Second hand smoke:

 More Presentations from Dr.Naina Mohamed Pakkir Maideen

¨  Second-hand smoke is a mixture of sidestream smoke (comes off a cigarette between puffs) and the smoke exhaled from the lungs of smokers.

¨  Fourty percent of nonsmokers are exposed to secondhand smoke.

¨  Second hand smoke may cause a wide range of adverse health effects, including:

o  Cancer (Sidestream smoke has higher concentrations of cancer-causing agents than mainstream smoke).

o  Asthma (Children of smoking parent (s) have a higher risk of developing asthma and allergies).

o  Respiratory infections

o  Reduced lung growth in children

o  Reductions in postnatal pulmonary function

o  Increased heart disease risk (Second hand smoke can damage the lining of blood vessels and increase the risk of heart diseases).

o  Low birth weight and weaker lungs in babies (Pregnant women exposed to second hand smoke can give birth to the baby with low birth weight and weaker lungs. Pregnant women should avoid exposure to environmental smoke).

o  Chronic otitis media

¨  Smoking family members should be advised to quit smoking and do everything possible to minimize environmental smoke exposure to the children around them.

Smoking and its health risks:

More Presentations from Dr.Naina Mohamed Pakkir Maideen

©  Tobacco smoke contains about 4800 compounds.

©  The chemicals found in tobacco smoke, are harmful to both smokers and nonsmokers.

©  About 69 carcinogens (Cancer producing agents) are identified in tobacco smoke.

©  Tobacco smoke increases the risk of…

o  Cardiovascular disease (including Myocardial infarction (Heart Attack) and sudden death)

o  Cerebrovascular disease (Stroke)

o  Peripheral vascular disease (Claudication, etc)

o  Chronic obstructive pulmonary disease (COPD)

o  Asthma

o  Cancers at many sites, including the lung, larynx, oral cavity, esophagus, bladder, kidney, pancreas, and uterine cervix.

o  Reduced Fertility

©  Smoking promotes atherosclerosis of blood vessels supplying heart, brain and lower limb leading to CVD, Stroke and Claudication respectively.

©  Tobacco smoke induces formation of epoxides leading to genetic mutation and cancerous production of cells.

©  Carbon monoxide and Cyanide present in tobacco smoke cause chronic inflammation and narrowing of the small airways leading to pulmonary damage.

©  Erectile dysfunction is occurred in tobacco smokers due to narrowing of blood vessels supplying the penis.

©  Nicotine and other harmful chemicals found in tobacco smoke, interfere with estrogen production leading to disrupted ovulation and female infertility.

©  Smoking during pregnancy results in to low birth weight due to intrauterine growth retardation (IUGR).

©  Reduced immunity is occurred due to tobacco smoke containing nicotine which increases CD4+ cell production.

©   Smoking also increases the risk of chronic kidney disease, diabetic nephropathy, postmenopausal osteoporosis and fracture, peptic ulcer disease, sensorineural hearing loss, gradual loss of eyesight, cataracts, skin wrinkling, staining of teeth and gums, periodontal disease, acid taste in the mouth, sprains and fractures, headaches, sinusitis, multiple sclerosis, chronic low back pain and degenerative disk disease. 

A New Class of Drugs to treat Type 2 Diabetes:

More presentations from Dr.Naina Mohamed Pakkir Maideen

SGLT2 Inhibitors (Gliflozins):

©  Sodium-Glucose Linked Transporter 2 (SGLT2) inhibitors such as Dapagliflozin (Farxiga), Canagliflozin (Invokana) and Empagliflozin (Jardiance) are a new class of oral drugs available to treat type 2 diabetes mellitus (Type 2 DM).

©  Dapagliflozin is the first drug to be developed, but got FDA approval by 8^th Jan 2014.

©  Canagliflozin is the first drug to be approved by FDA which got the approval by 29^th Mar 2013.

©  Empagliflozin got the FDA approval by 1^st Aug 2014.

©  Gliflozins inhibit SGLT2 transoporter at Proximal Convoluted tubule and prevent the reabsorption of glucose which can lead to glycosuria and reduction of blood glucose levels.

©  Through glycosuria, SGLT2 inhibitors induce net calorie loss of approximately 200–300 kilocalories per day which can cause beneficial effect of weight loss.

©  SGLT2 inhibitors induced glycosuria, also cause dehydration which could lead to reduction of blood pressure.

©  Common adverse effects of SGLT2 inhibitors include urinary tract infections and female genital fungal infections might be caused by glycosuria.

©  Increased urination, rapid weight loss and tiredness may also be caused by glycosuria.

