http://serratiopeptidase.weebly.com/
http://www.ehow.com/about_5130452_serratiopeptidase-side-effect.html
If you suffer from pain to any extent – occasionally, chronically or somewhere in between – an enzyme known as serratiopeptidase may just be the answer for you. This is especially true if you have an aversion to, or are experiencing any side effects of, the medication you currently use for pain management. Whether you take prescription or over-the-counter “painkillers,” serratiopeptidase is a safe, natural alternative with no known side effects.
Serratiopeptidase, also known as serrapeptase, is a proteolytic (that is, having the ability to break down proteins into simpler compounds) enzyme which is naturally present in the silkworm intestine. Now, before you go running for cover, screaming, “I’m not swallowing anything that came from a worm’s innards!” – let me just emphasize: The type that is available to consumers today is processed through fermentation of plant-grown enzymes, and is generally of such purity that it is suitable even for consumption by vegetarians.
Serrapeptase has been widely used for over 30 years in many Asian and European countries. In Austria and Germany for instance, it is available by prescription only. Fortunately, in the U.S. – and elsewhere – this is not the case. It is so safe, in fact, that it can be taken by children, pregnant women, and has even been successfully used on pets.
Chronic inflammation lies at the heart of a myriad of ailments, including headaches, muscle and joint pain (from exercise, or in conditions such as arthritis or fibromyalgia) – and ultimately, even more serious diseases such as cancer and heart disease. Unlike conventional pain med’s, which are designed to only relieve the inflammation, serratiopeptidase actually breaks down the protein deposits (known as fibrin) which often remain – and continue to cause pain and discomfort – even after your body has healed from an injury or other irritation.
And, as stated, serrapeptase has no known side effects – unlike aspirin, ibuprofen, naproxen, and other over-the-counter NSAIDs – as well as acetaminophen (which is not classified as an NSAID.) These non-prescription drugs have been proven in clinical studies to cause stomach, kidney, liver, and even heart problems, especially when used regularly, and for prolonged periods. What’s worse, certain prescription med’s – especially in the NSAIDs category – have had even more serious side effects, which have been well-documented in the media in recent years.
So for the millions of pain sufferers who turn to these medications on a regular basis, the emergence of serratiopeptidase as a viable alternative is most welcome, to put it mildly. In upcoming articles, we will be keeping you informed of exciting news and developments on this incredible enzyme – as well as the best source for obtaining it – so bookmark this site, and check back often.
This is a drug that I found out in my clinic. Before this, I never get to know this drug. Never have I know that this drug exist and it's so "natural". I really thought this is something artificial or some sort of complex channel blockers. [Most of the clinical studies conducted do not document any side effects. In the few that do document side effects, there is not enough data to determine if they are caused by the serratiopeptidase or if they were just a coincidence. With the positive results of the preliminary data, there is sure to be more studies to document the benefits and side effects.]
Thursday, December 16, 2010
Thursday, December 9, 2010
Conditions I Learnt Today
After looking at so many articles, the condition is actually named Chronic Fatigue Syndrome to replace other names like I mentioned below. I guess it's the difference between how the Americans and British call them? PVS seems to be written by UK people...
Post-Viral Syndrome: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1710789/pdf/jroyalcgprac00029-0021.pdf
I am going to share some conditions I witnessed today. First, post-viral syndrome. There is one patient who complains of whole body-ache after a viral infection.
Quote: "The syndrome typically follows an upper respiratory tract infection from which the sufferer fails to make a full recovery, complaining of a multitude of symptoms which may persist for months or even years. The cardinal symptom is profound
muscular fatigue and this is often accompanied by muscle pain, headache, paraesthesiae, dizziness, urinary frequency, cold extremities, bouts of sweating and fainting attacks. Other symptoms are poor memory, lack of concentration, sleep disturbance, mild expressive and receptive dysphasia, hyperacusis and emotional lability. Clinical examination usually shows no abnormalities, nor do routine laboratory investigations. The diagnosis is therefore one of exclusion. The illness follows one of three courses: many patients recover completely, in others there is a relapsing and remitting course and in some there is chronic illness. Relapses are precipitated by undue physical or mental stress: patients who rest adequately in the early stages are said to have the best chance of an early, complete recovery without relapse."
There is another term which I want to bring up: Neurasthenia. 'Neurasthenia is a condition of nervous exhaustion, characterised by undue fatigue on slightest exertion, both physical and mental, with which are associated symptoms of abnormalfunctioning, mainly referable to disorders of the vegetative nervous system. The chief symptoms are headache, gastrointestinal disturbances, and subjective sensations of all kinds'. (The term has remained in use in some European countries including France and Russia, but has become virtually obsolete in the United States.)
The doctor told me that there are people who suffer from this condition and landed up in their most downs in their life. It took one year for that person to finally decided to find the meaning of his life and strife to rid of this syndrome and become a normal person again. That was how debilitating this condition can do to a person.
Post-Viral Syndrome: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1710789/pdf/jroyalcgprac00029-0021.pdf
I am going to share some conditions I witnessed today. First, post-viral syndrome. There is one patient who complains of whole body-ache after a viral infection.
Quote: "The syndrome typically follows an upper respiratory tract infection from which the sufferer fails to make a full recovery, complaining of a multitude of symptoms which may persist for months or even years. The cardinal symptom is profound
muscular fatigue and this is often accompanied by muscle pain, headache, paraesthesiae, dizziness, urinary frequency, cold extremities, bouts of sweating and fainting attacks. Other symptoms are poor memory, lack of concentration, sleep disturbance, mild expressive and receptive dysphasia, hyperacusis and emotional lability. Clinical examination usually shows no abnormalities, nor do routine laboratory investigations. The diagnosis is therefore one of exclusion. The illness follows one of three courses: many patients recover completely, in others there is a relapsing and remitting course and in some there is chronic illness. Relapses are precipitated by undue physical or mental stress: patients who rest adequately in the early stages are said to have the best chance of an early, complete recovery without relapse."
There is another term which I want to bring up: Neurasthenia. 'Neurasthenia is a condition of nervous exhaustion, characterised by undue fatigue on slightest exertion, both physical and mental, with which are associated symptoms of abnormalfunctioning, mainly referable to disorders of the vegetative nervous system. The chief symptoms are headache, gastrointestinal disturbances, and subjective sensations of all kinds'. (The term has remained in use in some European countries including France and Russia, but has become virtually obsolete in the United States.)
The doctor told me that there are people who suffer from this condition and landed up in their most downs in their life. It took one year for that person to finally decided to find the meaning of his life and strife to rid of this syndrome and become a normal person again. That was how debilitating this condition can do to a person.
Thursday, November 11, 2010
Diet and Lifestyle
I am going to make a summary in regards of patient education for diet and lifestyle.
1. Exercise
CDC recommends 30-60 minutes of moderate (brisk walking, bicycling, vacuuming, gardening, or anything that causes small increases in breathing or heart rate) to vigorous (running, aerobics, heavy yard work, or anything else that causes large increases in breathing or heart rate) physical activity per day at least 5 days per week in all children.
Almost all patients should be able to incorporate recommended levels of physical activities in their lifestyle.
Barriers: Bad weather, lack of time and access to facilities or equipment etc. Attempts to further characterize and eliminate these barriers. PE classes are currently inadequate to meet physical activity recommendations.
2. Effect on Adolescents (all positive health-related behaviors)
- Decreased smoking
- Decreased drug use
- Increased fruit and vegetable consumption
- Decreased risk of pregnancy and STD
- Decreased anxiety, stress and depression
- Decreased illicit drug use
- Increased seat belt use
- Increased academic performance
3. Food
Plenty of fresh fruits and vegetables (5 servings) and less than 30% of total calories as fat
Fruit juice (can take only 10-12 ounces) is often an unrecognized culprit in childhood obesity and is not a substitute for fresh fruits.
Parents play a part as model since children will learn by example.
4. Others...
Avoid all diet fads and diet "revolutions"
Avoid anorexic drugs
Change composition of the diet
Attend multiple office visits to establish a baseline and to motivate continual weight loss
Decrease caloric intake to approx 500kcal/day less than energy expenditure --> loss 1 pound/week
Positive reinforcement from a support group etc.
Treat comorbid conditions
Hypercholesterolemia diet management:
Begin with Step 1 diet of AHA: no more than 300mg cholesterol, no more than 30% total fat and no more than 10% saturated fat.
Continue for at least 6 months. If cholesterol levels do not normalize, consider AHA step 2 diet: no more than 200mg cholesterol, no more than 30% total fat, and no more than 7% saturated fat.
1. Exercise
CDC recommends 30-60 minutes of moderate (brisk walking, bicycling, vacuuming, gardening, or anything that causes small increases in breathing or heart rate) to vigorous (running, aerobics, heavy yard work, or anything else that causes large increases in breathing or heart rate) physical activity per day at least 5 days per week in all children.
Almost all patients should be able to incorporate recommended levels of physical activities in their lifestyle.
Barriers: Bad weather, lack of time and access to facilities or equipment etc. Attempts to further characterize and eliminate these barriers. PE classes are currently inadequate to meet physical activity recommendations.
2. Effect on Adolescents (all positive health-related behaviors)
- Decreased smoking
- Decreased drug use
- Increased fruit and vegetable consumption
- Decreased risk of pregnancy and STD
- Decreased anxiety, stress and depression
- Decreased illicit drug use
- Increased seat belt use
- Increased academic performance
3. Food
Plenty of fresh fruits and vegetables (5 servings) and less than 30% of total calories as fat
Fruit juice (can take only 10-12 ounces) is often an unrecognized culprit in childhood obesity and is not a substitute for fresh fruits.
Parents play a part as model since children will learn by example.
4. Others...
Avoid all diet fads and diet "revolutions"
Avoid anorexic drugs
Change composition of the diet
Attend multiple office visits to establish a baseline and to motivate continual weight loss
Decrease caloric intake to approx 500kcal/day less than energy expenditure --> loss 1 pound/week
Positive reinforcement from a support group etc.
Treat comorbid conditions
Hypercholesterolemia diet management:
Begin with Step 1 diet of AHA: no more than 300mg cholesterol, no more than 30% total fat and no more than 10% saturated fat.
Continue for at least 6 months. If cholesterol levels do not normalize, consider AHA step 2 diet: no more than 200mg cholesterol, no more than 30% total fat, and no more than 7% saturated fat.
Sunday, October 31, 2010
Common Problems in Pediatrics
Fever of unknown origin (FUO) implies fever of prolonged duration (>=14 days), documented temeperature greater than 101 degrees on multiple occasions and uncertain etiology, for ex. infection, connective tissue disease, malignancy, etc.
History: Fever (Spiking? Intermittent? Describe the quality and duration), Toxicity (How severe is it?), Weight Loss, Anorexia
Exposure: Any ill contacts, residence (zoonotic infections), travel, food, drugs
Discriminative: Rashes, Pallor, Jaundice, Vasculitis, Tonsils, BCG flare, lymphadenopathy, hepatosplenomegaly, joint swelling.
Kawasaki Disease (aka mucocutaneous lymph node syndrome)
Three phases of the disease as listed here, some authors put "four":
Acute febrile phase - 1-2 weeks
1 The temperature is elevated (>104°F).
2 The child is irritable.
3 Bilateral conjunctivitis and rash are present.
4 The hands and feet develop the erythema and edema that cause the child to refuse to walk. Note that this finding may be the last to develop. Lack of extremity findings may cause consideration of incomplete Kawasaki disease.
5 The tongue and oral mucosa become red and cracked.
6 Hepatic dysfunction may develop.
7 Cardiac complications noted in the first stage include myocarditis and pericarditis.
Subacute phase - Begins when fever and other signs have abated. This phase should end by the 4th week.
