Narcissistic Personality Disorder

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People exhibiting the Narcissistic Personality Disorder demonstrate excessive need for admiration and lack empathy. They exaggerate their self-importance while appearing over-confident and grandiose.  Their sense of superiority remains distorted and pervasive.  These individuals are unable to tolerate criticism or disagreement and demonstrate difficulty forming close personal relationships. Narcissistic or Personality Disorder The Narcissistic Personality Disorder differs from the more common situation where people exhibit a variety of narcissistic traits.  The difference lies in degree with many cases straddling the border.  In those with the Narcissistic Personality Disorder (NPD) manifestations persist, prevent the individual from adapting and lead to significant functional impairment in multiple settings. This often lead to subjective distress.  NPD occurs less frequently than much less intrusive narcissistic traits. Actually NPD was only recently recognized with original descriptions dating…
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Kawasaki Disease

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Kawasaki Disease Related to Covid-19 Subscribe Now Considerable confusion surrounds a recently recognized complication of Covid-19 in young children and adolescents.  Since its original description in April 2020 it has been variously referred to as Kawasaki Disease, Toxic Shock Syndrome and Cytokine Storm. More recently the name has been changed from Pediatric Inflammatory Multisystem Syndrome to Multisystem Inflammatory Syndrome in Children. Without Symptoms of Covid-19 Children generally remain free of symptoms during their infection with the coronavirus.  Signs and symptoms of Kawasaki Disease typically manifest in the convalescent phase several weeks after the infection resolves.  It appears the immune system once stimulated to control the virus continues to spiral out of control and attacks tissues throughout the body. https://youtu.be/rguZShGIPqM Kawasaki Disease from WellNowDoctor on YouTube Manifestations Children with Kawasaki Disease…
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Singulair – Not Very Effective

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Subscribe Now Although Singulair or montelukast remains among the most frequently prescribed medicines with more than 25 million prescriptions each year, the drug is not very effective.  It routinely fails to live up to expectations.  Typically employed to treat nasal allergies, rhinitis or hay fever it may be administered to prevent asthma or breathing disorders associated with exercise.  Some doctors also prescribe Singulair off-label for individuals suffering from hives, itchy skin and for wheezing episodes in children.        Dose The dose remains one tablet daily in the evening except when used to prevent exercise related asthma.  These individuals should take the pill two hours before planned activities but the limit remains only one pill within any 24 hour period.  Montelukast is available for children over age 6 months as a packet…
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Remdesivir Treats Covid-19

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Accumulating evidence suggests enthusiasm surrounding Remdesivir as a treatment for Covid-19 appears warranted.  Originally introduced as a treatment during the Ebola epidemic of 2013-2016, Remdesivir targeted the virus in laboratory studies and test animals.  However it offered only mediocre results in comparison to other drugs in a major trial sponsored by the WHO. During initial studies in conjunction with investigators from the CDC, NIAID and US Army Research Institute of Infectious Diseases, Remdesivir demonstrated significant activity against the coronavirus cause of the Middle East Respiratory Syndrome or MERS.  Due to the small number of patients and the restricted geographic area, human testing was not undertaken.  Not unexpectedly laboratory experiments of Remdesivir also revealed enhanced control of the related coronavirus resulting in Severe Acute Respiratory Syndrome or SARS.   Ebola Shortly after…
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Hydroxychloroquine | Maybe For Coronavirus?

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Hydroxychloroquine Although hydyroxchloroquine received FDA marketing approval about 65 years ago, until recently it generated little interest.  Primarily indicated as therapy for systemic lupus erythematosus and rheumatoid arthritis, hydroxychloroquine remains among the top 150 prescription drugs in America.  In some circumstances hydroxychloroquine may also find use in treating or preventing malaria.  Hydroxychloroquine is a close relative of the slightly more toxic chloroquine. Laboratory Studies During the mid-1990s studies in the laboratory, not in humans, demonstrated hydroxychloroquine could inhibit growth of a wide array of RNA viruses including the causative agents of rabies, influenza, Dengue fever and some forms of hepatitis.  Other experiments suggested similar actions against bacteria and fungi.  In 2009 scientists observed an otherwise lethal exposure of newborn mice to coronavirus OC43 could be transformed into a survivable condition…
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Non-24 Sleeping Pill | $15,000 a Month

