Antibiotics to Avoid During Pregnancy

November 21st, 2008 healthwiki Pregnancy 0

Any antibiotic, chemical or drug based substance consumed during pregnancy may reach the fetus (the baby inside the uterus) through maternal circulation. Antibiotics that are able to cross the placenta are potentially harmful and cause adverse fetal effects during pregnancy. The effects depend highly on the type and dose of antibiotic. Not only in pregnancy but certain antibiotics are able to pass from mother to her baby through breast milk.

The Food and Drug Administration (FDA) established five pregnancy categories to indicate the risk level of drugs to the fetus. The categories are A-B-C-D and X. The category A being the least dangerous during pregnancy and category X to be completely avoided

Category X: Highly dangerous
Adequate well-controlled or observational studies in animals or pregnant women have demonstrated positive evidence of fetal abnormalities or risks.

Quinolones: Sparfloxacin (1st trimester)

Category D
Adequate well-controlled or observational studies in pregnant women have demonstrated a risk to the fetus. However, the drug may be acceptable if needed in a life-threatening situation or serious disease for which safer drugs cannot be used or are ineffective.

Tetracycline: Tetracycline, Doxycycline, Oxytetracycline

Others: Naproxen (3rd trimester)

Category C
Animal studies have shown an adverse effect but there are no adequate and well-controlled studies in pregnant women.

Quinolones: Cipro-floxacin, Levofloxacin, Moxifloxacin, Gatifloxacin, Ofloxacin, Sparfloxacin (2nd and 3rd trimester)

Macrolides: Clarithromycin

Aminoglycosides: Gentamicin

Others: Chloramphenicol

Category B
Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.

Penicillin: Amoxicillin, Ampicillin, Cloxacillin, Flucloxacillin

Cephalosporins: Cephalexin, Cefradine ( First generation); Cefuroxime ( Second Generation); Cefixime, Cefpodoxime, Cefotaxime, Ceftriaxone ( Third Generation)

Macrolides: Azithromycin, Erythromycin

Sulphonamides: Clotrimazole

Others: Metronidazoles, Naproxen (1st and 2nd trimester)

Category A: Least dangerous
Theoretically there are no antibiotics in this class for pregnancy.

Md Sojib Khan……

A Unique Lesson For Diabetic

November 19th, 2008 healthwiki Diabetes 0

Fahim Ahmed was tested as diabetic incidentally after a urine test. That was about ten years ago, and from then on Mr Fahim, like so many other people with diabetes, became fixated on his blood sugar. His doctor warned him to control it or the consequences could be dire — he could end up blind, lose a leg, fail his kidneys and so on.

Mr Fahim, a 45-year-old business executive of a reputed organisation in the city, tried hard. When dieting did not work, he began taking pills to lower his blood sugar and pricking his finger several times a day to measure his sugar levels. They remained high. So he agreed to add insulin to his already complicated regimen.

Blood sugar was always in his mind. But in focusing entirely on blood sugar, he ended up neglecting the most important treatment for saving lives — lowering the cholesterol level. That protects against heart disease, which eventually kills nearly everyone with diabetes. He was also missing a second treatment that protects diabetes patients from heart attacks — controlling blood pressure. He assumed everything would be taken care of if he could just lower his blood sugar level.

Most diabetes patients try hard but are unable to control their diseases in this way and most of the time it progresses as years go by. Like many diabetes patients, he ended up paying the price for his misconceptions about diabetes. Last year, Mr Fahim had a life-threatening heart attack.

Diabetes goes undetected in many heart patients. It is a silent threat for many people who end up with heart disease because these patients do not feel the actual intensity of pain due to nerve damage as a consequence of diabetes. Blood sugar control is important in diabetes, specialists say. It can help prevent dreaded complications like blindness, amputations and kidney failure. So, controlling blood sugar is not enough.

In part it is the fault of proliferating advertisements for diabetes drugs that emphasise blood sugar control, which is difficult and expensive and has not been proven to save lives. And in part it is the fault of public health campaigns that give the impression that diabetes is a matter of an out-of-control diet and sedentary lifestyle and the most important way to deal with it is to lose weight. Again, the fault for the missed opportunities to prevent complications and deaths lies with the medical system. The doctors typically spend just 5 minutes with diabetes patients, far too little for such a complex disease.

Mr Fahim found all that out too late. So, no matter how carefully patients try to control their blood sugar, they can never get it perfect — no drugs can substitute for the body’s normal sugar regulation. So while controlling blood sugar can be important, other measures also are needed to prevent blindness, amputations, kidney failure and stroke.

Dr Md Rajib Hossain

Family Care and Its Tremendous Impact on Diabetes

November 19th, 2008 healthwiki Diabetes 0

Diabetes has a great impact on the daily lives of the persons with diabetes. Family members play an important role in the management of diabetes. The Center for Policy Research and Social Responsibility (CPR2) has recently conducted a study to evaluate the impact of family and hospital care for the persons with diabetes. According to the opinion of the respondents (who are family members of diabetics), 58 percent consider diet, drug and discipline — all required for the management of diabetes; whereas, 22 percent consider discipline;17 percent consider diet; and only 3 percent consider drug as important for the management of diabetes.

Diabetes is the disease which direly needs support of the family members to a major extent. With the support from the families, they can lead normal lives even with deadly diabetes.

