Cold Sore

Hello! Do you know that the blister on the border of your mouth that usually heals on its own and recurs after some time due to some triggers may not be symptoms of malaria as you term it but could be Cold sores?

Now you would ask, what are cold sores? They are small often painful blisters on the border of the mouth or the lips. It is commonly caused by a virus named herpes simplex type 1 (HSV-1). It is transmitted through physical contact e.g kissing even when the patient is asymptomatic. An infected patient is often unaware till symptoms appear. Once the virus enters the body it resides in the body. They often have this tingling or itching feel around the mouth which then develops to a blister and after some days this blister opens up to expel its fluid and later turns to a sore before it heals. Fever and sore throat may be accompanying symptoms. Blisters occasionally reoccur after the initial infection when there is a trigger. The weak immune system, cold, fever, allergies, exposure to the sun, hormone changes( e.g Menstruation), and stress are possible triggers.

Picture source : https://www.medicalnewstoday.com/articles/how-long-do-cold-sores-last#stages

There is no permanent cure for cold sore but treatment is available to speed up the healing process when it occurs. Pain medications help to ease the pain and fever that comes with the infection. Topical antiviral creams can be useful at the stage where you experience that tingling sensation in the mouth and it’s least needed when sores have occurred. Antiviral tablets are prescribed in more severe conditions.

Possible triggers can be avoided to prevent their recurrence. Avoid kissing anyone including babies or sharing eating utensils while you have a cold sore because it is easily transmitted at such times. Stay hydrated and eat fruits rich in vitamins would boost the immune system especially immunocompromised patients who are at greater risk of getting infected.

Constipation

Bowel movement is an essential part of life as it enables one to eliminate waste( faces) from the bowel because the build-up of these waste in the body system would be discomforting. The consistency of stool as well as the frequency of bowel emptying varies in individuals and could be dependent on multiple factors. Bowel frequency ranging from thrice a day to three times a week bowel movement could be considered as a healthy bowel. An individual should be able to understand his/her bowel pattern so that any pattern deviating from the normal needs medical attention. One of such conditions that result from irregularities in bowel movement is constipation.

Constipation is simply defined as bowel movement occurring less than 3 times a week or difficulty in passing out stool. Fecal material is stored in the rectum before defecation. The walls of the rectum usually accommodate the waste, receptors on the rectal wall stimulate the feeling to defecate but when the urge is not acted upon immediately the stool returns to the colon. If there is no bowel movement in days, the content in the colon begins to lose water and get harden (Stool impaction) making it more difficult to defecate which results in straining the bowel to pass out this hard stool. Chronic straining causes stress on the pelvic floor, there could be tears in the tissue surrounding the anus and over time the veins surrounding the anus become inflamed( hemorrhoid).

There are various causes of constipation. Poor fiber in diet, Reduced fluid intake, Age, pregnancy, and side effect of drugs (e.g opioids, aluminum-containing antacid), are causes of constipation. The amount of fiber in the diet and fluid intake contributes to the consistency of stool. Constipation can be a symptom of a medical condition, for example, irritable bowel syndrome, colorectal cancer, e.t.c.

Photo source: https://www.verywellhealth.com/constipation-in-multiple-sclerosis-2440795

The first remedy to constipation is Diet. Increased intake of dietary fiber is encouraged. Dietary fibers are not digestible, they pull water and add bulk into stool which softens stool making it easier to defecate. Skins of fruits and vegetables are rich sources of dietary fiber. Drinking plenty of water would also help prevent constipation. Fluid aids digestion, it facilitates the movement of food down the digestive system. Also, it prevents the formation of hard stool. if the body lacks enough fluid, the large intestine draws up water from food waste hence forming a hard stool that would be difficult to excrete. Avoid caffeinated drinks as they worsen constipation.

Photo source : https://www.google.com/amp/s/www.news-medical.net/amp/health/The-Importance-of-Dietary-Fiber.aspx

In chronic cases, laxatives could be given. There are multiple choices of laxatives, Talk to Your Doctor/Pharmacist for a suitable choice. Abuse of laxatives can worsen constipation. In some cases, the underlying cause of constipation is managed and constipation resolves.

