Stem cell transplantation, the future treatment of multiple sclerosis

Multiple sclerosis is a chronic degenerative disease.The major fraction of people treated with disease modifying agents experience flare up of disease. The course of disease is unpredictable, it may progress rapidly or slowly. According to the clinical features there are four different types of MS.Relapsing/remitting MS (RRMS) forms 85% of cases, here  patients are stable in between the bouts and often may recover completely however there is risk of RRMS transforming into secondary progressive MS (SPMS).In SPMS neurological function may steadily deteriorates without clear relapses.

Why treatment is difficult in multiple sclerosis?

clinical manifestation vary from person to person.Treatment is also like this, the drug that works well in one person may not be effective in other person. As the best treatment vary from one person to other treatment need to be individualized.The key to finding the treatment and cure of this disease is through trial and error and research.

Stem cell transplantation in multiple sclerosis

As MS is a complex disease, its successful treatment requires a combination of treatments that control each of the disease mechanisms

1.Autoimmunity

2.Loss of nervous system cells

3.Lack of regenerative capacity of particular cell in the central nervous system.

Why stem cells are used?

1.Stem cells have unparalleled regenerative capacity thus offer the promise of filling this therapeutic goal. 

2.They have flexibility to grow into different type of cells and can differentiate into cells that produce the covering of neuron (myelin). 

3.Stem cells are capable of modulating the immune system and able to produce factors that protect the neuron.

Different type of stem cell that are used.

Hematopoietic stem cells (HSCs) are the main type of cells investigated.

Mesenchymal stem cells (MSCs)

Neural stem cells (NSCs) 

Oligodendrocyte precursor cells (OLPs) .

What is done in stem cell transplantation.

First patient with multiple sclerosis is treated with high-dose immunosuppressive therapy, then their own hematopoietic stem cells, are transplanted .This type of transplantation is called autologous transplantation as it is done with patients own cell.

Stem cells are harvested from patients bone marrow and then injected into the Cerebrospinal fluid that surrounds the spinal cord of the patient.Injections are repeated at 3 month intervals frequent monitoring of safety and efficacy is monitored through follow up.After the final injection patient needs monitoring upto 27 months.

How does stem cell transplantation work?

RRMS the most common form of Multiplesclerosis, is a progressive autoimmune disease where the exaggerated immune system attacks the brain and spinal cord. Stem cell transplantation will remove abnormal immune cells that cause disease and reset the immune system.

Result of stem cell transplantation  

There were sustained remission of active relapsing-remitting MS (RRMS in most of the patients and majority experienced improvement in neurologic symptoms). Useful in patients with aggressive disease.

Variables that determines the benefits of stem cell transplantation are the following

1.Maximum benefit is seen in patients with active inflammatory disease which is determined by frequent active relapses and  or gadolinium enhancement on MRI 

2.Better to start the treatment as early as possible before irreversible disability.

3.Use of safe conditioning regimen for immunosuppression.

Early side effects 

Seen on blood and gastro intestinal system and are reversible. 

Success rate in recent trials

Various clinical trials are going on based on stem cell transplantation.There are encouraging and promising results in various studies, upto 80 percentage of trial participants survived  without experiencing an increase in disability, relapse of MultipleSclerosis manifestations or new brain lesions .

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Drugs used for treatment of obesity

Drugs may be used in the short term that is up to 3 months for obesity treatment as an adjunct to the dietary regimen, but they are not substitute for strict dieting.

Indication for anti obesity drugs.

Adjuvant treatment with drugs are indicated  in

1.Patients with a BMI >30 kg/m 2.

2.Patients with BMI >27 kg/m 2 with concomitant obesity related diseases.

3.Patients with BMI >27 kg/m 2 who do not get satisfactory weight reduction with dietary and physical activity therapy.

Significance of lifestyle program with drugs. 

Patients should be engaged in a lifestyle program when an antiobesity drug is prescribed. The life style program will provides them the strategies and skills which are needed to use these antiobesity drug efficiently because this support increases total weight loss.

Targets of drug therapy for obesity.

Suppression of appetite via centrally active drugs which alter monoamine neurotransmitters is the most thoroughly explored treatment.

A second strategy is to decrease the absorption of selective macronutrients from the gut such a fat.

Type of antiobesity drugs.

Centrally acting drugs

They are appetite-suppressing drugs, or anorexiants, affect satiety and hunger.

Satiety is the absence of hunger after eating.

Hunger is a sensation which initiates eating.

These agents increase the satiety and decrease hunger, thus help to reduce the intake of calories without a feeling of deprivation of food.

Example of centrally acting drug is sibutramine (Meridia).

