General Health

One person in three has it so mildly that it almost requires no treatment.
Dithranol is another older treatment which is effective, alone or in combination with tar and salicylic acid, and removes the thick scales over the rash. Like tar, its effect is increased if used in association with ultraviolet light. Dithranol can stain clothes, so is best applied at night and old pyjamas worn.
Cortisone derivatives applied locally as creams, ointments, lotions or gels are effective and cosmetically acceptable. If strong preparations are used, the risk of side effects is increased.
Concentrated cortisone may be absorbed through the skin and suppress the body’s production of natural cortisone. The skin may become thinned and disfigured with dilated blood vessels.
In the long term, weaker preparations of cortisone produce a better result.

Better penetration of the cortisone is obtained by applying it, then occluding the area with plastic, which prevents the normal circulation of air, locally heats the skin and allows the active drug to penetrate into the deeper layers.

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Two new drugs, Fansidar and Maloprim, are used both for prevention of chloroquine-resistant falciparum malaria.
The first symptom of malaria is likely to be the fever and any undiagnosed fever in someone who has recently travelled through a malarious area should make the doctor think of that possibility.
It is important to identify which strain of Plasmodium is the cause so the correct treatment can be used.
Malaria can affect many organs of the body. The liver is usually involved and this can lead to jaundice. Kidney failure is also common.

If the red pigment of the red blood cells, haemoglobin, is released into the blood, it can be excreted by the kidneys and darken in color in the urine. This is called blackwater fever.

Cerebral malaria, where the brain is affected, is serious and can rapidly lead to death. There may be confusion, delirium or even coma.
The spleen which lies up under the left rib is usually enlarged in malaria and may be easily ruptured by a blow to the abdomen.

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It is usually accompanied by sweating and vomiting. The person often rolls around the floor or the bed and cannot lie still.
Urine will often need to be passed frequently and will usually contain blood. If the stone passes through the full length of the ureter and drops into the bladder, the pain will usually cease.

It may be passed to the outside with the urine and may cause no further pain as the urethra, the tube which carries the urine from the bladder to the outside, is wider than the ureter in both men and women.

Strong pain-relieving drugs like pethidine, a derivative of morphine, are usually needed to relieve renal or ureteric colic.
Stones are usually diagnosed by the symptoms but can be confirmed by X-ray. A plain X-ray of the abdomen may not be enough and an outline of the kidneys, ureters and the bladder can be obtained by an intravenous pyelogram (IVP), which also shows kidney function.

A radio-opaque dye, injected into a vein, is excreted by the kidneys. Serial X-rays show the outline of the renal system and can show any abnormalities, including stones.

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Methyldopa (Aldomet) is one drug which has stood the test of time. It is effective and is usually combined with a diuretic.
Large doses may lead to postural hypotension where the blood pressure drops suddenly as the person rises from the sitting or lying position. This can cause the person to feel giddy, to fall or faint.

Unless warned about this, the person may misinterpret this symptom to mean the pressure has risen and he may take extra tablets, which, of course, will only make the situation worse.

Like all the other hypotensives, methyldopa has other side effects. It can cause depression and can antagonise some drugs used to treat depression. It may even cause some changes to the bone marrow, but it remains the drug most commonly used.

The beta-blocker group of drugs are now widely used in treating blood pressure as well as coronary heart disease for which they were originally introduced. They have the advantage of not dropping the pressure below normal levels.

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General health