Dr. Medicine September month Medical newsletter

SEPTEMBER 2021 | ISSUE NO: 04 | ISSUE DATE: 25-09-2021
DR.MEDICINE MONTHLY MEDICAL NEWSLETTER
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WELCOME LETTER FROM DR.MEDICINE TEAM
Dear Readers, We take great pleasure in welcoming you to our Dr.Medicine's
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Regards,
DR.MEDICINE TEAM

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CONTENTS
5 Effects of love hormone ………….………………… 04
Parkinson’s disease …………………………..….………. 06
Mental health; Awareness is great,
but action is essential …………………..……………... 10
FDA APPROVALS …………………………..…………… 13
Editorial Board ………………………………….……….. 20

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5 Effects of the LOVE HORMONE
Edited by, SNEHA MAVIS
Oxytocin is a naturally occurring hormone and neurotransmitter that is
produced in the hypothalamus and delivered into the bloodstream via
the pituitary gland. It is also known as the "love hormone." To aid
reproductive functions, the hormone is released during childbirth, sex,
and lactation. The hormone appears to exist in both males and women.
It aids in the movement of sperm and the production of testosterone.
Why is it called the love hormone?
In social interactions and sexual reproduction, the "love hormone" plays
a crucial role. According to a 2012 study, people in the early phases of
romantic attachment have greater oxytocin levels, which last at least six
months. Similarly, during sexual activity and orgasms, the hormone is
stimulated.
5 effects of oxytocin:
1) Childbirth and lactation:
One of its most important functions in the body is to help the uterus
contract during labour and lactation. During labour, a substantial amount
of the hormone is released. It increases the number of contractions that
open the cervix and allow the baby to pass through the birth canal.
Pitocin, a synthetic oxytocin, has been used by doctors to aid labour for
decades. Following birth, oxytocin continues to cause uterine
contractions, promoting milk production in the breast.

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2) Sexual activity:
According to a study, oxytocin released in a woman's brain during sexual
activity aids in the development of a monogamous bond with her partner.
The love hormone, sometimes known as the "cuddle drug," plays a role
here.
3) Improve social skills:
Previous research has indicated that people with autism, a
developmental disorder characterized by difficulties with social skills and
communication, had lower levels of natural oxytocin. According to
Stanford results, people with autism who received intranasal oxytocin
spray improved their social behaviour significantly.
4) Boosts protective instincts.
According to one study, oxytocin boosts a person's defensive aggression
against anyone who appears to be a threat to their social group. This
protective instinct was first found in animal experiments, where oxytocin
was demonstrated to trigger an animal's protective behaviour against
predators—a critical survival factor.
5) Promotes sleep:
Cortisol, the body's known stress hormone, is combated by oxytocin.
According to a study published in the journal Regulatory Peptides, when
a person is not stressed, the oxytocin released in the brain naturally
encourages sleep. Because oxytocin has a relaxing impact, its
stimulation makes people feel relaxed and quiet, which helps them
sleep.

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ELABORATED
ARTICLE
PARKINSONS DISEASE
Edited by, SOWNDHARYA
Parkinson's disease is a neurodegenerative disease that leads to
shaking, stiffness, and difficulty with walking, balance, and coordination.
Parkinson's symptoms usually begin gradually and get worse over time.
As the disease progresses, people may have difficulty walking and
talking. They may also have mental and behavioural changes, sleep
problems, depression, memory difficulties, and fatigue.
It is common in both sexes. However, the disease affects about 50
percent more men than women. One clear risk factor for Parkinson's is
age. Although most people with Parkinson’s first develop the disease at
about age 60, about 5 to 10 percent of people with Parkinson's have
"early-onset" disease, which begins before the age of 50. Early-onset
forms of Parkinson's are often, but not always, inherited, and some
forms have been linked to specific gene mutations.
WHAT CAUSES PARKINSON’S DISEASE
Parkinson's disease occurs when neurons, in an area of the brain that
controls movement become impaired or die. Normally, these neurons
produce an important neurotransmitter known as dopamine. When the
neurons die or become impaired, they produce less dopamine, which

