Gout

Gout

Gout causes attacks of pain and swelling in one or more joints. A short course of an anti-inflammatory painkiller will usually ease an attack quickly. Certain lifestyle factors may reduce the risk of having gout attacks. These include losing weight if you are overweight, eating a healthy diet, not drinking too much alcohol and cutting back on sugar sweetened soft drinks. If gout attacks recur, then taking allopurinol each day can prevent attacks.

What is gout and what causes it?
Gout causes attacks of painful inflammation in one or more joints. It is a type of arthritis (although it is very different to the more common rheumatoid arthritis and osteoarthritis). The pain of a gout attack can be severe.Gout is caused by a chemical in the blood called uric acid (urate). Uric acid is usually harmless, and is made in the body. Most is passed out with the urine, and some from the gut with the faeces (stools). In people with gout the amount of uric acid in the blood builds up. From time to time the level may become too high and tiny grit-like crystals of uric acid may form. The crystals typically collect in a joint. The crystals irritate the tissues in the joint to cause inflammation, swelling, and pain - a gout attack.Note: some people have a high level of uric acid but do not form crystals or have gout. Also, rarely, some people with a normal level of uric acid have gout attacks. However, as a rule, the higher the level of uric acid, the greater the chance of developing gout.
Why does uric acid build up?
Normally, there is a fine balance between the amount of uric acid that you make, and the amount that you pass out in the urine and faeces. This keeps the level of uric acid in the blood in check. However, in most people with gout, their kidneys do not pass out enough uric acid and the blood level may rise. They are said to be 'under-excreters' of uric acid. Their kidneys usually work otherwise normally.In some people, the build up of uric acid may due to other factors. For example:
If you drink too much alcohol it can cause uric acid to build up.
If you drink sugar-sweetened soft drinks high in fructose it can cause uric acid to build up. A recent research study found that having two drinks a day of a sugar sweetened soft drink increased the risk of developing gout by 85%. (Drinks labelled as ‘diet' or drinks containing artificial sweeteners were not found to increase the risk.) Fructose rich fruits and fruit juices may also increase the risk.
Certain foods may 'tip the balance' to raise your uric acid higher than normal. In particular, if you eat a lot of heart, herring, sardines, yeast extracts, or mussels it may increase the level of uric acid. However, eating a normal balanced diet should not have much effect on the uric acid level.
Some medicines may raise the level of uric acid. For example, diuretics ('water tablets') especially the thiazide diuretics such as bendroflumethiazide, aspirin (at full painkiller dose - not low dose aspirin used to prevent blood clots), and some used as chemotherapy for cancer.
More uric acid is made than usual in illnesses where the cells of the body have a rapid turnover. For example, severe psoriasis and some blood disorders.
People with certain other conditions have an increased risk of developing gout. These include: obesity, high blood pressure, kidney damage, diabetes mellitus, bone marrow disorders, lipid disorders (especially hypertriglyceridaemia), vascular disease, enzyme defects such as hypoxanthine guanine phosphoribosyltransferase (HGPRT) deficiency and glucose-6-phosphate dehydrogenase (G6PD) deficiency.
How common is gout and who gets it?
Gout affects about 1 in 200 adults. Men are more commonly affected than women. A first attack of gout typically develops in middle age, but it sometimes occurs in younger people. It tends to run in some families as there is a family history of gout in about 1 in 5 cases. It may be that the genetic makeup that you inherit from your family may be a factor in becoming an 'under-excreter' of uric acid.

