Anticoagulants

Coagulation is the process of blood clotting and forming solid masses. The process of coagulation is initiated by platelets in blood. When coagulation occurs in blood vessels, it is called thrombosis. Though it is a natural process, clotting of blood causes certain health complications like kidney failure, deep vein thrombosis, pulmonary embolism, heart attack, stroke, and others. An anticoagulant is a blood thinner that can reduce the property of blood to form clots. These medications are generally consumed orally and have antithrombotic properties. Some of these anticoagulants are also administered in the intravenous route when a patient is hospitalized. Anticoagulants are used for the same purpose as antiplatelet medications, but they act different. They are prescribed to people who are at a risk of getting a heart attack or a stroke. These class of medications work by breaking the process of forming blood clots and by thinning blood. Warfarin (Coumarin group) is a commonly prescribed anticoagulant. Its method of action is to inhibit and block Vitamin K, which is responsible for activating the process of blood clotting. When Vitamin K epoxide reductase is blocked, clotting ability of blood is reduced and thus the risk of a blockage is avoided. This medication is also effective for preventing blood clots in veins. Another anticoagulant medication group that is widely used is Factor Xa inhibitor. Factor Xa present in blood is a major contributor in the coagulation cascade pathways. Factor Xa inhibitors act by selectively and reversibly blocking the process of clotting in blood and in the existing clot. This group of medications is effective for people who have undergone surgeries like knee & hip replacement, for prevention of pulmonary embolism, thromboembolism in atrial fibrillation, in deep vein thrombosis, and for people who are at a risk of heart attack. Heparins are a group of anticoagulants that can be injected. These come in two types – low molecular weight and high molecular weight heparins. These are given to high risk patients who are prone to develop blood clots and develop deep vein thrombosis, heart attack, and other conditions. These are also given to hospitalized patients. These group of medications act by blocking factor Xa and antithrombin III. Thrombin inhibitors are another class of anticoagulants that reduce the risk of blood clotting by inhibiting the action of thrombin. Since thrombin plays a vital role in the coagulation cascade pathways, inhibiting it reduces blood clot formation. These class of drugs are given as prophylactics in patients to avert angina, pulmonary embolism, and atrial fibrillation. Side effects of anticoagulants include dark colored urine due to urinary tract bleeding, dark colored stools due to intestinal bleeding, more bleeding than usual, bleeding gums, weakness, dizziness, headache, and stomachache. People with diabetes are at a higher risk of developing thrombosis and inflammation. This means that they are at a higher risk of having blood clots. Prolonged periods of high blood sugar levels, insulin resistance, and damage to blood vessels lead to many cellular level. People with diabetes are known to exhibit excessive activation of platelets and factors of blood clotting along with coagulation markers. Also, there is a decreased anticoagulant mechanism in blood. This places them in a high-risk group of stroke, heart attack, deep vein thrombosis, pulmonary embolism and many other macro and microvascular complications. People with diabetes are prone to get atrial fibrillation. Since anticoagulant medication can increase the risk of bleeding, it is important to adjust the dosage properly. These medications might also need some changes in the diet as some vegetable oils and legumes as they contain vitamin K and consumption of ginger, garlic, and gingko biloba improves the action of the medication.

Arrhythmia:

Arrhythmia:

Arrhythmia is a condition of the heart. It is also known as cardiac dysrhythmia. Arrhythmia is a condition where people have irregular heartbeat that is either too slow or too fast. It can manifest in the form of palpitations (See: Palpitations) where patients describe a perception of the heart pausing and starting in between beats. Arrhythmia is accompanied by shortness of breath, chest pain, and a loss of consciousness in case of certain diseases. Arrhythmia is of four types – extra beats, ventricular arrhythmias, supraventricular tachycardias, and bradyarrhythmias. These complications occur due to a defective electrical system of the heart. In its further classification, arrhythmias can be of atrial arrhythmia including sinus bradycardia, atrial fibrillation and others. It can be ventricular arrhythmia including ventricular fibrillation, ventricular tachycardia, and others. Also, junctional arrhythmia involves premature junctional contraction, junctional tachycardia, and others. Arrhythmia can also be caused due to blocks in the heart. Arrhythmias manifest with symptoms like frequent or infrequent palpitations with a sensation of the heart fluttering, lightheadedness, fatigue, chest pain, and rapid heartbeats. In some conditions, some people might not experience any symptoms. If left untreated, arrhythmias can lead to cardiac arrest and sudden cardiac death. Arrhythmias are generally diagnosed by auscultation with a stethoscope, using diagnostic tests like ECG or EKG, and Holter monitor. Treatment includes antiarrhythmic drugs, surgeries, and implantation of pacemakers. Though arrhythmia occurs in elderly people (above 60), it is also known to affect children. Diabetes is associated with numerous cardiovascular and heart diseases. It is known to cause arteriosclerosis and atherosclerosis. It is also strongly associated with heart rhythm disorders like atrial fibrillation and ventricular arrhythmias. Increased blood sugar levels damage the blood vessels and slows the electrical conduction of the heart’s electrical activity. Moreover, some people who are diabetic for many years are at a risk of developing autonomic neuropathy of the heart. The oxidative stress of diabetes is another factor leading to the risk of arrhythmias in people with diabetes. Episodes of hypoglycemia are also known to trigger cardiac arrhythmia and in some cases, leads to death in sleep.

