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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.

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 (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). 

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?


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.


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


A depressant approved for use in the treatment of narcolepsy, a disorder that causes daytime "sleep attacks.
Drugs that cause profound distortions in a person’s perceptions of reality, such as ketamine, LSD, mescaline (peyote), PCP, psilocybin, salvia, DMT, and ayahuasca.
An opioid drug made from morphine, a natural substance extracted from the seed pod of the Asian opium poppy plant.
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.
A dissociative drug used as an anesthetic in veterinary practice. Dissociative drugs are hallucinogens that cause the user to feel detached from reality.


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.
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.
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.
An extremely addictive stimulant amphetamine drug.
Over-the-counter Cough/Cold Medicines (Dextromethorphan or DXM):
Psychoactive when taken in higher-than-recommended amounts.


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
A hallucinogen in certain types of mushrooms that grow in parts of South America, Mexico, and the United States
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.
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).
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.


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.

Sunday, April 24, 2016

Metformin can be used to Treat certain Type II Diabetes Patients with Mild to Moderate Impaired Kidney Function

Posted by Prahallad Panda on 10:48 AM Comments

Traditionally, use of metformin is contraindicated in patients with renal failure due to concern about lactic acidosis.
Metformin 500mg tablets
Metformin 500mg tablets (Photo credit: Wikipedia)
In December of 2014, a seminal paper critically looked at the evidence for the use of metformin in mild to moderate renal failure and concluded that, “Metformin levels generally remain within the therapeutic range and lactate concentrations are not substantially increased when used in patients with mild to moderate chronic kidney disease (estimated glomerular filtration rates, 30-60 mL/min per 1.73 m2).”
The paper suggested that given the benefit of metformin to patients with diabetes, of whom up to one-quarter have some degree of renal failure, and the lack of evidence of harm, metformin should be able to be used in this group.
The paper recommended dose adjustments of metformin with maximum total daily dose in patients with mild renal insufficiency (GFR 45-60) of 2000 mg per day and in patients with moderate renal insufficiency (GFR 30-35) not to initiate therapy but that one may continue metformin with maximum daily dose of 1000 mg daily.
English: Physiology of Nephron
English: Physiology of Nephron (Photo credit: Wikipedia)
Now, the US Food and Drug Administration (FDA) is requiring labeling changes regarding the recommendations for metformin-containing medicines for diabetes to expand metformin’s use in certain patients with reduced kidney function. The current labeling strongly recommends against use of metformin in some patients whose kidneys do not work normally.

After reviewing a number of medical studies, the FDA concluded that metformin can be used safely in patients with mild impairment in kidney function and in some patients with moderate impairment in kidney function and is requiring changes to the metformin labeling to reflect this new information while providing the following specific recommendations on the drug’s use in patients with mild to moderate kidney impairment:
• FDA recommends that healthcare professionals follow the latest recommendations when prescribing metformin-containing medicines to patients with impaired kidney function.
• Patients should talk to their health care professionals, if they have any questions or concerns about taking metformin.
The labeling recommendations on how and when kidney function is measured in patients receiving metformin will include the following information: 
  • Before starting metformin, obtain the patient’s eGFR.
  • Metformin is contraindicated in patients with an eGFR below 30 mL/minute/1.73 m2.
  • Starting metformin in patients with an eGFR between 30-45 mL/minute/1.73 m2 is not recommended.
  • Obtain an eGFR at least annually in all patients taking metformin. In patients at increased risk for the development of renal impairment such as the elderly, renal function should be assessed more frequently.
  • In patients taking metformin whose eGFR later falls below 45 mL/minute/1.73 m2, assess the benefits and risks of continuing treatment.  Discontinue metformin, if the patient’s eGFR later falls below 30 mL/minute/1.73 m2.
  • Discontinue metformin at the time of or before an iodinated contrast imaging procedure in patients with an eGFR between 30 and 60 mL/minute/1.73 m2; in patients with a history of liver disease, alcoholism, or heart failure; or in patients who will be administered intra-arterial iodinated contrast. Re-evaluate eGFR 48 hours after the imaging procedure; restart metformin, if renal function is stable.
Generally, 90-120 ml/minute/1.73 m2 of eGFR is taken as normal value. Levels below 60 mL/min/1.73 m2 for 3 or more months are a sign of chronic kidney disease. A GFR lower than 15 mL/min/1.73 m2 is a sign of kidney failure and requires immediate medical attention.
Hence, in addition to the level of serum creatinine, it is recommended to have the eGFR estimated in patients of T2DM before starting of Metformin or metformin in combination; also periodically measure, while on the medication.
The article was published in FDA Web site, April 8, 2016. US Food and Drug Administration. Metformin-containing drugs: Drug safety communication – revised warnings for certain patients with reduced kidney function.