What are the symptoms of gout?
Gout usually occurs in 'attacks'. An attack typically develops quickly over a few hours. It usually causes severe pain in one joint. The base of the big toe is the most commonly affected joint. Walking can be very painful and even the weight of bedclothes can hurt.However, any joint can be affected. Sometimes two or more joints are affected. Affected joints usually swell, and the nearby skin may look red and inflamed. If left untreated, a gout attack may last several days, but usually goes completely within 7-10 days. Less severe attacks can occur which may be mistaken at first for other forms of arthritis. Weeks, months or even years may go by between attacks. Some people only ever have one attack.
Is gout serious?
A gout attack can be very painful. However, other effects from gout are uncommon. Joint damage may occur if you have recurring attacks. In a few people, uric acid crystals form kidney stones or may cause some kidney damage. Sometimes the crystals form bumps (tophi) under the skin. These are usually harmless and painless, but sometimes form in awkward places such as at the end of fingers. Tophi occasionally become infected.
How is gout diagnosed?
Gout is usually diagnosed if you have the typical symptoms and a raised blood level of uric acid. If there is doubt as to the cause of the pain and swelling, your doctor may take some fluid out of a swollen joint. This is done with a needle and syringe. The fluid is looked at under the microscope. Crystals of urate (uric acid) can be seen in the fluid to confirm the diagnosis of gout.

What is the treatment for a gout attack?
General measures
If you are able to, then raise the affected limb (usually a leg) to help reduce the swelling. The easiest way to raise your leg is to recline on a sofa with your leg up on a cushion. An ice pack (or pack of frozen peas) held against the inflamed joint may ease the pain until the other treatments (below) start to work.
Wrap the ice pack (or peas) in a towel to avoid direct skin contact and ice-burn.
Apply for about 20 minutes, then stop. (It should not be applied for long periods.)
Repeat as often as required BUT ...
Make sure the temperature of the affected part has returned to normal before applying again.
Anti-inflammatory painkillers
A short course of an anti-inflammatory painkiller will quickly ease most gout attacks (within 12-24 hours). There are several types and brands such as diclofenac, indometacin, and naproxen. Your doctor will prescribe one. Many people with gout like to have a supply of tablets in the home on 'standby' just in case an attack occurs. They are usually needed only for a few days until the inflammation and pain go.Most people can take short courses of anti-inflammatory painkillers without any problem, although side-effects occur in some people.
Bleeding from the stomach is the most serious possible side-effect. This is more of a risk if you are over 65, or have had a duodenal or stomach ulcer. Stop the tablets and see a doctor if you develop indigestion, upper abdominal pain, pass black stools (black faeces), or if you vomit or pass blood. Read the leaflet that comes with the tablets for a list of other possible side-effects.
Some people with asthma, high blood pressure, certain kidney problems, and heart failure may not be able to take anti-inflammatory painkillers.
Also, don't take more than one anti-inflammatory at a time unless specified by a doctor. For example, some people take low dose aspirin every day (which is classed as an anti-inflammatory) to prevent blood clots. Aspirin plus another anti-inflammatory increases the risk of bleeding from the stomach.Therefore, if you are already taking aspirin and develop gout, you need to discuss the options with your doctor. For example, your doctor may advise that you take another medicine to 'protect the stomach' if you need to take aspirin and another anti-inflammatory. Remember - some painkillers that you can buy from pharmacies contain aspirin.
Other treatments
Colchicine is an alternative medicine that eases gout attacks. It is usually only used if you have problems or side-effects with anti-inflammatory painkillers. Steroid tablets or injections can also reduce the pain and inflammation. They are another alternative if there are problems or side-effects with anti-inflammatory painkillers and colchicine.
Can further gout attacks be prevented?
Lifestyle measures and medicines can help to prevent gout attacks.
Lifestyle suggestions
If you are overweight, try to lose some weight. This can help to lower the uric acid level. However, do not use diets that increase urate levels, such as high-protein diets or starvation diets.
Eat sensibly. A high uric acid level may be lowered a bit by avoiding a high protein intake and foods rich in purines such as liver, kidneys, and seafood. Also avoid eating foods high in yeast extracts such as marmite.
If you drink a lot of alcohol then it may help if you reduced the amount that you drink. You do not need to stop drinking alcohol altogether, but cutting down may help if you drink a lot. In particular, avoid binge drinking. Keep to within the recommended levels of alcohol which is 21 units per week for men and 14 units per week for women.
If you drink a lot of sugar-sweetened soft drinks, especially those containing fructose, it may help to reduce the number or cut them out all together.
If you are taking any medicines, check whether they are a cause of gout (see above). An alternative medicine may be available. Your doctor will advise.
Avoid dehydration by drinking plenty of water (up to two litres per day unless there is a medical reason why not to).
Have your blood pressure checked at least once a year. High blood pressure is more common in people with gout.
With the help of lifestyle changes, many people only have an attack of gout every now and then. All you may need is to have some anti-inflammatory painkillers on 'standby' to treat each attack.For some people, attacks occur more often. In this situation, you can take a medicine to prevent attacks.
Allopurinol is used to prevent gout attacks
Allopurinol does not have any effect during a gout attack, and it is not a painkiller. It works by lowering the level of uric acid in the blood. It takes 2-3 months to become fully effective. You need to take it every day to keep the uric acid level normal to prevent gout attacks.As a general rule, regular allopurinol may be advised by your doctor if you:
Have had two or more attacks of gout within a year.
Have one or more tophi (described above).
Have any joint or kidney damage due to gout.
Have one or more kidney stone made from uric acid.
Have had a gout attack and are taking long-term medication that can cause gout.
When you first take allopurinol, it can sometimes cause a gout attack. This is because it may cause the level of uric acid to rise slightly before it falls. For this reason it is not normally started during a gout attack. It is best to start it about 3-4 weeks after an attack has settled. Also, an anti-inflammatory painkiller is often prescribed for the first 2-3 months after you start allopurinol, just in case the allopurinol causes a gout attack. Once the level of uric acid has been brought down, taking allopurinol each day usually works well to prevent gout attacks.The dose of allopurinol needed varies from person to person. Treatment is usually started with a low dose. A blood test is often done after a month or so to check that the level of uric acid has come down. If not, the dose may need to be increased. Most people end up taking about 100-300 mg each day to stop gout attacks.If a gout attack occurs while you are taking allopurinol, you can still take an anti-inflammatory painkiller to relieve the pain. However, this may indicate that you need an increased dose of allopurinol. Side-effects are uncommon with allopurinol. Read the information that comes with the packet of tablets for details about possible side effects. If side-effects do occur, other medicines with a similar action are sometimes prescribed.

