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NAEGLERIA FOWLERI AND IT’S UNEXPECTED OUTBREAK IN PAKISTAN

Posted on August 26, 2021 by Dsharf

Recently, cases of brain-eating amoeba; Naegleria fowleri have been reported in
Karachi. This is an alarming point for all the authorities as this infection can
prove to be fatal. In Karachi, two cases have been reported so far, one in
mid-May and another one in the first week of June. Both of the victims have no
record of recreational swimming in lakes, rivers, etc. It has been reported that
both of them contracted the parasite during ablution; ritual purification in
Islamic practices that one does before offering the obligatory prayers. The
first-ever case of infection from N.fowleri in Pakistan was reported in Karachi
in 2008. So far, 146 cases have been reported of infection due to this parasite
and the susceptible age group is 26-45 years old.

Naegleria fowleri is a free-living microscopic amoeba. This amoeba is
responsible for causing Primary Amoebic Meningoencephalitis commonly known as
PAM. It is fatal in 98% of the cases that have been reported so far in history.
This amoeba can survive in warm water as hot as 113 Fahrenheit. This amoeba was
first identified in Australia in 1965 but its evolution has occurred in the
United States. It has 20 strains and the one in Karachi can survive in saline
water.

It enters from the nose and from here the parasite travels up to the brain, it
is said that it has been attracted to chemicals in the brain. Where it releases
two proteases enzymes that end up eating the brain. Infection from Naegleria
fowleri does not occur by just drinking water, which means the only way it can
enter the body and can go to the brain is through the nose. Symptoms of PAM
start to occur within 1-7 days and they include headache, nausea, vomiting. In
the worst scenarios, the disease can progress due to the amoeba’s brain-eating
properties and can cause symptoms related to the Central Nervous System such as
hallucinations, seizures, lack of balance, unconsciousness, etc.

A person gets contracted with this due to uncontaminated water, which mainly
occurs due to the lack of sanitation practices and lethargy of the sanitation
board. Furthermore, due to chemical pollution contamination can also occur that
arises from the waste of industries, etc.

Prevention mostly includes not swimming in freshwater or do not mess with the
sediment.

Nagleria fowleri

The situation in Karachi is particularly not good as around 91% of water is
unfit for drinking purposes in Karachi. Furthermore in Pakistan drinking water
is not available to everyone, the majority of the remote areas have a shortage
of fresh water and due to that, they become victims of several water-borne
diseases such as Cholera, Typhoid, Giardiasis, etc. According to research 20% of
the population has access to safe drinking water and the remaining 80% continues
to survive on unfit water.

We need new regulations and rules for boards to ensure a safe water supply to
the population . In this regard, the already existing water plants should work
effectively and new water plants with upgraded practices should be built.


Posted in UncategorizedLeave a comment


CLINICAL TRIALS AND PHASES

Posted on August 21, 2021 by Dsharf

We have often come across terms like, “Phase 1 trials”, “Phase 2 trials”, etc.
and it confuses us what these phases are and what significance these phases
hold. Let us discuss a short account of these phases so next time we do not get
confused about them.

Firstly, discussing clinical trials, to test a drug or any product that may
assist in better health to human it undergoes particular trials to make that
drug perfect for use in humans. It has 5 phases,

 1. 0 phase
 2. phase I
 3. phase II
 4. phase III
 5. phase IV

0 Phase

In this phase small dose of medication is used in individuals of 15 in number,
from here we go to the higher concentration of the medication and in larger
groups of people. Any unexpected result here will cause further investigation in
pre-clinical trials.

Phase I

Here dosing and route of administration are observed and tested. The highest
dose a human can take without seeing further side effects of that drug on the
body. Moreover, here 20 to 80 people are involved.

Phase II

Here a larger number of partcipants are involved and the results of drugs are
observed in them. It may take one year or more. The testing is done on
information obtained from the previous phase.

Phase III

Here around 3000 participants are involved and the sole purpose of this phase is
to check how effective is the new drug as compared to the existing drugs. This
phase is double-blind where neither the investigator nor the participant knows
which drug is being used. Results of Phase III trials are necessary for FDA
approval.

