Cirrhosis of the liver

For the first time this term appeared in the literature in 1819. In our time, cirrhosis develops in 1-1.5% of the population of the Slavic countries. At what most often it is men in the age of 40 years. In 80-85% of cases, the main cause is alcoholism and viral hepatitis. Cirrhosis of the liver is a chronic liver disease that progresses rapidly and leads to the development of functional organ failure and portal hypertension (increased pressure in the system of vessels coming from the internal organs to the liver).

When cirrhosis is formed, the liver cells die and replace them with a connective tissue (similar to the scars on the skin), the blood vessels of the liver are modified. This leads to the fact that the liver stops performing its usual functions.

Stages of cirrhosis of the liver
Currently, there are several different classifications of liver cirrhosis, which are based on different aspects of the disease.

Classification by morphological features:
- Micronodular, or small-node cirrhosis - the diameter of the nodules varies in the interval 1-3 mm;
- Macronodular, or coarse nodular cirrhosis - diameter of nodules from 3 mm or more;
- Mixed cirrhosis - a combination of nodules of various shapes;
- Incomplete septal cirrhosis.

Classification of cirrhosis due to its occurrence:
- Viral cirrhosis - develops against the background of viral hepatitis B or C;
- Alcoholic cirrhosis of the liver - develops from long consumption of a large amount of alcohol, which first leads to fatty liver, followed by alcoholic hepatitis, and at the end - cirrhosis;
- Medicinal cirrhosis - arises from the long-term use of certain medicinal substances, which in large quantities can adversely affect the liver cell (for example, some antibiotics);
- Secondary biliary cirrhosis;
- Congenital - develops in children in the absence of bile ducts;
- Stagnant, cardiac cirrhosis of the liver - in case of circulatory failure, which arises in case of heart disease;
- Syndrome and Badd-Chiari disease - patients are concerned about pain in the liver area (under the right hypochondrium), abdominal enlargement, fever, minor jaundice, very large liver, lower edge painful, spleen slightly enlarged, frequent bleeding from esophageal veins. For this form, the defeat of the posterior surface of the liver and the changes in the vessels are most characteristic;
- Alimentary cirrhosis - with diabetes mellitus, obesity;
- Cirrhosis with an unclear reason:

Cryptogenic cirrhosis of the liver is extremely rare. But has a tendency to rapid development of clinical symptoms and the onset of complications. Is a direct indication for a liver transplant.

Children's Indian.

Primary biliary cirrhosis - the main complaints with this form are pronounced itching of the skin and intense jaundice, later the weakness in the whole body, weight and pain in the area of bones are added. Complications occur later than with other forms of the disease.

Classification by stages of cirrhosis:
- Compensated cirrhosis of the liver;
- Subcompensated cirrhosis of the liver;
- Decompensated cirrhosis of the liver.

Classification by clinical course:
- Subacute cirrhosis is a transient phase between hepatitis and cirrhosis. Lasts from 5 months to 1 year.
- Rapidly progressive cirrhosis - complications and a vivid clinical picture develop very quickly. Life expectancy is about 5-6 years after the onset of the disease.
- Slowly progressive cirrhosis - symptoms gradually develop gradually, and there is a long-lasting absence of complications. The duration of this variant of the disease is more than 11 years.
- Sluggish - there are practically no clinical symptoms, changes in the analyzes are minimal. The duration of this form is more than 16 years.
- Latent cirrhosis of the liver - there is no change in the analyzes, no complaints, and there are no complications. Life expectancy does not depend on this cirrhosis. The diagnosis is made by chance, when diagnosing other diseases.

An example of a diagnosis: cirrhosis of the liver in the stage of decompensation, micronodular, alcoholic etiology, grade C according to Child-Pugh, varicose veins of the esophagus of the 2nd degree, hepatic encephalopathy of the first stage.

Symptoms and signs of liver cirrhosis
Symptoms of cirrhosis include pronounced general weakness, unmotivated memory impairment, fever, pain in the right upper quadrant, weight loss, nausea, abdominal enlargement, dry skin.

The signs that the doctor discovers during examination include the enlargement of the liver and spleen, red palms, smooth and bright red tongue, vascular "sprouts", veins on the abdomen ("jellyfish head"), scalp and inguinal region, jaundice, various hemorrhages in the body, varicose veins.

Treatment of cirrhosis of the liver
The main measures for treatment include: remove the effect of the causative factor; compliance with diet (refusal of alcohol, from fatty, fried, spicy food, from certain food products); treatment of the disease that caused cirrhosis (sorbents, hepatoprotectors – Heptral, Layennec, detoxification therapy, antiviral and others- Phenotropil, Phenazepam).

Cardiac medicines

Pharmaceutical market overview of the ATC group C01EB - drugs for the treatment of heart diseases (others) in the retail commercial sector of the pharmaceutical market.

To maintain the heart in working order is simple - you just need to look after him, like the engine of your favorite car. Timely carry out diagnostics, fill in quality motor oil and warm up before the start. That is, visit preventive examinations with doctors, rationally distribute physical activities and, if necessary, use drugs that support cardiac activity - increasing oxygen supply to the muscles, improving metabolism, helping the heart to contract.

Hawthorn and meldonium
For drugs for the treatment of heart diseases in 2016 in the drugstores of the country was spent 7.76 billion rubles.2, for which 43.52 million packs of drugs were purchased.