Allopurinol

Allopurinol
Systematic (IUPAC) name
3,5,7,8-tetrazabicyclo[4.3.0] nona-3,5,9-trien-2-one
Identifiers
CAS number
315-30-0
ATC code
M04AA01
PubChem
2094
DrugBank
APRD00435
ChemSpider
2010
Chemical data
Formula
C5H4N4O
Mol. mass
136.112 g/mol
Pharmacokinetic data
Bioavailability
78±20%
Protein binding
Negligible
Metabolism
hepatic (80% oxypurinol, 10% allopurinol ribosides)
Half life
2 hours (oxypurinol 18-30 hours)
Excretion
?
Therapeutic considerations
Pregnancy cat.
C(USA)
Legal status
Schedule 6 (USA)
Routes
tablet (100, 300 mg)
Allopurinol is a drug used primarily to treat conditions arising from excess uric acid in blood plasma. Most notable of these conditions is chronic gout. Allopurinol does not alleviate acute attacks of gout, but is useful in preventing recurrence. Allopurinol has been used in the United States since 1964.
Contents[hide]
1 Mechanism of action
2 Uses (other than in treatment of gout)
3 Metabolism
4 Side effects
5 Brand names
6 References
//

[edit] Mechanism of action
Allopurinol is a structural isomer of hypoxanthine (a naturally occurring purine in the body) and is an enzyme inhibitor, inhibiting xanthine oxidase.[citation needed] Xanthine oxidase is responsible for the successive oxidation of hypoxanthine and xanthine resulting in the production of uric acid, the product of human purine metabolism.[1] In addition to blocking uric acid production, inhibition of xanthine oxidase causes an increase in hypoxanthine and xanthine, which are converted to closely related purine ribotides adenosine and guanosine monophosphates. Increased levels of these ribotides causes feedback inhibition of amidophosphoribosyl transferase, the first and rate-limiting enzyme of purine biosynthesis. Allopurinol therefore decreases both uric acid formation and purine synthesis.