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causes the movement problems of Parkinson's. Scientists still do not
know what causes cells that produce dopamine to die.
People with Parkinson's also lose the nerve endings that produce other
neurotransmitters like norepinephrine, the main chemical messenger of
the sympathetic nervous system, which controls many functions of the
body, such as heart rate and blood pressure. The loss of norepinephrine
might help explain some of the non-movement features of Parkinson's,
such as fatigue, irregular blood pressure, decreased movement of food
through the digestive tract, and sudden drop in blood pressure when a
person stands up from a sitting or lying-down position.
Many neurons of people with Parkinson's contain Lewy bodies, unusual
clumps of the protein alpha-synuclein. Scientists are trying to better
understand the normal and abnormal functions of alpha-synuclein and
its relationship to genetic mutations that impact Parkinson’s disease and
Lewy body dementia.
Although some cases of Parkinson's appear to be hereditary, and a few
can be traced to specific genetic mutations, in most cases the disease
occurs randomly and does not seem to run in families. Many
researchers now believe that Parkinson's disease results from a
combination of genetic factors and environmental factors such as
exposure to toxins.
Symptoms of Parkinson’s Disease
Parkinson's disease has four main symptoms:
• Tremor (trembling) in hands, arms, legs, jaw, or head
• Stiffness of the limbs and trunk
• Slowness of movement
• Impaired balance and coordination, sometimes leading to falls

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Other symptoms may include depression and other emotional changes;
difficulty swallowing, chewing, and speaking; urinary problems or
constipation; skin problems; and sleep disruptions.
Symptoms of Parkinson’s and the rate of progression differ among
individuals. Sometimes people dismiss early symptoms of Parkinson's
as the effects of normal aging. In most cases, there are no medical tests
to definitively detect the disease, so it can be difficult to diagnose
accurately.
Early symptoms of Parkinson's disease are subtle and occur gradually.
For example, affected people may feel mild tremors or have difficulty
getting out of a chair. They may notice that they speak too softly, or that
their handwriting is slow and looks cramped or small. Friends or family
members may be the first to notice changes in someone with early
Parkinson's. They may see that the person's face lacks expression and
animation, or that the person does not move an arm or leg normally.
People with Parkinson's often develop a parkinsonian gait that includes
a tendency to lean forward, small quick steps like hurrying forward, and
reduced swinging of the arms. They also may have trouble initiating or
continuing movement.
Symptoms often begin on one side of the body or even in one limb on
one side of the body. As the disease progresses, it eventually affects
both sides. However, the symptoms may still be more severe on one
side than on the other.
Many people with Parkinson’s note that prior to experiencing stiffness
and tremor, they had sleep problems, constipation, decreased ability to
smell, and restless legs.
Diagnosis of Parkinson’s Disease
A number of disorders can cause symptoms similar to those of
Parkinson's disease. People with Parkinson's-like symptoms that result
from other causes are sometimes said to have parkinsonism. While
these disorders initially may be misdiagnosed as Parkinson's, certain
medical tests, as well as response to drug treatment, may help to
distinguish Parkinson’s disease from others. Since many other diseases
have similar features but require different treatments, it is important to
make an exact diagnosis as soon as possible.

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There are currently no blood or laboratory tests to diagnose nongenetic
cases of Parkinson's disease. Diagnosis is based on a person's medical
history and a neurological examination. Improvement after initiating
medication is another important hallmark of Parkinson's disease.
Treatment of Parkinson’s Disease
Although there is no cure for Parkinson's disease, medicines, surgical
treatment, and other therapies can often relieve some symptoms.
Medicines for Parkinson's Disease
Medicines prescribed for Parkinson's include:
• Drugs that increase the level of dopamine in the brain – Dopamine
agonists
• Drugs that affect other brain chemicals in the body
• Drugs that help control nonmotor symptoms
The main therapy for Parkinson's is levodopa, also called L-dopa. Nerve
cells use levodopa to make dopamine to replenish the brain's dwindling
supply. Usually, people take levodopa along with another medication
called carbidopa. Carbidopa prevents or reduces some of the side
effects of levodopa therapy—such as nausea, vomiting, low blood
pressure, and restlessness—and reduces the amount of levodopa
needed to improve symptoms.
People with Parkinson's should never stop taking levodopa without
telling their doctor. Suddenly stopping the drug may have serious side
effects, such as being unable to move or having difficulty breathing.
Other medicines used to treat Parkinson’s symptoms include:
• Dopamine agonists to mimic the role of dopamine in the brain
• MAO-B inhibitors to slow down an enzyme that breaks down dopamine
in the brain
• COMT inhibitors to help break down dopamine
• Amantadine, an old antiviral drug, to reduce involuntary movements
though it is not used frequently
• Anticholinergic drugs to reduce tremors and muscle rigidity
DEEP BRAIN STIMULATION:
People with Parkinson’s who do not respond well to medications, deep
brain stimulation, or DBS, may be appropriate. DBS is a surgical
procedure that surgically implants electrodes into part of the brain and
connects them to a small electrical device implanted in the chest. The
device and electrodes painlessly stimulate the brain in a way that helps
stop many of the movement-related symptoms of Parkinson's, such as
tremor, slowness of movement, and rigidity.