The average price for packaging of cardiac funds over the past two years has grown significantly, and the reason for this was the drugs, which include hawthorn and meldonium. Sales of relatively expensive Meldonium in the anti-doping scandal increased by 56%, and sales of cheap drugs with hawthorn (including its tinctures) fell by 12% on the next precedent associated with its misuse. Due to these changes, the price for conditional packing of the drug in the segment increased.
Cheap funds for 99% (in monetary terms) are represented by unbranded drugs with trimetazidine from different manufacturers; In the middle price range, Trimetazidin-Biocom MV ("Farm Center") holds a 58% share, in another range with a 44% share is leading Deprenorm MV ("Canonfarma Production"), Antisthene MB ("Ozone") occupies 59% of the drug segment with at a price of 450 to 600 rubles., a niche of drugs with a price above belongs solely to Preductal MV (Servier).

TOP 5 drugs for the treatment of heart disease
1) Trimetazidine is an antihypoxic agent: (ischemic heart disease, angina prophylaxis, chorioretinal vascular disorders, dizziness, cochlear-vestibular disorders of ischemic nature)
2) Meldonium - Metabolic agent: (combined therapy of ischemic heart disease, cerebral circulation disorders, decreased work capacity, overstrain, withdrawal syndrome)
3) Ivabradine - Antianginal agent (stable angina, chronic heart failure)
4) Hawthorn thorny - Cardiotonic (functional disorders of cardiac activity, cardialgia, climacteric syndrome, astheno-neurotic states)
5) Riboxin (Inosine) - Metabolic agent (complex treatment of myocardial infarction, ischemic heart disease, heart rhythm disturbances, liver diseases, isolated kidney operations)

When the heart is starving
Most often, to support their "fiery motor", pharmacy visitors choose antihypoxic agents with INN trimetazidine, which optimize the metabolism and function of cardiomyocytes and neurons of the brain, increase the energy potential of cells and rationalize oxygen consumption. Also, agents with metabolic components (meldonium and inosine), antianginal and cardiotonic agents are popular.

Neurotic dysfunction of the gastrointestinal tract

The emergence of some somatic pathologies is directly related to the negative impact of the everyday psycho-emotional stress that a modern person is exposed to. A few decades ago, official medicine did not consider stress a serious risk factor, but today the results of numerous studies have confirmed the validity of the joke saying that "all diseases are from nerves."

Patients with disguised neuroses and their various manifestations, as a rule, consult therapists, cardiologists and gastroenterologists. Functional disorders of the cardiovascular system and the gastrointestinal tract are considered the most frequent consequence of mental trauma, prolonged experiences and depressive conditions. So, for example, in 80% of patients with functional disorders of the digestive system, the basis of the disease is psychogenic disorders and emotional overstrain.

In this case, even a qualified specialist does not always succeed in immediately revealing the true cause of the pathological condition, since Clinico-instrumental studies do reveal various variants of morphofunctional disorders-usually minor, in the form of superficial gastritis, motor abnormalities of the gastrointestinal tract, refluxes, and so on. To think about the neurotic nature of a patient's condition most often causes complete ineffectiveness of the prescribed treatment, the absence of any connection between the course of the disease and the patient's diet, and also some features of his behavior.

Neuroses of the gastrointestinal tract: mechanisms of formation and features of the course
A common opinion on the mechanisms of formation of systemic neuroses, incl. - with gastroenterological symptoms, among specialists for today there. It is almost impossible to predict in advance which organ or system of organs will be more unstable to the negative impact of psychoemotional stress. The variant of the course of the neurosis, the peculiarity of its symptomatology, largely depends not only on the psychological characteristics of each patient, but also on the functional state of various systems of its organism, lifestyle and hereditary predisposition.

Of particular importance are the way of processing / experiencing negative emotions, the presence of an unconscious conflict, the basic protective mechanisms and the type of psychotrauma that has occurred. In the formation of a pathological condition, the absence of vegetative disturbances, as well as the acquired features of the affected system - past illnesses, injuries, etc., can not be avoided.

It is believed that psychosomatic patients with a gastroenterological variant of a neurosis according to the peculiarities of its course can be conditionally divided into three groups:

- neurotic disorders associated with chronic gastrointestinal diseases (and complicating their course);
- directly neurotic disorders of the functions of the digestive system;
- neurotic fixation (a tendency to exaggerate) the existing minor dysfunction of the digestive system.

In addition, depending on the form of the neurosis itself, the clinical picture of gastroenterological disorders also varies significantly. So, for example, in patients with hysterical neurosis, there are often bright descriptions and demonstrative manifestations of problems with the digestive system. As a rule, they are prone to numerous additional studies (and the "most serious" diagnosis) and may even insist on performing surgical treatment.

A patient with neurasthenia usually has the opposite picture: the desire to be convinced of the absence of serious diseases of the gastrointestinal tract provokes them for all new examinations and consultations with different specialists. Such patients try to be hospitalized on a regular basis or to be on a dispensary record in order to exclude even the slightest possibility of diseases and disorders.

For obsessive-compulsive neuroses, a classic manifestation is the physical processing of gastrointestinal complaints, a fanatical adherence to various health-improving diets and treatment methods (usually from the field of "folk" medicine), as well as a tendency to unmotivated carcinophobia.

"Gastric" manifestations of neuroses
The clinical symptomatology of gastrointestinal disorders in neuroses is diverse and multifaceted. The most common neurotic dysfunction of the stomach, which previously described as functional dyspepsia, pseudo-ulcer syndrome, irritable stomach syndrome. This disorder, as a rule, is manifested by neurotic vomiting - hysterical, appearing in the event of any conflict or stressful situations, or habitual - arising from the experience of the patient's state, communication with sick people and suppression of negative emotions.