In conclusion, Observe a healthy bowel pattern, develop a habit of emptying your bowel daily, if possible, make it the same time every day. Grooming children this way would help them learn to empty their bowel regularly.

SORE THROAT

There is been a rise in the number of patients who come to the pharmacy with the complaint of pain and difficulty in swallowing, one reason for the increased number could be attributed to the dry and dusty season.

Sore throat is an irritation on a throat usually accompanied by pain and worsens over time resulting in difficulty in swallowing. It could be a symptom of many disease conditions, for example, Tonsilitis, Pharyngitis. A non-infectious cause of sore throat include allergies, Gastr-esophageal reflux disease, environmental factors ( pollutants, Dry air), Tumour, injury, drugs that cause dry mouth( eg antihistamine, antidepressants) are less common causes of sore throat. Viruses and bacteria are other causes of sore throat.

Oftentimes, symptoms would resolve easily with little or no treatment especially sore throat caused by a virus. A sore throat lasting for longer than a week accompanied by fever, difficulty in breathing, face/neck swelling calls for medical attention. Physical examination of the throat area and throat swab would assist in making a diagnosis.

Treatment could be based on the presenting symptoms as well as managing the underlying medical condition in certain cases. A pain-relieving oral tablet/ lozenge can be given to ease the pain. An antibiotic is added to therapy when the sore throat is caused by bacteria. Traditional home remedies that can provide relief include gargling with salt water which would reduce inflammation and swelling, diluted apple cider vinegar gargle would have a similar effect. Honey helps to soothe the throat. Staying hydrated by drinking plenty of fluid would help counter the adverse effect of mouth dryness. Avoid alcohol and caffeinated drinks. The patient is always encouraged to eat food/fruit or take supplements that help boost immunity.

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Diarrhoea

Most people usually have the habit of emptying their bowel at least once a day, which seems to be normal but a situation where an individual passes out loose or watery stool more than thrice a day or more frequently than normal for that individual is defined as diarrhoea. Diarrhoea is a common cause of death especially amongst children below the age of five in developing countries.

Diarrhoea results were there is an imbalance between the absorption and secretion of water and electrolytes in the gastrointestinal tracts. Infectious agents like bacteria (e.g Salmonella ), virus ( e.g RotaVirus) and protozoa ( e.g Giardia) could affect the intestines resulting in a condition termed as gastroenteritis. It results from the ingestion of contaminated food and water. Non-infectious cause includes drug-induced diarrhoea, excess alcohol, eating foods that upset the digestive systems, surgery, e.t.c. Diarrhoea could be a symptom for many disease condition.

Dehydration is a major complication of diarrhoea and calls for immediate medical attention. Passing out of bloody or mucoid stool indicates the presence of an underlying condition. Abdominal pain, fever, bloating are symptoms of diarrhoea.

Breastfeeding is encouraged in babies as breastmilk contains necessary nutrients that help protect the child. This can help limit the source of food contamination in babies. Babies should be immunized against Rotavirus, which is one of the leading cause of diarrhoea among young children. Proper handwashing alongside other hygienic measures like clean water, washing /cooking food properly, and good sanitation should be adopted.

The main treatment for diarrhoea is rehydration. This would help replenish the lost electrolyte and fluid. Mild to moderate cases of diarrhoea would resolve on its own with fluid rehydration therapy. Stool culture and blood test are recommended in very severe cases. Other treatment patterns would depend on the cause of disease. Foods to avoid while you have diarrhoea include caffeine-containing drinks, sugary food and food with high fibre content. Anti-motility drugs can be used alone when stool doesn’t contain blood or mucus. Antibiotics are used when diarrhoea is caused by bacteria or protozoan. Probiotics are adjunct treatment in the management of diarrhoea. If symptoms still persist, please see the doctor, so that better diagnosis be done and appropriate treatment given.

