A M/44 yrs. admitte in icu no h/o HT,Dm c/o chest pain with profuse sweating, giddiness, nausea. Bp 90/60 pulse 54/ min bsl 124mg/dl. tro t ck mb - ve. Ecg attach.pl diagnose Rx.

A 26 years old female presenting with sudden onset of palpitations. O/E - Tachycardia. Rest - NAD. No retrosternal pain or chest pain. Please , comment on ECG

Dear friends .... now a days .. so many patients with Corex or Tuusex or ( Codeine Addiction ) are coming with 3 bottle of syrup per day .........& are unable to leave because of severe with drawl ..... & affecting their personal social life .....& sexual life - leading to Divorce n marital discord ... & we treat successfully .... with latest medicine Injection n RTMS therapy ..... I am getting lot of inquiry after people ... seeing you tube ... my video testimony of a patient who was Corex addict & succesfully treated ... & living a normal life .... so i thought of giving all the relevant details about the treatment so that you can also do it at your clinic ... n can help millions ... in our country ... thanks to curofy for let us share our expetise with 1,500,00 fellow collegue doctors compiled with internet 50 sites added with my clinical experience .... Hope it will help you n our India ....young people Codeine Deaddiction What is Codeine? Codeine is part of a group of drugs known as opioids, Opioids interact with opioid receptors in the brain and elicit a range of responses within the body, from feelings of pain relief, to relaxation, pleasure and contentment1 Codeine is used to provide relief from a number of conditions, including: · Pain : Mild to moderate pain, Severe pain (when combined with aspirin or paracetamol) · Cough : Dry irritating cough · Diarrhoea · Cold and flu (when combined with antihistamines and decongestants)1 Codeine is usually swallowed and comes in different forms, including: · Tablets · Capsules · Suppositories · Soluble powders and tablets · Liquids1 Other names Codeine may also be known by a brand or trade name. Some common examples are: Codeines' other names Generic name Brand names Aspirin and codeine Aspalgin®, Codral Cold & Flu Original® Ibuprofen and codeine Nurofen Plus® Paracetamol and codeine Panadeine Forte®, Panamax Co® Paracetamol, codeine and doxylamine Mersyndol® and Mersyndol Forte®, Panalgesic® Overdose If the dose is too high, you might overdose. If you experience any of the below symptoms, Inability to pass urine · Severe constipation and obstructed bowel · Agitation · Cold clammy skin with a bluish tinge · Mental numbness · Very slow, shallow breathing · Hallucinations and sometimes seizures · Coma and death1 Using codeine with other drugs Codeine taken with alcohol can cause mental clouding, reduced coordination and slow breathing.1 Withdrawal Giving up codeine after using it for a long time is challenging because the body has to get used to functioning without it. Withdrawal symptoms usually start within a few hours after the last dose and become strongest between 48 and 72 hours.3 These symptoms can include: · Cravings for codeine · Dilated pupils ( eye) · Abdominal cramps, diarrhoea, nausea, vomiting · Lack of appetite · Runny nose and sneezing · Yawning and difficulty sleeping · Trembling, aching muscles and joints · Goosebumps, fever, chills, sweating · Restlessness, irritability, nervousness, depression1,2 Therapies Gradual discontinuation of opioids, Counseling, Supportive therapy and Opioid substitute / replacement therapy Two of the most common drugs used as substitutes during the treatment of opioid dependence are methadone and buprenorphine. When it comes to the treatment of codeine addiction, Buprenorphine is the substitute typically used. The aim of a substitute for codeine is that it can be administered during the detox process when you are trying to break free from your medication. Withdrawal from any type of opiate drug can lead to a range of rather unpleasant withdrawal symptoms, but the use of a drug such as buprenorphine can lessen the severity of the process. He or she will, for example, determine the dose to be taken, which will usually be between 12mg and 16mg. Your doctor might introduce Buprenorphine slowly while at the same time decreasing your dose of codeine. This helps to limit the type and severity of withdrawal symptoms that you might experience. Codeine is also known under the following street names: · Cough syrup · Coties · T-Threes · Schoolboy · Lean · Purple · Drank · Sizzurp Codeine Abuse Statistics · In 2016, the number of paracetamol deaths was 219. Twenty-eight per cent of those involved a paracetamol compound that included codeine. · The number of people attending hospital in England with opiate poisoning in 2015/2016 was 11,660. This related to drugs such as codeine, oxycodone, fentanyl, and morphine. · Codeine is available on prescription only in 25 countries, although it remains legal to purchase it in pharmacies and other outlets in the UK. · In 2015, the UK consumed almost 16% of the world’s share of codeine, second only to India with 19.3% and ahead of the United States with 12.8%. Some of the more common co-occurring disorders of opiate/codeine abuse include: · generalised anxiety disorder · panic disorder · post-traumatic stress disorder · obsessive compulsive disorder · major depressive disorder · Treating withdrawal With a doctor’s guidance, you can typically avoid severe withdrawal side effects. Your doctor will likely advise you to taper off your codeine use slowly rather than suddenly stopping the drug. Gradually reducing your use allows your body to adjust to less and less codeine until your body no longer needs it to function normally. Your doctor can help you through this process or refer you to a treatment center. They may also suggest behavioral therapy and counseling to help you avoid relapse. Your doctor may also suggest certain medications depending on whether you have mild, moderate, or advanced withdrawal symptoms. For mild pain and other symptoms Your doctor may suggest non-narcotic medications to ease more mild withdrawal symptoms. These medications may include: · pain medications such as acetaminophen (Tylenol) and ibuprofen (Motrin, Advil) to help reduce mild pain · loperamide (Imodium) to help stop diarrhea · hydroxyzine (Vistaril, Atarax) to help ease nausea and mild anxiety For moderate withdrawal symptoms Your doctor may prescribe stronger medications. Clonidine (Catapres, Kapvay) is often used to reduce anxiety. It can also help ease: · muscle aches · sweating · runny nose · cramps · agitation Your doctor may also prescribe a long-acting benzodiazepine such as diazepam (Valium). This drug can help treat muscle cramps and help you sleep. for advanced withdrawal symptoms If you have severe withdrawal, your doctor may try different options. For instance, they may switch you from codeine to a different medication, such as a different opiate. Or they may prescribe one of three medications that are commonly used to treat opiate addiction and severe withdrawal symptoms: · Naltrexone blocks opioids from acting on the brain. This action takes away the pleasurable effects of the drug, which helps prevent relapse of misuse. However, naltrexone may not stop drug cravings due to addiction. · Methadone helps prevent withdrawal symptoms and cravings. It allows your body function to return to normal and makes withdrawal easier. · Buprenorphine produces weak opiate-like effects, such as euphoria (a feeling of intense happiness). Over time, this drug can reduce your risk of misuse, dependence, and side effects from codeine. WHERE DO DRUGS COME FROM? Drugs like cannabis and heroin come from plants. Other drugs are man-made in laboratories.