1 This is characterized by persistent irritability, anorexia, and conjunctival injection.
2 Fever resolution begins this stage. However, persistent fever beyond 2-3 weeks may be an indication of recrudescent Kawasaki disease. (See Recrudescent Kawasaki disease below).
3 If fever persists, the outcome is less favorable because of a greater risk of cardiac complications.
4 Thrombocytosis develops, and the platelet count may exceed 1 million/mm3.
5 Desquamation of the fingertips and toes begins at this time.
6 Aneurysm formation may occur during this stage.
7 Children are at greatest risk of sudden death during this phase.
Convalescent phase - Approximately 4-6 weeks
1 This phase begins when all signs of illness have disappeared and continues until acute-phase reactants (ESR, CRP level) have returned to normal.
2 The most significant clinical finding that persists through this phase is the presence of coronary artery aneurysms.
(Taken from http://emedicine.medscape.com/article/804960-overview)
Lab test to do: Platelet count, ESR, echocardiogram (to look for coronary artery aneurysm. Big thing, can cause death)
Symptoms to look out for in your clinic: Fever, Rash, Conjunctival injection, Oropharyngeal changes, Peripheral extremity changes and cervical lymphadenopathy. Of course there are tons of other symptoms you may associate with this condition but these are the few things that you can pick up. One thing to note about this condition is that you need to have vigilant to be able to pick this condition up.
Treatment: IVIG and aspirin.
Inguinal Hernia
Patent processus vaginalis. Need to show patient how to reduce it. Do not attempt to massage it as it will cause adhesion and complications. Complication of this indirect inguinal hernia that you should pick up: distressed, irreducible, vomit or abdominal distention.
Hydrocele
Tend to get bigger during the evenings. Wait till 2years old for operation unless testis is big and tense. If there is any recent onset of tense testis, you need to exclude tumor.
Wheezing ==> High pitched musical sound heard during expiration and is caused by turbulence of air in the airway. Need to differentiate: broncholitis (viral, 3-6mths); bronchitis (viral, bacteria, atypical, affect older children); Pneumonia (viral, bacteria, atypical, any age group).
Wheezing = Mucosal edema + secretion (bronchospasm is not characteristic)
Recurrent Wheezing
1. Age -- > Congenital vs Non-congenital
2. Sudden wheezing -- > Foreign body
3. Pattern -- > Episodic vs Persistent
4. Assoc c cough -- > GERD, asthma, allergy
5. Assoc c feeding -- > GERD
6. Better/wose c positional changes -- > tracheomalacia, anomalies of great vessel
7. FH of wheezing -- > asthma, allergy
Fact about GER (affect 65% healthy infants, this is reflux, not a disease) whilst GERD affects 1:300 infants and associated with FTT, feeding/oral aversion, esophagitis
Types of childhood wheezing
Is divided into: 1) Transient Wheezing (typically occurs around 0-3 y/o during viral infection); 2) Non-atopic Wheezing; 3) IgE-associated wheezing/asthma
Intussusception
Re current jelly stool
3months to 1 year
Irritability and colicky pain
Laparotomy Reduction +/- resection
Newborn vomit
- Malrotation volvulus ==> green vomit (bilous vomit)
- Pyloric stenosis ==> 2-8wks (nonbilous projectile vomit)
Glue ear
http://www.ehealthmd.com/library/glueear/ge_whatis.html
Also known as otitis media with effusion, middle ear effusion, secreting otitis with effusion, serous otitis with effusion. (just put the effusion in it) Children comes with deafness. Frequently associated with Eustachian tube obstruction or dysfunction, e.g. adenoitis/nasopharyngitis; rhinosinusitis; cleft palate (the soft palate plays a role in closing or opening the Eustachian tube, therefore it makes sense when you don't have a soft palate, there is trouble for you to maintain the pressure in your middle ear)
Management:
1. Wait and see
2. Antibiotics (symptoms persist for more than 48 hrs), nasal steroid, decongestant
3. Surgery: ventilation tube (grommets) +/- adenoidectomy
History: Fever (Spiking? Intermittent? Describe the quality and duration), Toxicity (How severe is it?), Weight Loss, Anorexia
Exposure: Any ill contacts, residence (zoonotic infections), travel, food, drugs
Discriminative: Rashes, Pallor, Jaundice, Vasculitis, Tonsils, BCG flare, lymphadenopathy, hepatosplenomegaly, joint swelling.
Kawasaki Disease (aka mucocutaneous lymph node syndrome)
Three phases of the disease as listed here, some authors put "four":
Acute febrile phase - 1-2 weeks
1 The temperature is elevated (>104°F).
2 The child is irritable.
3 Bilateral conjunctivitis and rash are present.
4 The hands and feet develop the erythema and edema that cause the child to refuse to walk. Note that this finding may be the last to develop. Lack of extremity findings may cause consideration of incomplete Kawasaki disease.
5 The tongue and oral mucosa become red and cracked.
6 Hepatic dysfunction may develop.
7 Cardiac complications noted in the first stage include myocarditis and pericarditis.
Subacute phase - Begins when fever and other signs have abated. This phase should end by the 4th week.
1 This is characterized by persistent irritability, anorexia, and conjunctival injection.
2 Fever resolution begins this stage. However, persistent fever beyond 2-3 weeks may be an indication of recrudescent Kawasaki disease. (See Recrudescent Kawasaki disease below).
3 If fever persists, the outcome is less favorable because of a greater risk of cardiac complications.
4 Thrombocytosis develops, and the platelet count may exceed 1 million/mm3.
5 Desquamation of the fingertips and toes begins at this time.
6 Aneurysm formation may occur during this stage.
7 Children are at greatest risk of sudden death during this phase.
Convalescent phase - Approximately 4-6 weeks
1 This phase begins when all signs of illness have disappeared and continues until acute-phase reactants (ESR, CRP level) have returned to normal.
2 The most significant clinical finding that persists through this phase is the presence of coronary artery aneurysms.
(Taken from http://emedicine.medscape.com/article/804960-overview)
Lab test to do: Platelet count, ESR, echocardiogram (to look for coronary artery aneurysm. Big thing, can cause death)
Symptoms to look out for in your clinic: Fever, Rash, Conjunctival injection, Oropharyngeal changes, Peripheral extremity changes and cervical lymphadenopathy. Of course there are tons of other symptoms you may associate with this condition but these are the few things that you can pick up. One thing to note about this condition is that you need to have vigilant to be able to pick this condition up.
Treatment: IVIG and aspirin.
Inguinal Hernia
Patent processus vaginalis. Need to show patient how to reduce it. Do not attempt to massage it as it will cause adhesion and complications. Complication of this indirect inguinal hernia that you should pick up: distressed, irreducible, vomit or abdominal distention.
Hydrocele
Tend to get bigger during the evenings. Wait till 2years old for operation unless testis is big and tense. If there is any recent onset of tense testis, you need to exclude tumor.
Wheezing ==> High pitched musical sound heard during expiration and is caused by turbulence of air in the airway. Need to differentiate: broncholitis (viral, 3-6mths); bronchitis (viral, bacteria, atypical, affect older children); Pneumonia (viral, bacteria, atypical, any age group).
Wheezing = Mucosal edema + secretion (bronchospasm is not characteristic)
Recurrent Wheezing
1. Age -- > Congenital vs Non-congenital
2. Sudden wheezing -- > Foreign body
3. Pattern -- > Episodic vs Persistent
4. Assoc c cough -- > GERD, asthma, allergy
5. Assoc c feeding -- > GERD
6. Better/wose c positional changes -- > tracheomalacia, anomalies of great vessel
7. FH of wheezing -- > asthma, allergy
Fact about GER (affect 65% healthy infants, this is reflux, not a disease) whilst GERD affects 1:300 infants and associated with FTT, feeding/oral aversion, esophagitis
Types of childhood wheezing
Is divided into: 1) Transient Wheezing (typically occurs around 0-3 y/o during viral infection); 2) Non-atopic Wheezing; 3) IgE-associated wheezing/asthma
Intussusception
Re current jelly stool
3months to 1 year
Irritability and colicky pain
Laparotomy Reduction +/- resection
Newborn vomit
- Malrotation volvulus ==> green vomit (bilous vomit)
- Pyloric stenosis ==> 2-8wks (nonbilous projectile vomit)
Glue ear
http://www.ehealthmd.com/library/glueear/ge_whatis.html
Also known as otitis media with effusion, middle ear effusion, secreting otitis with effusion, serous otitis with effusion. (just put the effusion in it) Children comes with deafness. Frequently associated with Eustachian tube obstruction or dysfunction, e.g. adenoitis/nasopharyngitis; rhinosinusitis; cleft palate (the soft palate plays a role in closing or opening the Eustachian tube, therefore it makes sense when you don't have a soft palate, there is trouble for you to maintain the pressure in your middle ear)
Management:
1. Wait and see
2. Antibiotics (symptoms persist for more than 48 hrs), nasal steroid, decongestant
3. Surgery: ventilation tube (grommets) +/- adenoidectomy
Thursday, October 21, 2010
Clinical Pearls
These are 100 clinical pearls I come through from a forum. Why not read them and check it out?
1. If a patient has a fever, give acetaminophen (unless it is contraindicated)
2. If a patient is on a statin or you order a statin, get baseline LFTs and check frequently
3. If a patient is found to have abnormal LFTs, get a TSH
4. If a patient is going to surgery (including cardiac catheterization), make them NPO
5. All NPO patients must also have their urine output measured (type "urine output")
6. If a woman is between 12 and 52 years old and there is no mention of a very recent menses (that is, < 2 weeks ago), order a beta-hCG
7. Don't forget to discontinue anything that is no longer required (especially if you are sending the patient home)
8. When a patient is stable, decide whether or not you should change locations (if you anticipate that the patient could crash in the very near future, send the patient to the ICU; if the patient just needs overnight monitoring, send to the ward; if the patient is back to baseline, send home with follow-up)
9. In any diabetic (new or long-standing), order an HbA1c as well as continuous Accuchecks.
10. If this is a long-standing diabetic, also order an ophthalmology consult (to evaluate for diabetic retinopathy)
11. In any patient with respiratory distress (especially with low oxygen saturations), order an ABG
12. In any overdose, do a gastric lavage and activated charcoal (no harm in doing so, unless the patient is unconscious or has risk for aspiration)
13. In any suicidal patient, admit to ward and get "suicide contract" and "suicide precautions"
14. Patients who cannot tolerate Aspirin get Clopidogrel or Ticlopidine
15. Post-PTCA patients get Abciximab
16. In any bleeding patient, order PT, PTT, and Blood Type and Crossmatch (just in case they have to go to the O.R.)
17. In any pregnant patient, get "Blood Type and Rh" as well as "Atypical Antibody Screen"
18. In any patient with excess bleeding (especially GI bleeding), type "no aspirin" upon D/C of patient
19. If the patient is having any upper GI distress or is at risk for aspiration, order "head elevation" and "aspiration precautions"
20. In any asthmatic, order bedside FEV1 and PEFR (and use this to follow treatment progress)
21. Before you D/C a patient, change all IV meds to PO and all nebulizers to MDI
22. In any patient who has GI distress, make them NPO
23. All diabetic in-patients get Accuchecks, D/C oral hypoglycemic agents, start insulin, HbA1c, advise strict glycemic control, recommend diabetic foot care
24. All patients with altered mental status of unknown etiology get a "fingerstick glucose" check (for hypoglycemia), IV thiamine, IV dextrose, IV naloxone, urine toxicology, blood alcohol level, NPO
25. If hemolysis is in the differential, order a reticulocyte count
26. If you administer heparin, check platelets on Day 3 and Day 5 (for heparin-induced thrombocytopenia), as well as frequent H&H
27. If you administer coumadin, check daily PT/INR until it is within therapeutic range for two consecutive days
28. Before giving a woman coumadin, isotretinoin, doxycycline, OCPs or other teratogens, get a beta-hCG
29. If you give furosemide (Lasix), also give KCl (it depletes K+)
30. All children who are given gentamycin, should have a hearing test (audiometry) and check BUN/Cr before and after treatment
-
31. Don't forget about patient comfort! Treat pain with IV morphine, nausea with IV phenergan, constipation with PO docusate, diarrhea with PO loperamide, insomnia with PO temazepam
32. ALL ICU patients get stress ulcer prophylaxis with IV omeprazole or ranitidine
33. If you put a patient on complete bedrest (such as those who are pre-op), get "pneumatic compression stockings"
34. If fluid status is vital to a patient's prognosis (such as those with dehydration, hypovolemia, or fluid overload), place a Foley catheter and order "urine output"
35. If a CXR shows an effusion, get a decubitus CXR next
36. If you intubate a patient you ALSO have to order "mechanical ventilation" (otherwise the patient will just sit there with a tube in his mouth!)
