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Sunday, December 25, 2016

Use of Alpha 1 blocker as a part of Medical Expulsive Therapy (MET) for Ureteric Stone

Posted by Prahallad Panda on 12:41 PM Comments

The traditional teaching has been plenty of water, control of infection and some anti-spasmodic as an expectant treatment for small ureteric stones, i.e. around 5 mm. in diameter, to pass out; more than 10 mm, requires intervention.

In the recent days, the management of ureteric stone has been revolutionalised by introduction of Extra-Corporeal Shock Wave Lithotripsy (ESWL) and ureteroscopic surgery /other minimally invasive surgeries.
However, there is always a room for conservative management of ureteric stones, where the size of stone is around 5 mm. in diameter and is located more towards the distal part of the ureter.
Migration and increase in size of stone causes excruciating pain, only known to those, who suffer from it.
An article published in Cleveland Clinic Journal of Medicine, based on the original article published in the BMJ (British Medical Journal, Alpha Blockers & Treatment of Ureteric Stones, BMJ; ePub 2016 Dec 1; Hollingsworth, et al. December 20, 2016) recommends use of Alpha 1 blocker as a part of Medical Expulsive Therapy (MET) for ureteric stone, precisely located more distally in the ureter.
Urinary stones are common, with a prevalence of about 5% in the population. Non-contrast CT scan is the diagnostic modality of choice. When calculi are smaller than 5 mm, 90% will pass spontaneously, but as stones approach 10 mm., there is less than a 10% chance that they will pass.
Since, small stones pass spontaneously almost all of the times, alpha-blockers add little to the management of these small stones. The value of alpha-blockers is for stones of 5 mm to 10 mm in size, where the use of an alpha-blocker significantly improves the rate of passage without surgical intervention.
When conservative management of a ureteral stone is being considered and the patient has no associated signs of infection, uncontrollable pain, or renal failure, adjuvant pharmacologic intervention has proven efficacious in improving spontaneous stone passage rate and time interval, and in reducing analgesic requirements.
Many of the studies have administered the drugs in conjunction with steroids and/or NSAIDs, which may reduce ureteral edema and improve the ability for a patient to spontaneously pass a ureteral stone.
However, several of the more recent studies have shown benefit to both α-blockers and calcium channel blockers without the adjunctive use of steroids; furthermore, tamsulosin, in randomized trials, has been shown to be more efficient than nifedipine with a decreased time to expulsion and slightly higher rate of expulsion.
Alpha-1-adrenergic receptors are located throughout the human ureter. The physiologic response to antagonism of these receptors is decreased force of contraction, decreased peristaltic frequency, and increased fluid bolus volume transported down the ureter. These responses are likely, how α-blockers assist in ureteral stone passage.
Alpha-blockers, specifically α1 antagonists, are highly effective in increasing the expulsion rate of distal ureteral stones, reducing the time to stone passage, and decreasing the amount of pain medication needed during passage stones.
Alpha blockers may also be a useful adjunct in the treatment of both ureteral and renal stones after ESWL. They may also reduce the urinary symptoms and pain associated with double-J ureteral stents. 


  • Medical expulsion therapy is a useful adjunct to observation in the conservative management of ureteral stones. 
  • Alpha-1 receptors are located in the human ureter, especially the distal ureter; α-blockers increase expulsion rates of distal ureteral stones, decrease time to expulsion, and decrease need for analgesia during stone passage. Moderate quality evidence was observed that alpha blockers facilitate passage of ureteric stones. 
  • In the appropriate clinical scenario, the use of α-blockers is recommended in the conservative management of distal ureteral stones. 
  • The greatest benefit may be among patients with larger stones (57% higher likelihood of stone passage vs controls). 
  • Compared with controls, patients receiving alpha blockers had significantly shorter times to stone passage, fewer episodes, lower risks of surgical intervention, and lower risk of admission to hospital.
Urinary stone disease is frequently seen in the urology practice. Symptoms include flank or abdominal pain radiating to the groin or external genitalia. Although some patients with ureteral stones might remain asymptomatic, many have pain and thus commonly seek medical care. Ureteric stone and its' size are best assessed in a non-contrast CT in comparison to the ultrasound examination.