An important diagnostic feature of neurotic vomiting is the ease of the entire process, almost not accompanied by previous nausea and painful straining. In addition, with psychogenic vomiting, there are usually no signs of vegetative disorders (pallor, sweating, excessive salivation).

Not less frequent variant of a stomach neurosis is considered and gastralgia - a pain, feeling of gravity and raspiranija in an epigastric area, a burning sensation. Here, a diagnostic criterion can be a direct relationship between strong experiences and the appearance of uncomfortable gastric symptoms. At the same time, the patient practically does not have any negative reaction to the eaten food.

But the gastric manifestations of neuroses do not end there. Long or acute stress can manifest itself in a variety of monosymptomatic disorders: nausea, swallowing, etc. So, one of the well-known signs of a neurosis is psychogenic esophagospasm, in which the patient experiences serious problems with swallowing liquid or solid foods. If, at the appearance of dysphagia, the patient was not immediately diagnosed and an adequate treatment is not prescribed, then in due course esophagospasm will begin to manifest not only during food intake, but also out of touch with food. It can lead to the appearance of pressing or burning pain behind the sternum and cause a suspicion of angina. A kind of esophagospasm is the sensation of a foreign body in the throat, which patients describe as a pressing lump or a burning sensation in the neck that temporarily weakens during meals. This symptom is especially common in young women.

A more rare type of neurotic reactions is a false sensation of a sick person emanating from him (from the mouth) unpleasant odor. It is not always possible to convince the patient of the mistakenness of his sensations. The arising obsession can gradually develop into a more serious mental disorder, when a person fixes on their experiences / feelings, begins to avoid contact with others and tries to self-isolate. Sometimes this symptom is accompanied by a disorder of taste - a false sense of bitterness in the mouth, not dependent on food intake and not associated with any organic pathologies. In some cases, the symptom complex is supplemented by a burning sensation and tingling sensation in the tongue.

"Intestinal" neurotic symptoms
Neurotic disorders of the intestine have received the generalized name of irritable bowel syndrome (in some cases - dyskinesia of the intestine, etc.). In addition to the neurotic disorders proper, no less frequent are cases when neurosis only aggravates the already existing bowel disease.

Most often, patients complain of painful abdominal cramps (burning, stitching, aching, etc.), which appear spontaneously, and with nervous tension intensify. Also, intestinal neuroses are characterized by peculiar intestinal crises in the form of acute painful attacks accompanied by flatulence and urge to defecate. Often the patient is so fixed on his condition that he is forced to give up his usual daily activities, limit his communication with others and visit public places.

Among the neurotic intestinal symptoms include intestinal motility disorder, manifested by chronic constipation, psychogenic diarrhea (the so-called "bear disease"), and the alternation of these disorders. Such patients are characterized by increased attention to the peculiarities of their condition, excessive care for the act of defecation and exaggeration of the severity of their condition, up to the development of hypochondriacal depression.

In addition to gastric and intestinal disorders, gastroenterological neuroses are also referred to as aerophagia (occurs with hysterical neurosis) and pathology of eating behavior - anorexia nervosa and pathological overeating (bulimia).

Complex therapy options
Treatment of patients with neurotic disorders of the gastrointestinal tract primarily involves eliminating the root cause of the disease, i.e. a neurosis. Only in this case it is possible to normalize the patient's condition and prevent possible relapses.

The most important role is assigned to psychotherapeutic methods, both individual and group. Their goal is to understand the patient's existing psychological problems and the connection of his illness with stress, and, if possible, switching the attention of a person to solving conflict situations, etc.

Drug therapy for neuroses involves the appointment of tranquilizers (diazepam, chlordiazepoxide, Sibazone, meprobamate, Relanium) or, in more severe cases, small doses of neuroleptics (thioridazine, chlorprotixen, fluspirilene).

In case of prevalence of neurasthenic symptoms, the combined use of tranquilizers with nootropics (Phenibut, etc.) or Aminalone is indicated. In severe sleep disorders, sedatives (nitrazepam, phenazepam) are recommended.

And, of course, given the presence of gastroenterological manifestations, the patient needs a set of therapeutic measures aimed at eliminating the main symptoms.

Necessity in strict dietary restrictions, as a rule, no, except for cases with concomitant chronic pathology of the gastrointestinal tract. Nutrition of the patient must be physiological, containing a sufficient number of high-grade proteins and vitamins. In patients with anorexic phenomena, it is possible to temporarily administer parenteral nutrition or additional intake of multivitamin complexes.

As symptomatic treatment of gastroenterological disorders, depending on the nature of the course of neurosis, antacid preparations, gastroprotectors, antispasmodics and enzymatic agents can be prescribed. They will not only help to quickly repair existing violations, but also have a psychotherapeutic effect on the patient, which in turn will help to eliminate the underlying cause of the disease more quickly.

Actovegin ointment and Actovegin gel. Indeed - an ambulance!

The mythical hero Hercules for a long time could not cope with the Lernea hydra, because at the place of the severed head three immediately grew up. As you know, Hercules managed to make his second feat and win the same malignant amphibian. But the ability of the hydra to restore the lost, frankly, impressed. At first sight, in ordinary, non-mythical life, such miracles do not occur. But if we could, with the help of some magical gadget, see how the body repairs damaged tissue, in particular the skin, it would probably agree that it looks like a miracle. By the way, in the treatment of skin lesions, there is a mythology. We'll talk about this now.

MYTH
Each wound, abrasion or cut is an open gate for infection. Therefore, cuts and abrasions should be treated as quickly and carefully as possible with iodine or alcohol, without missing a millimeter of the damaged area.