37. With any major procedure (including surgery, biopsy, centesis), you MUST type "consent for procedure" (typing consent will not reveal any results)
38. With any fluid aspiration (such as paracentesis or pericardiocentesis), get fluid analysis separately (it is not automatic). If you don't order anything on the fluid, it will just be discarded.
39. With high-dose steroids (such as in temporal arteritis), give IV ranitidine, calcium, vitamin D, alendronate, and get a baseline DEXA scan.
40. In all suspected DKA or HHNC, check osmolality and ketone levels in the serum.
41. In ALCOHOLIC ketoacidosis, just give dextrose (no need for insulin), in addition to IV normal saline and thiamine
42. All patients over 50 with no history of FOBT or colonoscopy should get a rectal exam, a FOBT, and have a sigmoidoscopy or colonoscopy scheduled.
43. All women > 40 years old should get a yearly clinical breast exam and mammogram (if risk factors are present, start at 35)
44. All men > 50 years old should get a prostate exam and a PSA (if risk factors are present, start at 45)
45. If a patient has a terminal disease, advise "advanced directives"
46. In any patient with a chronic disease that can cause future altered mental status, type "medical alert bracelet" upon D/C
47. Any patient with diarrhea should have their stool checked for "ova and parasites", "white cells", "culture", and C.diff antigen (if warranted)
48. Any patient on lithium or theophylline should have their levels checked
49. All patients with suspected MI should be given a statin (and check baseline LFTs)
50. All suspected hemolysis patients should get a direct Coombs test
51. Schedule all women older than 18 for a Pap smear (unless she has had a normal Pap within one year)
52. Pre-op patients should have the following done: “NPO”, “IV access”, “IV normal saline”, “blood type and crossmatch”, “analgesia”, “PT”, “PTT”, “pneumatic compression stockings”, “Foley”, “urine output”, “CBC”, and any appropriate antibiotics
53. If a patient requires epinephrine (such as in anaphylaxis), and he/she is on a beta-blocker, give glucagon first
54. If lipid profile is abnormal, order a TSH
55. All dementia and alcoholic patients should be advised “no driving”
56. To diagnose Alzheimer’s, first rule out other causes. Order a CT head, vitamin B12 levels, folate levels, TSH, and routine labs like CBC, BMP, LFT, UA. Also, if the history suggests it, order a VDRL and HIV ELISA as well
57. Also rule out depression in suspected dementia patients
58. For all women who are sexually active and of reproductive age, give folate. In fact, you should give ALL your patients a multivitamin upon D/C home
59. All pancreatitis patients should be made NPO and have NG suction so that no food can stimulate the pancreas
60. Send patients home on a disease-specific diet: diabetics get a “diabetic diet”, hypertensives get a “low salt diet”, irritable bowel patients get a “high fiber diet”, hepatic failure patients get “low protein diet”, etc
61. Do not give a thrombolytic (tPA or streptokinase) in a patient with unstable angina patient
62. Patients who are having a large amount of secretions, order “pulmonary toilet” to reduce the risk of aspiration
63. Every patient should be advised to wear a “seatbelt”, to “exercise”, and advised about “compliance”
64. In any patient who presents with an unprotected airway (as in overdoses, comatoses), get a CXR to rule out aspiration
65. In any patient with one sexually transmitted disease (such as Trichomonas), check for other STDs as well (Gonorrhea, Chlamydia, HIV, syphilis, etc.) and do a Pap smear in all women with an STD
66. Remember to treat children with croup with a “mist tent” and racemic epinephrine
67. Any acute abdomen patient with a suspected or proven perforation, give a TRIPLE antibiotic: Gentamycin, Ampicillin, Metronidazole
68. Get iron studies in patients with microcytic anemia if the cause is unknown. Order “iron”, “ferritin”, “TIBC”
69. Women with vaginal discharge should get a KOH prep, saline (wet) prep, vaginal pH, cervical gonococcal, chlamydia culture
70. If a woman is found to have vaginal candida, check her fasting glucose
71. When the 5 minute warning screen is displayed, go through the following mnemonic (RATED SEX). I know it probably is not the best mnemonic, but it is difficult to forget!:
Recreational drugs / Reassurance
Alcohol
Tobacco
Exercise
Diet (eg. high protein, no lactose, low fat, etc.)
Seat belt / Safety plan / Suicide precautions
Education (“patient education”)
X (stands for safe seX)
72. All suspected child abuse patients should be admitted and you should order THREE consults: consult “child protection services”, consult “ophthalmology” (to look for retinal hemorrhages), consult “psychiatrist” (to examine the family dynamics)
73. When a woman reaches menopause, she should have a “fasting lipid profile” checked (because without estrogen, the LDL will rise and the HDL will drop), a DEXA scan (for baseline bone density), and of course, FOBT and colonoscopy (if she is over 50)
74. If colon cancer is suspected, order a CEA; if pancreatic cancer, order CA 19-9; if ovarian cancer, order CA 125.
75. Remember to give “phototherapy” to a newborn with pathologic unconjugated bilirubinemia (it is not helpful if it is predominantly conjugated). Also, with phototherapy, keep the neonate on IV fluids (the heat can dehydrate them), and give erythromycin ointment in their eyes
76. Before giving a child prednisone, get a PPD
77. If a patient is found to have high triglycerides, check “amylase” and “lipase” (high triglycerides can cause pancreatitis)
78. Remember that any newborn under 3 weeks of age who develops a fever is SEPSIS until proven otherwise. Admit to the ward and culture EVERYTHING: “blood culture”, “urine culture”, “sputum culture”, and even “CSF culture”. And give antibiotics to cover EVERYTHING.
79. If you get a high lead level in a child, you have to check a “venous blood lead level” to confirm. If the value is > 70, admit immediately and begin IV “dimercaprol” and “EDTA”. Order “lead abatement agency” and “lead pain assay” upon discharge.
80. If you perform arthrocentesis, send the synovial fluid for “gram stain” and the 3 Cs: “crystals”, “culture”, and “cell count”
81. If a patient has exophthalmos with hyperthyroidism, it is not enough to just treat the hyperthyroidism (as the eye findings may worsen). You should give prednisone.
82. If any patient has cancer, get an “oncology consult”.
83. In a patient with rapid atrial fibrillation, decrease the heart rate first (then worry about converting to sinus rhythm). Use a CCB (diltiazem) or a beta-blocker (metoprolol) for rate control.
84. In any patient with new-onset atrial fibrillation, make sure you check a TSH
85. In any patient with suspected fluid volume depletion, order “postural vitals” to detect orthostasis
86. Before a colonoscopy or a sigmoidoscopy, you should prepare the bowel: make the patient NPO, give IV fluids (if necessary) and order “polyethylene glycol”.
87. Any patient with Mobitz II or complete heart block gets an immediate “transcutaneous pacemaker”. Then order a cardiology consult to implant a “transvenous pacemaker”
88. If calcium level is abnormal, order a “serum magnesium”, “serum phosphorus”, and “PTH”
89. Treat both malignant hyperthermia and neuroleptic malignant syndrome with “dantrolene”
90. All splenectomy patients get a “pneumovax”, an “influenza” vaccine, and a “hemophilus” vaccine if not previously given.
91. If you give INH (for Tb), also give “pyridoxine” (this is vitamin B6)
92. If you give pyrazinamide, get baseline “serum uric acid” levels
93. If you give ethambutol, order an ophthalmology consult (to follow possible optic neuritis)
94. If you perform a thoracocentesis (lung aspirate), send the EFFUSION as well as a peripheral blood sample for: LDH and protein (to help differentiate a transudate versus an exudates) and pH of the effusion
95. Give sickle cell disease children prophylactic penicillin continuously until they turn 5 years old
96. Any patient with a recent anaphylactic reaction (for any reason), should get “skin test” for allergens (to help prevent future disasters) and consult an allergist
97. Do not give cephalosporins to any patient with anaphylactic penicillin allergies (there is a 5% cross-reactivity)
98. Order Holter monitor on patients who have had symptomatic palpitations.
99. Any patient with a first-time panic attack gets a “urine toxicology” screen, a TSH, and “finger stick glucose”
100. All renal failure patients get: “nephrology consult”, “calcium acetate” (to decrease the phosphorus levels), “calcium” supplement, and erythropoeitin"
Source taken from: http://cafemedico.net/forums/clinical-subjects-discussion-forum/11024-best-clincal-mcq-pearls.html
1. If a patient has a fever, give acetaminophen (unless it is contraindicated)
2. If a patient is on a statin or you order a statin, get baseline LFTs and check frequently
3. If a patient is found to have abnormal LFTs, get a TSH
4. If a patient is going to surgery (including cardiac catheterization), make them NPO
5. All NPO patients must also have their urine output measured (type "urine output")
6. If a woman is between 12 and 52 years old and there is no mention of a very recent menses (that is, < 2 weeks ago), order a beta-hCG
7. Don't forget to discontinue anything that is no longer required (especially if you are sending the patient home)
8. When a patient is stable, decide whether or not you should change locations (if you anticipate that the patient could crash in the very near future, send the patient to the ICU; if the patient just needs overnight monitoring, send to the ward; if the patient is back to baseline, send home with follow-up)
9. In any diabetic (new or long-standing), order an HbA1c as well as continuous Accuchecks.
10. If this is a long-standing diabetic, also order an ophthalmology consult (to evaluate for diabetic retinopathy)
11. In any patient with respiratory distress (especially with low oxygen saturations), order an ABG
12. In any overdose, do a gastric lavage and activated charcoal (no harm in doing so, unless the patient is unconscious or has risk for aspiration)
13. In any suicidal patient, admit to ward and get "suicide contract" and "suicide precautions"
14. Patients who cannot tolerate Aspirin get Clopidogrel or Ticlopidine
15. Post-PTCA patients get Abciximab
16. In any bleeding patient, order PT, PTT, and Blood Type and Crossmatch (just in case they have to go to the O.R.)
17. In any pregnant patient, get "Blood Type and Rh" as well as "Atypical Antibody Screen"
18. In any patient with excess bleeding (especially GI bleeding), type "no aspirin" upon D/C of patient
19. If the patient is having any upper GI distress or is at risk for aspiration, order "head elevation" and "aspiration precautions"
20. In any asthmatic, order bedside FEV1 and PEFR (and use this to follow treatment progress)
21. Before you D/C a patient, change all IV meds to PO and all nebulizers to MDI
22. In any patient who has GI distress, make them NPO
23. All diabetic in-patients get Accuchecks, D/C oral hypoglycemic agents, start insulin, HbA1c, advise strict glycemic control, recommend diabetic foot care
24. All patients with altered mental status of unknown etiology get a "fingerstick glucose" check (for hypoglycemia), IV thiamine, IV dextrose, IV naloxone, urine toxicology, blood alcohol level, NPO
25. If hemolysis is in the differential, order a reticulocyte count
26. If you administer heparin, check platelets on Day 3 and Day 5 (for heparin-induced thrombocytopenia), as well as frequent H&H
27. If you administer coumadin, check daily PT/INR until it is within therapeutic range for two consecutive days
28. Before giving a woman coumadin, isotretinoin, doxycycline, OCPs or other teratogens, get a beta-hCG
29. If you give furosemide (Lasix), also give KCl (it depletes K+)
30. All children who are given gentamycin, should have a hearing test (audiometry) and check BUN/Cr before and after treatment
-
31. Don't forget about patient comfort! Treat pain with IV morphine, nausea with IV phenergan, constipation with PO docusate, diarrhea with PO loperamide, insomnia with PO temazepam
32. ALL ICU patients get stress ulcer prophylaxis with IV omeprazole or ranitidine
33. If you put a patient on complete bedrest (such as those who are pre-op), get "pneumatic compression stockings"
34. If fluid status is vital to a patient's prognosis (such as those with dehydration, hypovolemia, or fluid overload), place a Foley catheter and order "urine output"
35. If a CXR shows an effusion, get a decubitus CXR next
36. If you intubate a patient you ALSO have to order "mechanical ventilation" (otherwise the patient will just sit there with a tube in his mouth!)