An acute episode of colic is the result of a stone entering the ureter and causing intermittent rise of pressure in the pyelocalyceal system. Spontaneous passage will occur in most of these stones. 
An review article published in Cochrane Library (2nd April, 2014, Authors: Campschroer T, Zhu Y, Duijvesz D, Grobbee DE, Lock M) identified 32 studies enrolling 5864 participants. The use of alpha-blockers in patients with ureteral stones resulted in a higher stone-free rate and a shorter time to expulsion and therefore decreased the duration of symptoms and rate of complications (UTI, hydronephrosis and impairment of kidney function).
Medical expulsive therapy includes the use of oral/intravenous hydration, analgesics, and medications that promote stone passage, including alpha-1 blockers.
The most common alpha-1 blocker used to aid in the passage of ureteral stones is tamsulosin. The indicated use for tamsulosin is for treating symptoms of benign prostatic hyperplasia (BPH) (Alexander, 2010); however, off-label use has recently emerged as an efficacious and safe option for the initial management of ureteral stones (Bensalah et al., 2008)
Tamsulosin may help patients pass a kidney stone by relaxing the smooth muscle of the intramural ureters, allowing urine and stones to pass through more easily.
Tamsulosin is an antagonist of alpha1Aadrenoreceptors in smooth muscle; blocking them leads to relaxation of smooth muscle in the bladder neck causing an improvement in urine flow (Alexander, 2010).
Tamsulosin also relaxes the smooth muscle of veins and arteries, which can cause patients to feel dizzy when getting up from a sitting or lying position (orthostatic hypotension). Patients who take tamsulosin should be careful not to move too quickly when changing positions to avoid dizziness or syncopy.
Other documented side or adverse effects include blurred vision, cough, decreased sexual function, diarrhea, dizziness, drowsiness, lightheadedness, runny or stuffy nose, sinus in flam mation, trouble sleeping, and weakness (Lexi-Comp, Inc., 2011). Overdose symptoms include clammy or cold skin, rapid heartbeat, lightheadedness, extreme headache, and passing out.
Because of its sustained release formulation, the manufacturer does not recommend opening, crushing, or chewing the capsule/tablet because this can increase the medication's potential side effects (Alexander, 2010). Patients with a sulfa allergy should not use tamsulosin as a cross reactivity has been noted (Lexi-Comp, Inc., 2011)
Most adverse effects were mild of origin and did not lead to cessation of therapy, and several studies reported no adverse events in either the treatment or control group.

Alpha-blockers could be considered as first-line treatment for patients presenting with urinary stones.

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Friday, December 23, 2016

All the Patients of Acute Myocardial Infarction (STEMI) may not require Oxygen therapy

Posted by Prahallad Panda on 11:32 AM Comments


Oxygen therapy has been a mandatory requirement for more than 100 years unquestionably, to treat acute heart attack, i.e. Myocardial Infarction, most of the times on the basis of anecdotal evidence, expert opinion, and tradition. Recent compelling evidences have challenged this conventional thinking.

myocardial infarction - Myokardinfarkt - scheme
myocardial infarction - Myokardinfarkt - scheme (Photo credit: Wikipedia)
Immediate treatment with Morphine, oxygen, nitrates and antiplatelets (MONA) has become the standard treatment for acute myocardial infarction (AMI) patient. Oxygen is a lifesaving drug. Giving oxygen to patient with impending clinical emergency has become knee-jerk reflex reaction of clinician. At the same time, if not provided immediately, raises many questions from all the quarters including patient and his attendants.

