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AUGUST 2021 | ISSUE DATE: AUG 25 | ISSUE NO: 03

2. WELCOME LETTER FROM DR.MEDICINE TEAM
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4. CONTENTS
Dr. STRANGELOVE SYNDROME ...............................01
DR.MEDICINE SPECIALS ...........................................04
ELABORATED ARTICLE .............................................10
NATUROPATHY CARE ...............................................16
NEW THERAPEUTIC TARGET
FOR TREATMENT OF ACUTE
MYELOID LEUKEMIA ................................................20
VICARIOUS MENSTRUATION ...................................22
3 MORE DRUGS IN COVID-19 TREATMENT? ...........25
EDITORIAL BOARD ..............................................................29

5. Alien hand syndrome, often known as
Dr.Strangelove syndrome is an interesting
condition in which a person loses control of his or
her hand and it starts to act independently. It's
called "Dr.Strangelove syndrome", after the
character in Stanley Kubrick's renowned 1964 film,
in which Dr.Strangelove's right arm constantly
tries to give a Nazi salute, and he has to knock it
down with his left arm.
Alien hand syndrome can be caused by a variety
of factors. Some people acquire alien hand
syndrome as a result of a stroke, trauma, or
malignancy. It is sometimes linked to cancer,
neurological disorders, and brain aneurysms.
DR.STRANGELOVE
SYNDROME
Edited by, SNEHA MAVIS
01

6. Alien hand syndrome has been linked to brain
surgeries that seperate the two hemispheres of
the brain. This may necessitate an incision along
the corpus callosum.
The most prominent symptom of alien hand
syndrome is the inability to control the hand as it
acts independently. During these episodes, the
affected hand feels foreign to its owner and
seems to move deliberately to perform
unintentional actions. The hand moves as if it's
being directed by someone else or has its own
mind. The hand may touch your face, button a
shirt, or pick up an object frequently or
compulsively. The hand may also engage in self-
oppositional acts such as closing a drawer that
the other hand has just opened or unbuttoning a
shirt that you have just buttoned.
There is no cure for alien hand syndrome.
Individuals who develop alien hand syndrome
after a brain illness or a stroke may recover after
some time. People suffering from
neurodegenerative disorders, on the other hand,
have a lower rate of recovery.
02

7. Muscle control therapies such as
botulinum toxin (Botox) and
neuromuscular blocking agents can be
used to treat or manage the condition.
In some cases, benzodiazepines have
been effective. Mirror box therapy,
cognitive therapy techniques, and
learning task behavioural therapies can
all aid with symptom management.
03

8. DR.MEDICINE
DR.MEDICINE
SPECIALS
SPECIALS
August marks Psoriasis Awareness Month, a time to
spread information about the disease and its
treatment options, as well as to support those who
experience its manifestations.
PSORIASIS-Everything You need to
know
Edited by, JOHN FELIX
Psoriasis is a non-communicable,
chronic, painful, itchy, disfiguring and
disabling disease. The symptoms of
psoriasis may subside totally and may
exacerbate again during the course of
the disease.
04

9. Psoriasis is derived from the Greek words
"Psora-meaning itching" and "sis-meaning
condition". The patient may have a lifelong
illness that may be emotionally distressing.
There is no cure for Psoriasis. Treatment
may help to reduce the frequency of
episodes and may relieve symptoms.
EPIDEMIOLOGY:
Psoriasis is spread worldwide. It can affect
any gender and any age group. Majority of
patients have their onset at two age groups
(i.e. 20-30 Years and 50-60 Years of age).
05

10. ETIOLOGY:
Psoriasis is a T-Lymphocyte mediated
inflammatory disease. Genetic predisposition
coupled with some precipitating factor triggers
abnormal immune response. This results in
psoriasis skin lesions. Keratinocyte proliferation
is the major cause for psoriasis symptoms.
Genetics, autoimmune reactions, Infections,
injury to skin, Medications (such as Lithium,
anti-malarial, propranolol and indomethacin),
stress and smoking are the risk factors for
Psoriasis.
PATHOPHYSIOLOGY:
The skin consists of 3 layers namely Epidermis,
dermis and hypodermis. Epidermis is the
outermost layer of skin.
06