Anaphylaxis:

Anaphylaxis:

Anaphylaxis is a severe form of allergy that involves multiple body systems including the respiratory system, gastrointestinal system, and the cardiovascular system among others. It is a life-threatening condition and a medical emergency. An anaphylactic attack might take 20 minutes to two hours to manifest when exposed to allergens (substances that cause allergy). In a condition called an anaphylactic shock, there is difficulty breathing, dizziness, loss of consciousness, swelling on the tongue and the respiratory tract, low blood pressure, and skin turning to blue color. This condition might lead to heart failure and death. It needs immediate medical attention. Anaphylaxis might occur due to several allergens including food, insect or snake bite leading to poison, use of certain medications, and other triggering factors some of which might be unknown. This severe allergic reaction might sometimes be caused due to immunological triggers. Typically, people who go into an anaphylactic condition exhibit symptoms like hives, itchiness, flushing, swelling, runny nose, swelling of the eyes and conjunctiva, skin turning blue, wheezing, difficulty breathing, low blood pressure, abdominal pain or cramps, vomiting, diarrhea, loss of bladder, and headaches. Symptoms might vary depending upon the organ system affected. People with asthma, eczema, and people having allergies to latex, or certain medications are prone to anaphylaxis. Treatment for anaphylaxis includes airway management through ventilator, giving intravenous fluids, and providing epinephrine (See: Epinephrine) and steroids. Insulin reactions are known to create anaphylaxis in some people with type 1 diabetes. People who are diabetic and have had anaphylaxis are prone to diabetic ketoacidosis.

Autotransplantation:

Autotransplantation:

It is the process of transplantation of tissues, proteins, and organs from one part of the body of the same person to another part. The transplantation of autologous tissue (tissue of a person grafted from another place in the body) by this procedure is also called an autograft. This is commonly used in blood donation, bone grafting, kidney transplantations, bone and tissue transplantations, teeth and root transplantations, skin grafts, cardiac autotransplantation, parathyroid autotransplantation, and islet cell autotransplantation ( in the pancreas).

Autonomic Neuropathy:

Autonomic Neuropathy:

Most of the process of the body are regulated by the autonomous nervous system. They regulate the breathing rate, blood pressure, heart rate, digestive system, metabolism, urination, the balance of electrolytes, production of saliva, tears & sweat, and sexual response. They are of two types namely sympathetic and parasympathetic divisions. Each division has a specific function and disorders of the autonomic nervous system are called autonomic neuropathies. Autonomic neuropathy might be caused due to various conditions like aging, peripheral nerve disorders, Parkinson disease, viral infections, and injuries to the neck and spinal cord. However, the main cause of autonomic neuropathy is diabetes mellitus. It can be hereditary or acquired. Autonomic neuropathy can manifest in the form of erectile dysfunction in men, urinary retention, dizziness, or lightheadedness, vomiting, urinary incontinence, constipation, or bowel incontinence. It is diagnosed by physical examination, blood pressure changes, ECG, tilt table test, and Valsalva maneuver. Treatments depend upon the organ or the region infected by autonomic neuropathy. The objective of the treatment is to provide relief from symptoms, and treating the underlying condition.