TRUE
If it is not a small surface abrasion, then use alcohol-containing solutions should be very carefully. Iodine, alcohol treat only the edges of the wound. The ingress of these funds to the wound surface further injures the tissues and causes a burn which will increase the number of dead cells and delay the normal healing process. Therefore, treat the wound better antiseptic, not causing burns - a solution of hydrogen peroxide or chlorhexidine. And then - in order to avoid re-infection of the wound and in order to speed up the healing process, it is useful to apply gel on the wound surface of Actovegin. It creates a breathable but insurmountable film on the wound and activates regenerative processes, stimulating blood circulation and improving the nutrition of tissues. And after the wound is delayed, you need to continue treatment with cream and ointment Actovegin - so that the skin does not form a coarse scar.

MYTH
Burns, incl. and solar, it is necessary to treat with alcohol or smear with oil.

TRUE
If the burnt skin is treated with alcohol, then a chemical burn is added to the thermal burn. As for oil, its use in the treatment of burns is not recommended for 2 reasons: oil forms a film on the surface of the burn which prevents the evaporation and cooling of the damaged area. In addition, the oil can not be attributed to sterile substances. Therefore, the probability of infection is high. To effectively treat burns, you can use Actovegin. With thermal burns with a wetting surface, Actovegin gel is suitable, with sunlight and thermal burns without wetting, help is provided by Actovegin cream. It has a light texture, it is easy to apply to damaged skin without causing additional pain. Cream Actovegin will accelerate skin regeneration, moisturize and soften irritated and inflamed skin.

MYTH
To heal skin damage, you can use natural remedies - plantain or yarrow, for example. And no "chemistry" is needed.

TRUE
Psyllium and yarrow, of course, can be used in marching conditions, if at hand there are no other effective means of help. But nevertheless it is necessary to consider, that such means can become a source of an infection. Therefore, it is better to use proven pharmacies in camping conditions: antiseptic and the means of the Actovegin line. This is not a "chemistry", but a set of natural factors that help to trigger natural metabolic processes. The main active substance is the deproteinized haemoderivat of the blood of young healthy calves. Included in the composition of drugs Actovegin substances improve skin nutrition, supplying cells of the affected tissue with oxygen, microelements and nutrients: amino acids and carbohydrate-lipid complexes, stimulate blood circulation.

MYTH
There is no point in spending money on various dosage forms of Actovegin. It is enough to buy either a gel, or a cream, or an ointment. After all, the active substance is the same everywhere.

TRUE
Actovegin is the only external preparation for 3-step therapy of wounds, abrasions, scratches and other superficial skin lesions. For each stage of healing is its Actovegin.

On a fresh wound with a wet antiseptic after separation, a 20% gel is applied. It covers the wound with a thin film, thereby reliably protects it from infection, and immediately starts the process of initial active healing. After 1-4 days, as soon as a fresh granular tissue (granulate) is formed in the wound, it is better to switch to 5% cream of Actovegin to accelerate the further healing. In the final phase of regeneration, for the full healing at the epithelization stage, the use of the Actovegin ointment is recommended. It is with this approach that the crusts will quickly disappear and the wound will heal without scars.

MYTH
If the drugs Actovegin contain the blood of calves, then these drugs need special storage conditions. And the shelf life of them, most likely, is small.

TRUE
Well, firstly, in the preparations Actovegin contains not blood, but deproteinized haemoderivat, containing only physiological substances - amino acids, oligopeptides, nucleosides, oligosaccharides and other useful trace elements. Due to this composition, Actovegin has antihypoxic, antioxidant and metabolic effects on damaged tissues. Secondly, all drugs Actovegin can be stored under normal conditions. They can be taken with them on a trip or on a summer residence. In this case, Actovegin has a long shelf life: the gel has 3 years, and the cream and ointment have 5 years.

Addiction to antidepressants

Among the "normal" people there is an opinion that "antidepressants are very harmful", "they can go crazy", "get used to them for life", etc. Is this true? Of course, there is no smoke without fire, but fire is the cost of Soviet psychiatry, when strong remedies "just in case" were prescribed in large doses with the corresponding results. In the rest of the world, the attitude towards drugs is completely different. To date, about 65 percent of the US population is taking psychotropic drugs (primarily antidepressants and tranquilizers).

There is a stereotype that taking antidepressants is a manifestation of a weak character. But at the same time, people who suffer from other diseases, such as hypertension or polyarthritis, take medication during periods of exacerbations and this is considered normal. For example, aspirin is not able to cure polyarthritis, but it can relieve pain in the joints and thereby alleviate the physical suffering of the patient. Unfortunately, in our society there is still a stereotype that depression is weak-willedness, non-assortment, and only a few understand that depression is the same disease that requires treatment. Yes, antidepressants can not always relieve depression, but they can reduce pain. Only not physical, but spiritual.

For many, the issue of addiction to antidepressants is important. Will not the body demand and after the release of depression another portion of the pills of joy? You can answer more than unequivocally - the drugs used to date in the treatment of depression, do not cause addiction, regardless of the duration of treatment. They only help the body to restore those mechanisms that were disturbed by depression.

Those people whose work is related to creativity, often worried about the question, will the antidepressant drug use interfere with the processes that are responsible for creativity? In most cases, depression does not have the best effect on creativity, but most often makes it impossible. Antidepressants are able to restore a broken inner world and restore the ability to create a person's ability to create, because most often creativity contributes to mental health.

