Little Bits of Stuff

Semen allergy, also known as sperm allergy or human seminal plasma hypersensitivity (HSP), is an allergic reaction to the proteins found in most men’s sperm.

It is a very rare condition or is it? I personally believe there may have been a lot of misdiagnosis going on with this condition, I mean, who knows, there’s a whole lot of women out there who have vaginal itch every time and think they have an infection. I mean, just look at that number, it’s a huge one.

Anyway, it is very unclear how much this occurs in men, that is men being allergic to their own semen, or even how much of this affects men who have sex with men! 

So, studies do actually show it is possible to be allergic to your own semen in what is known as a POST ORGASMIC ILLNESS SYNDROME.

Well, that’s a topic for another day. Essentially, the symptoms you have will be similar to having allergies that you well know before. 

You may experience some redness, burning, swelling, pain, hives and itching. For women, this usually occurs on the vulva or the inside of the vaginal canal, for men, these symptoms occur on the shaft or the area of skin above the genitals.

Now you get, how you must have gone to the pharmacy a lot of times to say you have an itch down there, especially after having sex with your partner.

Interestingly enough, I have heard stories of females who dump their boyfriends for this symptoms after sex, especially when this guy 

travels and comes back, saying he has cheated and brought back some infection. What if it was just semen allergy? Of course you may have been having sex with same guy before and nothing happened.

The sulphonamides have a long deep history from the times of Prontonsil Red to the newer products available in the markets now.

They are broad spectrum andgood for urinary tract infections.

These indirect nucleic acid synthesis inhibitors inhibits the formation of dihydropteroic acid in the folic acid synthesis pathway.

In this episode, we highlight highly tested content when it comes to sulfonamides and drugs containing sulfa.

Let's know in the comments if you have questions, clarifications and contributions.

Let’s get on to Macrolides, Lincosamides.

A little bit of stuff on protein biosynthesis won’t hurt to help us understand the pharmacology of these class of drugs, macrolides and Lincosamides.

Bacterial protein synthesis involves proteins required for reproduction, and is made possible by ribosomal RNA, mRNA and tRNA. To begin, the double stranded DNA first unwinds in an untwisting motion in the region which codes for the specific protein to be made and only that one strand of the DNA serves as a template for what is known as transcription.

RNA polymerase makes a copy of this segment, which now stands as what is called mRNA. Once the strand of mRNA is complete, it detaches from that segment, and in turn become attached to ribosomes.

Now it gets interesting.

Bacterial ribosomes are made of two subunits, the small 30s and a bigger 50s ribosomal subunits, together makes up 70s ribosomal unit. The numbers don’t add up right? Yes 30+50 is not 70. If you want to know why, download the Podroom app and join the discussion, there you can ask me and I’ll explain. For now, we move.

The ribosomal subunits attach to the mRNA strand like a zipper and begin the synthesis of the polypeptide chain, along that strand.

Now the amino acids needed for this synthesis, is bound to tRNA, so tRNA + amino acids bind to the ribosome which is on the mRNA strand and begins to work its way from one end of the strand to the other, making the polypeptide chain in the process, until it hits a stop codon which makes it stop and release the full polypeptide chain it has been making. The 70s ribosome couples itself back and awaits further instruction.

It’s very easy, see, these are the steps

1.    Bacterial DNA unwinds to reveal a segment to be copied

2.    RNA polymerase makes a copy of this segment, a complete mirror image of the segment, detaches this new copy, which now stands alone as mRNA

3.    This mRNA attaches to 70s ribosome, which clasps the strands above and below with its two subunits 50s and 30s

4.    tRNA which contains amino acids is then bound to the ribosome and this moves along the mRNA strand to synthesize the polypeptide chain.

5.    Macrolides and Lincosamides inhibit this ribosome and do not allow it to move. If it cannot move, polypeptide and hence protein synthesis stops, and bacteria cannot grow, everything becomes static, that is why they say these drugs are bacteriostatic.

So now, drugs that affect ribosomes in protein synthesis either affect the 50s or 30s subunits of the 70s ribosome.

Don’t worry, there is a mnemonic for that.

Buy AT 30 and CELL @50

Aminoglycosides and tetracyclines inhibit protein synthesis by inhibiting the 30s ribosomal subunit.

Chloramphenicol, Erythromycin (macrolides), Lincosamides and Linezolid all inhibit 50s ribosomal subunit.

So macrolides – are a class of antibiotics that contain the following drugs

1.    Erythromycin – the oldest, strep, staph, pertusis, diphtheria, M. pnemonia

2.    Clarithromycin- strongly g +ve, used in eradication of H. pylori, renal toxicity

3.    Azithromycin – strong G -ve, RTI mainly

As you go from erythromycin to azithromycin, you go from old to new, and also their half lives increases in that fashion, and hence their frequency of dosing reduces.