37. With any major procedure (including surgery, biopsy, centesis), you MUST type "consent for procedure" (typing consent will not reveal any results)
38. With any fluid aspiration (such as paracentesis or pericardiocentesis), get fluid analysis separately (it is not automatic). If you don't order anything on the fluid, it will just be discarded.
39. With high-dose steroids (such as in temporal arteritis), give IV ranitidine, calcium, vitamin D, alendronate, and get a baseline DEXA scan.
40. In all suspected DKA or HHNC, check osmolality and ketone levels in the serum.
41. In ALCOHOLIC ketoacidosis, just give dextrose (no need for insulin), in addition to IV normal saline and thiamine
42. All patients over 50 with no history of FOBT or colonoscopy should get a rectal exam, a FOBT, and have a sigmoidoscopy or colonoscopy scheduled.
43. All women > 40 years old should get a yearly clinical breast exam and mammogram (if risk factors are present, start at 35)
44. All men > 50 years old should get a prostate exam and a PSA (if risk factors are present, start at 45)
45. If a patient has a terminal disease, advise "advanced directives"
46. In any patient with a chronic disease that can cause future altered mental status, type "medical alert bracelet" upon D/C
47. Any patient with diarrhea should have their stool checked for "ova and parasites", "white cells", "culture", and C.diff antigen (if warranted)
48. Any patient on lithium or theophylline should have their levels checked
49. All patients with suspected MI should be given a statin (and check baseline LFTs)
50. All suspected hemolysis patients should get a direct Coombs test
51. Schedule all women older than 18 for a Pap smear (unless she has had a normal Pap within one year)
52. Pre-op patients should have the following done: “NPO”, “IV access”, “IV normal saline”, “blood type and crossmatch”, “analgesia”, “PT”, “PTT”, “pneumatic compression stockings”, “Foley”, “urine output”, “CBC”, and any appropriate antibiotics
53. If a patient requires epinephrine (such as in anaphylaxis), and he/she is on a beta-blocker, give glucagon first
54. If lipid profile is abnormal, order a TSH
55. All dementia and alcoholic patients should be advised “no driving”
56. To diagnose Alzheimer’s, first rule out other causes. Order a CT head, vitamin B12 levels, folate levels, TSH, and routine labs like CBC, BMP, LFT, UA. Also, if the history suggests it, order a VDRL and HIV ELISA as well
57. Also rule out depression in suspected dementia patients
58. For all women who are sexually active and of reproductive age, give folate. In fact, you should give ALL your patients a multivitamin upon D/C home
59. All pancreatitis patients should be made NPO and have NG suction so that no food can stimulate the pancreas
60. Send patients home on a disease-specific diet: diabetics get a “diabetic diet”, hypertensives get a “low salt diet”, irritable bowel patients get a “high fiber diet”, hepatic failure patients get “low protein diet”, etc
61. Do not give a thrombolytic (tPA or streptokinase) in a patient with unstable angina patient
62. Patients who are having a large amount of secretions, order “pulmonary toilet” to reduce the risk of aspiration
63. Every patient should be advised to wear a “seatbelt”, to “exercise”, and advised about “compliance”
64. In any patient who presents with an unprotected airway (as in overdoses, comatoses), get a CXR to rule out aspiration
65. In any patient with one sexually transmitted disease (such as Trichomonas), check for other STDs as well (Gonorrhea, Chlamydia, HIV, syphilis, etc.) and do a Pap smear in all women with an STD
66. Remember to treat children with croup with a “mist tent” and racemic epinephrine
67. Any acute abdomen patient with a suspected or proven perforation, give a TRIPLE antibiotic: Gentamycin, Ampicillin, Metronidazole
68. Get iron studies in patients with microcytic anemia if the cause is unknown. Order “iron”, “ferritin”, “TIBC”
69. Women with vaginal discharge should get a KOH prep, saline (wet) prep, vaginal pH, cervical gonococcal, chlamydia culture
70. If a woman is found to have vaginal candida, check her fasting glucose
71. When the 5 minute warning screen is displayed, go through the following mnemonic (RATED SEX). I know it probably is not the best mnemonic, but it is difficult to forget!:
Recreational drugs / Reassurance
Alcohol
Tobacco
Exercise
Diet (eg. high protein, no lactose, low fat, etc.)
Seat belt / Safety plan / Suicide precautions
Education (“patient education”)
X (stands for safe seX)
72. All suspected child abuse patients should be admitted and you should order THREE consults: consult “child protection services”, consult “ophthalmology” (to look for retinal hemorrhages), consult “psychiatrist” (to examine the family dynamics)
73. When a woman reaches menopause, she should have a “fasting lipid profile” checked (because without estrogen, the LDL will rise and the HDL will drop), a DEXA scan (for baseline bone density), and of course, FOBT and colonoscopy (if she is over 50)
74. If colon cancer is suspected, order a CEA; if pancreatic cancer, order CA 19-9; if ovarian cancer, order CA 125.
75. Remember to give “phototherapy” to a newborn with pathologic unconjugated bilirubinemia (it is not helpful if it is predominantly conjugated). Also, with phototherapy, keep the neonate on IV fluids (the heat can dehydrate them), and give erythromycin ointment in their eyes
76. Before giving a child prednisone, get a PPD
77. If a patient is found to have high triglycerides, check “amylase” and “lipase” (high triglycerides can cause pancreatitis)
78. Remember that any newborn under 3 weeks of age who develops a fever is SEPSIS until proven otherwise. Admit to the ward and culture EVERYTHING: “blood culture”, “urine culture”, “sputum culture”, and even “CSF culture”. And give antibiotics to cover EVERYTHING.
79. If you get a high lead level in a child, you have to check a “venous blood lead level” to confirm. If the value is > 70, admit immediately and begin IV “dimercaprol” and “EDTA”. Order “lead abatement agency” and “lead pain assay” upon discharge.
80. If you perform arthrocentesis, send the synovial fluid for “gram stain” and the 3 Cs: “crystals”, “culture”, and “cell count”
81. If a patient has exophthalmos with hyperthyroidism, it is not enough to just treat the hyperthyroidism (as the eye findings may worsen). You should give prednisone.
82. If any patient has cancer, get an “oncology consult”.
83. In a patient with rapid atrial fibrillation, decrease the heart rate first (then worry about converting to sinus rhythm). Use a CCB (diltiazem) or a beta-blocker (metoprolol) for rate control.
84. In any patient with new-onset atrial fibrillation, make sure you check a TSH
85. In any patient with suspected fluid volume depletion, order “postural vitals” to detect orthostasis
86. Before a colonoscopy or a sigmoidoscopy, you should prepare the bowel: make the patient NPO, give IV fluids (if necessary) and order “polyethylene glycol”.
87. Any patient with Mobitz II or complete heart block gets an immediate “transcutaneous pacemaker”. Then order a cardiology consult to implant a “transvenous pacemaker”
88. If calcium level is abnormal, order a “serum magnesium”, “serum phosphorus”, and “PTH”
89. Treat both malignant hyperthermia and neuroleptic malignant syndrome with “dantrolene”
90. All splenectomy patients get a “pneumovax”, an “influenza” vaccine, and a “hemophilus” vaccine if not previously given.
91. If you give INH (for Tb), also give “pyridoxine” (this is vitamin B6)
92. If you give pyrazinamide, get baseline “serum uric acid” levels
93. If you give ethambutol, order an ophthalmology consult (to follow possible optic neuritis)
94. If you perform a thoracocentesis (lung aspirate), send the EFFUSION as well as a peripheral blood sample for: LDH and protein (to help differentiate a transudate versus an exudates) and pH of the effusion
95. Give sickle cell disease children prophylactic penicillin continuously until they turn 5 years old
96. Any patient with a recent anaphylactic reaction (for any reason), should get “skin test” for allergens (to help prevent future disasters) and consult an allergist
97. Do not give cephalosporins to any patient with anaphylactic penicillin allergies (there is a 5% cross-reactivity)
98. Order Holter monitor on patients who have had symptomatic palpitations.
99. Any patient with a first-time panic attack gets a “urine toxicology” screen, a TSH, and “finger stick glucose”
100. All renal failure patients get: “nephrology consult”, “calcium acetate” (to decrease the phosphorus levels), “calcium” supplement, and erythropoeitin"
Source taken from: http://cafemedico.net/forums/clinical-subjects-discussion-forum/11024-best-clincal-mcq-pearls.html
Monday, October 18, 2010
Sick Building Syndrome
http://www.epa.gov/iaq/pubs/sbs.html
The term "sick building syndrome" (SBS) is used to describe situations in which building occupants experience acute health and comfort effects that appear to be linked to time spent in a building, but no specific illness or cause can be identified.
Symptoms of Sick Building Syndrome
Sick building syndrome involves a variety of seemingly unrelated symptoms, much like other unexplained conditions such as chronic fatigue syndrome (CFS), and Gulf War syndrome (GWS) do. Some authorities have attempted to separate the symptoms into distinct categories such as 'allergic' and 'non-allergic', or 'chemical related' and 'microbe related'. Since there is yet no concensus on these distinctions, the common symptoms of SBS are listed here together:
Headache
Eye, nose, and throat irritation
Dry cough
Dry, itchy skin, rashes
Dizziness and nausea
Difficulty in concentrating
Fatigue
Sensitivity to odors
Distinction between sick building syndrome and building related illness has to be identified. One reason is that they have different etiologies and that treatment method is different too.
The term "sick building syndrome" (SBS) is used to describe situations in which building occupants experience acute health and comfort effects that appear to be linked to time spent in a building, but no specific illness or cause can be identified.
Symptoms of Sick Building Syndrome
Sick building syndrome involves a variety of seemingly unrelated symptoms, much like other unexplained conditions such as chronic fatigue syndrome (CFS), and Gulf War syndrome (GWS) do. Some authorities have attempted to separate the symptoms into distinct categories such as 'allergic' and 'non-allergic', or 'chemical related' and 'microbe related'. Since there is yet no concensus on these distinctions, the common symptoms of SBS are listed here together:
Headache
Eye, nose, and throat irritation
Dry cough
Dry, itchy skin, rashes
Dizziness and nausea
Difficulty in concentrating
Fatigue
Sensitivity to odors
Distinction between sick building syndrome and building related illness has to be identified. One reason is that they have different etiologies and that treatment method is different too.
Wednesday, August 25, 2010
Cutaneous Manifestation of Hepatitis C
Resource: http://emedicine.medscape.com/article/1134161-overview
http://www.medscape.com/viewarticle/548006_4
I have seen a patient today with a history of Hepatitis C. The lesion is located inferior to the right medial malleolus. Itchiness and clear discharge due to scretching of lesion was mentioned by patient. No obvious erythema noted except for some purpura over the skin.