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Other Therapies
Other therapies may be used to help with Parkinson's disease
symptoms. They include physical, occupational, and speech therapies,
which help with gait and voice disorders, tremors and rigidity, and
decline in mental functions. Other supportive therapies include a healthy
diet and exercises to strengthen muscles and improve balance.
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MENTAL HEALTH:
AWARENESS IS GREAT, BUT
ACTION IS ESSENTIAL
Edited by, SRIRAM
It’s important to be aware of something that affects literally everyone,
and that a quarter of population regularly struggle. It’s weird that
anyone wouldn’t be when you put it in those terms, but that does seem
to the case.

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The term is a bit misleading, or not specific enough. It’s not exactly
mental health that people need to be made aware of, so much as the
fact that mental health can, and regularly does, go wrong. And when
someone’s mental health does falter or fail, they should receive the
same concern and help that someone with a more obvious “physical”
ailment should get, not scorn and stigma, as often happens.
Awareness:
If you end up with depression, anxiety, OCD or any other condition, it
can be hugely debilitating, often consuming your daily existence. Having
someone, be they a family member or total stranger, dismiss it outright
or accuse you of “faking it” or similar can only make it worse,
compounding the problem.
This is how campaigns to raise awareness of the issues can be
beneficial. Just like how increased exposure to people of different
ethnicities or backgrounds has been shown to reduced feelings of
prejudice and suspicion, so increased exposure to, or discussions about,
mental health problems and what they mean for those who deal with
them can enhance the understanding, or even trust the patience, of
those who don’t have to.
The human brain, powerful as it is, can still be overwhelmed by the
complex world we inhabit, so when it comes to creating mental models
of how the world works, it operates a general “stick to what you know”
policy. As such, things that are different or unfamiliar, especially if
they’re confusing and uncertain or introduce an element of perceived
threat or danger, are met with suspicion, doubt, and dismissal and so on.
But the brain is not that inflexible. Our idea of how the world (and those
in it) works is adaptable and ever-updating, based on what we
experience in our day-to-day lives. And if those experiences involve
people discussing mental health and the issues around it, that’s more
likely to become part of how we see the world and so has less chance of
unsettling us overall.

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The main problem is, the human brain is very good at becoming aware
of things, but it’s a lot harder for this awareness to lead to changes in
behaviour. Abstract concepts and understanding can be useful, but
things that cause strong sensory or emotional reactions carry more
“weight” as far as our grey matter is concerned.
Basically, someone experiencing a mental health problem or crisis may
not realise this. Many need help and assistance to even accept they
have an issue that requires dealing with. And the more there are people
around them who are “aware” of mental health problems and how they
manifest, the more likely this assistance is.
So, yes. Mental health awareness is good.
The point is, raising awareness of mental health is all well and good, but
it doesn’t automatically follow that the problems and concerns around
mental health will be affected in any appreciable way.
Essentially, mental health awareness is fine, but action is what’s actually
needed. Awareness is great for prompting those with issues to seek
help, but effectively meaningless if there’s no help available. And

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with ongoing cuts and shocking provisions to mental health services,
that’s where the real problems lie.
If mental health awareness can be channelled in to actually dealing with
the issues around it, then that would be great. But raising awareness is
just the start of the process, not the end. There’s a lot of work that needs
doing here. And that’s something we should all be aware of.
Raising awareness of mental health problems should be the start of
the process of tackling them, not the end.
FDA APPROVES THE FIRST
BIOSIMILAR FOR THE
TREATMENT MACULAR DEGENERATION
AND OTHER OCULAR CONDITIONS
Edited by, JASPER VICTORIA
Products obtained from any living source, such as animals,
microorganisms like bacteria or fungi are called biological products.
A bio similar product is a product that is approved by the FDA on the
basis of an already approved reference biological product which is
similar to the new bio similar in terms of potency, safety and purity. The
FDA has approved 31 biosimilar products, till date.
The FDA granted the approval for Byooviz (Ranibizumab) to Samsung
Bioepis, a biosimilar to Lucentis (Ranibizumab injection) to be used in
the treatment of certain ophthalmic conditions such as nAMD (wet) -
neovascular age-related macular degeneration, which is a common
cause for loss of vision and blindness in individuals aged 65 and above.
The biosimilar, Byooviz is also indicated to be used for macular edema
after retinal occlusion and a vision threatening complication of myopia,
the myopic choroidal neovascularization.
AMD may be wet or dry. The wet nAMD progresses to loss of vision
faster, though the dry AMD is much common. nAMD affects the daily