Phase IV

This phase is started after FDA approval and the effects of the drug in the
general population are observed. This is also called as a post-approval phase.


Posted in DRUGSLeave a comment


SHORT ACCOUNT ON THE NEW DRUG FOR ALZHEIMER

Posted on August 17, 2021August 17, 2021 by Dsharf

Alzheimer’s disease is the most common type of dementia. It is a progressive
disease beginning with mild memory loss and possibly leading to loss of the
ability to carry on a conversation and respond to the environment. Alzheimer’s
disease involves parts of the brain that control thought, memory, and language,
It can seriously affect a person’s ability to carry out daily activities.

Recently, a new drug has been approved for the treatment of Alzheimer, the name
is Aduhelm and scientifically known as Aducanumab. It can reduce the chances of
plaques in brain and can prevent changes in the brain. We will discuss the
pharmacology of this new drug.

MECHANISM OF ACTION

Aducanumab is a monoclonal antibody (a protein that helps your immune system
target other proteins), and it is designed to help your body remove something
called amyloid beta from the brain. Amyloid beta is an important protein
involved in the progression of Alzheimer. Aducanumab is given intravenously
(infused through a vein) monthly. Aducanumab does not cure Alzheimer’s disease,
but one (of two) large clinical studies suggests that aducanumab may slow the
progression of the earliest symptoms of Alzheimer’s disease.

PHARMACODYNAMICS

Aducanumab is a monoclonal IgG1 antibody that binds to amyloid-β, reducing
amyloid plaques in the brain. It has a long duration of action as it is given
once every 4 weeks.6 Patients should be counselled regarding the risk of amyloid
related imaging abnormalities, including microhemorrhages, and hypersensitivity
reactions.

ADVERSE EFFECTS/TOXICITY

There is no data available to specify the adverse effects of this new drug, in
case of toxicity we can say that patients experiencing dose-limiting toxicity
may present with amyloid-related imaging abnormalities including edema or
microhemorrhages of the brain.4 Symptoms of dose limiting toxicity were
generally transient, however patients may need to be treated with symptomatic
and supportive measures.

Posted in DRUGS, pharmacology, UncategorizedLeave a comment


THE FORGOTTEN ONES; MUHAMMAD IBN ZAKARIYA AL-RAZI

Posted on August 14, 2021August 14, 2021 by Dsharf

Born in 854 CE this Persian polymath largely swayed the world of Islamic
medicine and so western medicine. Using his observations and experimental
medicine he became a successful doctor and served as a Chief in the hospitals of
Baghdad and Ray. The first to write up limited or extensive notes on diseases
such as Smallpox and Chicken pox , a pioneer in ophthalmology, author of the
first book on pediatrics, making leading contributions in inorganic and organic
chemistry, also the author of several philosophical works.

According to Encyclopedia Britannica, it was Al-Razi who first discussed the
symptoms, pathology by fermentation theory, and directions for the treatment of
Smallpox. His book Al-Judari Wa Al-Hasbah clearly distinguishes Smallpox and
measles.

Al-Rāzī’s two most significant medical works are the Kitab Al-Mansuri, which he
composed for the Rayy ruler Manṣūr ibn Ishaq and which became well known in the
West in Gerard of Cremona’s 12th-century Latin translation, and Kitab al-Hawi,
 the “Comprehensive Book,” in which he surveyed Greek, Syrian, and early Arabic
medicine as well as some Indian medical knowledge. Throughout his works, he
added his considered judgment and his own medical experience as commentary. 

In Pharmacy he made many contributions, widely used apparatuses such as spatula,
mortar, pestle, etc. are his contributions. He also showed his doubts towards
Galen. Moreover, he devotedly worked in his field without showing any
discrimination in the rich or poor patients. He used to say, ‘ The doctor’s aim
is to do good, even to our enemies, so much more to our friends, and my
profession forbids us to do harm to our kindred, as it is instituted for the
benefit and welfare of the human race, and God imposed on physicians the oath
not to compose mortiferous remedies. ‘

Al-Razi’s books are as following

 1. Al- Hawi, an extensive encyclopedia
 2. Isbate Elime Pezeshki ( Proving the science of the medicine )
 3. Dar Amadi bar Elime Pezeshki ( An introduction to the science of the
    medicine )
 4. Kenash
 5. The book on menstrual cycle
 6. There are many other books and works of Al-Razi but his contributions in
    medical field are only limited to these and other notable works.