The task of a psychiatrist is to select the right preparations. Only half of the patients experience improvement after the first course of therapy, so that the selection of drugs can be called trial and error. A doctor can prescribe several drugs before he finds the most effective one. In many clinics, it is practiced to prescribe free drugs to persons who are on psychiatric records. Since the cost of the drugs of the last generations can reach $50-100, and they can be written down several types, imagine how much it can cost. Although - they say that over the past 30 years nothing better and stronger than the good old amytriptilin has not been invented. New drugs basically differ in contraindications (they are much less) and at a price (it is much higher).

The effect of the drug is not immediately apparent - usually between the time of the beginning of the reception and the appearance of a positive effect is not less than 2-3 weeks, although in some cases, positive mood changes may appear in one week. For someone, drugs are a panacea, and a person who has tried to escape from depression for many months unsuccessfully comes to life right before our eyes. Someone they are able to remove only some of the depressive symptoms. But there are people on whom drug therapy does not affect. Do not rush to rank yourself in the last category - everything is very individual, and in some cases a stable result can come only after a few months.

Often drugs are prescribed together with other methods of treatment. Antidepressants are most often unable to fill the inner world with light and completely rid themselves of depressive experiences, but they are able to give at least some feeling of stability, to ease the symptoms of depression.

Another important point is the name of the drugs. For example, fluoxetine, which is by far the most popular drug both in America and in Europe, is represented on the Russian market by almost 20 pharmaceutical companies. This means that the same drug is sold under 20 different names. And if the recipe simply says "fluoxetine", then you have to focus on the ratio of "price / quality." The cheapest are Russian and Indian drugs, but they often have a lot of side effects. Drugs produced by Western pharmacists are more expensive, but the side effects are not as pronounced.

Mary, 32 years: “For several years I have to take antidepressants. At first they really "help the body to restore those mechanisms that were disturbed by depression." Rather, they even make the body (in particular, the brain) what it should do by itself.

And he gets so used to it that he refuses to work after the drug is discontinued. Even if you cancel the medicine according to all the rules, with the exact calculation of dosages.

I tried to cancel antidepressants several times, in different ways, under the supervision of doctors. As a result, the brain simply refuses to work.”

Many will say that an untreated disorder simply returns again in its entirety. This is not so: before going to the drugs I felt much better - at least, I could walk and talk.

In practice, I have come across many people who have been suffering from depression for years and often in severe form, but have never been treated with antidepressants. Many of them have a stereotype that "like as long as I am without drugs - I can consider myself normal, and it is only necessary to start ..." And what, what will happen next? See what is already happening to your life. I repeat - the drugs are not addictive, and you can stop the therapy at any time even if you sit on drugs for many years, without prejudice to your health. Often, it is the depression that does not use any of the techniques in this section, because in order to try something, you need strength and a sense of stability, and depression takes it all away. Drugs are able to give the necessary foundation, change your attitude, ease depression, and then, while taking medications, you can go jogging, go to a therapist, practice sleep deprivation and do many other things. I myself took antidepressants for many years and they played an important role in the therapy of my depression, and years later, when I managed to deal with depression, and its symptoms became much weaker, I just stopped taking them. Do you understand?

Rating of hypnotics and sedatives

Most sedatives are combined medicines and herbal products. The leader of the segment by the volume of pharmacy sales for the third year in a row is Novo-Passit (Teva), the II place with 11.72% share of sales belongs to Valocordin, and the top three tablets Corvalol (producer - "Pharma Start"). "Traditional" Corvalol (in the form of drops) takes the 4th line of the rating of sedatives.

In addition to Corvalol, Valoserdin is a popular sedative for Russian production, which is also used as a cardiac remedy for rhythm disturbances. Over the past year, its sales grew by 5%.

TOP 10 hypnotics and sedatives

1) Novo-Passit
2) Valocordin
3) Corvalol drops
4) Corvalol tablets
5) Persen forte
6) Valoserdine
7) Persen
8) Melaxen
9) Valerian
10) Motherwort extract

Destructive Power of Cocaine

Cocaine destroys the nose

The incredible increase in cocaine consumption in all walks of life began in the 1960s. He attracted attention when the drug played a major role in the Hollywood blockbuster Easy Rider. He became a super-popular drug, and there was an explosion of demand for it, which caused an increase in supplies from South America. Formed international supply chains and the names of drug cartels have become well known. The largest drug lord of them all, Pablo Escobar, was one of the richest people in the world, earning millions of dollars every day.

Since Escobar, the cocaine business has expanded its product range. Now there is cocaine for every budget. This stuff costs $40 per gram. Can you easily see the difference, because it's powdery, while the coke that costs $80 grams, it is crystalline, you can even see a bit of shine. Just grind it. It's good stuff, you can taste the difference. This is a cheap material, it slightly hurts his nose. From this coke does not hurt at all, it runs beautifully and smoothly.

What is harmful about cocaine?
If you inhale too much of any type of coke, you can damage your nose. The mucous membrane inside the nostrils is affected, this causes the blood vessels to shrink and clot, depriving the surrounding tissues of supply with blood and oxygen. In the end, the tissues weaken and die. This can lead to a perforation in the nose. To treat these injuries, surgery is often required. Consultant Surgeon Sandeep Paun is a leading specialist in the field of nose reconstruction. As a result of regular use of cocaine, a hole formed in his nose in the nose. He wished to remain anonymous. Today we are going to carry out an operation to eliminate the perforation of your nasal septum. When did you do it last? I do it regularly, most recently six months ago. OK. there are no guarantees that we will be able to completely close the perforation. After consuming cocaine, the operation to close the perforation of the septum is quite difficult.

