Gastro-oesophageal Reflux During Pregnancy: Treat With Care

Gastro-oesophageal Reflux During Pregnancy: Treat With Care

from Drugs & Therapy Perspectives

Can Occur at Any Time

Typically, gastro-oesophageal reflux in pregnancy is of new onset. For those patients with pre-existing gastro-oesophageal reflux, symptoms may continue or worsen during gestation.

Gastro-oesophageal reflux can occur at any time during pregnancy and symptoms usually resolve post partum.[1]

Symptoms Similar to the General PopulationSymptoms of gastro-oesophageal reflux are no different during pregnancy than at any other time. The predominant symptoms are heartburn and regurgitation.[1] Other common complaints include indigestion, epigastric pain, waterbrash, anorexia, nausea and vomiting.

Precipitating factors include eating before bedtime, ingestion of fatty or spicy foods, caffeinated beverages, mints or chocolates, and sometimes inadvertent use of drugs that decrease lower oesophageal sphincter pressure (e.g. calcium antagonists, anticholinergics). Complications (e.g. oesophagitis) are rare in pregnancy.

Hormones Play a RoleAlthough the exact mechanism is unknown, the pathophysiology of gastro-oesophageal reflux in pregnancy is probably multifactorial including hormonal effects on lower oesophageal sphincter function, and mechanical factors.[1]

This is a part of article Gastro-oesophageal Reflux During Pregnancy: Treat With Care Taken from "Sucralfate Carafate" Information Blog

BBC SPORT | Rugby League | Super League | Saints finish lights up Super League

By Dave Woods BBC Sport

Go on, pinch yourself Warrington fans, but you won't wake from the nightmare.

Dave Woods' team of the week

It's still impossible to understand how St Helens turned certain defeat into one of the unlikeliest wins in Super League.

The Wolves, who played terrifically well for the most part, led 16-4 with barely six minutes left.

Warrington 16-18 St Helens

Then in a thrilling finale, Saints managed to squeak it, scoring three tries, including one with the very last play of the game.

It's a St Helens trademark - and they managed it without Long, Sculthorpe and Hooper.

Warrington were within seconds of seeing their season take off. But now they have to rebuild confidence again ahead of Leeds away next week.

Hull were powerfully impressive against a very well-organised Salford.

Salford 12-22 Hull

Paul Cooke put in a superb individual show - the two passes he produced to send over for Gareth Raynor and Kirk Yeaman would have had Hull fans of a certain age reminiscing about Steve "Knocker" Norton.

Salford are good though - top six is not beyond them.

Bradford's win over London Broncos can be filed in the "that's more like it" column.

Bradford 48-22 London

Apart from the opening 20 minute spell when London competed, the Bulls bossed the game looking back to their confident, powerful best.

Still, London's most important win of the week came off the field in the Super League boardrooms.

Their home games remain a priority and next week's match versus Wigan is of enormous significance.

Another defeat for Leigh, but give them credit for a battling approach to the game against Wakefield at the Atlantic Solutions Stadium.

Wakefield 38-26 Leigh

The freshly poured glass of champagne that was Trinity's initial form seems to have turned into half a carafe of cheap house wine.

They need to rediscover that early bubbliness they had.

And they certainly deserve better than a crowd of not much more than 4,000.

Widnes have now completed the opening month from hell, and the signs are they can kick on from here.

Widnes 20-32 Wigan

Two points from the first four fixtures against St Helens, Bradford, Leeds and Wigan could have been four points had it not been for a late fight-back by the Warriors at the Halton Stadium.

Widnes held the lead with around 20 minutes remaining, but Wigan had the stronger finish.

And what are we to make of Huddersfield?

Alright it was Leeds who trounced them at the Galpharm and Leeds are trouncing everyone at the moment.

But it's the third successive week that the Giants have got off to a dozy start, and this time they couldn't muster a fightback.

Huddersfield 10-54 Leeds

Last year the Giants were flying at this stage, this year they have only a win at Leigh from their first four weeks.

It's form that has to change quickly as the Super League table begins to take shape.


This is a part of article BBC SPORT | Rugby League | Super League | Saints finish lights up Super League Taken from "Sucralfate Carafate" Information Blog

Sildenafil in Erectile Dysfunction

Sildenafil in Erectile Dysfunction

from Current Medical Research and Opinion

Phosphodiesterase Type 5 and the cGMP Pathway in Penile Erection

Sildenafil is an orally active, potent and selective inhibitor of cGMP-specific PDE5.[2, 3] Phosphodiesterases (PDEs) catalyse the hydrolysis of the second messengers cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP), which are involved in signal pathways of cavernous smooth muscle. Indeed, the accumulation of cGMP sets in motion a cascade of events at the intracellular level which induces a loss of contractile tone of the vessels at the penile level. Many neurotransmitters activate guanylate cyclase which catalyses the conversion of guanosine triphosphate (GTP) to cGMP and subsequently triggers relaxation by lowering cytosolic Ca2+. Thus, relaxation of smooth muscle derives from the resumption of a pre-contractile state accomplished by lowering cytosolic Ca2+ or decreasing the sensitivity of the contractile machinery to Ca2+.[9] Many studies have demonstrated in animal models and in humans, both in vivo and in vitro, an essential role for nitric oxide (NO) in promoting the formation of cGMP and other pathways finally leading to erection of the penis.[10-16]

Phosphodiesterase type 5 belongs to a protein superfamily of cyclic nucleotide PDEs, which can be subdivided into at least 11 families of structurally and functionally related enzymes. More than 40 isoforms have been characterised so far, all differing from their primary structure to tissue distribution.[17-19] In human cavernous tissue the presence of messenger RNA (mRNA) transcripts specific for 14 different human PDE isoenzymes and isoforms has been demonstrated: three isogenes of PDE1, PDE2A, and PDE10A, which hydrolyse cAMP and cGMP; the cAMP-specific PDE3A; four isogenes of PDE4, PDE7A and PDE8A; and the cGMP-specific PDEs PDE5A and PDE9A19. PDE5 constitutes the majority of the cGMP hydrolytic activity in corpora cavernosa smooth muscle cells and, functionally, PDE3A and PDE5A seem to be the most important.[20, 21] Phosphodiesterase type 11 has also been detected in the cavernosal smooth muscle.

Recently, three PDE5 isoforms in human penile tissue have been described.[22] These subtypes are spliced variants with identical active sites. Phosphodiesterase type 5A1 and PDE5A2 are identical to other PDE5s previously isolated from non-penile tissue. in vitro, the novel PDE5A3 seems to be confined to tissues with smooth muscle or cardiac muscle components.[21] Early data seem to demonstrate that subtype selectivity of pharmacological agents is very unlikely.

This is a part of article Sildenafil in Erectile Dysfunction Taken from "Levitra Vs Sildenafil" Information Blog