11. Epidermis is composed of Four sub layers,
• Stratum Corneum
• Stratum granulosum
• Stratum Spinosum
• Stratum Basale
Epidermis is composed of Keratinocytes which is
produced in basal layer just above the epidermis,
and migrate to skin surface in 28-30 days.
Due to any one or more Etiologic factors such as
injury, trauma or infections the immune system
gets activated. The immune cells such as
dendritic cells, macrophages and T-Cells gets
activated within dermis.
These immune cells moves to epidermis from
dermis and secretes chemical mediators such as
IL-36‫ץ‬, TNF∝, IL-1ß, IL-6 etc. This causes
epidermal hyperplasia and improper cell
maturation leading to pre-maturation of
keratinocytes. Pre-mature keratinocytes fail to
release adequate lipids. These lipids are
generally a cement adhesive of corneocytes. Lack
of these lipids forms poorly adherent Stratum
Corneum. This results in Flaking and scaly
presentation of Psoriasis.
07

12. Skin cells are produced every 3-5 days in
psoriasis patients rather than the usual 28-30
days. Due to over production of cells, the cells
buildup on the skin surface forming thick
patches, plagues and other characteristics of
psoriasis.
TYPES:
Psoriasis may be classified into different types
namely;
• Plaque psoriasis - Raised inflamed red patches
on skin
• Guttate psoriasis- Small psoriatic papules
• Inverse Psoriasis- Occurs in the folded areas of
skin like Knee, Elbow, and Armpit
• Pustular Psoriasis- Pus filled lesions
• Psoriatic arthritis- Psoriasis in the joints
• Erythrodermic Psoriasis- Superficial scaling
that appears like burns
• Nail Psoriasis- Occurs in nails 08

13. DIAGNOSIS:
• Physical Examination
• Psoriatic Area and Severity Index (PASI) to classify the severity
of Psoriasis as mild, moderate and severe.
TREATMENT:
Though this disease cannot be cured, treatment may help reduce
the symptoms and to reduce the frequency of exacerbations.
Proper counselling should be given to the patient to reduce stress.
• Phototherapy or Photochemotherapy for severe cases
• Topical corticosteroids such as Hydrocortisone butyrate 0.1%
cream may be used. Topical corticosteroids are available in the
form of lotions, creams, gels, foams, shampoo and solutions.
• Vitamin D analogues like Calcipotriol is used in mild cases of
psoriasis. They inhibit Keratinocyte differentiation and production
• Retinoids: Tazarotene is a topical retinoid. They normalize the
abnormal keratinocyte differentiation and proliferation.
• Salicylic acid: This is used as an adjuvant therapy to reduce
scaling
• Coal tar has anti-inflammatory property and reduces
keratinocyte proliferation
• Calcineurin Inhibitors: This is effective in treating Plaque
psoriasis. 09

14. ELABORATED
ARTICLE
Edited by,
SOWNDHARYA
SUBSTANCE ABUSE DISORDER – CAUSES,
COMPLICATIONS AND PREVENTION OF RELAPSE
Continuation of last
month's Elaborated
Article....
CAUSES
Like many mental health disorders, several factors may
contribute to development of drug addiction. The main
factors are:
• Environment. Environmental factors, including your
family's beliefs and attitudes and exposure to a peer group
that encourages drug use, seem to play a role in initial drug
use.
• Genetics. Once you've started using a drug, the
development into addiction may be influenced by inherited
(genetic) traits, which may delay or speed up the disease
progression.
CHANGES IN THE BRAIN
Physical addiction appears to occur when repeated use of a
drug changes the way your brain feels pleasure. The addicting
drug causes physical changes to some nerve cells (neurons) in
your brain. Neurons use chemicals called neurotransmitters
to communicate. These changes can remain long after you
stop using the drug.
10