Destructive Power of Cocaine
I learned about the hole only when I went to the doctor, and he pulled blood clots from his nose that covered the hole that looked really scary. And all the fault was cocaine, a drug. When you look at Danielle Westbrook, as soon as you see her, you will understand what happened to her, her nose actually collapsed and the worst thing is that it can happen to you. During operation, the patient's nose will be cut and divided into two parts. The picture is very illustrative. We'll just look in the nose of this gentleman now. We move in through the nostrils, that's the inner view. On the front wall we can see this hole. In fact, this is a relatively small hole for a patient who abuses cocaine. It should be much more. Often these holes progress far beyond the size that we see here. Knife, please. Sometimes, when you make a strip, you experience a very strong, unbearable burning sensation from the very beginning of your nose to the back of your throat, very painful. The next day, you wake up with blood clots, and you, in fact, snot the pieces of your nose.

With chronic cocaine abuse, perforation becomes more and more, and the cartilage becomes weaker and weaker, because it lacks support. The upper part of the nose begins to collapse, and you can, ultimately, get a boxing appearance. Scissors please. I had patients who had destroyed the entire nasal septum. They had one nasal cavity, and everything just fell through. I sniffed coke every day. You do not worry when you do this. But then, the nose hurts scared, when the nose is bleeding you regret that they were doing it .. So, we see inside the nose, the mucous membrane, on the one hand, you can see the hole in the shell, first the cocaine forms a hole in the shell, and not in the cartilage, but then it corrodes the cartilage and eventually forms a through hole.

About coke
Cocaine is often mixed with all kinds of contaminants, including soda, glucose and, in the worst case, even with talc, which can lead to an intense inflammatory reaction. This inflammation can cause tissues in the nose to die even faster. Ironically, Mr. Pawn uses cocaine to stop the bleeding of the patient. Patients do not inhale it in advance, we give them a small amount in a liquid form. I just cut out a small piece of cartilage from the back of the nasal septum, which we then intend to insert into the front part, A little cartilage will close the hole. So, you can see here that the shell was completely closed, in the place where the hole was. If we look at the other side, There's no opening right now. I do quite a lot of nose surgery in London. There is a lot of money. About once every few weeks, I have a patient who has problems with cocaine use.

Second stage of alcoholism

Duration 5-15 years.

At this second stage all the symptoms of alcoholism become heavier. The pathological attraction to alcohol becomes more intense and arises not only in connection with "alcoholic situations", but also spontaneously. Patients are more likely to find motivation for alcoholization themselves than to use the appropriate situations.

Tolerance in the formation of the second stage continues to increase, reaches a maximum, and then, for a number of years, remains constant. Alcoholic amnesia becomes systematic, individual episodes of a significant part of the intoxication period are forgotten.

During this period of the disease, the form of alcohol abuse changes. This can be expressed in the tendency to periodic or constant abuse of alcohol throughout the disease. In the first case, frequent single drinks are replaced by drinking-bouts. Drinks are characterized by periods of daily drunkenness, the duration of which can range from a few days to several weeks.

There is a physical dependence on alcohol. A sharp break in drunkenness is accompanied by an abstinence syndrome: limb tremor, nausea, vomiting, lack of appetite, insomnia, dizziness and headache, pain in the heart and liver.

Alcoholics have changes in the mental sphere. The level of personality decreases, creative possibilities are lost, intellect is weakened. There is psychopathy and delusions of jealousy. In the future, it can go into a persistent delirium, extremely dangerous for the patient and his loved ones.

How to treat fungal diseases

Currently, fungal - mycotic - infections affect about 20% of the world's population. More than 100 thousand mushrooms are known, of which about 50 thousand are pathogenic for humans. In this case mycosis is very contagious.

The most common mycoses with a lesion of smooth skin and nail plates - onychomycosis. The causative agent of onychomycosis can be dermatophytes (Trichophyton rubrum) that affect the nail plates on the toes of the feet, brushes, smooth skin, as well as long and hairy hair, and Trichophyton interdigitale - the nails that damage the toes and the interdigital folds, the upper third of the sole and the arch of the foot. Often, onychomycosis causes yeast-like fungi of the species Candida and mold fungi - Scopulariopsis brevicaulis, Aspergillus, Fusarium and others.

The defeat of the nail plates can proceed according to the normotrophic type - only the color of the nails changes: in their lateral areas, spots and bands appear, the color of which varies from white to yellow, gradually the whole nail changes its color while retaining its thickness.

In hypertrophic type, subungual hyperkeratosis is attached to the changed color; the nail loses color, becomes dim, thickens and deforms.

For the onycholitic type, a dull brownish-gray color of the affected part of the nail, its atrophy and rejection from the bed is characteristic, the exposed area is covered with loose hyperkeratotic scales. In 15-25% of patients with mycosis, the stop fungal process spreads primarily to large skin folds, then to other parts of the skin. The effects of mycosis feet are quite serious. Under the influence of fungi and the products of their vital activity, polyvalent sensitization is formed, which leads to an increase in the frequency of allergic skin diseases, mucous membranes, attachment of eczematous complications, drug intolerance, especially antibiotics of the penicillin series. In addition, through erosion and cracks in the macerated, loosened horny layer of the skin, bacteria easily penetrate. Bacterial complications are characterized by resistance to therapy, bacteria under the influence of antibiotic substances produced by fungi, acquire increased resistance to antibiotics.

Combating the fungus from the outside and inside

Etiotropic treatment of onychomycosis happens:

- local (external) - the antifungal drug is applied to the smooth skin or the affected nail;
- systemic - the drug is prescribed inside, and it enters the nail plate through the blood.

To the requirements for antifungal drugs, in addition to their effectiveness, include a wide range of antifungal activity, rapid absorption, safety (the absence of common and local side effects), as well as ease of use.

