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Antacids

One of the common stomach disorders encountered is gastro esophageal reflux also known as heartburn. The stomach contains hydrochloric acid which helps in digestion of the food and subsequently killing ingested microorganisms. The acidity of the gastric HCl is 2M and any increase in the acidity leads to reflux, in which the gastric HCl travels through the cardiac sphincter muscle to the esophagus causing burning sensation and discomfort. Antacids are common choice of drugs which are administered in these conditions as they reduce the acid reflux and peptic ulcer.

Antacids act locally in the stomach region to neutralize the effect of the gastric HCl in order to prevent the onset of peptic ulcer. Most antacids are not absorbed and they are easily excreted in the stool. The predominant forms of chemicals used in the preparation of antacids include sodium bicarbonate, potassium bicarbonate, aluminum hydroxide, aluminum carbonate, magnesium carbonate, magnesium oxide and calcium carbonate. The natural forms of antacids include ginger, bananas, aloe vera, chamomile (used along with tea), carrots and turmeric. The action of antacids on the stomach is carried out throughout the wall to prevent ulcer formation.


Types of antacids

Antacids are recommended depending upon the intensity of the gastric disorder. In normal or mild conditions of acidity, non systemic antacids are recommended as they do not cause much damage. Prolonged administration of systemic antacids may lead to a condition called alkalosis in which the PH of the blood is raised leading to renal failure. Some of the common types of antacids used in the treatment of reflux and peptic ulcers are:

Sodium bicarbonate: It is recommended by many doctors to treat acid reflux and also reduce the acidity of urine and blood. Antacids which contain sodium bicarbonate also contain baking soda and hence it is not recommended for patients having congestive heart failure, hypertension, kidney disorders and gastrointestinal bleeding. Antacids containing sodium bicarbonate should be taken only after meals on a partially full stomach. The side effects include nausea, flatulence, weakness, increased thirst, black stools and irritability.

Aluminum hydroxide: Aluminum hydroxide is widely used as a non-systemic antacid and in most cases is available without prescription. The side effects of aluminum hydroxide include constipation and abdominal discomfort. In order to avoid constipation and abdominal stress, aluminum hydroxide is given in combination with magnesium hydroxide which has laxative properties along with antacid effects The combination of two such compatible antacids helps in sustained action in relieving peptic ulcers and protecting the wall of the stomach.

Calcium Carbonate: These antacids are mainly used in the treatment of indigestion, flatulence along with acidity and more commonly used as it is less expensive than other types of antacids. They are mostly recommended for children below the age of 12. In patients who have a previous history of osteoporosis or any other type of calcium deficiencies, the intake of calcium carbonate in case of acidity also helps in balancing the calcium requirement. If patients have a history of renal calculi or any other allergic reaction, calcium carbonate antacids should be avoided. The major side effect of this antacid is that it interacts with cardiac drugs. Calcium carbonate based antacids usually disintegrate and dissolute in forty minutes.

Drug side effects

Antacids react with many medications; digoxin, isoniazid, quinidine, pseudoephedrine and tetracycline. The potency and absorption of the drug reduces when the antacids interact with the corresponding drugs.

Alzheimer's disease

Alzheimer's disease is a progressive mental disorder that brings about changes in the brain slowly leading to dementia. Named after the German physician Alois Alzheimer, Alzheimer's disease has 2 characteristic neuronal changes : Loss of cholinergic cells in the basal forebrain and the development of neuritic plaques in the cerebral cortex. Neurofibrillary tangles can also occur due to Neuritic plaques.

Here the brain cells degenerate and die thus causing a decline in the mental functioning and memory of a person. Alzheimer's disease (AD) or Presenile dementia as it was earlier known as, is one of the primary causes of dementia. The levels of the brain neurotransmitters serotonin, norepinephrine and acetylcholine are found to be low in AD. This kind of brain disorder causes loss of social and intellectual skills of a person. In severe cases it interferes with the day-to-day activities of a person.


Alzheimer's disease causes

  • Most scientists believe that Alzheimer's disease is caused due to increase in production and accumulation of a protein called beta-amyloid protein. The accumulation of this protein leads to nerve cell death.
  • Environment factors that causes a change in the brain's functioning can also lead to Alzheimer's disease
  • Genetic causes
  • Abnormal levels of elements like aluminum and lead
  • Chronic cerebrovascular condition resulting from high blood pressure can lead to cerebral microbleeds. These microbleeds over a long period can result in mild cognitive impairment.
  • Head injury
  • Some viruses
  • Lifestyle changes that causes change in the brain's functioning can also lead to Alzheimer's disease


There are 4 major cognitive deficits arising out of AD :

1. Amnesia : Memory loss is probably the most common symptoms of Alzheimer' disease.
2. Aphasia : Loss of Language - Failure to recollect names of objects
3. Apraxia : Inability to perform voluntary movements
4. Agnosia : Inability to recognize people and places


Alzheimer's disease symptoms
  • Forgetfulness, unusual difficulty in remembering things
  • Mild confusion
  • Occasional memory lapse
  • Disorientation day, date, etc.
  • Problem with speaking and writing
  • Problem in thinking and reasoning
  • Decision making problems
  • Depression, anxiety, mood swing and many such behavioral problems
  • Problems with cognitive skills like calculating, judgment, etc


Alzheimer's disease diagnosis

1. A physical examination and a neurological examination to check:


  • Muscle tone and strength
  • Sense of touch and sight
  • Reflexes
  • Balance
  • Coordination, etc.