Patient with AMI has compromised myocardial perfusion and event arises due to myocardial hypoxia. It appears quite logical and biologically plausible to give oxygen in such situations to improve the oxygenation of the ischemic myocardial tissue and decrease ischemic pain.
On the other side, oxygen may be harmful for its’ paradoxical effect in decreasing coronary artery blood flow and increasing coronary vascular resistance, evidenced by intra-coronary Doppler ultrasonography. This effect leads to decrease in cardiac output and stroke volume. Excess Oxygen in blood (hyperoxia) causes increase in vascular resistance and reperfusion injury due to increased oxygen free radicals.
A survey among doctors managing AMI cases had showed that oxygen supplementation was given to 96% of their patients with acute coronary syndrome. About 50% of participants believed that oxygen reduces fatality, 25% thought it is helpful in decreasing pain, and 25% thought it has no effect.
Researchers like, Nicholson, Beasley et al. and Wijesinghe et al. have suggested that efficacy and safety of high flow oxygen in MI is not substantial. The existing evidence suggests that the routine use of high flow oxygen in uncomplicated MI can cause greater infarct size and possibly increase the risk of mortality.
Cochrane systemic review by Cabello et al., did not find any conclusive evidence from randomized controlled trials (four parallel-design, randomized controlled trials reported between 1976 and 2012) to support the routine use of inhaled oxygen in patients with acute AMI.
Recently published, Air Verses Oxygen in myocardial infarction study (AVOID Study) suggested routine oxygen supplementation to AMI patients from the ambulance through to the recovery room might actually be hurting their hearts. AVOID was a randomized, controlled, multicenter trial with the aim of comparing oxygen supplementation (6–8 L/min) with no oxygen in STEMI patients with oxygen saturation in the normal range pulse oximetry saturation >94%.
The study found a significant 25% increase in creatine kinase, suggestive of increased myocardial injury and cardiac magnetic resonance imaging (cardiovascular magnetic resonance) at 6 months suggestive of larger infarction size with oxygen therapy. Although, the mortality was similar in both groups, significant increases in recurrent MI and arrhythmias were observed in the oxygen group. Even though, AVOID Study used higher oxygen flow 6–8 L/min (more than usual clinical practice) and study was not powered for hard clinical end points, AVOID trial would really question the current practice of oxygen supplementation to all patients with acute myocardial ischemia and definitely to those with normoxia.
This subject is being further studied by researchers with the Swedish Coronary Angiography and Angioplasty Registry in an open-label randomized trial DETO2 X-AMI (with more than 5000 enrolled patients in multi centres) with mortality as the primary endpoint. Results are awaited which may have definitive conclusive evidence.
American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care recommends oxygen in patients with dyspnea, hypoxemic, or with signs of heart failure and shock, based on monitoring of oxy-hemoglobin saturation, to ≥94%. However, evidence to support oxygen use in uncomplicated acute coronary syndromes is inadequate.
Oxygen overdose is not a new, but the way we use oxygen in coronary emergency needs reconsideration. Time has come to reassess oxygen treatment in acute coronary syndrome. Clinical practice should be based on proven benefits and safety, not on tradition. Oxygen is a life-saving drug and how much you give the patients, depends on how much they need.
The question of oxygen administration to all patients of AMI remains unanswered until new strong evidence comes.
The original article can be accessed here.
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Saturday, June 25, 2016

A Question on "International Drug Day" Addiction a Choice or Disease?

Posted by Prahallad Panda on 9:24 PM Comments

A new Bollywood film gives a rare glimpse into the exploitation and enslavement of women in India's drug trade, highlighting how the stigma surrounding women drug users leaves them vulnerable to abuse.
'Udta Punjab' (Flying Punjab), directed by Abhishek Chaubey and released on 17th June, 2016, shows how one of India's most prosperous states has been blighted by drug use, with corrupt politicians and police complicit in the trade that largely afflicts young men.
Alongside a drug-addicted rock star, the film tells the story of a nameless young female migrant worker, who is enslaved by a gang of drug dealers, made an addict and forced to have sex with multiple men. 

Addiction is defined as a chronic relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.

 

According to the United Nations there are more than 10 million drug addicts in India. Drug addiction has crossed all barriers of caste and class. The drug addicts in cities in India are predominantly synthetic drug users, while in rural India natural substances like ganja & hashish form the majority of usage.