[edit] Uses (other than in treatment of gout)
In addition to its use in gout, allopurinol is also commonly used as prophylaxis with chemotherapeutic treatments, which can rapidly result in very high uric acid concentrations due to widespread cell death (see tumor lysis syndrome). Other established indications for allopurinol therapy include ischaemic reperfusion injury, kidney stones with a uric acid component (uric acid nephrolithiasis) and protozoal infections (Leishmaniasis).

[edit] Metabolism
Allopurinol is rapidly metabolized by its target, xanthine oxidase, to its active metabolite oxypurinol, which is also an inhibitor of xanthine oxidase. Allopurinol is almost completely metabolized to oxypurinol within two hours of oral administration, whereas oxypurinol is slowly excreted by the kidneys over 18-30 hours. For this reason, oxypurinol is believed to be responsible for the majority of allopurinol's effect.

[edit] Side effects
Side effects of allopurinol are rare, though significant when they occur. A small percentage of people develop a rash and must discontinue this drug. The most serious adverse effect is a hypersensitivity syndrome consisting of fever, skin rash, eosinophilia, hepatitis, worsenend rectal function and, in some cases, allopurinol hypersensitivity syndrome. Allopurinol is one of the drugs commonly known to cause Stevens-Johnson syndrome (SJS), and Toxic Epidermal Necrolysis Syndrome (TENS) which is an adverse drug reaction.
Allopurinol can cause severe pancytopenia if given with azathioprine or mercaptopurine, due to inhibition of xanthine oxidase which metabolizes these drugs.

[edit] Brand names
Allopurinol is marketed by Prometheus in the United States as Zyloprim, while in other countries it continues to be marketed by GlaxoSmithKline. Other brand names are Allohexal, Allosig, Progout, and Zyloric.

Fried Egg

UK and Ireland
Fried eggs are commonly regarded as breakfast food, sometimes served on toast, or in a sandwich, often with bacon or sausages. It is also an essential part of the full breakfast commonly eaten in Britain and Ireland. Fried eggs are often served with ham or gammon steak as a popular pub grub meal. They are almost always cooked "sunny side up", though the term is not used locally.

North America
North Americans may choose among the following methods:
'Over well', — cooked on both sides until the yolk has solidified
'Over hard', also called 'hard' — cooked on both sides until the yolk has solidified.
'Over medium' — cooked on both sides; the yolk is of medium consistency and the egg white is thoroughly cooked.
'Over easy', also called 'runny' — cooked on both sides; the yolk is a thin liquid, while the egg white is partially cooked. This is occasionally called 'sunny side down.' These are also commonly referred to as 'dippy eggs' or 'dip eggs' by Marylanders and by Pennsylvania Dutch persons living in southern Pennsylvania, mainly due to the practice of dipping toast into the yolk while eating. Also called 'treasure eggs' in southwestern Pennsylvania.
'Sunny side up' — cooked only on one side; yolk is liquid (the oil or fat may be used to baste the sunny side, however.) The egg white is often still rather runny as well. This is often known simply as 'eggs up'. Covering the frying pan with a lid throughout cooking allows for a less "runny" egg.
Another style known simply as 'Fried' - eggs are fried on both sides with the yolks broken until set or hard. These are common in fried egg sandwiches and in Asian cuisine.

Spain and Latin America
A single sunny-side-up egg served over white rice is a popular side-dish eaten at lunch time in Latin American countries. In Spain, it is served with tomato sauce and called Arroz a la Cubana. In Brazil, a runny egg placed over a steak with a side dish of rice and black beans is called a Bife à Cavalo, literally "Horse-Riding Steak". A similar dish, with the name Bife a Caballo in Spanish, is also common in Argentina and Uruguay with fried potatoes and salad replacing the beans and rice. In Mexico, a popular breakfast starts with fried eggs and a fresh tomato, onion and cilantro salad. Red chile is optional, or a blender style sauce.

Russia

Yaichnitsa
The Russian version of fried eggs is called yaichnitsa (Russian: яичница). Multiple eggs are cracked into a saucepan or frying pan and cooked without flipping. The whites flow together and individual portions (one or more yolks surrounded by white) are divided up after the whole pan-full has cooked.