Peripherally acting drugs 

Example of peripherally acting drugs is Orlistat.

It is a lipase inhibitor, inhibit the hydrolysis of dietary fat the essential step required for their absorption. Thus Orlistat blocks the digestion and absorption of 30% of dietary fat and help to achieve weight loss. Weight regain will occurs once the drug is stopped. Studies have shown that Orlistat produces a weight loss of about 9 - 10% at the end of one year. Orlistat has minimal gut absorption so it is devoid of systemic side effects. Tolerability to Orlistat is related to the malabsorption of dietary fat and passage of fat in the feces. About 10 percentage of people treated with  this drug experience gut side effect. They are flatus with discharge, fecal urgency, increased defecation and oily stool. These side effects of Orlistat is seen early in the course of treatment. The side effect can be reduced if the patient controls the dietary fat intake.Psyllium mucilloid if taken along with orlistat will helps to reduce the gut side effects. There is decreased concentration of fat-soluble vitamins D, E and ß-carotene is seen in patients treated with Orlistat.Vitamin supplements are necessary to prevent deficiency disease.

The Endocannabinoid System 

Rimonabant is the first selective cannabinoid CB 1 receptor antagonist, used for treatment of obesity. This drug antagonizes the orexigenic effect of endocannabinoid system and suppresses appetite. Rimonabant is a weight-loss agent which shows improvement in waist circumference and reduce the heart problems. However increased risk of certain side effect such as seizures, depression, aggressiveness and suicidal thoughts anxiety, insomnia are seen. Even though the drug was available in 56 countries in 2008, European Medicines Agency (EMEA) has officially withdrawn this drug in January 2009, due to increased side effect compared to its benefits.

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Life style changes for psoriasis

Psoriasis is a chronic skin disease which produce plaque and scales on skin giving unhealthy appearance to your skin.But if you care about certain factors they will definitely help you to cope with disease and improve the quality of life.

If you are a psoriatic patient you should get educated about this disease, understand  as much as about the disease about its treatment options and various researches going on in this field.Strictly follow your doctors advise  regarding the treatment options and lifestyle changes. You can join the support groups in your locality or online to get help from from them.

There are certain triggers for psoriasis. A psoriatic patient should know which all factors aggrevate his or hers disease,identification of these factors are extremely helpful as avoidance of trigger help to keep your disease in a stable state preventing flares.Infections, skin injuries, smoking and stress are few examples of psoriatic triggers. All psoriatic patients should avoid alcohol as alcohol consumption is associated with reduced effectiveness of your drug.

Coping with this disease is a challenge especially it affect large areas of your body that is easily visible to others especially face and hands.There are certain lifestyle modifications for psoriasis which even though cannot cure psoriasis may help to improve the appearance  and feel of your damaged skin ,

Read the following measures which may work for you.

Importance of daily bath if you are  suffering from psoriasis your skin may contain scales which wont look healthy. If you take daily baths this helps to  remove scales and  also calm inflamed  part of skin.For better results you can add bath oil, colloidal oatmeal, Epsom salts or Dead Sea salts to  the water. You should avoid hot water baths and harsh soaps, both can  worsen  your symptoms and skin condition.For better results you can  use lukewarm water and mild soaps with  added oils and fats.

Use moisturizers they can help you to relieve discomfort and give healthy look to skin. For better results they are used , after bathing,while your skin is still moist .They act by preventing evaporation of water from your skin thus keeping the water content of skin.During cold season you have to repeat the application several times a day to get  good results.Use  either an ointment based moisturizer or oils if your skin is very dry.

Small amount of sunlight is shown to have beneficial effect on psoriatic skin lesions.But this should be done after discussing with your doctor .Because intense sun exposure is a trigger for your disease.While going out protect your skin with sunscreens that  has SPF of minimum 30. ,sometime you may need to apply it more frequently every 2 or 3 hourly if you are perspiring.Cover up the lesions with clothings especially when you are going out.

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New drugs that give hope to diabetic patients

Diabetes is a disease that can affect multiple system in the body. Since the prevalence of this disease in the community is very high and there is high chance to develop various complication if it is not controlled well lot of drug trial are going on this field. Newer drugs with different modes of action are tried to bring the blood sugar under control. Three such drugs are recently approved for treatment.

They are 

For people with type 2 diabetes drugs approved are 

1. Exenatide injection (Byetta)

2. Sitagliptin (Januvia)

3. Pramlintide acetate (Symlin)

For those with type 1 diabetes along with insulin Pramlintide acetate (Symlin) can be tried.

Why this drugs are useful in diabetes?