Like every year, yesterday was observed as the World Diabetes Day which is the primary global awareness campaign for diabetes.

56 percent respondents think that their family members know that it is possible to lead normal life with diabetes. Again, 27 percent respondent’s family members believe that any disease can happen to anybody. Family members of 10 percent respondents consider that long term treatment is required for diabetes.

It has been found from the research that the diabetics suffer from lack of confidence, do not feel comfortable in attending family and social functions, can not participate fully in household affairs as they feel tired and cannot wake up early and also they remain depressed and suffer from anxiety. The role of family is very critical in resolving these daily life problems of the patients. A sympathetic and patient consideration approach of the family members can make the life of the patients more comfortable and meaningful.

The society can also play an important role by creating an enabling environment for the diabetics. A food choice for the diabetes patient should be available in the family and social gatherings so that the people with diabetes do not feel uncomfortable in those situations.

The state should take a leading role in disseminating basic information about prevention and it should also encourage and facilitate the awareness programmes of the NGOs. Media can address awareness programmes focusing on prevention and management of diabetes. It is also evident from this research that there are misleading information prevailing in the society about diabetes. So, an aggressive communication programme is needed to inform the mass people about the real facts of diabetes.

An organised intervention by the government, health NGOs, citizen groups, media and other stakeholders is the need of the time for developing a diabetes-aware society through lifestyle research, family care, social communication, establishing patient support forum and policy making.

A careful and systematic approach of diabetes management can ensure a healthy life of diabetes patients and can help manage the most common form — type-2 diabetes.

Childhood Diabetes Needs Extra Care

November 19th, 2008 healthwiki Diabetes 0

When a child is diagnosed with diabetes, along with the child the parents will experience everything as new.

Diabetes mellitus ( DM) is not a single entity but rather a heterogeneous group of disorders in which there are distinct genetic patterns as well as other etiological and pathophysiological mechanism that lead to impairment of glucose tolerance. There are two types of diabetes, those are:

Type 1 diabetes: Type 1 diabetes is an immune system disease where the body makes little or no insulin. It usually begins in childhood or teens. Children with type 1 diabetes need daily insulin shots to help their bodies use food. Type 1 diabetes often runs in families.

Type 2 diabetes: Type 2 diabetes is a disease where the body cannot make enough or cannot properly use insulin. Although this form of diabetes usually occurs most often in adults, it is becoming more common in youth. The average age of diagnosis of type 2 diabetes in youth is 12-14 years. It is more common among girls than boys.

Most of the children suffer from type 1 diabetes, so insulin is the treatment of choice. Some are treated with oral drugs. But proper nutritional plan and exercise can reduce the blood glucose effectively.

When choosing foods for a child who has diabetes, it is important to know how different foods affect blood glucose levels. Children who have diabetes basically need the same foods that all children need to grow and thrive. The recommended calorie intake is based on size or surface area of the child.

The following guideline will help provide a healthy diet to help control a child’s diabetes:

Offer balanced meals at regular intervals every day; Learn how different foods affect the child’s blood glucose level; Offer healthy snacks between meals; Encourage the child to drink water when thirsty; Choose whole-grain foods with higher fiber contents; Limit sweets, regular soft drinks, pastries, candy, jam, and honey; Limit saturated fat and cholesterol; Avoid trans fat (found in foods with hydrogenated or partially-hydrogenated oils) etc.

Aerobic exercise, that gets the heart beating faster and uses the large muscles, can help keep blood glucose levels in balance. It can also help lower cholesterol and blood pressure. Exercise also can help the child sleep better, feel more relaxed and even help concentrate better.

Hypoglycemia during or in the 2-8 hours after exercise can be prevented by careful monitoring of blood sugar level before, during or after exercise, sometimes by reducing dosage of insulin or giving extra snacks

Signs of low blood glucose include confusion, grouchiness, irritability, tiredness etc.

If the child has signs of low blood sugar, check blood glucose levels. If the level is under 70 mg/dL, try one of the following:

Have the child drink ½ cup of grape or orange juice, 1 cup of milk, a juice box, or ½ can of a regular (not diet) soft drink Give the child 1-2 tablespoons of sugar or honey

Parents cannot manage there child’s diabetes alone. The stress imposed on the family around the time of initial diagnosis of DM may lead to feeling of shock, denial, sadness, anger, fear and guilt. Meeting with a specialist to express these feelings at the time of diagnosis helps with long term adaptation. The physician must discuss various aspects of child’s diabetes with the child as also with the parents. The exercise has got to be a continuing programme. This needs a good rapport between the physician on one hand and the child and the family on the other hand. Parents need to learn administration of insulin injection, blood sugar testing, recognition of warning signals of hypoglycemia, hyperglycemia, ketoacidosis, infection etc.

Although children can be taught to perform many of the tasks of diabetes management. They do better when supportive — NOT over bearing-parents continue to be involved in management of their disease. Schools have the responsibility to provide diabetic students with a medically safe environment as well as equal access to the same opportunities and activities enjoyed by other students.

Diabetes is a very complicated and life threatening disease. There is no cure for diabetes, it can be controlled. So people of all corners should work together and create awareness, so that a diabetic child can lead a healthy, active and fun-filled life.

Dr Abu Sayeed Shimul