MOA- just like I said, inhibits 50s, along with other counterparts in the mnemonic CELL @50

Spectrum of activity – G -ve and +ve, anaerobes (upper airway), atypical bacteria (legionella, chlamydia, mycoplasma etc), others like mycobacterium avium complex, campylobacter, treponema pallidum etc

Absorption- food decreases it, why enteric coated ones are made. Clarithromycin is well absorbed irrespective of food.

Distribution- all body fluids and placenta except CSF and Elimination- Hepatic: ALL, only clarithromycin is partially excreted by renals, why it needs renal adjustment at times. Cannot dialyze.

Erythro t1/2- 1.5hrs, clarithromycin about 6hrs, Azithro – 68hrs

Resistance- 80% is through the active efflux mechanism in which the mef gene encodes for an efflux pump that actively pumps macrolide out of the cell, away from the ribosome it is supposed to inhibit.

Another mechanism is one in which a gene alters the binding site of the macrolide on the ribosome.

Lastly, there is cross resistance which occurs between all macrolides.

Adverse Reactions-

M- Motility

A: Arrythmias (prolonged qt interval)

C: Cholestatic Hepatitis

R: Rash

0: eosinophilia

Drug interaction: it inhibits CYP3A4 enzyme leading to increased effects of carbamazepine, theophylline, warfarin, valproate.

Enough of Macrolides. Let’s talk about a close relative in mechanism of action.

The Lincosamides Briefly!

In this class is Clindamycin and Lincomycin

They are active against staph, gram +ve and -ve anaerobes. Also against Bacteroides.

Mechanism of action – You know this already, yes say it, of course if you Cell@ 50 you will know it binds to 50s ribosome and hence inhibits protein synthesis.

It is absorbed well, penetrates well into most tissues including bone, but not CSF

Excreted via the liver, bile and Urine.

Resistance: mechanisms via drug inactivation, alteration of 50s ribosomal subunit by adenine methylation and mutation of the 50s ribosomal protein.

USES:

1.    Anaerobic infections

2.    Osteomyelitis, arthritis

3.    AIDS related toxoplasmosis (combined with pyrimethamine)

4.    AIDS related pneumocystis carinii pneumonia.

ADVERSE REACTIONS:

1.    Severe diarrhea- pseudomembranous enterocolitis caused by clostridium deficille

2.    High IV dose – neuromuscular blockade

3.    Neutropenia

4.    Impaired liver function

5.    Hypersensitivity

And that’s all fellas. Next, we talk about Sulphonamides in the next episode.

This content is made for medical students, all pharmacology enthusiasts and medical practitioners who want to refresh their memory within the shortest possible time. This is meant to be used in conjunction with detailed pharmacology notes or texts, not sufficient as a standalone.

This is the big question that patients ask over and over again, Is Eczema Curable? Eczema is an umbrella term for several kinds of dermatitis, also known as atopic dermatitis more commonly. Others include contact dermatitis, Nummular dermatitis, discoid dermatitis etc

This episode discusses Eczema in detail, the risk factors, symptoms, treatment, prevention, impact on everyday life and myths.

How has eczema affected you or those close to you? Lets hear your thoughts.

This EM Quick Fire Under 10Minutes episode talks about seizures and terminologies and how to manage seizures in the Emergency Department.

This episode features one of the foremost and brilliant emergency physicians in Nigeria - Dr. Kehinde Ojifinni as he dissects seizures in the ED under 10minutes for health professionals.

The Covid 19 vaccine has rolled out in Nigeria in millions of the Astrazeneca shots shipped in on 2nd of March 2021. Nigerians have waited anxiously for this despite the side effects issues initially encountered in some European countries where some batches have been suspended.

What side effects await us? What are your thoughts on this vaccine? Have you taken your shot? Let us know in the comments section.

Apologies for the bad audio.

The Nigerian health system is highly dependent on good policy making and political will. The Abuja declaration of 2001 has been a yardstick for measuring the adequacy of the nation's commitment to a better and quality health care. The question is, how much does the Nigerian government value your health when proposing a health budget?

On October 20, 2020, young Nigerians who were protesting police brutality were shot at by men in Nigerian military uniforms. Unarmed, peaceful citizens were massacred at the Lekki Toll Gate in Lagos, southwest Nigeria.

There are several reports with varying numbers of body counts, some said 12, some 10. But I am not interested in those numbers at all. I am not interested in how many were injured, because even if it is one person, it counts. What even counts more is the realisation that the Nigerian military will open fire on protesters, blank bullets or not.

Nobody is safe, anywhere, that’s what that tells you. And the moment that begins to sink in, you begin to realise all over again how bad a situation you are in as a citizen of this country.

Recently, Mr. Macaroni and some others went out when the Lekki toll gate was to be reopened and he was arrested. Surprising right? No! I wasn’t. I wasn’t surprised at all. In fact, when I heard the news, I was like yea I knew that would happen for sure.