15. RISK FACTORS
People of any age, sex or economic status can become
addicted to a drug. Certain factors can affect the likelihood and
speed of developing an addiction:
• Family history of addiction. Drug addiction is more common
in some families and likely involves genetic predisposition. If
you have a blood relative, such as a parent or sibling, with
alcohol or drug addiction, you're at greater risk of developing a
drug addiction.
• Mental health disorder. If you have a mental health disorder
such as depression, attention-deficit/hyperactivity disorder
(ADHD) or post-traumatic stress disorder, you're more likely to
become addicted to drugs. Using drugs can become a way of
coping with painful feelings, such as anxiety, depression and
loneliness, and can make these problems even worse.
• Peer pressure. Peer pressure is a strong factor in starting to
use and misuse drugs, particularly for young people.
• Lack of family involvement. Difficult family situations or lack
of a bond with your parents or siblings may increase the risk
of addiction, as can a lack of parental supervision.
• Early use. Using drugs at an early age can cause changes in
the developing brain and increase the likelihood of
progressing to drug addiction.
• Taking a highly addictive drug. Some drugs, such as
stimulants, cocaine or opioid painkillers, may result in faster
development of addiction than other drugs. Smoking or
injecting drugs can increase the potential for addiction.
Taking drugs considered less addicting — so-called "light
drugs" — can start you on a pathway of drug use and
addiction.
11

16. COMPLICATIONS
Drug use can have significant and damaging short-term and
long-term effects. Taking some drugs can be particularly
risky, especially if you take high doses or combine them with
other drugs or alcohol. Here are some examples.
• Methamphetamine, opiates and cocaine are highly addictive
and cause multiple short-term and long-term health
consequences, including psychotic behavior, seizures or
death due to overdose.
• GHB and flunitrazepam may cause sedation, confusion and
memory loss. These so-called "date rape drugs" are known to
impair the ability to resist unwanted contact and recollection
of the event. At high doses, they can cause seizures, coma
and death. The danger increases when these drugs are taken
with alcohol.
• Ecstasy or molly (MDMA) can cause dehydration, electrolyte
imbalance and complications that can include seizures. Long-
term, MDMA can damage the brain.
• One particular danger of club drugs is that the liquid, pill or
powder forms of these drugs available on the street often
contain unknown substances that can be harmful, including
other illegally manufactured or pharmaceutical drugs.
• Due to the toxic nature of inhalants, users may develop
brain damage of different levels of severity.
12

17. OTHER LIFE-CHANGING
COMPLICATIONS
Dependence on drugs can create a number of dangerous and
damaging complications, including:
• Getting a communicable disease. People who are addicted
to a drug are more likely to get an infectious disease, such as
HIV, either through unsafe sex or by sharing needles.
• Other health problems. Drug addiction can lead to a range
of both short-term and long-term mental and physical health
problems. These depend on what drug is taken.
• Accidents. People who are addicted to drugs are more likely
to drive or do other dangerous activities while under the
influence.
• Suicide. People who are addicted to drugs die by suicide
more often than people who aren't addicted.
• Family problems. Behavioural changes may cause marital or
family conflict and custody issues.
• Work issues. Drug use can cause declining performance at
work, absenteeism and eventual loss of employment.
• Problems at school. Drug use can negatively affect academic
performance and motivation to excel in school.
• Legal issues. Legal problems are common for drug users
and can stem from buying or possessing illegal drugs, stealing
to support the drug addiction, driving while under the
influence of drugs or alcohol, or disputes over child custody.
• Financial problems. Spending money to support drug use
takes away money from other needs, could lead to debt, and
can lead to illegal or unethical behaviors.
13

18. PREVENTION
The best way to prevent an addiction to a drug is
not to take the drug at all. If your doctor prescribes
a drug with the potential for addiction, use care
when taking the drug and follow the instructions
provided by your doctor.
Doctors should prescribe these medications at safe
doses and amounts and monitor their use so that
you're not given too great a dose or for too long a
time. If you feel you need to take more than the
prescribed dose of a medication, talk to your
doctor.
14