What is addiction:



People feel pleasure when basic needs such as hunger, thirst and sex are satisfied. In most cases, these feelings of pleasure are caused by the release of certain chemicals in the brain. Most addictive substances cause the brain to release high levels of these same chemicals that are associated with pleasure or reward. 
Over time, continued release of these chemicals causes changes in the brain systems involved in reward, motivation and memory. When these changes occur, a person may need the substance to feel normal. The individual may also experience intense desires or cravings for the addictive substance and will continue to use it despite the harmful or dangerous consequences. The person will also prefer the drug to other healthy pleasures and may lose interest in normal life activities. In the most chronic form of the disease, addiction can cause a person to stop caring about their own or other’s well-being or survival.  
These changes in the brain can remain for a long time, even after the person stops using substances. It is believed that these changes may leave those with addiction vulnerable to physical and environmental cues that they associate with substance use, also known as triggers, which can increase their risk of relapse.
Short Definition of Addiction American Society of Addiction Medicine:
Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

Reasons:
Here are some of the reasons young people have given for taking drugs:
  • To fit in
  • To escape or relax
  • To relieve boredom
  • To seem grown up
  • To rebel
  • To experiment
They think drugs are a solution. But eventually, the drugs become the problem.

Commonly Abused Drugs:


Commonly abused classes of prescription drugs include opioid painkillers, stimulants, and depressants. Opioids are usually prescribed for pain relief. Commonly prescribed opioids include hydrocodone (e.g., Vicodin®), oxycodone (e.g., OxyContin®), morphine, fentanyl, and codeine.

Marijuana:

Marijuana (cannabis) is the most commonly used illicit substance. This drug impairs short-term memory and learning, the ability to focus, and coordination. It also increases heart rate, can harm the lungs, and may increase the risk of psychosis in vulnerable people.

Medical Marijuana:

However, THC-based drugs to treat pain and nausea are already FDA approved and prescribed. Scientists continue to investigate the medicinal properties of cannabinoids—or the individual components of the marijuana plant (e.g., THC, CBD). 
 
Alcohol:

People drink to socialize, celebrate, and relax. Alcohol often has a strong effect on people—and throughout history,people have struggled to understand and manage alcohol’s power. Why does alcohol cause people to act and feel differently? How much is too much? Why do some people become addicted while others do not?

Ayahuasca:

A hallucinogenic tea made in the Amazon from a DMT-containing plant (Psychotria viridis or Diplopterys cabrerana or other) along with another vine (Banisteriopsis caapi) that contains an MAO Inhibitor preventing the natural breakdown of DMT in the digestive system, thereby facilitating a prolonged hallucinatory experience.

Cocaine:

A powerfully addictive stimulant drug made from the leaves of the coca plant native to South America.
DMT:
A synthetic drug producing intense but relatively short-lived hallucinogenic experiences; also naturally occurring in some South American plants (Ayahuasca).

GHB:

A depressant approved for use in the treatment of narcolepsy, a disorder that causes daytime "sleep attacks.
Hallucinogens:
Drugs that cause profound distortions in a person’s perceptions of reality, such as ketamine, LSD, mescaline (peyote), PCP, psilocybin, salvia, DMT, and ayahuasca.
Heroin:
An opioid drug made from morphine, a natural substance extracted from the seed pod of the Asian opium poppy plant.
Inhalants:
Solvents, aerosols, and gases found in household products such as spray paints, markers, glues, and cleaning fluids; also nitrites (e.g., amyl nitrite), which are prescription medications for chest pain.
Ketamine:
A dissociative drug used as an anesthetic in veterinary practice. Dissociative drugs are hallucinogens that cause the user to feel detached from reality.

Khat:

Pronounced "cot," a shrub (Catha edulis) found in East Africa and southern Arabia; contains the psychoactive chemicals cathinone and cathine. People from African and Arabian regions (up to an estimated 20 million worldwide) have used khat for centuries as part of cultural tradition and for its stimulant-like effects.
Kratom:
A tropical deciduous tree (Mitragyna speciosa) native to Southeast Asia, with leaves that contain mitragynine, a psychoactive (mind-altering) opioid. Kratom is consumed for mood-lifting effects and pain relief and as an aphrodisiac.
LSD:
A hallucinogen manufactured from lysergic acid, which is found in ergot, a fungus that grows on rye and other grains. LSD is an abbreviation of the scientific name lysergic acid diethylamide.
Marijuana (Cannabis):
Marijuana is made from the hemp plant, Cannabis sativa. The main psychoactive (mind-altering) chemical in marijuana is delta-9-tetrahydrocannabinol, or THC.
MDMA (Ecstasy/Molly):
A synthetic, psychoactive drug that has similarities to both the stimulant amphetamine and the hallucinogen mescaline. MDMA is an abbreviation of the scientific name 3,4-methylenedioxy-methamphetamine.
Mescaline (Peyote):
A hallucinogen found in disk-shaped “buttons” in the crown of several cacti, including peyote.
Methamphetamine:
An extremely addictive stimulant amphetamine drug.
Over-the-counter Cough/Cold Medicines (Dextromethorphan or DXM):
Psychoactive when taken in higher-than-recommended amounts.