Autoimmune Disease:

Autoimmune Disease:

These diseases are not preventable. These are conditions arising from an aberrant response from the immune system. It is also termed as an overreaction of the immune system leading to the attack of the body’s own healthy cells and tissues. Though the causes of this phenomenon is not fully understood, it is believed to be caused due to gene mutations caused by exogenous and endogenous factors. There are around 80 types of autoimmune diseases including type 1 diabetes, rheumatoid arthritis, inflammatory bowel disease, Hashimoto’s thyroiditis, psoriasis, and multiple sclerosis. Our immune system produces B cells and T cells. In autoimmunity (See: Autoimmunity), the T cell and the B cell mechanisms go awry and start attacking a specific organ’s tissues (thyroid, pancreas, etc.). This is supposed to be triggered by certain bacterial or viral infections (enterovirus), environmental factors, vitamin D deficiency, and other factors. After a genome association scan, a scan of the genes of the populations affected by various autoimmune diseases, it was found that there was a high degree of self-reactive immune response due to the presence of autoantibodies (See: Autoantibodies) and self-reactive T cells. Autoimmune diseases affect the endocrine system, blood vessels, connective tissues, skin, the blood cells, muscles, and joints. They are diagnosed by antinuclear antibody tests, autoantibody tests, C-reactive protein test, and erythrocyte sedimentation rate test (ESR). The treatment involves controlling the process of autoimmunity, reduction of symptoms, and fighting the disease.

Autoimmunity:

Autoimmunity:

Autoimmunity is a kind of immunity response that triggers the immune system to attack the body’s healthy tissues and cells. Diseases resulting from an autoimmunity are called autoimmune diseases. This condition is also characterized by the immune system’s inability to recognize between foreign substances and body’s own cells. Generally, the B cell lymphocyte (a cell that forms in the plasma) produces antibodies to fight foreign substances like bacteria, virus, chemicals, and protozoa. This is an antigen. But, the immune system should be able to distinguish between a foreign substance and an own cell before launching an attack. In autoimmunity, this fails to happen and the immune system damages the organs. This leads to diseases like type 1 diabetes, systemic lupus erythematosus, and many others.

Autoantigens:

Autoantigens:

While antigens (See: Antigen) induce the immune system to produce antibodies, autoantigens are a result of mutations. Autoantigens are responsible for stimulating autoantibodies (See: Autoantibodies), thereby causing autoimmune diseases. Many identified autoantigens are responsible for autoimmunity and autoimmune diseases. In the case of type 1 diabetes, beta cell autoantigens and the activation of autoreactive lymphocytes against them is the leading cause for the failure of the pancreas to produce of insulin. Most autoantibodies and autoantigens are identified in people with type 1 diabetes in their early childhood around the ages of one and three and then they peak around their puberty.

Autoantibodies:

Autoantibodies:

Autoantibody is a type of antibody (See: Antibodies) that are produced by the immune system. As against the regular antibodies, autoantibodies, mistakenly attack the target the body’s own cells, and tissues as intruders and destroy them. They lack the mechanisms to distinguish between foreign entities and the body’s own cells. In normal circumstances, the immune system of the body has the ability to distinguish between foreign entities and own cells. The immune system is designed to fight against bacteria, virus, and other chemicals. However, in the case of autoantibodies, due to a state called autoimmunity where the immune system targets the healthy tissues of the body, it leads to autoimmune disorders. Autoantibodies are produced in the B cells either randomly or as a response to a foreign protein entering the body. This leads to diseases like type 1 diabetes, Graves’ disease, Hashimoto’s thyroiditis, Addison’s disease, and celiac disease.

Atherosclerosis:

Atherosclerosis:

It is a condition of the arteries that is characterized by the thickening of the walls of the arteries and blockage of arteries by the formation of plaques. Arterial blood vessels carry oxygenated blood from the heart to all the cells and tissues of the body. Atherosclerosis is a slow and progressive condition that might start even from the childhood. It might aggravate mid-age due to high cholesterol levels and triglycerides, hypertension, and smoking. Sedentary lifestyles, and other problems also contribute to the development of atherosclerosis. In people who smoke, atherosclerosis develops in the aorta, coronary arteries, and the peripheral arteries (arteries in the legs). Atherosclerosis is also known to be caused due to diabetes because diabetes damages the blood vessels. Symptoms of atherosclerosis depend upon the arteries affected by the condition. If the coronary arteries are damaged, people experience chest pain, anxiety, vomiting, and feeling faint. If the condition is in the carotid arteries, the symptoms would be difficulty breathing, paralysis, weakness, numbness in the face, and headache. In atherosclerosis of the peripheral arteries, symptoms would show up in the form of impotence, leg numbness, leg weakness, change of color in the leg, hair loss in the leg, and toenails getting thicker. In atherosclerosis of renal arteries, one would get symptoms of swelling in the legs and arms, difficulty concentrating, and lack of appetite. It is diagnosed by a blood test, Doppler ultrasound, ankle-brachial index, ECG, angiogram, CT-scan, and MRI. Treatment is given in the form of cholesterol medication, beta-blockers, ACE inhibitors, and other medications.