Wednesday, April 13, 2016

Acetaminophen makes it Harder to recognize Errors

Posted by Prahallad Panda on 6:53 AM Comments

Dan Randles and researchers from the University of British Columbia researched in a first neurological study to look at the potential of acetaminophen to inhibit the brain response associated with making errors.
It is a well established fact that physical pain and social rejection share a neural process that can be traced to the same part of the brain..
Recent research has begun to show how exactly acetaminophen inhibits pain, while behavioural studies suggest it may also inhibit evaluative responses more generally. Randles own past research has found that people are less reactive to uncertain situations when under the effect of acetaminophen.
In the research, two groups of 30 were given a target-detection task called the Go or No Go. Participants were asked to hit a Go button every time the letter F flashed on a screen but refrain from hitting the button if an E flashed on the screen. "The trick is you're supposed to move very quickly capturing all the GOs, but hold back when you see a No Go," says Randles.
The activity of brain of person was mapped through electroencephalogram (EEG) during the experiment. The researchers were looking for a particular wave called Error Related Negativity (ERN) and Error Related Positivity (Pe). Essentially what happens is that when people are hooked up to an EEG and make an error in the task there is a robust increase in ERN and Pe.
One group, which was given 1,000 mg of acetaminophen -- the equivalent of a normal maximum dose -- showed a smaller Pe when making mistakes than those who didn't receive a dose, suggesting that acetaminophen inhibits our conscious awareness of the error.
Cognitive control is an important neurological function because people are constantly doing cognitive tasks that flow automatically like reading, walking or talking. These tasks require very little cognitive control because they are well mapped out neurological processes, notes Randles.
"Sometimes you need to interrupt your normal processes or they'll lead to a mistake, like when you're talking to a friend while crossing the street, you should still be ready to react to an erratic driver," explains Randles.
"The task we designed is meant to capture that since most of the stimuli were Go, so you end up getting into a routine of automatically hitting the Go button. When you see a No Go, that requires cognitive control because you need to interrupt the process."
The study was double blind, so neither the researcher running the study nor the participant knew whether they had been given a placebo or acetaminophen.
An unexpected and surprise finding that Randles plans to explore more closely is that those who received an acetaminophen dose appeared to miss more of the Go stimuli than they should have. He plans on expanding on the error detection aspect of the research to see whether acetaminophen is possibly causing people to "mind wander" and become distracted.
"An obvious question is if people aren't detecting these errors, are they also making errors more often when taking acetaminophen? This is the first study to address this question, so we need more work and ideally with tasks more closely related to normal daily behaviour."
The research is published in the current edition of the journal Social Cognitive and Affective Neuroscience.
The news published in the Sciencedaily can be accessed here.

Sunday, April 10, 2016

Cyclodextrin for Treatment of Atherosclerosis

Posted by Prahallad Panda on 11:34 AM Comments

Cardiovascular disease from atherosclerosis is one of the most common causes of death worldwide. Inflammation plays a crucial role in atherosclerosis and cholesterol crystals are considered to be main culprit.

Researchers have found out that cyclodextrin dissolves cholesterol crystals and reduces atherosclerotic plaques. This is a promising therapeutic approach for treating atherosclerosis. Their find was published in Science Translational Medicine.
Micrograph of an artery that supplies the hear...
Micrograph of an artery that supplies the heart with significant atherosclerosis and marked luminal narrowing. Tissue has been stained using Masson's trichrome. (Photo credit: Wikipedia)
Cyclodextrin works by reprogramming macrophages so that they do not cause such a strong inflammatory response in blood vessels that contain cholesterol crystals. The cyclodextrin also dissolves cholesterol crystals so that the cholesterol can be excreted from the body in urine. The result is prevention of plaque formation and even atherosclerotic plaque reduction in mice. Furthermore, when researchers used cyclodextrin to treat biopsies of plaques from human carotid arteries, they found similar results.
he study points to cholesterol crystals as a target for treatment of atherosclerosis, meaning that using cyclodextrin to dissolve the crystals could affect how the disease is treated.
The original idea for the test of cyclodextrin came from Chris Hempel, an American mother whose twin daughters are affected by a rare illness called Niemann-Pick Type C disease, in which cholesterol accumulates in the body. The children are being treated with cyclodextrin with promising results.
Hempel read about previous research on cholesterol crystals conducted by senior researcher Eicke Latz from the University Hospital Bonn and his colleagues from the Center of Molecular Inflammation Research (CEMIR) at the Norwegian University of Science and Technology (NTNU) in Trondheim. She contacted Dr. Latz to suggest that they test cyclodextrin as a possible treatment for atherosclerosis.
It was published in Sciencedaily, can be accessed here .


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