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Dermatology Case No 21. Chilblains

ছবিটার দিকে লক্ষ করুন –

নারগীস আক্তার শীতকালে কুয়াশাচ্ছন্ন ভোরে গ্রামের সবুজ ঘাসের উপর হাঁটাহাঁটি করছিলো, বাসায় আসার পর তার পা টা লাল হয়ে গেছে, একদিন পর ফুলে গেছে, তারপর ব্যাথা করে, সাথে চুলকায়,,,,,

আমরা এখন সিনারিও থেকে এইটার ডায়াগনোসিস এ যেতে হবে———

প্রথমে রেড হয়েছিলো–

তার মানে তার skin er capillary bed গুলি ড্যামেজ হয়ে extravasation of blood হবার কারণে redness হয়ে গেছে,৷ আর বিষয় টা হয়েছে শীতকালে কুয়াশাচ্ছন্ন ভোরে —- মানে অতিরিক্ত ঠান্ডা পরিবেশে Exposed হবার পরে

এরপরে সেখানে ইনফ্লামেশন হয়েছে,

যেখানে ইনফ্লামেশন হয়, সেখানেই সাইন অফ ইনফ্লামেশন হিসাবে পেইন ও হয়-

তাহলে পুরো সিনারিওতে আমরা কি পেলাম—

Excessive cold exposure = Chill

Then inflammation =Blains

এই রোগ টার নাম হচ্ছে Chilblains

ঠান্ডা থেকে Chill

ইনফ্লামেশ/ blister থেকে blains

দুইটা মিলে ছিলব্লাইন্স

Chilblains are the painful blistering swelling of the hand and foot specially fingers due to damage to the tiny blood vessel(capillary bed)

As a result of repeated exposure to excessive cold

..

চিকিৎসা কি?

Anti histamine

Tablet 1:Fexo 60 mg AS A Fexofenadin Hydrochloride AS A Non Sedating.

NSAID/ paracetamol

Tablet 2:Napa extra 500 mg (AS A (Paracetamol+Caffeine) AS A Non Opipode Analgesic ).

Vitamine B-3, nicotinic acid (Nicoson 500 BD)

Tablet3:Nicosit 500 mg 1+0+1 AM (As A Myo-Inositol As A Nicotinic acid group, Oral nutritional preparations).

Indications of Tablet:Nicosit 500 mg 1+0+1 AM (As A Myo-Inositol As A Nicotinic acid group, Oral nutritional preparations).

Inositol (Nicosit) is indicated in adults for the treatment of:

  • Polycystic ovary syndrome (PCOS)
  • Anovulation
  • Menstrual disorders such as amenorrhea
  • Hyperandrogenism complaints such as hirsutism, alopecia, acanthosis nigricans, acne
  • Ovarian hyperthecosis
  • Insulin resistance
  • Male infertility

Composition of Tablet:Nicosit 500 mg 1+0+1 AM (As A Myo-Inositol As A Nicotinic acid group, Oral nutritional preparations).

Each film Coated tablet contains Inositol (Myo-inositol) USP 750 mg.

Pharmacology of Tablet:Nicosit 500 mg 1+0+1 AM (As A Myo-Inositol As A Nicotinic acid group, Oral nutritional preparations).

Inositols are important molecules in promoting female fertility and in sustaining physiological pregnancy. Myo-inositol, a major form of Inositol, has an established role in human physiology. Myo-inositol represents the most abundant inositol isomer in humans, and it is commonly found in almost every tissue, particularly in brain, blood, fat, kidney, lung, ovaries, and testes, where it participates in several cellular pathways,

Inositol (Myo-inositol) as second messenger of gonadotropins and insulin, it guarantees the correct development of oocytes and the progression of embryogenesis. Available evidence demonstrates that the supplementation with Inositol (Myo-inositol) enhances the probability of achieving pregnancy and reduces the onset of adverse maternal effects and neonatal outcomes. Specifically, in the pursuit of pregnancy, Inositol (Myo-inositol) proved to induce ovulation and restore the physiological menstrual cycle in infertile women, particularly in those with Polycystic ovary syndrome (PCOS). Moreover, Inositol (Myo-inositol) supplementation is also useful for women undergoing Assisted reproductive technology (ART), improving oocyte and embryo quality. During pregnancy, Inositol (Myo-inositol) reduces the risk of altered metabolic conditions like Gestational Diabetes Mellitus (GDM), which may lead to miscarriages or stillborn babies. In addition, Inositol (Myo-inositol) seems to reduce the risk of Neural tube defects (NTDs) in folate-resistant women.

Dosage & Administration of Tablet:Nicosit 500 mg 1+0+1 AM (As A Myo-Inositol As A Nicotinic acid group, Oral nutritional preparations).

Recommended dosage for lipid-lowering and improving conditions related to peripheral vascular insufficiency ranges from 1500 mg to 4000 mg daily, in divided dosages of two to three times daily with or without food for at least 3 months.

Use in children and adolescents: There is a lack of long-term safety data to support the safe use of Inositol (Myo-inositol) in children and adolescents.

Interaction of Tablet:Nicosit 500 mg 1+0+1 AM (As A Myo-Inositol As A Nicotinic acid group, Oral nutritional preparations).

Concomitant use of anti-diabetic drug and Inositol (Nicosit) may result in more reduced blood glucose than only anti-diabetic drug therapy

Contraindications of Tablet:Nicosit 500 mg 1+0+1 AM (As A Myo-Inositol As A Nicotinic acid group, Oral nutritional preparations).

Patients with a known hypersensitivity to any component of this product.