Japan
Fried eggs with ham, sometimes with salad, is a popular western-style breakfast item in Japan. It is often called 目玉焼き (medamayaki), literally 'fried eyeball', because of its supposed resemblance to the eyeball of a fried, whole fish. It is usually seasoned at the table with soy sauce or "sosu" (fruity Japanese Worcestershire sauce), depending on the preference of the diner.

France
Fried eggs are served atop the croque madame (distinguishing it from the croque monsieur), and also sometimes on other foods such as pizza and steak haché, in which case it is referred to as oeuf à cheval (literally "egg on horseback").

Korea
In Korea it is common to put a fried egg on top of a dish known as bibimbap (mountain vegetables over rice, usually with a spicy pepper sauce). However, it is more common to see fried eggs as side dish with rice.

Southeast Asia
Nasi goreng, one of the most popular dishes in Indonesia, Malaysia and Singapore, is often served with a fried egg. A fried egg served over white rice, topped with a dab of oyster or hoisin sauce, is also popular in east Asia. Fried eggs are also sometimes used in a Vietnamese breakfast roll.

Philippines
In the Philippines, fried eggs are often cooked like a sunny side egg but the yolk is half cooked by sprinkling with salt and oil on it while being fried giving it a distinctive pink colored membrane. It is served in the morning with garlic rice and a choice of breakfast meat such as beef tapa, longaniza, fried milkfish, dried fish, tocino (caramelised pork), Spam, or corned beef. In addition, fried eggs are eaten in a dish called arroz a la Cubana, seasoned ground beef with raisins, cubed potatoes, tomato sauce, and olives, along with white rice and fried ripe plantains.

India
In India, fried eggs, usually referred to as "poached eggs," are sometimes known as omlette or bullseyes as a reference to "bullseye" targets. They are commonly served alone or as accompaniment to a variety of dishes including appam, dosa, paratha etc. Bullseyes are commonly prepared over pans smeared with a variety of oils such as coconut oil and palm oil. During or after the frying stage, they are sometimes sprinkled lightly with condiments such as black pepper, chili powder, green chilis and salt. Bullseyes are a common street vendor dish in South India. Some restaurants also refer to them as Egg Fry (over hard) or Egg 'Half Fry' (sunny side up).

Cheese

"Cheese, glorious cheese!" Most people love cheese, whether in chunks or strips, or melted on bread for a grilled sandwich. Cheese is a part of the cuisine of nearly every culture, and variations on the theme are legion.

Cheese is usually categorized into four types: soft, semi-soft, semi-hard and hard. The designation refers to the amount of moisture in the cheese, which directly affects its texture. Making cheese is an ancient practice, dating back thousands of years, and the home cheese maker can usually find recipes for cheese that falls into any of the four categories.

Soft cheese includes cottage cheese, cream cheese, ricotta, brie, bleu, roquefort, mozzarella, meunster and similar cheeses. These cheeses generally pair well with fruit or meats, or can be used as breakfast cheeses in an omelette or as pasta fillings. They are usually mildly flavored and very high in moisture
.
American, Colby, co-jack and similar cheeses are in the semi-soft category. These are slightly stronger in flavor and cover a wide range of uses. Co-jack cheese, a blend of Colby and Monterey jack, is one of the most popular. This allows the sharper flavor of Colby to be combined with the milder jack cheese, and also melts better than plain Colby. Grilled cheese sandwiches often use American cheese, and Mexican cheeses such as Asadero and Quesa Fresca are becoming more popular.

Semi-hard cheese has an even bolder flavor than semi-soft, and is often paired with fruit, used on cheese trays and eaten with crackers. Cheeses in this category include cheddar, provolone, gouda, Jarlsberg and others. Cheese in this category may come in a smoked variety. Smoked cheddar and gouda are very common. Milder cheddar, gouda and Jarlsberg all melt well, and may be used in casseroles or as stuffing for chicken breasts or pork chops.