PCP:

A dissociative drug developed as an intravenous anesthetic that has been discontinued due to serious adverse effects. Dissociative drugs are hallucinogens that cause the user to feel detached from reality. PCP is an abbreviation of the scientific name, phencyclidine.
Prescription Sedatives (Tranquilizers, Depressants):
Medications that slow brain activity, which makes them useful for treating anxiety and sleep problems.
Barbiturates: pentobarbital, phenobarbital, Benzodiazepines: alprazolam, chlorodiazepoxide, diazepam, lorazepam, triazolam, Sleep Medications: eszopiclone, zaleplon, zolpidem.
Prescription Opioids:
Pain relievers with an origin similar to that of heroin. Opioids can cause euphoria and are often used nonmedically, leading to overdose deaths.
Codeine (various brand names), Fentanyl, Hydrocodone or dihydrocodeinone, Hydromorphone, Meperidine, Methadone, Morphine, Oxycodone, Oxymorphone.
Prescription Stimulants:
Medications that increase alertness, attention, energy, blood pressure, heart rate, and breathing rate.
Amphetamine and Methylphenidate
Psilocybin:
A hallucinogen in certain types of mushrooms that grow in parts of South America, Mexico, and the United States
Flunitrazepam:
A benzodiazepine chemically similar to prescription sedatives such as Valium® and Xanax®. Teens and young adults tend to abuse this drug at bars, nightclubs, concerts, and parties. It has been used to commit sexual assaults due to its ability to sedate and incapacitate unsuspecting victims.
Salvia:
A dissociative drug (Salvia divinorum) that is an herb in the mint family native to southern Mexico. Dissociative drugs are hallucinogens that cause the user to feel detached from reality.
Steroids (Anabolic):
Man-made substances used to treat conditions caused by low levels of steroid hormones in the body and abused to enhance athletic and sexual performance and physical appearance.
Nandrolone, oxandrolone, oxymetholone, stanozolol, testosterone cypionat.
Synthetic Cannabinoids:
A wide variety of herbal mixtures containing man-made cannabinoid chemicals related to THC in marijuana but often much stronger and more dangerous.
Synthetic Cathinones (Bath Salts):
An emerging family of drugs containing one or more synthetic chemicals related to cathinone, a stimulant found naturally in the khat plant. Examples of such chemicals include mephedrone, methylone, and 3,4-methylenedioxypyrovalerone (MDPV).
Tobacco:
Plant grown for its leaves, which are dried and fermented before use.
Cigarettes, cigars, bidis, hookahs, smokeless tobacco (snuff, spit tobacco, chew)

Burden in India

According to Data and Analysis of 2011 by UNODC, use of cannabis among young people in India was between 12 – 18 years of age. About 3% of youngsters consume cannabis at least once in a year (as recorded in 2001).

In his message on World Drug Day, the Secretary General Ban Ki-Moon said, “Drug abuse and illicit trafficking have calamitous consequences for the world’s efforts to deliver greater prosperity and equality for all. There are up to 200,000 preventable deaths each year from overdoses. Illicit drugs spawn criminal violence and weaken a state’s essential institutions.”
The Narcotics Control Bureau (NCB) of India has devised various awareness programs for school and college students as part of celebration of 'International Day against Drug Abuse and Illicit Trafficking', which falls on June 26.
Iran marked the International Day against Drug Abuse and Illicit Trafficking on Tuesday in ceremonies which were held concurrently across the country.
During a ceremony, which was held in Tehran, Interior Minister Abdolreza Rahmani Fazli said there are some 7,500 rehabilitation centers in Iran which helped about 700,000 drug users quit addiction over the past year.
Nearly 380,000 former drug addicts who are now detoxed are being trained under job training programs, Mehr news agency quoted Rahmani Fazli as saying.
Over some 2,522 operations we succeeded in seizing 618 tons of drugs and disbanding 3,017 smuggling organizations,” he added.