45 year female with severe palpitation, irritability, some anxiety, nausea vomiting, mild left st chest pain , pulse 175/mit , BP 110/70 , RBS 100mg/dl , spo2 98%, chest xray normal 2D echo normal , D/D ?

WHAT is a PANIC DISORDER ? Many a times, I was forced to go to my casualty to see patients with PD in the middle of the nights. Let me share the information about what I learnt. ! Panic disorder(PD) is a frequent and debilitating psychiatric condition associated with reduced Quality of life and impaired work performance. The condition is characterized by discrete periods of intense fear or discomfort often accompanied by somatic and/or cognitive symptoms. Genuine physical signs such as chest pain, palpitations and shortness of breath resembling the known symptoms of Acute Cardiac events are common. PD often remains undiagnosed or untreated. It is estimated up to 40% of Individuals with panic attacks never seek treatment of any kind. Around 30-40% of patients with chest pain and normal angiographic findings meet the diagnostic criteria of PD. Most of them get labelled as dyspepsia ironically. Between 30-50% of Individuals diagnosed with PD also suffer from Agoraphobia( fear of places and situations that might cause panic or helplessness or embarrassment ), but by itself the prevalence of agoraphobia is considerably higher. Typically onset of PD occurs between late adolescence and the early twenties, but I , myself has seen in premenopausal women very often. Currently the diagnosis of PD is mainly based on the Diagnostic and Statistical Manual of Mental Disorders ( DSM ), which is the standard system to classify mental disorders for clinical studies. The most important risk factor for the development of PD is family history of anxiety disorders. First degree relatives of subjects with PD have a 4-7 times greater risk of developing PD. Finally PD can be defined as an inherited biochemical disturbance in the overall function or structure of GABAergic, noradrenergic, serotoninergic and/or dopaminergic systems. It is generally agreed that treatment of PD is Long term, lasting minimally 1 year and often 3 yrs or longer. But then the treatment of PD can come only in my next post !