If you stayed in this country long enough, you will know there was a 95% chance that will happen.

And I don’t blame people for going out still. There comes a time when you become numb to everything and you just don’t care anymore. If you perish you perish!

The reason why I’m ranting about this now, and not before is this; when the going gets tough, a lot of decisions are taken on impulse, in seconds. You may get killed, injured or beaten and so on, but it is not at that particular time really that you feel the consequences, the implications of what just happened. It takes time. It all begins to come back to you, plays and replays in your head multiple times, to the point where you find it hard to sleep at night.

That’s the essence of this episode. How has the Lekki toll gate shooting affected us as a nation? How have we been coping with all the half truths and lies, the tussle here and there, not to mention the denials, those responsible saying they are not and so on.

Months down the line, have we asked how the parents of the families that were hurt are coping? How the injured are able to feed their families? How about the people that escaped unhurt, by bullets though, but have not been able to get over what happened that night?

There are so many issues here,

1.      Post-traumatic stress disorder (PTSD) – intrusive memories and distressing dreams

I lived in Jos at a time, and during my stay witnessed several horrors, I witnessed someone getting killed in cold blood, stabbed over and over as people watched, silent, some in anger, some numb, some looking away and some shouting yes, good for him. Let me tell you, it has not left me since then, it is there, clear as day in my head even though its more than 11years ago. There was this other time it was so bad, I and my friends had to drop our mobile devices inside nylon bags like offering just for a driver going our way in the convoy of military men to take us out of Jos. We withdrew from ATM in Abuja enroute lokoja so we could get our phones back and inform our parents we were ok. When I got home eventually, sleep was far from me. Even a needle dropping on the floor could wake me, and this continued for months.

Till date, when I take up any apartment or sleep in a hotel room, without knowing it I start looking and checking round for escape routes just in case. Just in case what?this is straight up PTSD! So, when I think about that and then reason with the Lekki toll gate survivors, I can literally feel what they are going through, then bring that full circle to what the concerned citizens of Nigeria are going through.

Talk about the grief from families who lost loved ones, can that eventually lead to depression in some? It’s the big question on everybody’s minds. And when I say depression, I see a lot of people saying they are depressed, a lot of times, the word is wrongly used. Depression is a whole lot, has different levels to it medically. So each time a family who lost someone passes through that toll gate, what do you think will be on their minds?? The rush of emotions back and forth, I mean, I cannot even imagine.

Don’t even get me started on anxiety disorders, seeing someone carrying a gun at a check point and you are like I hope he won’t use me for point and kill very soon and you start panicking so much you are covered with sweat.

How about people who can’t cope with all this naturally and are looking for other means? Do you know people may take solace in alcohol or some other form of substance abuse just to get past a day of sorrow, a day of regret, anger and sadness?

All this could effectively cause several issues relating to

·        Loss of productivity at work leading to loss of means of livelihood.

·        Relationships between families could be torn apart, blame games here and there.

·        Relationships with outsides are also jeopardized.

·        The health and general wellbeing are diminished.

·        These can all lead to ailments and sicknesses which further plunge the individual into a hole they may not be able to climb out off.

Who is responsible for all this? Has the government put in place any psychological support program to help people go through this? Let us assume, that the toll gate must be opened at all cost, how have we helped the citizens of Nigeria deal with this?

I am aware of the mentally aware Nigeria initiative (MANI) and some other mental health institutions trying to help in this times, but they can’t do it all, they still need help from a greater source who will provide resources and funding so a larger populace can be helped.

What should you do if you realise you or someone else near you is experiencing issues relating to mental health?

·        Break your routine! Do something new, try to have fun, meet people, hang out and see if you get your mind off it.

·        Try to get enough sleep if you can, it helps.

·        Eat a healthy diet.

·        Always stay positive, keep a positive attitude to things.

·        Avoid alcohol and drugs at all cost

·        Listen to calm music

·        Get help! Don’t ever think you can go through this alone, talk to somebody. It can be anybody, your friends, family and lastly if you don’t feel relieved, talk to a psychologist or psychiatrist, and your journey begins from there.

However, not everybody will cope, I do hope everybody will, but well, these things happen.

It is our responsibility as individuals, as a nation, to help each other achieve a common goal, a healthy lifestyle, a healthy nation and ultimately, a healthy world.

Infertility - the inability to conceive and bear a child despite regular unprotected sexual intercourse after one year is one of the many big issues in our society, that affects the mental health of couples, relations and the society at large.

Join Dr. Nick in this episode as he dissects the causes and management of infertility.

Many Faith Based Organisations made this mandatory for their members a while ago, and for obvious reasons. While everyone is debating whether this is a right or wrong move, we will discuss the benefits of having a planned premarital health screening done before you say I do!