Means of local therapy. If the patient has various diseases (chronic hepatitis, nephritis, pathology of the cardiovascular system), as well as with superficial mycosis and mycosis of smooth skin, the main principle of treatment is the appointment of local antifungal therapy (ointments, creams, gels, sprays, solutions and varnishes ). Antifungal components of these forms do not penetrate through the nail plate, so the drugs are applied to the smooth skin or to the naked nail bed - they are rubbed 2-3 times a day until a healthy nail plate grows.

Drugs containing only antimycotic are isolated, for example: bifonazole (1% cream, 1% solution, spray, powder), isoconazole (1% cream), ketoconazole (2% cream), clotrimazole (1% ointment, 1% solution, 1% cream, 2% cream, suppositories), miconazole (2% cream), econazole (1% cream, 10% solution), naphthiphine (1% cream, 1% solution), terbinafine (1% cream), natamycin (2% cream), chloronitrophenol (1% solution).

Drugs of double action, which, in addition to antimycotics, include anti-inflammatory substances: clotrimazole and betamethasone (cream), miconazole and mazipredon (ointment), isoconazole and diflucortolone (cream).

Preparations of triple action - with antifungal, antibacterial and anti-inflammatory action: clotrimazole, gentamicin and betamethasone (cream, ointment), natamycin, neomycin and hydrocortisone (cream, ointment, lotion).

Very convenient for use in local therapy of onychomycosis varnishes (with active substance 8% cyclopyrox and 5% amorolfin). They differ not only in high fungicidal activity against dermatophytes, molds and yeast-like fungi, but also antibacterial against gram-positive and gram-negative flora. To cure onychomycosis, 6 months of therapy is sufficient on the hands, 9-12 months on the feet.

A solution containing the active ingredient terbinafine hydrochloride (1%) is applied once a day. When applied, a thin film forms on the surface of the epidermis, from which the active component is released into the deeper layers in the therapeutic concentration for 13 days. Sprays, which include terbinafine and bifonazole, have a primary fungicidal effect.

At local use of preparations there are no systemic side effects, but when applied to the surface of the nail they do not always reach the pathogen capable of damaging not only the nail plate, but also penetrating into the nail bed, deep layers of the skin and even into the medullary canal of the fingers, especially with total defeat a nail plate. As practice shows, local treatment alone, in most cases, does not lead to complete recovery of patients.

Preparations of systemic action. Systemic therapy provides penetration of drugs into the nails through the blood. Although it does not allow you to immediately create in the nail such high concentrations as with topical application, but the supply of the drug in the nail bed and matrix with systemic therapy is guaranteed. Many systemic drugs accumulate in the nail matrix in quantities far exceeding the minimum inhibitory concentrations, and are able to remain there after the treatment is over.

There are 3 groups of compounds created for the systemic treatment of fungal infections in humans:

- inhibitors of ergosterol biosynthesis; it is the main sterol of the fungal cell and is necessary for the propagation of fungi;
- allylamines, squalene epoxidase inhibitors, blocking the conversion of squalene to squalene epoxide);
- azoles, inhibiting the activity of fungal cytochromes P-450;
- morpholines inhibiting delta14-reductase and delta8-delta7-isomerase.

Synthetic antimycotics of the azole series include itraconazole and fluconazole. Itraconazole has the widest spectrum of action on dermatophytes, different species of Candida and many mold fungi found in onychomycosis. At the distal ends of the nail plate, itraconazole can be detected after 1 week of treatment. In the matrix, the drug accumulates and is excreted only when the new nail plate grows, therefore, the effective concentration of the drug after its abolition is maintained in the nails on the hands for another 3 months, and on the legs - for 6-9 months with a 3-month course of treatment.

Fluconazole in the treatment of onychomycosis is used according to the pulse therapy scheme, the duration of which depends on the form and localization of onychomycosis: about 6 months with nail damage on the hands, up to 12 months on the legs.

Terbinafine (an allylamine derivative) is highly effective and safe in the treatment of onychomycosis, the drug can be used in children. But many yeast fungi, in particular Candida albicans, are resistant to terbinafine. At infections of fingernails or nails on arms or hand the term terbinafine treatment makes 6 weeks, at infections of fingernails or nails on legs or foots - 12 weeks (3 months).

The above drugs are metabolized in the liver with cytochrome P-450, but itraconazole, in addition, interacts with this enzyme, disrupting the metabolism of many medications, which it somehow influences. Hepatic complications from increasing the level of hepatic enzymes to the possibility of hepatitis are higher in itraconazole than in terbinafine (0.3-5% vs. 0.1%, respectively).

Ketoconazole, a synthetic preparation from the class of azoles, has a wide spectrum of action, but many mold fungi - causative agents of non-dermatophytic onychomycosis - are resistant to ketoconazole. With onychomycosis, the treatment takes 4-6 months and 8-12 months - with onychomycosis stops. The main toxic effect of ketoconazole is its effect on the liver. An increase in the concentration of hepatic transaminases during treatment is observed in 5-10% of patients taking ketoconazole.

The greatest efficacy of mycosis therapy is still achieved with combined etiotropic treatment, which combines the administration of a systemic antimycotic and a local drug.

It is also necessary to remember the prevention of the disease, which includes personal hygiene, nail and foot skin care, the prophylactic use of antifungals after exercise, visits to public institutions (saunas, swimming pools), disinfection of shoes and bath, sex and pedicure accessories, once a week For prevention, you can cover your toenails with antifungal lacquer.