As mentioned by Edward Brownie, a renowned Iranologist,

Probably the greatest and most original of all the Muslim physicians, and one of
the most prolific as an author.

Posted in UncategorizedLeave a comment


VARIANTS OF COVID-19

Posted on August 12, 2021 by Dsharf

In the past one and half year a novel virus took over the world with its wrath
and severity, the mankind endeavored to contain it, prevent minimal damage but
all in vain to some extent. With an extremely short period of time it came with
vaccines that proved successful and gave a ray of hope to the mankind stuck in
the darkness of dismay and despair. But this virus did not succumb and pledged
to come back with greater severity, virulence. Now, this virus ( SARS-CoV-2) has
variants particularly due to mutation and keep frightening the mankind.

The variants of COVID-19 have been classified according to their prevalence,
symptoms, and treatment.

There are four variants by now,

 1. Alpha variant
 2. Beta variant
 3. Gamma variant
 4. Delta variant

Alpha Variant/ B.1.1.7

First identified in United Kingdom, this variant spreads quickly than other
variants and is capable of inducing severe symptoms and can cause death.
Currently, authorized vaccines and treatments are effective against it.

Beta Variant/ B.1.351

This variant was first identified in South Africa, it may spread faster than
other variants. Currently, no data is available to show that it causes severe
symptoms or can cause death easily. Authorized vaccines can work against it and
in treatment all approved treatments are effective excluding monoclonal antibody
treatment that is proved to be less effective.

Gamma Variant/ P.1

This variant was first identified in Japan/Brazil. It also spreads at a fast
rate and less data is available for its ability to cause potential symptoms.
Already authorized vaccines and treatments are effective against it.

Delta Variant/ B.1.617.2

This variant was first identified in India and currently causing great menace
all over the world. It spreads faster and may cause severe illness and can lead
to death. However, preliminary evidence suggests that fully vaccinated people
who do become infected with the Delta variant can spread the virus to
others. All other approved effective vaccines can work against it, yesterday the
Health Minister of Russia stated that Sputnik V has an overall effectiveness of
83% against it.

Posted in COVID 19Leave a comment


MY SECOND YEAR AT PHARMACY SCHOOL

Posted on August 4, 2021 by Dsharf

When I started my university life back in 2019 the only certain thing I knew was
of facing consistent changes, the changes that I have to accept unwillingly, and
the changes that I have to resist with my full might. The second year was
different from the first one, here I confronted many challenges other than
academics. From mental health to thinking about the future every possible
thought came here.

As the profound maxim says, “Every difficulty is an opportunity towards a
success story” in the same we have to confront challenges because they are there
to strengthen us not to weaken us and if you are afraid of them or running away
from them then it’s your misery.

I am dividing the second year into 3 phases; the winter, the spring, and the
summer. Secondly, I’ll be presenting a brief account of what I faced in these
phases and how I tackled them.

The winter

Winter was the start of the second year here everything was smooth and favorable
for few weeks until I passed by the notion of not standing still and that the
journey hasn’t ended yet. The primary problem here was how to muster up your
courage to reiterate after losing almost everything. Well, sometimes it is all
about gambling things and taking risks. In my perspective, things become way
easier when you have faced failures. Because at that time you perceive that you
are nothing and you have nothing to live for and that time you come to the
turning point of striking back. Because you have nothing to lose but if you win
then the world is yours.

Sometimes setbacks and failures are inevitable and fated, not to weaken you but
to give you courage and give you discernment of everything that is volatile.

I did the same here, gambling was the last option. It was not surely sufficient
I needed more to get back and then came positivity!