©  SGLT2 inhibitors induced hypotension can result in dizziness and/or fainting and a decline in renal function.

©  SGLT2 inhibitors should not be used in patients with Type 1 Diabetes, Diabetic ketoacidosis, Severe renal impairment, End stage renal disease and Dialysis patients.

©  The risk of Hypotensive reactions (Dizziness, fainting, etc.) possibly increased by the concomitant use of SGLT2 inhibitors and Diuretics.

Harmful Health Effects of Tobacco consumption:

More presentations from Dr.Naina Mohamed Pakkir Maideen

§  Tobacco consumption can cause various illnesses and premature death.

§  Tobacco is consumed either as Smokeless Tobacco (Chewing Tobacco, Snuff, Creamy Snuffs, Dipping Tobaccos, Gutka and Snus) or Burned Tobacco (Cigarette Smoking, Cigar Smoking, Beedi (Bidi) smoking, Kreteks and Hookah).

§   Consumption of smokeless tobacco may cause various types of cancers (Mouth, tongue, throat, esophagus, stomach and Pancreatic cancer), Heart diseases, Leukoplakia, Receding gums, Bone loss around the roots of the teeth, Abrasion of teeth, Tooth loss, Stained and discolored teeth and Bad breath.

§  Burned tobacco (Tobacco smoking) can increase the risk of Myocardial Infarction (Heart Attack), Stroke, Peripheral Vascular Disease (PVD), chronic obstructive pulmonary disease (COPD), Asthma, Cancers of lung, larynx, oral cavity, esophagus, bladder, kidney, pancreas, and uterine cervix and Impotence.

Fluoroquinolones associated “Photogenotoxicity”:

 Dr.Naina Mohamed Pakkir Maideen

¨  High doses of Fluoroquinolones can bind to DNA directly and cause DNA damage by inhibiting topoisomerase IIα activity.

¨  In presence of Ultraviolet A (UVA) radiation, Fluoroquinolones cause DNA oxidation & topoisomerase IIα inhibition which may lead to DNA damage.

¨  Patients should be warned to avoid exposure to direct sunlight or UV light during treatment and until 36 hours after the discontinuation of treatment, because of the risk of Photogenotoxicity.

¨  Due to severe side effects of Fluoroquinolones, they are not used for regular treatment of bacterial infections.

Fluoroquinolones associated “Tendinopathy”:

 Dr.Naina Mohamed Pakkir Maideen

ª  Fluoroquinolones may cause tendinopathies such as tendinitis and tendon rupture of Achilles tendon and also other tendons like rotator cuff (the shoulder), the hand, the biceps, and the thumb.

ª  According to FDA, patients should stop taking fluoroquinolone at the first sign of tendon pain, swelling, or inflammation.

ª  Due to the chelating properties, Fluoroquinolones may form complex with several metal ions (e.g., calcium, magnesium, aluminum) and cause direct toxicity to type 1 collagen synthesis which leads to collagen degradation.

ª  Fluoroquinolones may also interact with regulating proteins of tenocytes because of their Chelating properties to damage the tendon structure.

ª  By Chelating with magnesium in joint cartilage, Fluoroquinolones may induce irreversible cartilage lesions.

ª  Fluoroquinolones associated Tendinopathy could be managed by taking rest, decreasing the physical load on the tendon and initiating physical therapy.

ª  Most Fluoroquinolones are contraindicated in children and during pregnancy and lactation, due to possible damage to juvenile weight-bearing joints by FQs.

ª  Fluoroquinolones associated Tendon rupture could be prevented or reduced by appropriate use of a fluoroquinolone, patient selection, and careful monitoring. 

Flouroquinolones associated “Permanent Nerve Damage”:

 Dr.Naina Mohamed Pakkir Maideen

©  Fluoroquinolones like Levofloxacin, Ciprofloxacin, Moxifloxacin, Norfloxacin, Ofloxacin and Gemifloxacin may induce serious nerve damage which might be permanent.

©  Fluoroquinolones induced peripheral neuropathy may include symptoms in arms and legs such as dysesthesia (pain), burning, paresthesia (tingling), hypoesthesia (numbness), weakness and other sensorimotor problems. 

¨  Due to severe side effects of Fluoroquinolones, they are not used for regular treatment of bacterial infections.

©  Fluoroquinolones may cause Peripheral neuropathy by inducing axonal degeneration with secondary breakdown of the myelin sheath, or more rarely primary segmental demyelinisation

©  If a patient develops symptoms of peripheral neuropathy, the fluoroquinolone should be stopped, and the patient should be switched to another, non-fluoroquinolone antibacterial drug, unless the benefit of continued treatment with a fluoroquinolone outweighs the risk.