Difficult as it may be to face one’s problems, the consequences of drug use are always worse than the problem one is trying to solve with them. The real answer is to get the facts and not to take drugs in the first place.






Your genes are not your destiny. The 50% of addiction that is caused by poor coping skills is where you can make a difference. Lots of people have come from addicted families but managed to overcome their family history and live happy lives. 
 

















Use this opportunity to change your life.

Continue...


A Question on "International Drug Day" Addiction a Choice or Disease?

Posted by Prahallad Panda on 9:24 PM Comments

A new Bollywood film gives a rare glimpse into the exploitation and enslavement of women in India's drug trade, highlighting how the stigma surrounding women drug users leaves them vulnerable to abuse.
'Udta Punjab' (Flying Punjab), directed by Abhishek Chaubey and released on 17th June, 2016, shows how one of India's most prosperous states has been blighted by drug use, with corrupt politicians and police complicit in the trade that largely afflicts young men.
Alongside a drug-addicted rock star, the film tells the story of a nameless young female migrant worker, who is enslaved by a gang of drug dealers, made an addict and forced to have sex with multiple men. 

Addiction is defined as a chronic relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.

 

According to the United Nations there are more than 10 million drug addicts in India. Drug addiction has crossed all barriers of caste and class. The drug addicts in cities in India are predominantly synthetic drug users, while in rural India natural substances like ganja & hashish form the majority of usage.

What is addiction:



People feel pleasure when basic needs such as hunger, thirst and sex are satisfied. In most cases, these feelings of pleasure are caused by the release of certain chemicals in the brain. Most addictive substances cause the brain to release high levels of these same chemicals that are associated with pleasure or reward. 
Over time, continued release of these chemicals causes changes in the brain systems involved in reward, motivation and memory. When these changes occur, a person may need the substance to feel normal. The individual may also experience intense desires or cravings for the addictive substance and will continue to use it despite the harmful or dangerous consequences. The person will also prefer the drug to other healthy pleasures and may lose interest in normal life activities. In the most chronic form of the disease, addiction can cause a person to stop caring about their own or other’s well-being or survival.  
These changes in the brain can remain for a long time, even after the person stops using substances. It is believed that these changes may leave those with addiction vulnerable to physical and environmental cues that they associate with substance use, also known as triggers, which can increase their risk of relapse.
Short Definition of Addiction American Society of Addiction Medicine:
Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

Reasons:
Here are some of the reasons young people have given for taking drugs:
  • To fit in
  • To escape or relax
  • To relieve boredom
  • To seem grown up
  • To rebel
  • To experiment
They think drugs are a solution. But eventually, the drugs become the problem.

Commonly Abused Drugs:


Commonly abused classes of prescription drugs include opioid painkillers, stimulants, and depressants. Opioids are usually prescribed for pain relief. Commonly prescribed opioids include hydrocodone (e.g., Vicodin®), oxycodone (e.g., OxyContin®), morphine, fentanyl, and codeine.

Marijuana:

Marijuana (cannabis) is the most commonly used illicit substance. This drug impairs short-term memory and learning, the ability to focus, and coordination. It also increases heart rate, can harm the lungs, and may increase the risk of psychosis in vulnerable people.

Medical Marijuana:

However, THC-based drugs to treat pain and nausea are already FDA approved and prescribed. Scientists continue to investigate the medicinal properties of cannabinoids—or the individual components of the marijuana plant (e.g., THC, CBD). 
 
Alcohol:

People drink to socialize, celebrate, and relax. Alcohol often has a strong effect on people—and throughout history,people have struggled to understand and manage alcohol’s power. Why does alcohol cause people to act and feel differently? How much is too much? Why do some people become addicted while others do not?

Ayahuasca:

A hallucinogenic tea made in the Amazon from a DMT-containing plant (Psychotria viridis or Diplopterys cabrerana or other) along with another vine (Banisteriopsis caapi) that contains an MAO Inhibitor preventing the natural breakdown of DMT in the digestive system, thereby facilitating a prolonged hallucinatory experience.