Differential Diagnosis:
1) Prurigo nodularis
2) Acral necrolytic erythema
3) Cryoglobulinemia (Leukocytoclastic vasculitis)
4) Erythema nodosum
5) Erythema multiforme
6) Porphyria Cutanea Tarda (Least likely due to the fact that it required sunlight to cause symptom)
http://www.medscape.com/viewarticle/548006_4
I have seen a patient today with a history of Hepatitis C. The lesion is located inferior to the right medial malleolus. Itchiness and clear discharge due to scretching of lesion was mentioned by patient. No obvious erythema noted except for some purpura over the skin.
Differential Diagnosis:
1) Prurigo nodularis
2) Acral necrolytic erythema
3) Cryoglobulinemia (Leukocytoclastic vasculitis)
4) Erythema nodosum
5) Erythema multiforme
6) Porphyria Cutanea Tarda (Least likely due to the fact that it required sunlight to cause symptom)
Saturday, August 21, 2010
Family Medicine
https://www.med-ed.virginia.edu/CourseSites/quiz/quizsheet.cfm?keywordID=1999&CourseID=19&num=1&start=1&noindex=1
http://www.gpnotebook.co.uk/homepage.cfm
http://fmclerkship.mc.duke.edu/student/commprob.html
http://www.hmc.psu.edu/ume/fcmonline/
http://www.sh.lsuhsc.edu/fammed/OutpatientManual.htm
http://www.nlhep.org/books/pul_Pre/intro-plpr.html
I come across 2 women the other day and domestic violence was brought up between conversation before they broke out into tears. Helpless as I can say and I think I can do more for them. SAFE questionnaire and Abuse Assessment Screen (AAS) can be used to access the situation.
Common stuffs in FM:
1) Post-nasal drip
Post-nasal drip is mucus accumulation in the back of the nose and throat leading to, or giving the sensation of, mucus dripping downward from the back of the nose. One of the most common characteristics of chronic rhinitis is post-nasal drip. Post-nasal drip may lead to chronic sore throat or chronic cough. Post-nasal drip can be caused by excessive or thick secretions, or impairment in the normal clearance of mucus from the nose and throat.
2) Skin Problems
Scabies and tinea. http://www.medicinenet.com/ringworm_pictures_slideshow/article.htm A good website with slideshow showing you a list of tinea problems. One thing good to know is that it is NOT a problem with WORM, but it's a fungus problem. The word that comes after tinea dictates which part of the body it is occuring. I think you know it already. Scabies, big thing. 5% permethrin preparation should do it.
http://dermatlas.med.jhmi.edu/derm/
3) Osteoporosis
http://www.medpagetoday.com/Endocrinology/Osteoporosis/4247http://www.webmd.com/osteoporosis/features/soda-osteoporosis Interestingly, scientists are trying to link osteoporosis with consumption of soft drink. Theory-wise, it's linked but there are still a long way down the road to proof the connection.
4) http://www.mhhe.com/socscience/hhp/fit_well/web15/
http://www.gpnotebook.co.uk/homepage.cfm
http://fmclerkship.mc.duke.edu/student/commprob.html
http://www.hmc.psu.edu/ume/fcmonline/
http://www.sh.lsuhsc.edu/fammed/OutpatientManual.htm
http://www.nlhep.org/books/pul_Pre/intro-plpr.html
I come across 2 women the other day and domestic violence was brought up between conversation before they broke out into tears. Helpless as I can say and I think I can do more for them. SAFE questionnaire and Abuse Assessment Screen (AAS) can be used to access the situation.
Common stuffs in FM:
1) Post-nasal drip
Post-nasal drip is mucus accumulation in the back of the nose and throat leading to, or giving the sensation of, mucus dripping downward from the back of the nose. One of the most common characteristics of chronic rhinitis is post-nasal drip. Post-nasal drip may lead to chronic sore throat or chronic cough. Post-nasal drip can be caused by excessive or thick secretions, or impairment in the normal clearance of mucus from the nose and throat.
2) Skin Problems
Scabies and tinea. http://www.medicinenet.com/ringworm_pictures_slideshow/article.htm A good website with slideshow showing you a list of tinea problems. One thing good to know is that it is NOT a problem with WORM, but it's a fungus problem. The word that comes after tinea dictates which part of the body it is occuring. I think you know it already. Scabies, big thing. 5% permethrin preparation should do it.
http://dermatlas.med.jhmi.edu/derm/
3) Osteoporosis
http://www.medpagetoday.com/Endocrinology/Osteoporosis/4247http://www.webmd.com/osteoporosis/features/soda-osteoporosis Interestingly, scientists are trying to link osteoporosis with consumption of soft drink. Theory-wise, it's linked but there are still a long way down the road to proof the connection.
4) http://www.mhhe.com/socscience/hhp/fit_well/web15/
Thursday, August 19, 2010
Cancer Screening
http://www.cancer.org/Healthy/FindCancerEarly/CancerScreeningGuidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer
I guess this link will provide you a knowledge on cancer screening:
American Cancer Society Guidelines for the Early Detection of Cancer
The American Cancer Society recommends these screening guidelines for most adults. Good to know so that you can get up-to-date information.
Enjoy reading'em.
I guess this link will provide you a knowledge on cancer screening:
American Cancer Society Guidelines for the Early Detection of Cancer
The American Cancer Society recommends these screening guidelines for most adults. Good to know so that you can get up-to-date information.
Enjoy reading'em.
Sunday, August 8, 2010
My Ob Gyn
www.permanente.net/homepage/kaiser/pdf/6289.pdf
https://secure1.csmc.edu/nicu/cbg/ (Cord gas)
This is a good article talking the difference of level 1 ultrasound and level 2 ultrasound. Still have a lot of readings to do and assignments to complete. Got to hasten my pace.
http://www.gentlebirth.org/archives/dic.html
This is an article about DIC in pregnancy. I witnessed a patient with this condition. Was transferred to ICU and was well taken care of. Let's not forget that there is a possibility that a mother will get into this condition during pregnancy.
https://secure1.csmc.edu/nicu/cbg/ (Cord gas)
This is a good article talking the difference of level 1 ultrasound and level 2 ultrasound. Still have a lot of readings to do and assignments to complete. Got to hasten my pace.
http://www.gentlebirth.org/archives/dic.html
This is an article about DIC in pregnancy. I witnessed a patient with this condition. Was transferred to ICU and was well taken care of. Let's not forget that there is a possibility that a mother will get into this condition during pregnancy.
Tuesday, July 6, 2010
Golden phrase from Jefferson
Below listed are the phrases I got from today's orientation:
1. Don't ever ask questions that you can look up the answers.
2. Never pimp another student in front of team.
3. Never answer question directly specific to another student. Wait for your turn.
4. If you are asked a question, even if you do not the answer, make sure you reason them "out loud"
5. Always be within or easy contact with residents. Observe also what the residents are doing.
6. Check patient often!
7. Appear interested all times!
8. Think "How can I make my resident's job easier?" e.g. discharge summaries, scripts, pre/post-ops checks
9. Do not get caught in race for information with fellow students
Journals:
1. Periodically bring respected journals e.g. NEJM, JAMA
2. Read whole article and make an intelligent sentence or 2 summing them up
3. Do not overdo a.k.a. overkill (one to two times per week will be good)
4. Do not print and distribute to whole team
Presentation:
1. Handouts for all
2. Appropriate presentation
3. Practice before you give presentation
4. If information is split among teammates, NEVER present information someone was assigned to
Handheld/Smartphones:
Do not use them in rounds unless looking for drugs. Resident will think you are playing games. You are warned!
If you are absent in rotation, call the clerkship coordinator or resident on team.
Nurses are your biggest ally. DO NOT SLEEP IN ROTATION!
1. Don't ever ask questions that you can look up the answers.
2. Never pimp another student in front of team.
3. Never answer question directly specific to another student. Wait for your turn.
4. If you are asked a question, even if you do not the answer, make sure you reason them "out loud"
5. Always be within or easy contact with residents. Observe also what the residents are doing.
6. Check patient often!
7. Appear interested all times!
8. Think "How can I make my resident's job easier?" e.g. discharge summaries, scripts, pre/post-ops checks
9. Do not get caught in race for information with fellow students
Journals:
1. Periodically bring respected journals e.g. NEJM, JAMA
2. Read whole article and make an intelligent sentence or 2 summing them up
3. Do not overdo a.k.a. overkill (one to two times per week will be good)
4. Do not print and distribute to whole team
Presentation:
1. Handouts for all
2. Appropriate presentation
3. Practice before you give presentation
4. If information is split among teammates, NEVER present information someone was assigned to
Handheld/Smartphones:
Do not use them in rounds unless looking for drugs. Resident will think you are playing games. You are warned!
If you are absent in rotation, call the clerkship coordinator or resident on team.
Nurses are your biggest ally. DO NOT SLEEP IN ROTATION!
Monday, June 14, 2010
Hidradenitis suppurativa
http://www.aocd.org/skin/dermatologic_diseases/hidradenitis_suppu.html
http://www.mayoclinic.com/health/hidradenitis-suppurativa/ds00818
Hidradenitis Suppurativa
Hidradenitis suppurativa, also known as acne inversa, is a chronic, often debilitating disease primarily affecting the axillae, perineum, and inframammary regions. Prevalence rates of up to 4% have been estimated. Our understanding of the disease has changed over time. It is now considered a disease of follicular occlusion rather than an inflammatory or infectious process of the apocrine glands. Clinically, the disease often presents with tender subcutaneous nodules beginning around puberty. The nodules may spontaneously rupture or coalesce, forming painful, deep dermal abscesses. Eventually, fibrosis and the formation of extensive sinus tracts may result. The location of the lesions may lead to social embarrassment and the failure to seek medical treatment. Therapies in the past have consisted of long-term antibiotics, antiandrogens, and surgery. New treatments like tumor necrosis factor-alfa inhibitors have given clinicians more options against this difficult disease.
From: http://www.ncbi.nlm.nih.gov/pubmed/19293006
http://www.mayoclinic.com/health/hidradenitis-suppurativa/ds00818
Hidradenitis Suppurativa
Hidradenitis suppurativa, also known as acne inversa, is a chronic, often debilitating disease primarily affecting the axillae, perineum, and inframammary regions. Prevalence rates of up to 4% have been estimated. Our understanding of the disease has changed over time. It is now considered a disease of follicular occlusion rather than an inflammatory or infectious process of the apocrine glands. Clinically, the disease often presents with tender subcutaneous nodules beginning around puberty. The nodules may spontaneously rupture or coalesce, forming painful, deep dermal abscesses. Eventually, fibrosis and the formation of extensive sinus tracts may result. The location of the lesions may lead to social embarrassment and the failure to seek medical treatment. Therapies in the past have consisted of long-term antibiotics, antiandrogens, and surgery. New treatments like tumor necrosis factor-alfa inhibitors have given clinicians more options against this difficult disease.
From: http://www.ncbi.nlm.nih.gov/pubmed/19293006
Thursday, June 10, 2010
Corn a.k.a. hyperkeratosis, clavus, heloma and tyloma
http://www.epodiatry.com/corns-callus.htm
http://footcare.ygoy.com/foot-corns-and-corn-treatment/
The above mentioned websites are some reference if you are interested in a condition called foot corn. Well, it's basically, as suggested from the name, a corn-like lesion over the foot. To be accurate, it's hyperkeratosis. The function is nothing but to protect your feet from the hardship they are exposed to. Differentiation from it with that of a callus is important. Here is the difference: A callus generally refers to a more diffuse thickening of the skin (more common on the toes, but can occur under the ball of the foot) whereas a corn is a thicker more focal area area (more common on the toes). A corn can occur under and be surrounded by callus. Complication worried is that infection can occur on the it, and eventually leading to the formation of an abscess.
http://footcare.ygoy.com/foot-corns-and-corn-treatment/
The above mentioned websites are some reference if you are interested in a condition called foot corn. Well, it's basically, as suggested from the name, a corn-like lesion over the foot. To be accurate, it's hyperkeratosis. The function is nothing but to protect your feet from the hardship they are exposed to. Differentiation from it with that of a callus is important. Here is the difference: A callus generally refers to a more diffuse thickening of the skin (more common on the toes, but can occur under the ball of the foot) whereas a corn is a thicker more focal area area (more common on the toes). A corn can occur under and be surrounded by callus. Complication worried is that infection can occur on the it, and eventually leading to the formation of an abscess.