Positivity is that weapon that has helped man to win more battles than anything
else. Many battles have been won by these two things; gambling big and
positivity and so here it summarizes how to muster up your courage to come back
in the worst of your circumstances. I used these two things and conquered the
worst of happenings.

This ends my winter phase, in short,  it was all about how to get back, this
phase didn’t focus on how to get back stronger but how to get back!

The spring

Spring was different and more dilemmatic than any other phase, in the prior
phase I endeavored to get back but here the main concerns were of staying,
keeping myself motivated, and how to avoid distractions. This phase passed with
VLE or online system and so like other students, it became very difficult to
maintain everything, stay focused, and remain productive.

It is a human instinct that sometimes proves to be fatal that a person totally
loosens himself after the acquisition of a particular goal, and so it happened
to me. I somehow slacked at the beginning of the second phase and so it
concerned me how to get motivated and how to avoid distractions, and how to stay
here. Then after gambling big, positivity there came the not abandoning yourself
factor or commitment with one’s self. This matters a lot and this is that sole
entity that helps you to stay focused on your goals.

This factor matters, from a broader perspective we can say that this whole
system is committed to itself, everything is committed to its assigned role. The
sun, the moon, the plants, the animals, the microbes, everyone has a role and
everyone is sincere with that role. This is what comes first before any
execution of a plan, if there is no commitment with a plan then everything is
futile and volatile even hard work fails here. Everything starts with this
commitment factor and once a man learns not to abandon himself then everything
becomes easier for him, he starts to engross himself with different sorts of
activities and in the end manages to excel in it. So, once it starts planning
comes there, smart work comes there, and so on. And so I did every possible step
of not abandoning myself, going into an extensive explanation we can say I
started giving myself two hours per day for my studies, 2 hours for whole social
media activities, not missing any class even though the 70% of the semester
passed with the online system. Preparing for every quiz, assignment, exam, class
activity, and such other things that are missed by or slackened by the majority
of the students in this online system. Keeping everything within the limits and
not exceeding them and above all avoiding procrastination as procrastination is
the second step to destruction, oversleeping remains the first one as
procrastination arises for oversleeping, and destruction arises from
procrastination. Apart from dealing with academic problems this factor also
plays a focal role in the practical life where you have to cope with many things
at a moment such as job, family, relationship, etc. Therefore, grasping this
factor is a pivotal thing as it all starts with you.

The Summer

This phase was a blend and testimony of the above-mentioned phases, it was a
phase when the above-mentioned things were needed. Here the major concern was
for a solid plan, after mustering up the courage to come again with the gambling
big and positivity, and further paving the way with the commitment factor, the
final and the last thing required was a plan.

As the maxim says, “all is well when the plans are well.”

So, here the main apprehension was the need of a solid plan or calculations, I
want to say this factor is the last but it is the most essential thing as any
error in it can lead to a troublesome happening. The question that surfaces here
is how to get a solid plan? Well as step by step one walks far, if you have
completed the above-mentioned steps then it surely becomes easier for you to
complete this one and the momentous step.

Speaking with my example, I started earlier this time so limited efforts can be
given and commitment with the least time can be shown.

As mentioned earlier when you have covered and struggled through other factors
this factor becomes easy as 60% of the work has been done beforehand, explaining
further that your sheer commitment will aid you to get to a solid plan.

And once all these things gather the results are adequate for the validation!

This ends all the 3 phases and how I tackled those problems.

In the end, I want to conclude with the ayah,

YOUR LORD HAS NEITHER FORSAKEN YOU, NOR IS HE DISPLEASED WITH YOU [93:3]

Posted in UncategorizedLeave a comment


A SHORT LOOK ON PASTEUR’S WORKS

Posted on June 6, 2021 by Dsharf

Many people are familiar with the name Louis Pasteur, this man alone made
several breakthroughs and contributed more than a single person to science and
humanity. Today we will take a short look at his works.

Vaccines

Pasteur contributed to the ultimate extent in the field of vaccination. He first
developed the Cholera vaccine in 1880 when he forgot his culture. Later on, he
developed Anthrax and Rabies vaccine. In 1885 he inoculated a nine-year old boy
with rabies and helped him and humanity to recover from these diseases.