Cocaine:

A powerfully addictive stimulant drug made from the leaves of the coca plant native to South America.
DMT:
A synthetic drug producing intense but relatively short-lived hallucinogenic experiences; also naturally occurring in some South American plants (Ayahuasca).

GHB:

A depressant approved for use in the treatment of narcolepsy, a disorder that causes daytime "sleep attacks.
Hallucinogens:
Drugs that cause profound distortions in a person’s perceptions of reality, such as ketamine, LSD, mescaline (peyote), PCP, psilocybin, salvia, DMT, and ayahuasca.
Heroin:
An opioid drug made from morphine, a natural substance extracted from the seed pod of the Asian opium poppy plant.
Inhalants:
Solvents, aerosols, and gases found in household products such as spray paints, markers, glues, and cleaning fluids; also nitrites (e.g., amyl nitrite), which are prescription medications for chest pain.
Ketamine:
A dissociative drug used as an anesthetic in veterinary practice. Dissociative drugs are hallucinogens that cause the user to feel detached from reality.

Khat:

Pronounced "cot," a shrub (Catha edulis) found in East Africa and southern Arabia; contains the psychoactive chemicals cathinone and cathine. People from African and Arabian regions (up to an estimated 20 million worldwide) have used khat for centuries as part of cultural tradition and for its stimulant-like effects.
Kratom:
A tropical deciduous tree (Mitragyna speciosa) native to Southeast Asia, with leaves that contain mitragynine, a psychoactive (mind-altering) opioid. Kratom is consumed for mood-lifting effects and pain relief and as an aphrodisiac.
LSD:
A hallucinogen manufactured from lysergic acid, which is found in ergot, a fungus that grows on rye and other grains. LSD is an abbreviation of the scientific name lysergic acid diethylamide.
Marijuana (Cannabis):
Marijuana is made from the hemp plant, Cannabis sativa. The main psychoactive (mind-altering) chemical in marijuana is delta-9-tetrahydrocannabinol, or THC.
MDMA (Ecstasy/Molly):
A synthetic, psychoactive drug that has similarities to both the stimulant amphetamine and the hallucinogen mescaline. MDMA is an abbreviation of the scientific name 3,4-methylenedioxy-methamphetamine.
Mescaline (Peyote):
A hallucinogen found in disk-shaped “buttons” in the crown of several cacti, including peyote.
Methamphetamine:
An extremely addictive stimulant amphetamine drug.
Over-the-counter Cough/Cold Medicines (Dextromethorphan or DXM):
Psychoactive when taken in higher-than-recommended amounts.

PCP:

A dissociative drug developed as an intravenous anesthetic that has been discontinued due to serious adverse effects. Dissociative drugs are hallucinogens that cause the user to feel detached from reality. PCP is an abbreviation of the scientific name, phencyclidine.
Prescription Sedatives (Tranquilizers, Depressants):
Medications that slow brain activity, which makes them useful for treating anxiety and sleep problems.
Barbiturates: pentobarbital, phenobarbital, Benzodiazepines: alprazolam, chlorodiazepoxide, diazepam, lorazepam, triazolam, Sleep Medications: eszopiclone, zaleplon, zolpidem.
Prescription Opioids:
Pain relievers with an origin similar to that of heroin. Opioids can cause euphoria and are often used nonmedically, leading to overdose deaths.
Codeine (various brand names), Fentanyl, Hydrocodone or dihydrocodeinone, Hydromorphone, Meperidine, Methadone, Morphine, Oxycodone, Oxymorphone.
Prescription Stimulants:
Medications that increase alertness, attention, energy, blood pressure, heart rate, and breathing rate.
Amphetamine and Methylphenidate
Psilocybin:
A hallucinogen in certain types of mushrooms that grow in parts of South America, Mexico, and the United States
Flunitrazepam:
A benzodiazepine chemically similar to prescription sedatives such as Valium® and Xanax®. Teens and young adults tend to abuse this drug at bars, nightclubs, concerts, and parties. It has been used to commit sexual assaults due to its ability to sedate and incapacitate unsuspecting victims.
Salvia:
A dissociative drug (Salvia divinorum) that is an herb in the mint family native to southern Mexico. Dissociative drugs are hallucinogens that cause the user to feel detached from reality.
Steroids (Anabolic):
Man-made substances used to treat conditions caused by low levels of steroid hormones in the body and abused to enhance athletic and sexual performance and physical appearance.
Nandrolone, oxandrolone, oxymetholone, stanozolol, testosterone cypionat.
Synthetic Cannabinoids:
A wide variety of herbal mixtures containing man-made cannabinoid chemicals related to THC in marijuana but often much stronger and more dangerous.
Synthetic Cathinones (Bath Salts):
An emerging family of drugs containing one or more synthetic chemicals related to cathinone, a stimulant found naturally in the khat plant. Examples of such chemicals include mephedrone, methylone, and 3,4-methylenedioxypyrovalerone (MDPV).
Tobacco:
Plant grown for its leaves, which are dried and fermented before use.
Cigarettes, cigars, bidis, hookahs, smokeless tobacco (snuff, spit tobacco, chew)

