Kidney beans

Removal of phytohaemagglutinins from those food items

The toxic factor can be destroyed completely by soaking the grain overnight and later autoclave.

The importance of such factors in human nutrition should not be discounted, as pulses form an important item in most diets.

Toxic substances in pulses

Deleterious substances of various kinds are present in legume grain eaten by man. Among them are:

1. Trypsin inhibitors
2. Cyanogenic glucosides
3. Goitrogenic factors
4. Hemagglutinins/Haemagglutinins
5. Saponins
6. Alkaloids
7. Tannins
8. flatulent factors
9. Antivitamins
10. Aflatoxin

Contamination with microorganisms could result in the formation of toxins (aflatoxin) which produce adverse effects when ingested.

In most pulses these toxins are destroyed by adequate soaking, removal of the skin and ordinary methods of cooking. In some species removal of the skin and inactivation toxins require prolonged cooking time, pressure cooking or autoclaving, facilities that are available in few households. For any pulse to welcome in a household it should lend itself to ordinary methods of preparation, needing little fuel. Pulses form such an important item of the diet in developing countries that every effort should be made to encourage their consumption by increasing their digestibility.

In the preparation of whole grains, the seeds should be soaked for 24 to 36hoursin a small volume of water, changing the water every 8 to 12 hours. Skins can be removed by rubbing the seeds gently. The grain is then boiled in a little water till it softens. The cooking water should be consumed as it contains water soluble nutrients. When feeding young children, the seeds should be mashed to increase the digestibility. The dhal is more easily cooked than gram. Pulses are the one food that benefits by over boiling.

Azelaic acid for acne

Azelaic acid is a saturated dicarboxylic acid. It is found as a white powder. Number of skin and hair conditioners contains azelaic acid as a component. Oleic acid is used as the precursor to produce azelaic acid industrially. Malassezia furfur (a Yeast) produces azelaic acid.

Mild to moderate acne can be treated with azelaic acid. Both comedonal acne and inflammatory acne is treatable with this compound.

Adapalene for acne

Mild to moderate acne can be treated with adapalene. Adapalene is a retinoid (third generation). Adapalene is topically applied for acne vulgaris. It should be applied once a day basis. Before the application of adapalene, face should be washed with soap and water. Some patients may experience skin irritation.

ACTH stimulation test

Introduction

The anterior pituitary is often referred to as the “master gland” because, together with the hypothalamus, it orchestrates the complex regulatory functions of multiple other endocrine glands. The anterior pituitary gland produces six major hormones: (1) prolactin (PRL), (2) growth hormone (GH), (3) adrenocorticotropin hormone (ACTH), (4) luteinizing hormone (LH), (5) follicle-stimulating hormone (FSH), and (6) thyroid-stimulating hormone (TSH)

ACTH secretion is pulsatile and exhibits a characteristic circadian rhythm, peaking at 6 A.M. and reaching a nadir about midnight. Adrenal glucocorticoid secretion, which is driven by ACTH, follows a parallel diurnal pattern.

ACTION

The major function of the HPA axis is to maintain metabolic homeostasis and to mediate the neuroendocrine stress response. ACTH induces cortical steroidogenesis by maintaining adrenal cell proliferation and function. The receptor for ACTH, designated melanocortin- 2 receptor, is a GPCR that induces steroidogenesis by stimulating a cascade of steroidogenic enzymes

LABORATORY INVESTIGATION

Biochemical diagnosis of pituitary insufficiency is made by demonstrating low levels of trophic hormones in the setting of low target hormone levels. The diagnosis of adrenalInsufficiency may be established by means of an ACTH stimulation test.

Test

This is a screening test (the so-called rapid ACTH stimulation test) which involvesthe administration of 25 units (0.25 mg) of cosyntropin intravenously or intramuscularly and measurement of plasma cortisol levels before administration and 30 and 60 min after administration, the test can be performed at any time of the day. The most clear-cut criterion for a normal response is a stimulated cortisol level of >500 nmol/L (>18 µg/dL), and the minimal stimulated normal increment of cortisol is >200 nmol/L (>7 µg/dL) above baseline. Severely ill patients with elevated basal cortisol levels may show no further increases following acute ACTH administration.

Acunol homeopathic medication for acne

Acunol is a compound used in homeopathic system of medicine. Active constituents of acunol are Potassium Bromide, Sodium Bromide, Zinc Sulphate ,Sulphur and Nickel Sulphate. Whereas inactive ingredients are Lactose, Magnesium Stearate, and Copper. Acunol tablet is 600mg. it should be swallowed or chewed. Exact mechanism of action is not well understood. But its active ingredients may enhance phagocytic and bactericidal activity of neutrophils.

Acunol is indicated in mild to moderate acne vulgaris, acne rosacea, peri-oral dermatitis, and folliculitis whereas allergy to ingredients of acunol is a contraidication.

Acunol should not be used during pregnancy but there are no evidence to suggest that it is harmful during pregnancy. Lactating mothers should use it with cautions as acunol can be secreted via breast milk. Dose should be adjusted in pediatrics practice.
Significant side effects are not reported but drug overdoe can give rise to gastrointestinal disturbances like nause, vomoting and diorrhea. Allergic reaction is a possible side effect.

Isotretinoin for acne

Isotretinoin(Accutane) is a vitamin A derivative therefore it is a retinoid. Small amount of Isotretinoin(Accutane) is naturally present in the human body as well. Initially it was produced to treat cancers such as brain cancers and pancreatic cancers but now it is also useful as an acne treatment as well. Accutane, amnesteem, isotane and sotret are the few trade names. Oral preparations are available for the acne.

Topical treatment and oral antibiotics should be used for acne before isotretinoin. If those treatment fail, Isotretinoin can be used. Isotretinoin is indicated for the treatment of severe cystic acne vulgaris and severe acne rosacea.

Patient’s weight and the severity of the conditions are the determinats of isotretinoin dose. But usual dosage varies between 0.5 mg/kg/day to 2 mg/kg/day. Treatment should be continued for four to six months for a better result. 40% of patients will achieve complete cure while 20% will relapse. Isotretinoin is available in tablets and topical forms.

Common side effects are flaring up of acne, conjunctivitis, raised blood sugar and impotence. Teratogenicity is the most feared side effect of this drug therefore it should not be used during pregnancy.

Bence Jones protein

The Bence Jones protein was described by the English physician Henry Bence Jones in 1847. Bence jones protein can be found in blood and urine. it is a monoclonal globulin protein. it's molecular weight i s 22-24 kDa. There are several conditions such as multipla myeloma can give rise to bence jones protein therefore detection of bence jones protein in the urine or blood can be used as a diagnostic test for those conditions. 2/3 of patients with multiple myeloma will be positive for bence jones protein test. Bence jones protein is produced by the neoplastic plasma cells (cancer cells).And these protens are immunoglobulin light chains