Diabetes and Fasting:

 Dr.Naina Mohamed Pakkir Maideen

ª  The risks associated with Fasting in Diabetes patients include…

Ø Hypoglycemia

Ø Hyperglycemia

Ø Diabetic Ketoacidosis

Ø Dehydration

Ø Thrombosis

ª   The healthcare professionals should be aware of potential risks associated with fasting in diabetics and appropriate measures to mitigate those risks.

ª   The diabetics should undergo Pre-Ramadan medical assessment 1-2 months before Ramadan.

ª   During assessment, the diabetics should be informed about the risks associated with Fasting, advice to monitor them and changes in diet or medication regimen.

ª   Ramadan-focused structured education should be targeted both the healthcare professionals and the diabetics.

ª   The healthcare professionals should be trained to achieve safer fasting in diabetics. The education program should include informations on basics of “Diabetes and Fasting” such as

Ø Glucose monitoring

Ø Meal planning to avoid hypoglycemia and dehydration

Ø Meal choices to avoid postprandial hyperglycemia

Ø Timing and intensity of physical activity during fasting

Ø Use of diabetes-related medications and their potential risk during fasting

FDA's warning against “Toxin Discharged Tea”:

More Presentations from Dr.Naina Mohamed Pakkir Maideen

§  On 17^th June 2014, the Food and Drug Administration (FDA) is advising consumers not to purchase or use “Toxin Discharged Tea”.

§  Toxin Discharged Tea is a product promoted and sold for weight loss on various websites and in some retail stores.

§   FDA laboratory analysis confirmed that “Toxin Discharged Tea” contains Fluoxetine.

§  Fluoxetine is a Selective Serotonin Reuptake Inhibitor (SSRI) and is approved to treat depression, bulimia, obsessive-compulsive disorder (OCD), panic disorder, and premenstrual dysphonic disorder (PMDD).

§  SSRIs including Fluoxetine are not approved by the U.S. Food and Drug Administration (FDA) for weight loss.

§  Due to the content of Fluoxetine, Toxin Discharged Tea may cause some serious Adverse effects including Serotonin syndrome, Suicidal thoughts, Depression, worsening, Mania, Prolonged QT interval, Serious Bleeding, Seizure, etc.

§  Due to the content of Fluoxetine, Toxin Discharged Tea use is contraindicated in patients taking…

Ø Metoclopramide

Ø MAO Inhibitors (Linezolid, Nialamide, Toloxatone,  Methylene Blue (IV), Clorgyline, etc)

Ø CYP2D6 substrates (Thioridazine, Pimozide, Iloperidone)

Ø QT Interval Prolonging Drugs like Terfenadine, Mesoridazine, etc.

§  Toxin Discharged Tea (Fluoxetine) may also have major interaction with drugs such as…

Ø  Tricyclic antidepressants (Imipramine, Desipramine)

Ø Serotonergic agents (Sumatriptan, Rizatriptan or other antidepressants)

Ø Class Ia Antiarrhythmic Agents (Quinidine, Procainamide, Disopyramide)

Ø Phenothiazines (Chlorpromazine, Fluphenazine)

Ø Anticoagulants (Warfarin)

Ø Antiplatelets ( Clopidogrel, Ticlopidine,  Prasugrel)

Ø NSAIDs (Ibuprofen, Aspirin)

§  The concomitant use of Toxin Discharged Tea (Fluoxetine) and Metoclopramide is contraindicated due to increased risk of Extrapyramidal reactions or Neuroleptic malignant syndrome (Fever, sweating, confusion, Muscle stiffness).

§  It is contraindicated to use Toxin Discharged Tea (Fluoxetine) and MAO Inhibitors (Linezolid, Nialamide, Toloxatone,  Methylene Blue (IV), Clorgyline, etc) due to CNS toxicity or serotonin syndrome (Restlessness, myoclonus, changes in mental status, hyperreflexia, diaphoresis, shivering, and tremor).

§  CYP2D6 substrates like Thioridazine, Pimozide, Iloperidone may interact with Toxin Discharged Tea (Fluoxetine) and risk of additive QT-interval prolongation which leads to the contraindication.

§  Coadministration of Toxin Discharged Tea (Fluoxetine) and QT Interval Prolonging Drugs like Terfenadine, Mesoridazine, Bepridil, Sertraline, Erythromycin, Telithromycin, is contraindicated due to increased risk of cardiotoxicity (QT prolongation, torsades de pointes, cardiac arrest).

§  FDA advises the Consumers to exercise caution before purchasing any product typically promoted for sexual enhancement, weight loss, and body building, and are often represented as being “all natural”.