Sunday, May 23, 2010
ECG -- RBBB & LBBB
I am showing a case of ECG from this website. Actually if you just google it, you will get it. Nevertheless I put down the list of ECG interpretation here just in case I need to refer, or maybe you who would like to know more.
http://meds.queensu.ca/courses/assets/modules/ts-ecg/right_bundle_branch_block.html
http://library.med.utah.edu/kw/ecg/ecg_outline/Lesson6/index.html
http://www.americanheart.org/presenter.jhtml?identifier=563
http://cmbi.bjmu.edu.cn/uptodate/electrocardiography%20tutorial/ECG%20tutorial-Miscellaneous%20diagnoses.htm
http://ecgblog.com/?tag=rp-interval
http://www.amc.edu/amr/archives/200408/EKG2_ans.html
To date, I am still doubtful of the ECG interpretation, especially the RBBB and LBBB which kind of haunted me and that during the cardiovascular module back in IMU, these are the few ECGs which I could not fully understand. These are the questions I have in mind: what is an RP interval? In regards of ST segment shapes, there are not much literature reviewing the articles about them. Only one reference quote a significant observation to be noticed of, whether the ST segment shape is concave, straight or convex[1].
Loads of websites teaching you but how much can I absorb? Aiz...
Reference:
1. Karadede A., Aydinalp O., Temamogullari A.V., Toprak N. The relationship of ST segment elevation shape with preserved myocardium
and signal-averaged electrocardiography in acute anterior
myocardial infarction. Heart and Vessels [serial on the Internet]. 2002; 16(4): 146-153. Available from: http://www.springerlink.com/content/cqu8tkxdvc83q91j/fulltext.pdf
http://meds.queensu.ca/courses/assets/modules/ts-ecg/right_bundle_branch_block.html
http://library.med.utah.edu/kw/ecg/ecg_outline/Lesson6/index.html
http://www.americanheart.org/presenter.jhtml?identifier=563
http://cmbi.bjmu.edu.cn/uptodate/electrocardiography%20tutorial/ECG%20tutorial-Miscellaneous%20diagnoses.htm
http://ecgblog.com/?tag=rp-interval
http://www.amc.edu/amr/archives/200408/EKG2_ans.html
To date, I am still doubtful of the ECG interpretation, especially the RBBB and LBBB which kind of haunted me and that during the cardiovascular module back in IMU, these are the few ECGs which I could not fully understand. These are the questions I have in mind: what is an RP interval? In regards of ST segment shapes, there are not much literature reviewing the articles about them. Only one reference quote a significant observation to be noticed of, whether the ST segment shape is concave, straight or convex[1].
Loads of websites teaching you but how much can I absorb? Aiz...
Reference:
1. Karadede A., Aydinalp O., Temamogullari A.V., Toprak N. The relationship of ST segment elevation shape with preserved myocardium
and signal-averaged electrocardiography in acute anterior
myocardial infarction. Heart and Vessels [serial on the Internet]. 2002; 16(4): 146-153. Available from: http://www.springerlink.com/content/cqu8tkxdvc83q91j/fulltext.pdf
Lesson I Learnt from Jefferson -- Sexual & Interpersonal Relationship
Sometimes in your interview, you will come across people with gay or lesbian relationship. First and foremost, do not show any signs of surprise since it will make patient feels uncomfortable. Try to be neutral and more understanding.
Before I begin, quick mention on what kind of words to be used. Start of by asking permission. "I care about you. To do that, I need to ask something private"/ "As a physician, I need to know that. It will be kept confidential." Reassure the patient that you are asking in good will and that you will keep his/her private live in secret. (Homosexuality is still a big issue here despite efforts of making homosexual legal). Afterwards, ask about the sexual history. "Are you in a relationship? With men or women or both?" Same rule applies, do not beat around the bush. Ask straight, but don't do it too prominent, of course.
Ask about screening tests done in any couples. Tests like HIV testing and STDs. (People always think HIV test first then other tests, therefore I can't think of any other tests which you can do)
Ask about a possible abuse relationship. This is not a funny issue as domestic violence or sexual assault is pretty common. Approximately 25% of women in US will be abused by a current or former partner sometime during their lifetime and most of the time (85%), victims are women[1]. Kick start this by asking "How's your marriage?" or "How's things going on at home?". If you suspect possible abuse, initiate SAFE questionnaire. 1. Stress/Safety; 2. Afraid/Abuse; 3. Friends/Family; 4. Emergency plan. Then proceed to Abuse Assessment Screen (AAS) to access how severe the abuse can be. One point I want to mention is patient may indirectly hint you that they are in an abuse relationship. Remember that women tend to cover up this messy relationship and tend not to talk about them too much. Say for example, patient may say their relationship is good but they did argue. Argue but still in a good relationship? Ask more...
Depressed patient. They won't say anything (sometimes), even though they start speaking, it will be slow. It's pretty hard, actually, to get a full history done by a short period of time due to the slow nature of the interview. Nevertheless, you need to be patient and try not to hurry the patient too much. It's bad. Question patient intention of how to overcome them. Let's just start a scenario like this. Firstly, NO BEATING AROUND THE BUSH. Ask him/her "I think you are feeling depressed because ..." Explain to him/her and explore whether he/she has suicidal intention. Questions like "Do you feel you want to harm yourself/other people?" should be asked. Optional question like "Do you own a gun?" can be asked.
P/S: As long as you see a gown, please drape. Assure patient that you have the best quality of care and that you do your best to help. Scenario: Patient indecisive of admission to hospital for treatment as he/she is afraid that he/she will end up dying like of his/her parents who have the same disease as he/she. Assure her: "We have the equipments to make you feel better and that we need to put you early to hospital." (S.P. amazed but the bolded phrase. This is just an example I made up with the intention which I feel from the S.P.) Night sweats. Can be lymphoma, TB etc. In diarrhea, talk about quality of stool (watery? Color? Frequency?) When you want to do examination on female patients, due to modesty, you would need to ask "May I go under the gown?"
Reference:
1. Fortner K B, Szymanski L M, Fox H E, Wallach E E. The Johns Hopkins Manual of Gynecology and Obstetrics. Baltimore: LWW; 2007, p. 355
Before I begin, quick mention on what kind of words to be used. Start of by asking permission. "I care about you. To do that, I need to ask something private"/ "As a physician, I need to know that. It will be kept confidential." Reassure the patient that you are asking in good will and that you will keep his/her private live in secret. (Homosexuality is still a big issue here despite efforts of making homosexual legal). Afterwards, ask about the sexual history. "Are you in a relationship? With men or women or both?" Same rule applies, do not beat around the bush. Ask straight, but don't do it too prominent, of course.
Ask about screening tests done in any couples. Tests like HIV testing and STDs. (People always think HIV test first then other tests, therefore I can't think of any other tests which you can do)
Ask about a possible abuse relationship. This is not a funny issue as domestic violence or sexual assault is pretty common. Approximately 25% of women in US will be abused by a current or former partner sometime during their lifetime and most of the time (85%), victims are women[1]. Kick start this by asking "How's your marriage?" or "How's things going on at home?". If you suspect possible abuse, initiate SAFE questionnaire. 1. Stress/Safety; 2. Afraid/Abuse; 3. Friends/Family; 4. Emergency plan. Then proceed to Abuse Assessment Screen (AAS) to access how severe the abuse can be. One point I want to mention is patient may indirectly hint you that they are in an abuse relationship. Remember that women tend to cover up this messy relationship and tend not to talk about them too much. Say for example, patient may say their relationship is good but they did argue. Argue but still in a good relationship? Ask more...
Depressed patient. They won't say anything (sometimes), even though they start speaking, it will be slow. It's pretty hard, actually, to get a full history done by a short period of time due to the slow nature of the interview. Nevertheless, you need to be patient and try not to hurry the patient too much. It's bad. Question patient intention of how to overcome them. Let's just start a scenario like this. Firstly, NO BEATING AROUND THE BUSH. Ask him/her "I think you are feeling depressed because ..." Explain to him/her and explore whether he/she has suicidal intention. Questions like "Do you feel you want to harm yourself/other people?" should be asked. Optional question like "Do you own a gun?" can be asked.
P/S: As long as you see a gown, please drape. Assure patient that you have the best quality of care and that you do your best to help. Scenario: Patient indecisive of admission to hospital for treatment as he/she is afraid that he/she will end up dying like of his/her parents who have the same disease as he/she. Assure her: "We have the equipments to make you feel better and that we need to put you early to hospital." (S.P. amazed but the bolded phrase. This is just an example I made up with the intention which I feel from the S.P.) Night sweats. Can be lymphoma, TB etc. In diarrhea, talk about quality of stool (watery? Color? Frequency?) When you want to do examination on female patients, due to modesty, you would need to ask "May I go under the gown?"
Reference:
1. Fortner K B, Szymanski L M, Fox H E, Wallach E E. The Johns Hopkins Manual of Gynecology and Obstetrics. Baltimore: LWW; 2007, p. 355
Thursday, May 13, 2010
Lesson I Learnt from Jefferson -- End of Life
Person attending: Patient's wife
Patient's info
Name : Mel Voight
Age : 55
Gender : Male
Diag & Rx : Adenocarcinoma of lung, underwent resection of lung mass followed by chemotherapy and radiation.
Comments : Recurrence of cancer after vacation and metastasize to lymph nodes, brain and lung
History of Presenting Illness
Time : One week ago
Last activity : Gardening
Comments : Patient tachycardic and hypotensive. During transport to ED, patient became pulseless and CPR initiated. Arrival to ED, PEA was reported. Epinephrine and atropine was given, CPR discontinued and intubation started. After 25 mins of ACLS protocol, patient regain spontaneous circulation and was transferred to MRICU on respiratory and BP support.
Patient condition: Stabilized, remain ventilator dependent and failed all trials to wean him from ventilator. Remained unresponsive to voice, touch, painful stimuli.
CT of head : Negative for hemorrhagic or ischemic stroke
Enlarging metastatic lesions spotted.
Comments : Patient diagnosed with severe anoxic brain injury due to prolonged resusucitation effort
CT of chest : Recurrent rapidly progressing adenocarcinoma
Comments : Bad prognosis
Your task as an attendant of MRICU, talk to Mrs Voight as she wishes to talk to you about the events that have occurred since last week and inform her about what his chances are for survival after the event. She has been told briefly about the code blue by the covering intern.
My own personal experience
It's really bad to make patient's relative or spouse to be left in a blank or confused state. I need to be confident in delivering the news and don't be afraid to mention the word "death", but mention them in a correct manner. The phrase here as quoted in my OSCE book: Assure the iwfe of the certainty of her husband's diagnosis and prognosis. [2]I give an example of how to start the conversation, (you can actually ask anything you want since you are the creator):
Physician: Good morning. How are you feeling today?
Patient: Better than I did a week ago.
Physician: I'm glad of that. We have some very serious matters to discuss regarding your health. Do you feel ready for this discussion?
The aforementioned dialog [1] is a nice approach to prepare patient, as in to prepare the patient of the information he or she is going to hear. One can also try to offer a conclusion or the details first. "Do you want the big picture first?" is a nice phrase to be used.