Side Effects of Tablet:Nicosit 500 mg 1+0+1 AM (As A Myo-Inositol As A Nicotinic acid group, Oral nutritional preparations).

Common: Well tolerated in recommended dose. Only mild gastrointestinal side effects can be shown with higher doses.

Pregnancy & Lactation

Inositol is possibly safe when taken by mouth during pregnancy. There isn’t enough reliable information to know if Inositol (Myo-inositol) is safe to use when breast-feeding.

Precautions & Warnings

Patient with diabetes should be cautious about use of this medication.

Overdose Effects

Generally, Inositol (Nicosit) seems to be safe and relatively well tolerated in recommended dose.

Therapeutic Class of Tablet:Nicosit 500 mg 1+0+1 AM (As A Myo-Inositol As A Nicotinic acid group, Oral nutritional preparations).

Nicotinic acid group, Oral nutritional preparations

Vasodilator (Nifedipine)

Tablet 4:-Nidipine SR 20 mg (As A Nifedipine As A Calcium-channel blockers).

Indications of Tablet:-Nidipine SR 20 mg (As A Nifedipine As A Calcium-channel blockers).

Nidipine SR is indicated in the management of all types of essential & renal hypertension. Also indicated in the management of hypertension during pregnancy & during coronary by pass surgery.

Nidipine SR is also used for prophylaxis and the treatment of unstable & variant angina, myocardial infarction, and silent myocardial ischaemia. Moreover Nidipine SR is also used in Raynaud’s phenomenon & heart failure.

Pharmacology of Tablet:-Nidipine SR 20 mg (As A Nifedipine As A Calcium-channel blockers).

Nifedipine is an inhibitor of Calcium Channel Blocker that blocks the transmembrane influx of Calcium ions into muscle cells. Nifedipine has selective effects as a dilator of arterial vessels. Nifedipine dilates main coronary and systemic arteries. As a result blood pressure falls and this elicits a sympathetic reflex response causing tachycardia and an increased cardiac output. Pulmonary arterial pressure also falls. Nifedipine has direct negative inotropic effects on cardiac muscles and these effects are seen at higher doses than dose which causes arterial vasodilatation.

Dosage & Administration of Tablet:-Nidipine SR 20 mg (As A Nifedipine As A Calcium-channel blockers).

Nifedipine 10 mg:

  • Angina: Initially 10 mg 3 times daily with food increased to 20 mg 3 times daily if necessary, in elderly patients, initially 5 mg 3 times daily.
  • Raynaud’s Phenomenon: 10 mg 3 times daily; maximum 60 mg daily. In urgent cases, the tablet should be dissolved under the tongue like a sublingual tablet. The effect occurs within some minutes.

Nifedipine 20 mg: The starting dose for patients, not previously prescribed Nifedipine products is one tablet once daily. The recommended dose in hypertension and angina prophylaxis is 20 mg twice daily during or after food. Dosage may be adjusted within the range 10 mg twice daily to 40 mg twice daily.

Patients with liver dysfunction should commence therapy with 10 mg twice daily with careful monitoring.

Patients with renal impairment do not require adjustment of dosage.

Interaction of Tablet:-Nidipine SR 20 mg (As A Nifedipine As A Calcium-channel blockers).

  • ACE inhibitors: Enhanced hypotensive effect.
  • Anti-arrythmics: Plasma concentration of quinidine is reduced.
  • Anti-bacterials: Rifampicin possibly increases metabolism of Nidipine SR.
  • Anti-epileptics: Plasma concentration of phenytoin increases.
  • Antipsychotics: Enhanced hypotensive effect.
  • β-blockers: Occasionally severe hypotension and heart failure may occur.
  • Cyclosporin: Plasma concentration of Nidipine SR possibly increases.
  • Muscle relaxants: Effect of muscle relaxants e.g. tubocurarine increases.
  • Ulcer healing drugs: Metabolism of Nidipine SR increases.

Contraindications of Tablet:-Nidipine SR 20 mg (As A Nifedipine As A Calcium-channel blockers).

Cardiogenic shock, advanced aortic stenosis, nursing mothers, GI obstruction, inflammatory bowel disease, hypotension.

Side Effects of Tablet:-Nidipine SR 20 mg (As A Nifedipine As A Calcium-channel blockers).

Headache, flushing, lethargy, gravitational oedema rash, nausea, increased frequency of micturation, eye pain, gum hyperplasia, depression, tremor, photosensitivity and few cases of jaundice have been reported. These reactions may regress on discontinuation of therapy. Its introduction may induce attacks of ischaemic pain in some patients with angina pectoris.

Pregnancy & Lactation of Tablet:-Nidipine SR 20 mg (As A Nifedipine As A Calcium-channel blockers).

There are no adequate and well controlled studies in pregnant women. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Precautions & Warnings of Tablet:-Nidipine SR 20 mg (As A Nifedipine As A Calcium-channel blockers).

Tablets should be swallowed whole and should not be bitten, chewed or broken up. It should be used with caution in patient whose cardiac reserve is poor. Should be withdrawn if ischaemic pain occurs or existing pain worsens shortly after initiating treatment. Use in diabetic patients requires adjustment of their control. Since the absorption of the drug could be modified by renal disease, caution should be exercised in treating such patients.

Therapeutic Class of Tablet:-Nidipine SR 20 mg (As A Nifedipine As A Calcium-channel blockers).

Calcium-channel blockers

গরম পানিতে ভিজিয়ে রাখা 20-25 minute 4 times Daily….

সাথে হাত মোজা, পা মোজা, গরম পানিতে অযু।

ধুমপায়ি হলে stop smoking.

Raiyyan Tahsan Date:25-01-2025 Saturday Time:12-20-45 PM

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