NOTE: Do not self medicate, the habit of using metronidazole (Flagyl) and Tetracycline capsule at every diarrhoea episode should be discouraged. Even when they are used the complete dosage should be taken.

ACNE

One of the changes that are noticed at the onset of puberty is acne and sometimes resolves on its own before adulthood but some others still experience it even after puberty. It is usually experienced by male and female gender. The severity varies in individual and it becomes a thing of great concern when acne begins to affect the patient physical looks thus affecting the psychology of the patient resulting in reduced self-confidence.

Acne is a globally prevalent skin disease characterised by pimples, blackhead, whitehead which usually present on some part of the body like face, chest and back. Acne results when the hair follicle becomes clogged with dead skin cells and sebum. There are several factors that could be responsible for acne. Genetics plays a role in the development of acne. If your parents had it you might also have it. Specific Hormones ( androgens) can also trigger the excessive production of sebum( oil) by stimulating the sebaceous gland to produce more sebum, this is often the case during puberty. Colonization of the sebaceous gland by bacteria called Cutibacterium (formerly called Propionibacterium ) could also be responsible for acne.

Certain medications (e.g corticosteroids) can worsen acne. Certain Diets ( chocolates, carbohydrate-rich foods, skimmed milk) can aggrevate acne. Stress and some environmental factors may also contribute to worsening it. Please note that acne is not caused because your skin is dirty.

Some non-pharmacological remedies that can help get rid of acne – washing the face with mild soap and water at least twice daily, avoid scrubbing the face this irritates the face, avoid oil-based cosmetics, ensure you keep your hands off the acne because touching or picking it can trigger more acne and cause scarring too.

Acne treatment is aimed at reducing the severity, recurrence of skin lesion as well as improve appearance. The treatment plan is designed based on the severity and underlying pathophysiology. Topical creams are used for mild acne. Antimicrobial creams (like erythromycin cream, clindamycin cream) which can be used in combination with benzoyl peroxide creams or retinoid creams are creams of choice. For moderate to severe acne oral therapy are added. Antibiotics, isotretinoin, anti-androgenic drugs and combined oral contraceptives are drug choices.

Nappy Rash

Most mothers usually get worried when they discover that their babies develop a rash on the buttocks. The nappy rash occurs in most babies regardless of the care given to the child’s buttock. It’s so much of a concern because of the discomfort it brings to the child. A nappy rash usually results when a child wears a wet or dirty nappy for too long.

It is a skin condition that results in visible red and a sore rash around the nappy area- the buttocks, genitals, and sometimes on the thighs.

Common causes of diaper rash include the following: irritation from stool and urine due to prolonged skin contact with a wet diaper, skin reaction from a new product(new brand of diaper, baby lotion, baby powder, wipes), bacterial or yeast infection. The covering of the buttocks/genital area with a diaper makes the region susceptible to bacteria or yeast. Also, antibiotics misuse also kills the healthy bacteria in the body creating an imbalance between the good and bad bacteria thus encouraging yeast growth which increases the risk of diaper rash.

One way to prevent or treat diaper rash is to change the baby’s diaper more frequently ensuring that the nappy area is clean and dry at all times. Once, it is noticed that it is soiled, the diaper should be changed immediately. Petroleum jelly could be applied before wearing a new diaper. Tight-fitting diapers should not be used as this would not encourage proper airflow. Sometimes, allow the child to go without a diaper to promote air entry to that area.

In a situation where the nappy rash is a result of reaction from a new product, such products can be easily discontinued. The rash resolves after some days. An anti-inflammatory and antifungal cream can be recommended to be applied on the affected area to clear the rash off. Protective barrier creams like petroleum jelly, castor oil help keep the skin in good condition.
Seek medical help if the condition worsens.

Osteoarthritis

I guess we know what a joint in the body is? A joint is a connection made between two bones in the body creating a link in the skeletal system to function as a whole, thus permitting easy movement in different degrees. The hips, elbow, knee, wrist are examples of joints. The joint is comprised of cartilage, synovial membrane, and fluid, tendon, etc playing several important roles to aid joint movement.