A good handshake (you can use both of your hands to hold their hands) can mean a difference. Even a tap on shoulder or if you want to offer a patient a hug can help the patient, at least to let them feel that death of the loved ones is inevitable and that they need to overcome them. "We really try our best" should be mentioned. Mind you that everyone deep down wants the truth no matter how bad a situation is.
Talking about overcoming them, it's nice. Ask them what else can be done to help, e.g. access to phone to contact family members or access to clergy[2] and always offer support or help. Words like "My doors are opened to you. If you have any questions, you can consult me." If patient's relative still can't make any decision, it's fine mainly because they are shocked about the bad news.
There are a few points mentioned in the handbook. Just act according to situation, and as Dr. Majdan said, "Treat your patient not by your brain, but by your heart."
Correct me if I am wrong in any part of my article
Reference:
1. P Gordon, J Marsh. Crash Course: History and Examination. Philadelphia: Elsevier| Mosby; 2005, p.14.
2. Katrina F Hurley. OSCE and Clinical Skills Handbook. Toronto: Elsevier | Saunders; 2005, p.362.
Patient's info
Name : Mel Voight
Age : 55
Gender : Male
Diag & Rx : Adenocarcinoma of lung, underwent resection of lung mass followed by chemotherapy and radiation.
Comments : Recurrence of cancer after vacation and metastasize to lymph nodes, brain and lung
History of Presenting Illness
Time : One week ago
Last activity : Gardening
Comments : Patient tachycardic and hypotensive. During transport to ED, patient became pulseless and CPR initiated. Arrival to ED, PEA was reported. Epinephrine and atropine was given, CPR discontinued and intubation started. After 25 mins of ACLS protocol, patient regain spontaneous circulation and was transferred to MRICU on respiratory and BP support.
Patient condition: Stabilized, remain ventilator dependent and failed all trials to wean him from ventilator. Remained unresponsive to voice, touch, painful stimuli.
CT of head : Negative for hemorrhagic or ischemic stroke
Enlarging metastatic lesions spotted.
Comments : Patient diagnosed with severe anoxic brain injury due to prolonged resusucitation effort
CT of chest : Recurrent rapidly progressing adenocarcinoma
Comments : Bad prognosis
Your task as an attendant of MRICU, talk to Mrs Voight as she wishes to talk to you about the events that have occurred since last week and inform her about what his chances are for survival after the event. She has been told briefly about the code blue by the covering intern.
My own personal experience
It's really bad to make patient's relative or spouse to be left in a blank or confused state. I need to be confident in delivering the news and don't be afraid to mention the word "death", but mention them in a correct manner. The phrase here as quoted in my OSCE book: Assure the iwfe of the certainty of her husband's diagnosis and prognosis. [2]I give an example of how to start the conversation, (you can actually ask anything you want since you are the creator):
Physician: Good morning. How are you feeling today?
Patient: Better than I did a week ago.
Physician: I'm glad of that. We have some very serious matters to discuss regarding your health. Do you feel ready for this discussion?
The aforementioned dialog [1] is a nice approach to prepare patient, as in to prepare the patient of the information he or she is going to hear. One can also try to offer a conclusion or the details first. "Do you want the big picture first?" is a nice phrase to be used.
A good handshake (you can use both of your hands to hold their hands) can mean a difference. Even a tap on shoulder or if you want to offer a patient a hug can help the patient, at least to let them feel that death of the loved ones is inevitable and that they need to overcome them. "We really try our best" should be mentioned. Mind you that everyone deep down wants the truth no matter how bad a situation is.
Talking about overcoming them, it's nice. Ask them what else can be done to help, e.g. access to phone to contact family members or access to clergy[2] and always offer support or help. Words like "My doors are opened to you. If you have any questions, you can consult me." If patient's relative still can't make any decision, it's fine mainly because they are shocked about the bad news.
There are a few points mentioned in the handbook. Just act according to situation, and as Dr. Majdan said, "Treat your patient not by your brain, but by your heart."
Correct me if I am wrong in any part of my article
Reference:
1. P Gordon, J Marsh. Crash Course: History and Examination. Philadelphia: Elsevier| Mosby; 2005, p.14.
2. Katrina F Hurley. OSCE and Clinical Skills Handbook. Toronto: Elsevier | Saunders; 2005, p.362.
Wednesday, May 12, 2010
Lesson I Learnt from Jefferson
It's about two weeks since I have come to Jefferson Medical College, Philadelphia, PA, USA. Everything is new to me here and I have had really good time, as well as bad time here. Lots of mistakes and just tons of things I need to bear in mind when in clinical examination.
I will just point out the serious mistakes I made, some ideas of thoughts and comments I would like to make.
1) History taking.
I need to be more focus on what I should be doing. Do not shoot like a shotgun, and hoping u hit something, instead ask specific and more case related questions. DO NOT SAY TOO OFFENSIVE THINGS. Say it in a rather indirect and polite way. Do not ask a patient some judgmental questions. "Are you obese?" (Duh, bad question. Whether you are overweight or underweight rely mostly on BMI. In other words, just don't ask this question) "Do you have sex with men?" (You are being judgmental about the patient being gay)
Try to speak in a layman level, besides not speaking medical jargon, as it's not just them altogether. If you suddenly utter some too medical jargons, explanation should be made to make them understand.
Review system. Try to do as appropriate. As told earlier, try to generate some questions pin-pointing yourself to the right track. Housing and working environment can be asked at social history (?). If you have the high likely suspicion that patient is not telling the truth, try to prompt them to saying them, ex. smoking. Patient may just say I quit smoking last year, then they tell you that he/she smoke a few cigarettes yesterday. Same goes for drinking. (I forgot how Dr. Majdan phrase it, but it's something like asking you how many you drink, instead of asking do you drink) ALWAYS DEFINE THE PATIENT'S DEFINITION OF BEING NORMAL. Always ask what is normal to patient, ex. bowel movements (no need to say a lot, you know what I mean. :-p)
ALWAYS REMEMBER TO SIT DOWN. Don't bring into your mind any idea of person seeing at eye-level is respect. They WANT you to really sit down and really care for them, and REALLY listen to what they say. Just imagine if you are standing up and taking history, you can just walk out of the room. But if you are sitting, you are showing to patient that you really a caring doctor. Thus, never stand up. Remember to sit down. Screw the eye-level looking respect thingy.
Obstructive Sleep Apnea (OSA), questions like snoring, sleeping well should be asked. "Does your wife tell you that you snores at night?" "Do you feel breathless during the night?" etc.
SEXUAL HISTORY
Just be sensitive. Maintain confidentiality, that's utmost important. Questions like "Do you have regular sexual partner?" "How do you avoid pregnancy?" "What do you mean by protection" In cases of underage sex, ask "Do you have boyfriend or girlfriend?" "Can you talk about sex?" (I remembered that sexually abused kids normally have a really "adult" knowledge on sex)"Have you been abused?" can be replaced by "Do you feel safe at home?"
RELIGION
"Are you raised in any particular faith?" "Do you still practice them?"
2) Clinical skills
In GI, always make a point of auscultate before you palpate the abdomen. IT'S A MUST! Don't be shocked in front of a lady patient or be stunned. Quote from Dr. Majdan: "Do not let the situation controls you. YOU CONTROL THE SITUATION." Just be yourself, be authoritarian somehow but not too obvious and too exaggerating.
A note about american way of doing clinical examination. First and foremost, is standing on patient's RIGHT side, not only it's for the exam, but all the equipments are on patient's right. So, why not? Why not take this as a note, always go for the equipments side to do your examination. The bed or couch (I not sure of myself) is a fantastic bed/couch which can be extended on the leg side (it won't be taken out, if you don't open them, patient's legs will be left dangling, which is bad. The bed can be tilted 45 degrees too, to do your CVS and Respi examination. Better to use the antiseptic solution than using the soap. Seriously. If vitals are not given, DO ALL THE VITALS, ex. BP, pulse etc. Basically just do everything.
Respi and CVS examination can overlap, especially the apex beat.
3) Conclusion
If you don't know, say you don't know. Do not push your responsibility to other people, ex. the doctor who will be doing the imaging will tell you what's wrong with you (something like that). You are solely responsible of the well-being of the patient upon coming to you. Just tell him/her what you want to do, let him understand the procedures, and to be considerate of patient's possibility of phobia of your words like surgery (maybe the guy have had surgery before and will be traumatized that you tell him/her that she need another surgery).
Oh yeah, most Americans will know the generic name of the drugs. Therefore, be familiarize with the terms so that you will know what drugs they are. They may or may not be as well knowledgeable as you do.
There are lots more to learn. I need time to compile them and put it on my blogspot. I hope that these are all the deterrents that will help me and anyone who is reading this blog. AMITABHA!!!
I will just point out the serious mistakes I made, some ideas of thoughts and comments I would like to make.
1) History taking.
I need to be more focus on what I should be doing. Do not shoot like a shotgun, and hoping u hit something, instead ask specific and more case related questions. DO NOT SAY TOO OFFENSIVE THINGS. Say it in a rather indirect and polite way. Do not ask a patient some judgmental questions. "Are you obese?" (Duh, bad question. Whether you are overweight or underweight rely mostly on BMI. In other words, just don't ask this question) "Do you have sex with men?" (You are being judgmental about the patient being gay)
Try to speak in a layman level, besides not speaking medical jargon, as it's not just them altogether. If you suddenly utter some too medical jargons, explanation should be made to make them understand.
Review system. Try to do as appropriate. As told earlier, try to generate some questions pin-pointing yourself to the right track. Housing and working environment can be asked at social history (?). If you have the high likely suspicion that patient is not telling the truth, try to prompt them to saying them, ex. smoking. Patient may just say I quit smoking last year, then they tell you that he/she smoke a few cigarettes yesterday. Same goes for drinking. (I forgot how Dr. Majdan phrase it, but it's something like asking you how many you drink, instead of asking do you drink) ALWAYS DEFINE THE PATIENT'S DEFINITION OF BEING NORMAL. Always ask what is normal to patient, ex. bowel movements (no need to say a lot, you know what I mean. :-p)
ALWAYS REMEMBER TO SIT DOWN. Don't bring into your mind any idea of person seeing at eye-level is respect. They WANT you to really sit down and really care for them, and REALLY listen to what they say. Just imagine if you are standing up and taking history, you can just walk out of the room. But if you are sitting, you are showing to patient that you really a caring doctor. Thus, never stand up. Remember to sit down. Screw the eye-level looking respect thingy.
Obstructive Sleep Apnea (OSA), questions like snoring, sleeping well should be asked. "Does your wife tell you that you snores at night?" "Do you feel breathless during the night?" etc.
SEXUAL HISTORY
Just be sensitive. Maintain confidentiality, that's utmost important. Questions like "Do you have regular sexual partner?" "How do you avoid pregnancy?" "What do you mean by protection" In cases of underage sex, ask "Do you have boyfriend or girlfriend?" "Can you talk about sex?" (I remembered that sexually abused kids normally have a really "adult" knowledge on sex)"Have you been abused?" can be replaced by "Do you feel safe at home?"
RELIGION
"Are you raised in any particular faith?" "Do you still practice them?"
2) Clinical skills
In GI, always make a point of auscultate before you palpate the abdomen. IT'S A MUST! Don't be shocked in front of a lady patient or be stunned. Quote from Dr. Majdan: "Do not let the situation controls you. YOU CONTROL THE SITUATION." Just be yourself, be authoritarian somehow but not too obvious and too exaggerating.
A note about american way of doing clinical examination. First and foremost, is standing on patient's RIGHT side, not only it's for the exam, but all the equipments are on patient's right. So, why not? Why not take this as a note, always go for the equipments side to do your examination. The bed or couch (I not sure of myself) is a fantastic bed/couch which can be extended on the leg side (it won't be taken out, if you don't open them, patient's legs will be left dangling, which is bad. The bed can be tilted 45 degrees too, to do your CVS and Respi examination. Better to use the antiseptic solution than using the soap. Seriously. If vitals are not given, DO ALL THE VITALS, ex. BP, pulse etc. Basically just do everything.