19. PREVENTING A RELAPSE
Once you've been addicted to a drug, you're at
high risk of falling back into a pattern of addiction.
If you do start using the drug, it's likely you'll lose
control over its use again — even if you've had
treatment and you haven't used the drug for some
time.
• Stick with treatment plan. Monitor cravings
• Avoid high-risk situations.
• Get help immediately if you use the drug again
15

20. CARE
NATUROPATHY
DIABETES MELLITUS
Diabetes mellitus, commonly known as
diabetes, is a metabolic disease that causes
high blood sugar. Untreated high blood
sugar from diabetes can damage your
nerves, kidneys, and other organs. There are
a few different types of diabetes:
❖Type 1 diabetes is an autoimmune
disease.
❖Type 2 diabetes occurs when your body
becomes resistant to insulin, and sugar
builds up in your blood.
❖Prediabetes occur when your blood sugar
is higher than normal
❖Gestational diabetes is high blood sugar
during pregnancy.
16

21. Role of naturopathY in diabetes Focusing on the
whole person, naturopathic doctors take the
time to identify and address the genetic,
environmental and behavioral/lifestyle factors
that play significant roles in diabetes. Lifestyle
changes around diet and exercise are essential
in the treatment of all types of diabetes.
GENERAL APPROACH OF PHYSICIAN:
o Review of diet and blood sugar log.
o Dietary guidance for more balanced blood sugar.
o Lifestyle counseling strategies.
o Herbs and nutritional supplements to support
blood sugar
management.
o Consultation on medication management
(including insulin)
TREATMENTS:
o DIET THERAPY: Certain food’s that are prescribed to
improve the disorder and to regulate blood sugar
levels.
o HYDROTHERAPY: It helps to improve a person's
metabolism and control blood sugar levels, and the
enema helps to cleanse toxins from the colon,
detoxify the system. 17

22. o YOGA: Asanas improve functions of the liver,
pancreas and digestive system some asanas
that are beneficial in treating diabetes are -
utthitapadasana, bhujangasana,
paschimottasana, Pavanamuktasana,
Vajrasana, Matsyasana, Suryanamaskar.
o MUD THERAPY: Helps to eliminate toxins
and corrects imbalances in the digestive and
endocrinal systems.
18

23. o The other methods given are CHROMO
THERAPY, HELIOTHERAPY, PRANAYAMA AND
KRIYAS
Precautions:
They have to follow the instructions given by
the physician.
SIDE EFFECTS:
It is natural, prescribed according to the
individual's ailment and is administered with
constant monitoring, so there is no side
effects.
Lifelong changes which they have to adapt:
Patients will have to maintain a healthy
lifestyle; they have to eat right, exercise hard,
stop smoking and drinking alcohol.
Leading a healthy lifestyle will keep diseases
away.
Reference:
-Dr. Sowmya Leonard.BNYS.,FINEM.
-Dr. Sruthy S John. MBBS.
By: - Adarsh J.BNYS.,EMCNY,namakkal,TN.
19

24. NEW THERAPEUTIC TARGET FOR TREATMENT
OF ACUTE MYELOID LEUKEMIA
Edited by, JASPER VICTORIA
Acute myeloid leukemia (AML) is the cancer
associated with the blood and bone marrow, from
where the blood cells originate. It is myelogenous,
since it affects the myeloid cells which may
become either the red blood cells, white blood
cells or the platelets. It is known for its rapid
progression.
With the help of a CRISPR (clusters of regularly
interspaced short palindromic repeats) screening
tool, researchers have set a new drug target for
the treatment of AML. It is also capable to reduce
the side effects associated with the now-available
medications.
They have found out that ZMYND8 is an epigenetic
(not associated with alterations in DNA) regulatory
protein that the cancer cells require for their
growth and survival, and not a gene.
20