Osteoarthritis is one of the most common types of arthritis. It is a degenerative joint disease. It commonly affects joints of the knee, hip, hand, and spine.

The cartilage is a firm, smooth and slippery tissue that helps to cushion the ends to the bone to ensure a frictionless joint motion. Over time, the cartilage begins to degenerate and eventually becomes worn out causing the two bones to rub on each other resulting in pain and inflammation. As one age, the makeup of the cartilage degenerates and gradually becomes Lost at old age, causing friction between two bones leading to pain and decreased joint mobility. The body tries to repair this damage, surrounding tissues becomes more active trying to compensate for the loss of the cartilage. The repair process, in the long run, causes more damage to the joint, it changes the joint structure and causes an increase in symptoms of pain, swelling, and joint mobility.

Obesity, trauma, gout, certain metabolic disease like diabetes, and hemochromatosis (iron overload), congenital abnormalities could be other causes of osteoarthritis. Overweight people are at risk of developing osteoarthritis of the knee. Obesity increases mechanical stress on the cartilage.

Approach to management would include both Non-Pharmacotherapy and Pharmacotherapy measures. Exercise, physical and occupational therapy, and weight loss are some Non- Pharmacological approaches. Topical and oral Nonsteroidal anti-inflammatory agents can help relieve pain and inflammation associated with osteoarthritis. Supplements like glucosamine, chondroitin can also be taken to reduce symptoms. Surgery could be recommended in cases were patient fails to respond to a medical management plan.

Halitosis

HALITOSIS

Have you ever sat close to someone in a vehicle and the moment the person opened the mouth to talk the whole atmosphere became polluted? You are sure the person must have brushed the teeth that morning because he looked well dressed and had a good body smell cause you could perceive he used a good perfume but yet you surprised why the mouth smells so bad.

Halitosis ( bad breath) is a term used to describe any disagreeable bad and unpleasant smell that emanates from the mouth breath. It can occur amongst any age group whether young or old. Sometimes it’s just the individual that can perceive that his mouth has odor but in other cases, others can easily detect that the other party has mouth odor. Bad breath may result from the build-up of bacteria in the mouth.

Halitosis can result from poor dental hygiene. When we do not brush our teeth regularly, we notice that food particles get trapped in the teeth giving room for bacteria to dwell. The combination of trapped decayed food particles and bacteria in the mouth result in an unpleasant smell. The plagues build up causing periodontal diseases that would affect the mouth health. The bacteria now have extra spaces to hide in the mouth beyond the reach of the toothbrush or floss, contributing to halitosis. Some food we eat might also be responsible for halitosis. Onions, garlic, and beverages like coffee contribute to mouth odor. Alcoholics and smokers( tobacco) would also develop halitosis.

There are also other underlying conditions that might contribute to halitosis. Decrease salivary flow resulting in dry mouth can cause halitosis. Certain drugs and salivary gland disease can be responsible for causing dry mouth. Patients with sinus, mouth, or throat conditions can have a mouth odor. Medical conditions like Gastroesophageal reflux disease (GERD) kidney, liver, and diabetes can cause bad breath. Oral cancer, tooth extraction, ulceration, prosthetics are other oral factors that can contribute to halitosis.

Practicing good oral hygiene is the first therapy for halitosis. Brush with a fluoride-containing toothpaste at least twice daily- morning and at bedtime, do not forget to brush the tongue too. Brushing the teeth after every meal is also advised. Dental flossing would help to remove plaque stuck between the teeth. Rinsing the mouth with a good antibacterial mouthwash is recommended. The toothbrush should be changed every 3 months.

Drink plenty of fluid. This would help keep the mouth moist. Chewing gum can help stimulate saliva production. Saliva would assist to wash away food and bacteria. Smoking and alcohol should be avoided.

Visit the dentist regularly to have your teeth examined and professionally cleaned, this way any oral health issue can be easily detected and treated.