Fermentation

Pasteur worked on fermentation in the 1850s and learned many aspects of
fermentation and the causes that compel milk to sour. In 1857 he presented that
all microorganisms cause fermentation and specific types of microorganisms cause
a specific type of fermentation.

Pasteurization

Associated with his name Pasteur saved the brewing industry of France with this
process. He helped in preserving the quality of beer, wine, etc. with it. Later
on, this process was used to kill microbes like M.tuberculosis in milk.

Germ Theory

Pasteur’s work on Pasteurization and Fermentation led to a more clear
understanding of Germ Theory and how microbes from outside the body are
responsible for causing diseases. Therefore, a strong sense of cleaning and
sterilizing the medical instruments developed from here.

Spontaneous Generation

Pasteur disapproved of Spontaneous generation by conducting his experiment where
he trapped the dust particles along with microbes in the neck of the swan-necked
Pasteur flask and noted no growth in the broth. When he titled the flask cloudy
turbidity was observed in the broth leading to the conclusion that microbes are
with dust particles and living creatures can not arise from non-living
creatures. He subsequently stated that life comes from life.

Posted in UncategorizedLeave a comment


THE FORGOTTEN ONES: ERNEST DUCHESNE

Posted on June 5, 2021June 5, 2021 by Dsharf

Whenever we discuss Penicillin the name that comes to our mind in the first blow
is Alexander Fleming after that there comes Ernst Boris Chain and Howard Florey
who purified Penicillin. But less is known about a young brat; Ernest Duchesne.

Though less is known about his early life, the record states that he in 1894
entered the Military Medical School of Lyon. He started his thesis work, ”
Contribution to the study of vital competition in micro-organisms: antagonism
between molds and microbes .” He submitted his thesis in 1897 to get his medical
degree and then went for a one-year residency.

But from where it all started? During his thesis, Duchesne took tap water and
added P. glaucum in it, the mold died in it. He did it again and again and the
results were the same. This time, he added the bacteria found in tap water such
as S.typhi or E.coli in the culture and in the same culture the mold was
inoculated. The results were still the same. The mold kept on dying. He then
performed his experiment on guinea pigs and concluded that P.glaucum somehow was
able to alter the virulence of the bacteria to an extent where it could not be
lethal. When he injected the animal with P.glaucum the animal got cured of the
disease it was suffering. The same conclusion was given by Fleming after 35
years!

Now the question arises, why he was not given the credit for this? There are two
possible reasons, actually, Duchesne used P.glaucum that produces patulin which
is less effective or we can say has less antibiotic properties, whereas Fleming
used P.notatum which produces penicillin and has good antibiotic properties. He
was on the right path but was using the wrong mold. Only if he had remained
steadfast or endeavored more he would have reached to P.notatum too.

The second reason is that Duchesne was quite young at that time ( 23 years old )
that is why Pasteur institute did not take him seriously.

Furthermore, after getting his thesis he got promoted to various posts in the
military and worked there. Like his tragic fate with his experiment he also had
a tragic fate for the rest of his life. His wife died of Tuberculosis after 2
years of their marriage and he also in 1904 one year after his wife’s death got
infected with a pulmonary infection. For the next 8 years, he spent his life
going in and out of the sanatorium and did not find much time to think of his
thesis. Finally, in 1912, this person died without realizing that his little
thesis would become the greatest weapon for fighting bacteria.

He was posthumously honored in 1949 for his thesis.

Posted in UncategorizedLeave a comment


ALLERGY ITS TYPES AND MECHANISMS

Posted on May 29, 2021 by Dsharf

Allergy can be defined as ” An unwanted or altered reaction that takes in the
body due to foreign substances the response of the body is known as allergy. ”
In 1906 Von Pirquet was the first person to give this term, deriving from two
Greek words; Allos meaning other and Gens meaning reactions.