Burden in India

According to Data and Analysis of 2011 by UNODC, use of cannabis among young people in India was between 12 – 18 years of age. About 3% of youngsters consume cannabis at least once in a year (as recorded in 2001).

In his message on World Drug Day, the Secretary General Ban Ki-Moon said, “Drug abuse and illicit trafficking have calamitous consequences for the world’s efforts to deliver greater prosperity and equality for all. There are up to 200,000 preventable deaths each year from overdoses. Illicit drugs spawn criminal violence and weaken a state’s essential institutions.”
The Narcotics Control Bureau (NCB) of India has devised various awareness programs for school and college students as part of celebration of 'International Day against Drug Abuse and Illicit Trafficking', which falls on June 26.
Iran marked the International Day against Drug Abuse and Illicit Trafficking on Tuesday in ceremonies which were held concurrently across the country.
During a ceremony, which was held in Tehran, Interior Minister Abdolreza Rahmani Fazli said there are some 7,500 rehabilitation centers in Iran which helped about 700,000 drug users quit addiction over the past year.
Nearly 380,000 former drug addicts who are now detoxed are being trained under job training programs, Mehr news agency quoted Rahmani Fazli as saying.
Over some 2,522 operations we succeeded in seizing 618 tons of drugs and disbanding 3,017 smuggling organizations,” he added.

Difficult as it may be to face one’s problems, the consequences of drug use are always worse than the problem one is trying to solve with them. The real answer is to get the facts and not to take drugs in the first place.






Your genes are not your destiny. The 50% of addiction that is caused by poor coping skills is where you can make a difference. Lots of people have come from addicted families but managed to overcome their family history and live happy lives. 
 

















Use this opportunity to change your life.

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Saturday, May 28, 2016

How much low Salt in Diet might be Safe

Posted by Prahallad Panda on 10:53 AM Comments


General advice to patients suffering from hypertension is to consume low salt diet. But, how much less is safe for the patient has not been clearly defined. Generally, it is advised to remain below 2.3 gms/day. Some say 1.5 gms/day.
A large worldwide study has found that, contrary to popular thought, low-salt diets may not be beneficial and may actually increase the risk of cardiovascular disease (CVD) and death compared to average salt consumption. The study suggests that the only people who need to worry about reducing sodium in their diet are those with hypertension (high blood pressure) and have high salt consumption.
The study, involving more than 130,000 people from 49 countries, was led by investigators of the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences.
Current intake of sodium in Canada is typically between 3.5 and 4 grams per day. Some guidelines suggest to consume salt below 2.3 grams per day, a level that fewer than five per cent of Canadians and people around the world consume.
Only about 10 per cent of the population in the global study had both hypertension and high sodium consumption (greater than 6 grams per day).
Low sodium intake reduces blood pressure modestly, compared to average intake, but low sodium intake also has other effects, including adverse elevations of certain hormones which may outweigh any benefits.
This new study shows that the risks associated with low-sodium intake -- less than three grams per day -- are consistent regardless of a patient's hypertension status.
"An approach that recommends salt in moderation, particularly focused on those with hypertension and high salt intake, appears more in-line with current evidence."
The study was funded from more than 50 sources, including the PHRI, the Heart and Stroke Foundation of Canada and the Canadian Institutes of Health Research.
The article was published in the ScienceDaily, can be accessed here.
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