Insulin secretion from pancreas is stimulated by GLUCOSE. These newer drugs target the hormone incretin. Incretins potentiate this glucose stimulated insulin secretion from pancreas. As the insulin synthesizing and secreting action of GLP-1 is preserved in type 2 diabetic patients this has been developed as therapeutic agent for this disease. These are useful in treatment irrespective of the severity and duration of the disease. Diabetes is a chronic progressive disease sometime the agent that works for a period of time may become less effective and ,then we need to introduce new one.

Basic mechanism of action of these drugs.

Incretin are produced in the intestine in response to food intake. Incretin effect is mainly  mediated by two peptide hormones, they are glucose-dependent insulin releasing polypeptide(GIP), and glucagon-like peptide-1(GLP-1). Both GIP and GLP-1 are rapidly metabolized  into inactive metabolites by the action of  dipeptidyl-peptidase-IV (DPP-IV) enzyme. As the insulin synthesizing and secreting action of GLP-1 is preserved in type 2 diabetic  patients this has been developed as therapeutic agent. These are useful in treatment irrespective of the severity and duration of the disease. Thus the modulation of GLP-1 levels and GLP-1 activity by administration of the native hormone, its analogs, and mimetics or the agents that inhibit its degradation has become the chief focus of investigation for type 2 diabetes  treatment.

Advantage of this drugs in diabetes.

1. They enhance the insulin secretion.In addition to its effects on insulin secretion, GLP-1.

2. Stimulate the insulin synthesis.

3. Inhibit  the glucagon secretion ,glucagons increases the blood sugar.

4. Delays the  gastric emptying thus reduces the sugar. 

5. Reduction of food intake.

6. It has trophic effects on the pancreas. Stimulate betacell proliferation.

Drugs act on GLP1 receptor are

1. Exenatide injection (Byetta)

Indicated in those people with type 2 DM whose blood sugar fails to bring under control with oral drugs. They helps to control the blood sugar by mimicking the insulin action and slowing stomach emptying. Since the patient feel full faster and stop eating these agents will help to reduce weight. This is given as injection 2 times a day at mealtime. Special advantage of this drug is it help to reduce weight and wont produce hypoglycemia. But there is risk of hypoglycemia if taken with other agents that enhance the insulin secretion. Side effect of this drugs are nausea, inflammation of pancreas, risk of kidney disease. Exenatide should not be used in people with kidney disease. Approved for either as single therapeutic agent or in combination with other drugs. To minimize the initial side effect treatment started at lower doses, dose limiting side effect is nausea that is tendency to vomit. Exenatide extended release (Bydureon) advantage of this extended release formulations is it require injection only once a week. Action and side effects are similar to Byetta.

2. Liraglutide (Victora)

Liraglutide is other GLP 1 agonist it is injected once a day. Not used in those people with family history of medullary type of thyroid cancer.

3. Amylin agonist

Pramlintide acetate (Symlin)

Pramlintide acetate is useful for those with type 1 or type 2 diabetes who are on insulin. This is injected at mealtime,it should not be mixed with insulin in same syringe. Advantage of this drug is that it helps to achieve better control of blood sugar, mainly reduce the blood sugar spike after meals. Weight reduction is other added advantage of this drug. This is injected at mealtime. Unwanted side effects is hypoglycemia if used with insulin.

4. DPP-IV inhibitors

Sitagliptin (Januvia), saxagliptin (Onglyza), and linagliptin (Tradjenta)

All are orally active drugs taken once a day, indicated in type 2 DM, they may be combined with metformin. They wont promote weight loss. Associated with only few unwanted effects. Used with precaution in patients with kidney disease. They act by protecting the breakdown of incretin, so incretins are available for long duration for insulin stimulation.

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Banana mask for hair fall - Natural beauty tips

Hair fall is a problem faced by many people, thick and shiny hair add to your beauty more than anything. Are you struggling with hair fall? Try this banana mask to prevent hair loss and to get shiny, smooth hair.

Why banana is used for hair loss?

Banana is enriched with essential nutrients that are good for your hair that is why it is a chief ingredient in home made remedy for hair growth.

Banana is rich in

1. Potassium 

2. Powerhouse of vitamins A, E, and C.

3. It is a rich source of  natural oils. 

What are the hair benefits of banana hair mask? 

1. Nutrients in banana helps to keep your hair hydrated and healthy, if you use it regularly this will increase the moisture content of hair and thus smoothen the hair and give it natural shine.