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activities of individuals such as reading, driving, etc. by destruction of the
sharp, central vision needed for clarity.
Byooviz is an intravitreal injection, meant to be administered into the
vitreous humor of the eye, once a month. The most common side-effects
include haemorrhage, eye pain, black spots that float in the eye-vitreous
floaters and increased intra-ocular fluid pressure, while the
endophthalmitis, retinal detachment, ocular thromboembolism are the
most serious adverse events.
Edited by, SANTHOSH KUMAR

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BDR pharma, a generic pharmaceutical company has developed and
announced the launch of a new drug named CABOZANTINIB which they
claim to treat metastatic medullary thyroid cancer, hepatocellular
carcinoma and also advanced renal cell carcinoma.
However Carbozantinib is used as a second line treatment against renal
cell carcinoma but used s a first line treatment for progressive metastatic
medullary thyroid cancer.
Carbozantinib belongs to a class of medications called kinase
inhibitors. It works by blocking the action of the abnormal protein that is
involved in signaling the cancer cells to multiply. It inhibits the activity of
RET, MET, VEGFR2 and other receptor tyrosine kinases. These kinases
are responsible for normal cellular function and pathogenesis such as
oncogenesis and tumour angiogenesis.
Carbozantinib is used along with nivolumab for RCC (renal cell
carcinoma) and also in hepatocellular patients who were previously
treated with sorafenib.
TRUDHESA-FDA APPROVES A NEW
DRUG FOR THE TREATMENT OF
MIGRAINE
Edited by, JOHN FELIX
Trudhesa (dihydroergotamine mesylate) is manufactured by Impel
NeuroPharma, Inc. and this drug have recently been approved by the
FDA on September 2, 2021. Trudhesa is a nasal spray formulation
which is used in the treatment of Migraine with or without aura in adults.
It is a prescription medicine used for the acute treatment of migraine and
it is not used to prevent migraine. It is not used to treat other types of
headaches.

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Trudhesa can cause serious side effects:
• Serious problems with blood circulation to your legs and feet
(Peripheral ischemia)
• Pain in legs and hip
• Burning pain in feet and toes
• Numbness and weakness in legs
• Slurred speech
• Sudden weakness
• Tingling sensation in legs
There are lot of contraindications. This drug should not be taken without
a proper prescription.

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FDA GRANTS FULL APPROVAL
FOR PFIZER-BIONTECH COVID-19
VACCINE ON AUGUST 23, 2021
Edited by, VAISHNAVI
It is the first and only Covid vaccine that got complete approval by the
Food and Drug Administration (FDA). Two doses of Pfizer's Covid-19
Vaccine has received full approval from the US FDA - the first jab to be
licensed in the nation. The vaccine had initially been given emergency
use Authorization. It's two jabs, three weeks apart, are now fully
approved for the use in age group of more than 16 years. This vaccine
has been known as the Pfizer-BioNTech COVID-19 Vaccine, and will
now be marketed as Comirnaty, for the prevention of COVID-19 disease.
FDA says that this approval is a milestone to fight against COVID-19
pandemic. While other vaccines were still not approved by FDA, this
Pfizer gives a belief among people regarding safety, efficacy, and

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manufacturing quality. Since December 11, 2020, the Pfizer vaccine has
been available under EUA in individuals 16 years of age and older, and
the authorization was expanded to include those 12 to 15 years of age
on May 10, 2021.
Comirnaty contains mRNA which mimics a specific type of protein
present in the virus which causes COVID-19. The immune system of the
individual receiving this vaccine ultimately react defensively to the SARS
CoV-2 virus.
mRNA of Comirnaty will be present in the body only for short period of
time. It is neither incorporated nor alters the genetic material of the
individual. Based on results from the clinical trials, the vaccine was 91%
effective in preventing the COVID-19 disease.
The most commonly reported side effects by those clinical trial
participants who received Comirnaty were Pain, redness and swelling at
the injected site, Fatigue, headache, muscle or joint pain, chills, and
fever.

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EDITORIAL BOARD
CHIEF EDITOR: JOHN FELIX
ADMINISTRATION: JASPER VICTORIA LEELARANI
EDITORIAL COORDINATOR: SANTHOSH KUMAR
REPORTED: DEEPAK HARI
HEAD CONTENT WRITERS: SOWNDHARYA
SNEHA MAVIS
ASSOCIATE CONTENT WRITERS: VAISHNAVI
SRIRAM

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