2. Brain imaging (CT scans, MRI) to check for tumors, etc.
3. Lab tests for thyroid etc so as to rule out other possibilities for memory loss


Treating Alzheimer's disease

As this disease is of degenerative nature, there is no permanent cure. Early diagnosis and changes in lifestyle can slow down its progression or improve the quality of life for the afflicted.


  • Drugs to deal with cognitive changes and memory symptoms
  • Drugs to increase acetylcholine or butylcholine levels. eg; Donepezil hydrochloride or rivastigmine, a cholinergic agonist or Cholinesterase inhibitor.
  • Vitamin E combined with Cholinesterase inhibitors
  • Alternate medicines like Ginkgo Biloba, Brahmi, Gotu kola, Ginseng and St. John's Wort
  • Exercise
  • Well balanced and nutritious food
  • Lifestyle changes that help deal with and improve the current condition

Erythrasma

Erythrasma is a skin infection caused by a gram positive anaerobic bacillus known as Corynebacterium Minutissimum and Erythrasma occurs in intertriginous area - where two skin areas touch or rub together. Overlapping skin helps to propagate the bacteria. The result is scaly skin fold patches slowly enlarging and gradually changing the skin color to pink or brown dry skin. Erythrasma looks like a patch of red to pink scaly skin. The border of the infection is well defined, that is, there is a sharp patch between the patch and the surrounding normal skin. In course of time the pink skin takes a brown or tan shade. Erythrasma is more common in warm climates. It is more common in dark skinned individuals.


Erythrasma risk factors

There are contributory factors that increase the chances of Erythrasma.


  • Warm, humid climate
  • Poor hygiene
  • Increased/excessive sweating
  • Diabetes
  • Advanced age
  • Poor immune function

Erythrasma Variants

Two distinct variants of Erythrasma are generalized Erythrasma and inter digital Erythrasma. Of the two, inter digital is most common. The infection happens in the feet, the inter spaces of the toes, particularly the fourth or fifth toe of the feet. The generalized variant is seen in diabetics (Type 2 diabetes). Herein, the skin lesions may extend beyond the intertriginous areas.


Diagnosing Erythrasma

Patches may appear in the groin, armpits, under the breasts and skin folds. It may itch slightly or the person may experience burning sensation. There is a possibility of the infection spreading. It occurs most commonly in the foot, where it causes scaling, cracking and breakdown of the skin between the 4th and 5th toes. In middle aged women, the skin folds under the breasts, on the abdomen and the area between the vaginal opening and the anus are prone to this infection. It could also spread to the torso and the anal area in some.


  • Skin appears pink or brown and dry.
  • Reddish-brown slightly scaly patch with sharp borders on the affected skin area.
  • Occurs in groin, armpit as well as other skin folds.
  • Mild itching or burning especially in the groin area.
  • Mild headaches, fatigue, swelling, weight gain.
  • Pain in abdomen, chest, back, joint, urinary tract.

If diabetic, the infection can involve the arms, trunk and the leg. Without ignoring it as a fungal infection and resorting to self care measures, seek medical help.


Erythrasma Diagnosis

To confirm that the rashes aren't due to any fungal infection, a wood's lamp examination - (under Ultra Violet light) is the most preferred choice. Fix up an appointment with the dermatologist for the examination. The procedure is performed in a dark room. For few seconds, ultraviolet light is directed on the affected area. In Erythrasma, a bright coral-red fluorescence is seen. Any change in color confirms the diagnosis.

If the results are negative, the doctor may recommend culture test of the scrapings from the lesion, or microscopic examination of skin scrapings. Few areas may be scraped to gather specimens to be sent to the lab for definite diagnosis.


Erythrasma Treatment

After confirming diagnosis, Erythrasma treatment is related to the infection being localized, extensive or frequent recurrences. Photo dynamic therapy using a red light is used in some cases to clear Erythrasma and to improve the rash in the remaining patients. Complete recovery is expected in each of the following procedures.

Localized Erythrasma: Topical application of erythromycin or clindamycin 1% two to three times daily for 14 days or washing twice daily with an antibacterial soap for up to three weeks. Solution of aluminum chloride inhibits moisture and sweating as Erythrasma occurs in moist skin, this could be used. Whitfield's ointment which is a mixture of benzoic acid and salicylic acid is also prescribed for Erythrasma.

Extensive involvement: Oral erythromycin or clarithromycin

Frequent recurrences: Prophylactic therapy combined with the use of antibacterial soap during bathing.


Prevention tips

There are simple ways to prevent Erythrasma.

Ensure that skin is dry after shower and before dressing to reduce possibility of bacteria to grow on the damp areas of the skin.

Use antibacterial soap instead of regular soap to prevent recurrence.

Maintaining ideal weight and not being obese and keeping sugar under control also helps in prevention of the infection.


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Bibliography / Reference

Collection of Pages - Last revised Date: November 19, 2019