There are total four types of allergies,

 1. Type I hypersentivity/ Anaphylaxsis
 2. Type II hypersensitivity/ Cytotoxic
 3. Type III hypersensitivity/ Arthur’s reaction
 4. Type IV hypersensitivity/ cell-mediated allergy

In type I, the foreign substance enters the body and attaches to the surface of
mast cells, this leads to the release of IgE antibodies. On the second exposure
the antibody and antigen complex is formed which leads to the release of
anaphylactic mediators such as prostaglandins, leukotrienes etc. They cause
bronchoconstriction, fall in B.P., edema etc.

In type II, the same happens but this time the site of attack is the surface of
RBCs and the antibodies released are IgG and IgM. On second exposure the complex
causes cell death/lysis. If the lysis occurs in the RBC then it is hemolytic
anemia.

In type III we have IgM antibodies and the complex causes the inflammation of
the organs. Pneumonitis etc.

In type IV, the foreign substances sensitize the T-lymphocytes and macrophages,
on the second exposure the sensitized T-lymphocytes and macrophages cause the
release of lymphokinins. They also cause inflammation.

The mechanism involved in the first three types is the same, the antigens enter
the body and trigger the antibody production, these antibodies make
antigen-antibody complex. This also lead to bronchoconstriction, edema,
hemolytic edema, pneumonitis etc.

The mechanism for the fourth type is when the antigens enter the body, as they
are incomplete antigens they find themselves proteins to form complete antigens
and these complete antigens combine with the langerhan cells. The langerhan
cells want to get freedom from these antigens and then these antigens attach to
WBCs where lymphocytes are activated. The activated lymphocytes enter lymph node
and divide to form blast cells. There are two blast cells one stimulating cells
that on second exposure release lymphokinins and the other is memory cell.

Posted in UncategorizedLeave a comment


THE STORY OF BLACK FUNGUS, WHITE FUNGUS AND YELLOW FUNGUS IN INDIA

Posted on May 28, 2021 by Dsharf

With the surge in COVID-19 cases and the situation getting out of control, now
India is struck by another menace, that was first of Black fungus, later on,
White fungus joined and now Yellow fungus is also in the club. All three are
associated to affect those having a compromised or weakened immune system which
is the case with COVID-19. The secondary causes include overuse of steroids and
diabetes are leading these that occur after COVID-19.

Let’s explore all these individually,

Black fungus

Also known as Mucormycosis, caused by a group of molds called Mucormycetes. It
is a rare fungal disease but can be severe. According to the Centers for Disease
Control and Prevention (CDC) it occurs in patients who have weak immune systems
due to intake of medicines or have health problems. It affects the sinuses and
lungs after the spores are inhaled. The symptoms depend on the part of the body
where the fungus grows,

Symptoms of Rhinocerebral ( Sinus and Brain ) mucormycosis are one-sided facial
swelling, nasal or sinus congestion and headache etc. Symptoms of Pulmonary
mucormycosis are fever, cough, and chest pain, etc. Symptoms of gastrointestinal
mycormycosis are abdominal pain, nausea and vomiting, and gastrointestinal
bleeding. In case of developing Mucormycosis contact your health care provider
the drugs opted for its treatment are Amphotericin B, Posaconazole or
Isavuconazole.

Currently in India the Health Ministry has already declared this Black fungus as
an epidemic and India has record more than 11000 cases so far.

White fungus

White fungus comes from the Candida group. It also affects the people having
compromised or weakened immune systems. The disease itself is not contagious but
can affect the person. It spreads by molds. Symptoms include cough, fever,
diarrhea, pains, and swelling etc. It needs only anti-fungal medicines the
treatment is less expensive.

Yellow fungus

Of all infections, Yellow fungus can be proven fatal, because its symptoms begin
internally and they can delay the diagnosis. People with weakened immune system
or lung diseases tend to develop this. The symptoms include fever, chest
pain,cough, shortness of breath, in some cases headache etc.

So, basically after getting COVID-19 and recovering from it many people have a
weakened immune system due to the virus itself or the medications or they tend
to have lung damage with this susceptibility they are vulnerable to fungal
infections. The best thing now is to prescribe anti-fungal medicines after
recovering or during treatment.

Posted in COVID 19Leave a comment


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