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Prescription Drug Abuse

There are some drugs that can be easily sold to a patient without a prescription while some others can only be dispensed to a patient who has a valid prescription. Prescription medicine has the tendency to be misused /abused and might result in severe consequences that may be hazardous to health. Prescription drug abuse is simply described as the usage of prescription drugs for purposes other than what they were prescribed for use.

These prescription drugs are prescribed to manage certain clinical conditions. Pentazocine, morphine, tramadol, codeine are opioids prescribed to treat moderate to severe pain. They could be given as post-surgery medication to help ease the excruciating pain that results from surgery. Dry cough can be suppressed using codeine. Another drug class that has the potential of being abused is Benzodiazepines (e.g diazepam) which are used as anti-anxiety drugs and in patients experiencing sleeplessness. Barbiturates are Central Nervous System depressants found to be used as an anesthesia and to treat seizures. CNS stimulants like amphetamine gives the body a great boost in attentiveness, alertness, and energy, they are clinically used to manage sleep disorder, attention-deficit hyperactivity disorder, obesity. These drugs would in certain ways interact with the body systems especially the central nervous system( brain) stimulating the increase of specific brain chemicals which are responsible for the drug actions and overtime plays a role in addiction. The brain is structured in a way that it saves the memory of the ‘pleasure’ derived from these drugs and over time there is an increased craving for such drugs to sustain that feeling.

SYMPTOMS/SIGNS OF PRESCRIPTION DRUG USE

OPIOIDS- constipation, nausea, feeling high, slowed breathing, drowsiness, e.t.c.

CNS DEPRESSANTS- drowsiness, slurred speech, reduced concentration, memory problem, slow breathing.

CNS STIMULANTS- alertness, reduced appetite, insomnia, anxiety

Long term use of these drugs can lead to addiction and may also cause some serious medical conditions like hypertension, lung disease, and mental diseases. Opioids abuse, for example, would decrease the patient’s blood pressure, slow the breathing rate which leads to coma and eventually lead to death. Seizures, high blood pressure, hallucination aggressiveness are associated with CNS stimulant abuse

One of the ways to prevent drug abuse is to create awareness. The Public should be aware of the dangers associated with drug abuse. Prescribers should closely monitor their patients who are on medications that are highly addictive. These drugs should only be used when necessary and prescribed at the lowest possible dose and to be used within the shortest possible time. The pharmacist dispensing these medications should only dispense them to people with valid doctor’s prescriptions in the exact quantity prescribed.

Migraine

We hear some people ascribe every headache as a migraine but this is often not always true, not every headache is a migraine headache. Migraine is just a type of headache. There are several other types of headaches; tension headache, cluster headache, a thunderclap headache, e.t.c. A headache can occur at any part on the head, the ache could be one sided or on both sides of the head. A headache could result from stress or emotional distress, sometimes it could be a symptom of an underlying medical condition e.g hypertension, glaucoma.

Migraine usually occurs on one side of the head, it is a very severe throbbing pain in the head often accompanied by extreme sensitivity to light and sound, nausea, and vomiting. The symptoms can last for some time, if untreated, the pain becomes more severe and could interfere with daily activities. Some people can have migraines much more frequently than some others, it’s reoccurrence varies in individuals.

There are no known causes of migraines, it could be linked with changes in the brain or it could be hereditary. There could be possible triggers of migraine, some of which includes fluctuations in estrogen levels in women, drinks( alcohol, coffee), stress, changes in sleep pattern, medications ( oral contraceptives, nitroglycerin), food and food additives (processed foods, aspartame), e.t.c.

The treatment for migraine is usually aimed at dealing with the symptoms and preventing future recurrence. Pain-relieving drugs like diclofenac, aspirin, ibuprofen, e.t.c, Triptans e.g. sumatriptan, Dihydroergotamine, and anti-nausea drugs are drug choices used for the treatment of migraines. Antidepressants like amitriptyline are used to prevent future attacks.

Patients are usually advised to take note of their possible triggers and try to avoid them. Plenty of fluids and exercising is recommended. As a home remedy, patients starting to experience pain should try taking a nap in a dark room, an ice pack can be placed on the forehead, this would help to soothe the pain.