2. Banana controls dandruff and it will reduce the itching of the dry scalp.

3. Soften your hair, helps to protect the natural elasticity of hair.

4. Banana is useful in preventing split ends and breakage. 

5. Encourages hair growth. 

6. Vitamins in Banana will helps to regain the strength of your hair.

7. Banana is a natural volumizer of hair so adds volume to your hair.

8. Hair is protected from sun and wind damage.

How often it should be used ? 

To get best results use it once weekly.

1. Banana hair mask for rapidly growing and long hair

a) Simple banana recipe - Take a ripe banana, make it into paste, apply this on your hair and cover with a plastic bag. Then wrap a hot towel around the head, this step will help to lock the nutrients. Remove the cap after 15 to 20 minutes. Wash hair with a mild shampoo. If you make the content into smooth paste there wont be any difficulty in washing it off. For better results add almond or olive oil to the banana mask. 

b) Mix ripe banana pulp and yogurt apply it on hair leave it there for 20 minute and rinse it off.

2. How to make hair fall mask with banana

Mix the ingredients.

Two ripe banana, a tablespoon of honey few drops of olive oil, or coconut oil apply it on scalp and leave for 20 minutes rinse well.

3. Banana pack for soft hair

Mix the following

Ripe banana.

Avocado or cocoa.

Coconut milk.

Apply the mask on your hair leave  for 15-20 minutes.

This pack helps to make the hair soft ,if cocoa is added instead of avocado it improves the natural colour of your hair.

4. Pack For Shine And Health:

Mix banana with 1/4 cup of olive oil and one egg white in a blender then puree for 1 to 2 minutes. Leave this  on your hair for 10 to 15 minutes after that wash hair with shampoo and conditioner.

5. Banana hair pack for dry damaged hair

a) Make a hair mask mixing pulp of banana and  few drops of almond oil, apply it on scalp and hair, keep it there for 10 to 15 minute  .then wash it off.

b) Blend ripe banana with three spoons of honey apply this mask on your hair. Let the hair pack sit on your hair for 15-20 minutes, then wash the hair.

Benefit of above mask.

Banana contains  vitamin A and C and Vitamin E of the almond oil make your hair shiny and silky. It also hydrate your skin make it soft. Honey helps to keep the hair hydrated.

6. Deep conditioning mask with banana

Mix banana and melted shea butter, apply it over the hair leave it there overnight and rinse with mild shampoo. To get much better result add avocado oil or hemp oil. This increases the moisture content of hair and give extra nutrients to hair This mask will work as a deep conditioner for your dry hair. 

Take care of the following 

a) After hair wash there should not be any chunks of banana in your hair, so while making mask  use banana in pulp form without chunks, blend all contents well

a) You should not let  the mask dry on hair, wash it when it is wet, so hair can be easily cleaned. 

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Treatment of heartburn and Gastro esophageal reflux disease

Aims of treatment is adequate symptom control.

For most patients, the aim is acceptable symptom control.

General measures for managing gastro-oesophageal

reflux disease

Obese and overweight people are advised to lose weight, this will help in better symptom control.

Patients are advised to  raise the head end  of the bed on 15 cm wooden blocks.This has been found to be useful

Medications - Avoid non-steroidal anti-inflammatory drugs.

Avoid or reduce dose of nitrates, calcium channel antagonists, and anticholinergics.

Patients are advised to avoid or reduce smoking,large evening meals, food or drink within 3 hours of bedtime  should be avoided - Small frequent meals are better in these patients.

Fats or chocolate should be reduced or avoided.

Problem producing food and drinks are avoided especially citrus fruits, fruit juices, tea, coffee, peppermint, onions, garlic, cinnamon, cloves

Antacids and analgesics.

Short term relief is obtained with antacids. Many people on self medication are on this drugs. Antacids form a layer over the stomach content and help to reduce the reflux. Better when given with food.

Acid suppression therapy

H2 receptor Inhibitors  and the proton pump inhibitors are the two major groups.  Proton pump inhibitors are more rapid and effective in symptoms  relief and  healing oesophagitis.

The optimal daily dose  of proton pump inhibitors are given below

Omeprazole 20 mg.

Lansoprazole 30 mg

Pantoprazole 40 mg.

Rabeprazole 20 mg.

Motility modifying drugs

Metoclopramide and Domperidone are the agents, they are useful in symptom control but not useful in healing esophagitis. Metoclopramide is particularly useful GERD ,however, these drugs may be more useful in heart burn with nausea or early satiety.

Surgery

Indicated only in those people require long term medical therapy. Conventional and Laparoscopic anti-refluxsurgery is useful.

Indications for surgical treatment

Patients poorly responding to medical treatment and patients with persisting reflux that is regurgitation of gastric contents without symptom of heartburn especially at night may get benefit from surgery.

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