Many people with foot mycosis try to start treatment on their own, which in most cases does not bring the desired effect, but only aggravates the course of the disease (spreading skin rashes, involving more nail plates and complications in the form of eczematiza- tion), so treatment should be done after consultation of a specialist - a doctor-mycologist who correctly diagnoses and selects treatment for each individual patient individually.

How to quickly remove hangover syndrome

Dilute 5-6 drops of ammonia in a glass of cold water and drink. Dead drunk unclot your mouth and pour in. 20 drops of mint alcohol help in the same way.

Lay the one you want to bring back to life. With the palms of your hands, rub both his ears quickly and strongly. A rush of blood to the head should lead the drunk into consciousness.

Strong sweet tea eliminates dizziness.

If things have gone too far, you should wash your stomach. A malicious but effective procedure: two fingers in the mouth - and vomiting. If it does not become easier, drink a weak solution of baking soda or potassium permanganate. Then take a laxative. Thus from you all the remnants of the holiday will come out.

A small, but a wide glass, moisten a few drops of vegetable oil (to cover the walls). Mix egg yolk with 10-20 drops of vodka and add a pinch of ground red and black pepper. Drink with a volley, pre-mixing properly.
The easiest method to combat a light hangover is a cup of coffee or tea on an empty stomach. These drinks relieve the feeling of weakness and fatigue. However, already a double dose can increase nervousness and irritability. In tea it is good to add lemon, honey or currant jam. All these additives can be consumed by mixing lemon or currant juices with mineral water. Folk remedies like brine or sour cabbage soup also fit into the pharmacological canons, although none of the medicines are listed. Paradoxically, these acutely acidic drugs are struggling with the acidification of blood, which is inevitable in a hangover. The weak acids contained in them, the blood only alkali.

When all standard brine-type methods have already been tried, and the soul craves something extravagant, try some foreign method. For example, out of solidarity with the Puerto Rican workers, get drunk according to their methods: take half a lemon and rub it under your armpits.

If the heart allows, go to the bath in the morning. Abundant sweating opens the pores and removes harmful metabolic waste from the body. After that, join the happy in marriage to men, from the earliest times, a borsch, a soup or broth brewed by good wives on the eve.

Maybe it's time for us, Slavs, to move on to cultural wine drinking? Then there would be no reason to write about alcohol poisoning.

Well, those who still decided to "tie" with alcoholic dope, but can not do it even with the help of official medicine, we will give some advice. The people have accumulated a lot of recipes to help people who pass before the green serpent. Here are some of them:

- Take 1 tbsp. a spoonful of centaury, one part of herb wormwood and one part of thyme - all dried. Pour 15 g of the mixture (5 g each) 200 ml of boiling water. Insist, wrapped, 2 hours, strain. Take 1 tbsp. spoon 4 times a day before meals;
- in 250 grams of vodka put a clean dried celery root and two dry leaves of the laurel of the noble. Insist for two weeks. To give a glass of such a tincture - most drinkers have a strong aversion to alcohol;
- 1 tbsp. Spoon the crushed dry roots of the claw into a glass of water. Boil for 10-15 minutes on low heat. Insist, wrapped, 30 minutes, strain, 1 tbsp. Spoon the decoction of the root of the claw into a glass with vodka, give a drink. Such a mixture will cause vomiting and a persistent dislike for alcohol. Precisely observe the dosage, since the plant is poisonous. The drunkard should not know that something has been mixed with vodka.

The use of glycine

In those ancient times, when every amateur photographer himself exhibited films and himself printed photographs, in the photoshop it was possible to buy glycine, a substance that was part of many developers. So called in everyday life the simplest of amino acids - aminoacetic acid.

Later, in the 80's, glycine began to produce the pharmaceutical industry. It was used as a metabolic corrector, that is, a substance capable of influencing delicate metabolic processes.

Not so long ago, a little over a decade ago, physicians paid attention to another property of glycine. It turned out that glycine is capable of neutralizing the toxic products of decomposition of ethyl alcohol and reduces the pathological attraction to alcohol. He was prescribed to people who abuse alcohol, or a patient with chronic alcoholism for interrupting drinking bouts and in an acute hangover period. Glycine prevents the development of alcohol "white fever" and alcoholic psychosis.

Glycine practically does not cause unpleasant side effects, except that the blood pressure decreases slightly and only in rare cases there is an individual intolerance of the drug. Habituation to it is not noted. The only thing that is not recommended is to use the drug along with sleeping pills, tranquilizers and neuroleptics - there can be unpredictable inhibition of the central nervous system.

Natural products containing glycine

Where to get the glycine? It is produced in a very primitive way from the cartilaginous tissue of cattle, if desired, you can get as many as you want. He is in the pharmacies of major cities, but should he chase after him?

The fact is that at the disposal of any hostess there are natural products containing glycine. This is a rich soup, an ear, a jellied fish, a cold. Even jelly marmalade contains glycine. In each 100 gram bag of gelatin contains not less than 20 g of glycine. Apparently not for nothing that our ancestors liked to have a snack of vodka with cold and jellied sturgeon!

In Armenia, for example, it is known as "hash". It is brewed from beef or mutton bones for a long time, and is eaten hot. They say that in Armenia you can not take a step so that you do not stumble upon "armenian cafe".

Now glycine is a part of many anti – hangover means, it even went so far that some distilleries began to produce special alcohol-free vodka, which includes glycine.

Back in 1994, a group of astronomers from the University of Illinois announced the receipt of evidence of the existence in space of glycine. This is the simplest form of an amino acid - one of the building blocks of DNA, and, consequently, of life on Earth. Even earlier, newspapers wrote about clouds of alcohol found in space. Apparently, someone there, upstairs, decided to prepare a lot of alcohol-free vodka.