25. Therefore, the scientists suggest that development
of inhibitors of ZMYND8, could possibly disrupt the
AML pathway. A biomarker for measuring the
sensitivity, epigenetic status or expression level of
IRF8 gene of the AML cells to ZMYND8 was also
brought to light during the screening. The scientists
found high expression of IRF8 gene in patients who
were treated for AML and also a DNA enhancing
the IRF8 gene in them supportive to their results.
As of real time scenario, AML affects 20,000
individuals, inclusive of paediatric as well as adult
patients and also reduce their life time drastically
to five years or by 27%.
The new researches and studies aid beneficial and
life-saving by improving the quality of
chemotherapy and developing newer drugs
curbing the neoplasmic growth.
21

26. VICARIOUS MENSTRUATION
Edited by, VAISHNAVI
It is a cyclic bleeding in extrauterine organs during
the period of menstruation. It is an extremely rare
condition, where bleeding occurs from the surface
other than the mucous membrane of uterine
cavity but from lips, eyes, lungs, stomach and
commonly from nose.
The bleeding from lungs usually occurs in
reproductive age. Ocular vicarious menstruation is
the state where there occurs bloody tears which is
also called as Haemolacria.
ETIOLOGY:
This all happens because of endometriosis.
Endometriosis is a condition where there is a
visible growth of bits of tissues that are similar to
endometrium (Uterus lining). Like the uterine
lining this tissue builds up and sheds in response
to hormone and causes a periodical bleeding.
22

27. Endometriosis often occurs in the age of 25-40.
Another reason for this state of condition, is
may be because of disruption of
hormones(estrogen and progesterone) which
increases in the menstrual period and in turn
tends to increase the blood flow to eyes, and
other parts.
SIGNS AND SYMPTOMS:
It may cause swelling, inflammation but
without any pain or discomfort. The vision in
ocular vicarious menstruation patients were
not altered. Even others like ear, nose and
throat also seemed to be good.
DIAGNOSIS:
As there is no pain, most patients came up
lately for clinical diagnosis. As eyes, ear, nose
and everything seemed normal it was difficult
to diagnose but they identified this
extrauterine bleeding only in the menstrual
period and hence they found it was an
abnormal vicarious menstruation.
23

28. TREATMENT:
Patients are advised to intake less coffee during
their menstrual period as the caffeine present
in it can exacerbate the pain and causes
tenderness of breast.
The medication may includes oral
contraceptives and gained a better result by
ceasing bleeding from other parts of the body.
24

29. World Health organisation has informed that they
will soon be testing 3 more drugs on people
affected by covid-19. These drugs are said to be
chosen by an independent panel and the three
drugs to be tested are Artesunate, infliximab and
imatinib.
Artesunate is an artemisinin derivative which is
used as an antimalarial often used in combination
therapy against severe malarial conditions caused
by plasmodium vivax and Ovale.
Infliximab is chimeric monoclonal antibody used
against autoimmune diseases like Chron's disease,
psoriasis, psoriatic arthritis and rheumatoid
arthritis etc. Initially it was used as a chemotherapy
drug for cancer but later it was found effective
against autoimmune diseases and so used. They
are TNF-Alpha blockers which is responsible for
proper immunity development and fight against
pathogens. But too much TNF-alpha can lead to
autoimmune conditions for which infliximab is
used.
3 MORE DRUGS TO GET INCLUDED IN THE
COVID DRUGS LIST?
Edited by, SANTHOSH KUMAR
25

30. Imatinib is a anticancer drug specifically a
tyrosine kinase inhibitor and is used in treating a
number of leukemias like
Myelodysplastic/myeloproliferative disease,
systemic mastocytosis, hypereosinophilic
syndrome, dermatofibrosarcoma protuberans,
and gastrointestinal stromal tumors. It acts by
inhibiting bcr-abl tyrosine kinase which is formed
by abnormality in the Philadelphia chromosome
in cases of chronic myeloid leukaemia (CML).
26

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32. 28

33. 29
EDITORIAL
BOARD

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30