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[caption id="attachment_254" align="alignleft" width="150"] logo created by RKL[/caption] The cash price for a single month of Vanda Pharmaceuticals’ highly advertised “Non-24” sleeping pill averages $15,000.  This translates to $500 a night or $180,000 a year for basically a sleeping pill that targets the melatonin receptors in the brain.  A four month supply of melatonin readily available without a prescription at any grocery store or pharmacy costs about $6. This drug, more properly known as Hetlioz, gained FDA marketing approval in 2014.  That year the cost for one month of Hetlioz was an egregious $7500.  By 2017 it rose to in excess of $13,000 and surpassed $15,00 by early 2018. The “Non-24” pill sold as Hetlioz contains a molecule similar to but somewhat different from over-the-counter melatonin preparations.  For obvious reasons…
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Victoza Heart Disease Diabetes and Survival

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[caption id="attachment_254" align="alignleft" width="150"] logo created by RKL[/caption] Can Victoza favorably disrupt the unholy trinity of obesity, type 2 diabetes and heart disease?  Since most type 2 diabetics die of cardiovascular disease rather than elevated blood sugar, this question significantly impacts survival. Advertising claims suggest advantages for the injectable anti-diabetic drug Victoza in protecting the heart, stimulating weight loss and reducing the likelihood of death from cardiac events.  Are these based in reality or merely commercial entreaties from the drug maker looking to ensnare more customers? Among the results emphasized by the company are a statistically significant fall in death from cardiovascular causes from 1.6 in 100 patient-years down to 1.2.  Regarding death from any cause Victoza reduced the toll from 2.5 deaths in 100 patient-years to 2.1. While statistically…
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Prevagen – Save Your Money Instead

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[caption id="attachment_254" align="alignleft" width="150"] logo created by RKL[/caption] Considering Prevagen - save your money instead.  Want to think like a jellyfish – take Prevagen.  Tiresome repetitious televised commercials somehow link brain health, clearer thinking and a sharper mind to an amino acid present in jellyfish. This moderately expensive supplement at once claims to improve mental clarity while at the same moment noting “this product is not intended to diagnose, treat, cure or prevent any disease.” Studies supposedly demonstrating Prevagen’s benefits must be taken with the proverbial grain of salt.  These company sponsored “investigations” appear highly flawed, unscientific, unreliable and not published in any recognized peer review journal.  Apparently the company and its principals even played a dominant role in writing the papers. Evidence supporting for Prevagen stems from the Madison…
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Gabapentin Remains an Enigma

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[caption id="attachment_254" align="alignleft" width="150"] logo created by RKL[/caption] Gabapentin remains an enigma: one of the most widely prescribed and abused drugs yet one with relatively little scientific justification for its use.  Approved as an add on for partial seizures in adults and children, it gained a certain following for treatment of severe nerve pain following in the aftermath of shingles – post-herpetic neuralgia (PHN). Even for post-herpetic neuralgia, gabapentin fails to live up to expectations.  Only moderate quality evidence exists regarding this indication.  Unfortunately studies indicate only 15% of individuals benefit by a 50% reduction in pain compared to those receiving a placebo.  And typically the investigations lasted only two to three months in PHN where symptoms persist for months to years. Gabapentin finds a certain cache as therapy for…
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Linzess Targets Chronic Constipation

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[caption id="attachment_254" align="alignleft" width="150"] logo created by RKL[/caption] Linzess targets chronic constipation related to long term conditions of undetermined cause such as the Irritable Bowel Syndrome.  By definition this requires fewer than 3 bowel movements each week for at least 3 months.  Unfortunately this very expensive drug, whose price continues to steadily increase, provides only mild relief.  With a cash price in excess of $15 a day, the drug seems as likely to cause harm as benefit. Approximately 1 in 5 individuals receiving Linzess experience diarrhea which at times may be quite serious.  Especially among the more fragile this may lead to dehydration, low blood pressure, dizziness and possibly fainting episodes. Advertisements aimed at the general public suggest the drug offers major advances in combating constipation.  Studies however suggest Linzess…
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