Aspartame:

Aspartame:

Aspartame is an artificial sweetener (See: Artificial Sweeteners), which is used as a substitute in certain foods and beverages. It is a non-saccharin sweetener that is 200 times sweeter than sucrose and its calorific value is negligible. Though its taste differs from ordinary sugar, its taste lasts longer. So, it is blended with other sweeteners to produce a distinct taste profile. Aspartame breaks down into amino acids and has high pH. The ingredients of aspartame are methanol, aspartic acid, and phenylalanine. Though aspartic acid, and phenylalanine are naturally occurring amino acids and the FDA had approved the use of aspartame, there are concerns for people with phenylketonuria. And, excess consumption of methanol over a period of time can lead to toxicity. It is even linked to certain types of cancer.

Aspart insulin:

Aspart insulin:

This is a fast-acting insulin manufactured from human insulin, which enables the insulin to be absorbed within minutes. This means that a person can consume food right after injecting with this insulin. The action time of this insulin is approximately 15 minutes.

Artificial Sweetener:

Artificial Sweetener:

Artificial sweeteners are used as substitutes for sugar. They are food substitutes with lesser amounts of energy. Some of them are produced synthetically and others are available naturally. Some are high intensity sweeteners like sucrose and maltodextrins used in soft drinks. Others like acesulfame potassium (See: Acesulfame Potassium), stevia, neotame, sucralose, aspartame, and saccharin are approved sugar substitutes used in foods. Certain sugar alcohols like sorbitol, and xylitol are sugar alcohols are less sweet and are also used in foods. They are generally used in foods and beverages to enhance taste, reduce weight, improve shelf life of the product, and to assist people with diabetes.

Artificial Pancreas:

Artificial Pancreas:

The pancreas is a flat gland in the abdomen. It is located in the left side of the abdomen and is surrounded by the spleen, liver, and the small intestine. It plays a key role in the digestion of food and maintaining the blood sugar levels of a person. Being an exocrine (See: Exocrine) gland, it produces many enzymes like amylase to break down carbohydrates, and chymotrypsin and trypsin to break down proteins. Pancreas is also an endocrine gland and it produces important hormones like insulin and glucagon. Insulin lowers blood sugar, and glucagon raises blood sugar levels. In people with diabetes, especially people with type 1 diabetes, managing the condition means that the patients should constantly their monitor blood sugar levels, measure their insulin dosages, and be ready for any emergency low blood sugar levels. This can be bothersome. For this reason, an artificial pancreas is being developed to control the blood glucose levels. The artificial pancreas is actually a system of devices that functions as a substitute for the real pancreas. It consists of a continuous glucose monitoring system, an insulin pumping device, a blood glucose device, and a control algorithm. The artificial pancreas allows a person with type 1 diabetes to have basal control, bolus control, and complete insulin therapy.

Artery:

Artery:

Blood vessels are of two types. They are arteries and veins. Arteries are blood vessels that carry oxygenated blood from the heart to all the organs and parts of the body. However, there are two exceptions. The pulmonary artery carries deoxygenated blood from the right ventricle of the heart to the lungs. Also, the umbilical arteries (paired arteries) in a pregnant woman carry deoxygenated blood from the fetus to the placenta. These umbilical arteries surround the urinary bladder and they regress after the birth of the child. Generally, arteries are of three types. They are elastic arteries, muscular arteries, and arterioles. Arteries have a higher blood pressure when compared to other circulatory systems and it depends upon the cardiac cycle. While the aorta is the root systemic artery, the capillaries are the smallest blood vessels which form the microcirculation system. Complications of the arteries include atherosclerosis, coronary artery disease, aortic aneurysm, peripheral vascular disease, atheroma, and complications of diabetes.