Hard cheeses include parmesan, romano, asiago, Swiss, Gruyere and others. Parmesan and romano are most familiar as the grated powder used to top spaghetti, but they are also used as accompaniments for fruit, wine, nuts and other appetizer items. Swiss is a popular sandwich cheese and melts well, unlike some other hard cheeses.

Cheese is one of the most versatile foods in a cook's arsenal. It can add flavor and texture to a dish -- and may even cover a few mistakes.

Chinese Food

　　中式早點
　　烧饼　Clay oven rolls
　　油条　Fried bread stick
　　韭菜盒　Fried leek dumplings
　　水饺　Boiled dumplings
　　蒸饺　Steamed dumplings
　　馒头　Steamed buns
　　割包　Steamed sandwich
　　饭团　Rice and vegetable roll
　　蛋饼　Egg cakes
　　皮蛋　100-year egg
　　咸鸭蛋　Salted duck egg
　　豆浆　Soybean milk

　　饭 类
　　稀饭　Rice porridge
　　白饭　Plain white rice
　　油饭　Glutinous oil rice
　　糯米饭　Glutinous rice
　　卤肉饭　Braised pork rice
　　蛋炒饭　Fried rice with egg
　　地瓜粥　Sweet potato congee

　　面 类
　　馄饨面　Wonton & noodles
　　刀削面　Sliced noodles
　　麻辣面　Spicy hot noodles
　　麻酱面　Sesame paste noodles
　　鴨肉面　Duck with noodles
　　鱔魚面　Eel noodles
　　乌龙面　Seafood noodles
　　榨菜肉丝面　Pork, pickled mustard green noodles
　　牡蛎细面　Oyster thin noodles
　　板条　Flat noodles
　　米粉　Rice noodles
　　炒米粉　Fried rice noodles
　　冬粉　Green bean noodle

　　汤 类
　　鱼丸汤　Fish ball soup
　　貢丸汤　Meat ball soup
　　蛋花汤　Egg & vegetable soup
　　蛤蜊汤　Clams soup
　　牡蛎汤　Oyster soup
　　紫菜汤　Seaweed soup
　　酸辣汤　Sweet & sour soup
　　馄饨汤　Wonton soup
　　猪肠汤　Pork intestine soup
　　肉羹汤　Pork thick soup
　　鱿鱼汤　Squid soup
　　花枝羹　Squid thick soup

　　甜　点
　　爱玉　Vegetarian gelatin
　　糖葫芦　Tomatoes on sticks
　　长寿桃　Longevity Peaches
　　芝麻球　Glutinous rice sesame balls
　　麻花　Hemp flowers
　　双胞胎　Horse hooves
　　冰　类
　　绵绵冰　Mein mein ice
　　麦角冰　Oatmeal ice
　　地瓜冰　Sweet potato ice
　　紅豆牛奶冰　Red bean with milk ice
　　八宝冰　Eight treasures ice
　　豆花　Tofu pudding

　　果　汁
　　甘蔗汁　Sugar cane juice
　　酸梅汁　Plum juice
　　杨桃汁　Star fruit juice
　　青草茶　Herb juice
　　点 心
　　牡蛎煎　Oyster omelet
　　臭豆腐　Stinky tofu （Smelly tofu）
　　油豆腐　Oily bean curd
　　麻辣豆腐　Spicy hot bean curd
　　虾片　Prawn cracker
　　虾球　Shrimp balls
　　春卷　Spring rolls
　　蛋卷　Chicken rolls

　　碗糕　Salty rice pudding
　　筒仔米糕　Rice tube pudding
　　红豆糕　Red bean cake
　　绿豆糕　Bean paste cake
　　糯米糕　Glutinous rice cakes
　　萝卜糕　Fried white radish patty
　　芋头糕　Taro cake
　　肉圆　Taiwanese Meatballs
　　水晶饺　Pyramid dumplings
　　肉丸　Rice-meat dumplings
　　豆干　Dried tofu
　　其 他
　　当归鸭　Angelica duck
　　槟榔　Betel nut
　　火锅　Hot pot