Respi and CVS examination can overlap, especially the apex beat.
3) Conclusion
If you don't know, say you don't know. Do not push your responsibility to other people, ex. the doctor who will be doing the imaging will tell you what's wrong with you (something like that). You are solely responsible of the well-being of the patient upon coming to you. Just tell him/her what you want to do, let him understand the procedures, and to be considerate of patient's possibility of phobia of your words like surgery (maybe the guy have had surgery before and will be traumatized that you tell him/her that she need another surgery).
Oh yeah, most Americans will know the generic name of the drugs. Therefore, be familiarize with the terms so that you will know what drugs they are. They may or may not be as well knowledgeable as you do.
There are lots more to learn. I need time to compile them and put it on my blogspot. I hope that these are all the deterrents that will help me and anyone who is reading this blog. AMITABHA!!!
Thursday, April 1, 2010
Urine Alkalinization
I kind of forgotten the physiology of the alkalinization and acidition thingy which physiology lecturers like to talk about. Sounds confusing and lots of chemistry inside them. I found out some good sources and why not check'em out?
http://www.fpnotebook.com/Renal/Pharm/UrnAlklnztn.htm
http://www.clintox.org/documents/positionpapers/UrineAlkalinization.pdf
http://www.cystinuria.com/articles/urinary-alkalization/
Urinary Alkalization
By David S Goldfarb, M.D.
Director, Kidney Stone Prevention Program, St. Vincents Hospital
Professor of Medicine and Physiology, NYU School of Medicine
Alkalization of the urine is important in cystinuria because it increases the solubility of cystine, meaning that more cystine can be dissolved in a given amount of urine. Alkalization means neutralizing the acid in the urine by adding base. When acid is neutralized there are fewer H+ molecules (also called protons) and the pH rises. pH is a measure of the amount of acid in the urine. Human urine can have pH ranging from about 4 (acid) to about 8 (alkaline). When urine pH rises above 7, cystine becomes much more soluble, so achieving a urine pH of 7.5-8 for a good part of the day is desirable. Measuring and recording your urine pH at various times of the day is very helpful to you and your doctor to show whether you are getting to the desired range.
You can alkalinize your urine by decreasing the amount of acid you take in. You can lower the amount of acid you eat (and therefore the amount of acid your kidneys have to get rid of) by eating less animal protein. Protein is what muscle is made of, and includes fish, beef, chicken and pork. These products also contain some cystine, so limiting your intake of these has 2 benefits.
You can also take in more base to alkalinize your urine. If you eat more fruits and vegetables when you reduce your protein intake, you will take in more base. Base comes in the form of molecules called “organic anions”, such as citrate and malate. They are converted to bicarbonate by the liver. Bicarbonate is the blood’s form of base. One citrate is converted to 3 bicarbonates. So taking citrate and bicarbonate are equivalent. Some of the citrate also is found in the urine where it helps prevent calcium stone formation in non-cystinuric people with the more commonly found calcium oxalate stones. Citrus fruits like oranges and lemons and all fruits and vegetables contain these organic anions.
For most people adequate alkalization does not occur without taking in extra base. It comes in many preparations. Potassium (K) citrate is preferable to sodium citrate preparations because sodium may increase cystine excretion. This is also why I don't usually prescribe baking soda, which is sodium bicarbonate. But the alkalinizing effect, if it works, could override the increase in cystine excretion. If you are doing well with sodium preparations I would not change your prescription.
The major reason why I sometimes prescribe sodium citrate instead of potassium citrate is if there's too much potassium in the blood, which is rarely a problem in young people with normal overall levels of kidney function. Another reason to use sodium citrate is taste. Some people prefer it. A third reason is gastrointestinal tolerance. Some people find that potassium citrate causes heartburn, or diarrhea, or abdominal cramps. These are not usually serious side effects but can be avoided by changing preparations.
Sodium bicarbonate comes as baking soda and in pill form. Sodium citrate can be taken as Bicitra, Shoal’s solution. Polycitra (NOT the same thing as Polycitra-K!) has both sodium citrate and potassium citrate in it. All three contain sodium citrate and citric acid. Why is it OK to take citric acid if you are trying to avoid acid? Because the citric acid provides both base (citrate) AND acid, which neutralize each other. It has no net effect on urine pH, unlike the citrate in food which has only the base part, not the proton (H+) part. Why is it there then? To help dissolve the sodium citrate.
Potassium citrate comes in various preparations. Polycitra-K comes as a liquid and in crystals (packets) that you mix in water. It comes in several flavors which are worth trying. In either case they can be sufficiently diluted or mixed into other juices to minimize the taste. Another option is K-Lyte which comes as an effervescent tablet that dissolves in water, like an Alka-Seltzer. It also comes in different flavors worth trying on your kids. It's a combination of potassium citrate and potassium bicarbonate; that's OK because citrate and bicarbonate are equivalent. It also comes as "DS" or double strength. (You DON'T want K-Lyte/Cl which is potassium chloride and has no alkalinizing property). Another popular form of potassium citrate is Urocit-K, a pill form. They are actually in a wax matrix from which the drug dissolves. People often see the unabsorbed, undissolved wax in their bowel movements; this does not mean the mineral is not being absorbed.
Compare doses of these preparations in milliequivalents (mEq) of bicarbonate equivalents; ignore the number of milligrams. Most people need anywhere from 20 to 120 mEq per day, but measuring the urine pH is the way to determine how much you need. Bicitra and Shohl’s solution are 15 mEq per tablespoon (1 tbsp=15 cc, cubic centimeters), or 1 mEq per cc. Polycitra liquid has 2 mEq per cc (half as sodium, half as potassium). Polycitra-K liquid is 2 mEq per cc, all potassium. Polycitra-K crystals come as 30 mEq per packet. Urocit-K comes in 5 and 10 mEq tablets. K-Lyte comes as 25 mEq per tab, and 50 mEq for the “double-strength” DS. The standard generic sodium bicarbonate tab (325 milligrams, like an adult aspirin) is about 4 mEq.
I know that people often hesitate when a doctor reaches for a prescription pad. I tell my patients that potassium citrate is more like a vitamin, not a drug. Potassium and citrate are in all of your cells, and all the fruits and vegetables you eat. Both are normally found in urine in significant amounts because we take in more than we need. You can't be allergic to these minerals, though rarely people are allergic to dyes in the preparations. If your blood potassium is in the normal range you should not have a problem: the extra potassium is excreted by the kidneys. The occasional heartburn or other GI symptoms can usually be overcome by taking them with meals, which doesn't diminish their absorption or effect on the urine. Sodium citrate or bicarbonate may be a problem for people with decreased heart function, kidney function, or high blood pressure, and can increase urinary cystine levels, but like eating salty pretzels should not cause problems for most otherwise healthy people. I wouldn't be concerned about taking these “supplements” or about giving them to children. I view these medications as safe and effective, though inexplicably expensive.
http://www.fpnotebook.com/Renal/Pharm/UrnAlklnztn.htm
http://www.clintox.org/documents/positionpapers/UrineAlkalinization.pdf
http://www.cystinuria.com/articles/urinary-alkalization/
Urinary Alkalization
By David S Goldfarb, M.D.
Director, Kidney Stone Prevention Program, St. Vincents Hospital
Professor of Medicine and Physiology, NYU School of Medicine
Alkalization of the urine is important in cystinuria because it increases the solubility of cystine, meaning that more cystine can be dissolved in a given amount of urine. Alkalization means neutralizing the acid in the urine by adding base. When acid is neutralized there are fewer H+ molecules (also called protons) and the pH rises. pH is a measure of the amount of acid in the urine. Human urine can have pH ranging from about 4 (acid) to about 8 (alkaline). When urine pH rises above 7, cystine becomes much more soluble, so achieving a urine pH of 7.5-8 for a good part of the day is desirable. Measuring and recording your urine pH at various times of the day is very helpful to you and your doctor to show whether you are getting to the desired range.
You can alkalinize your urine by decreasing the amount of acid you take in. You can lower the amount of acid you eat (and therefore the amount of acid your kidneys have to get rid of) by eating less animal protein. Protein is what muscle is made of, and includes fish, beef, chicken and pork. These products also contain some cystine, so limiting your intake of these has 2 benefits.
You can also take in more base to alkalinize your urine. If you eat more fruits and vegetables when you reduce your protein intake, you will take in more base. Base comes in the form of molecules called “organic anions”, such as citrate and malate. They are converted to bicarbonate by the liver. Bicarbonate is the blood’s form of base. One citrate is converted to 3 bicarbonates. So taking citrate and bicarbonate are equivalent. Some of the citrate also is found in the urine where it helps prevent calcium stone formation in non-cystinuric people with the more commonly found calcium oxalate stones. Citrus fruits like oranges and lemons and all fruits and vegetables contain these organic anions.
For most people adequate alkalization does not occur without taking in extra base. It comes in many preparations. Potassium (K) citrate is preferable to sodium citrate preparations because sodium may increase cystine excretion. This is also why I don't usually prescribe baking soda, which is sodium bicarbonate. But the alkalinizing effect, if it works, could override the increase in cystine excretion. If you are doing well with sodium preparations I would not change your prescription.
The major reason why I sometimes prescribe sodium citrate instead of potassium citrate is if there's too much potassium in the blood, which is rarely a problem in young people with normal overall levels of kidney function. Another reason to use sodium citrate is taste. Some people prefer it. A third reason is gastrointestinal tolerance. Some people find that potassium citrate causes heartburn, or diarrhea, or abdominal cramps. These are not usually serious side effects but can be avoided by changing preparations.
Sodium bicarbonate comes as baking soda and in pill form. Sodium citrate can be taken as Bicitra, Shoal’s solution. Polycitra (NOT the same thing as Polycitra-K!) has both sodium citrate and potassium citrate in it. All three contain sodium citrate and citric acid. Why is it OK to take citric acid if you are trying to avoid acid? Because the citric acid provides both base (citrate) AND acid, which neutralize each other. It has no net effect on urine pH, unlike the citrate in food which has only the base part, not the proton (H+) part. Why is it there then? To help dissolve the sodium citrate.
Potassium citrate comes in various preparations. Polycitra-K comes as a liquid and in crystals (packets) that you mix in water. It comes in several flavors which are worth trying. In either case they can be sufficiently diluted or mixed into other juices to minimize the taste. Another option is K-Lyte which comes as an effervescent tablet that dissolves in water, like an Alka-Seltzer. It also comes in different flavors worth trying on your kids. It's a combination of potassium citrate and potassium bicarbonate; that's OK because citrate and bicarbonate are equivalent. It also comes as "DS" or double strength. (You DON'T want K-Lyte/Cl which is potassium chloride and has no alkalinizing property). Another popular form of potassium citrate is Urocit-K, a pill form. They are actually in a wax matrix from which the drug dissolves. People often see the unabsorbed, undissolved wax in their bowel movements; this does not mean the mineral is not being absorbed.
Compare doses of these preparations in milliequivalents (mEq) of bicarbonate equivalents; ignore the number of milligrams. Most people need anywhere from 20 to 120 mEq per day, but measuring the urine pH is the way to determine how much you need. Bicitra and Shohl’s solution are 15 mEq per tablespoon (1 tbsp=15 cc, cubic centimeters), or 1 mEq per cc. Polycitra liquid has 2 mEq per cc (half as sodium, half as potassium). Polycitra-K liquid is 2 mEq per cc, all potassium. Polycitra-K crystals come as 30 mEq per packet. Urocit-K comes in 5 and 10 mEq tablets. K-Lyte comes as 25 mEq per tab, and 50 mEq for the “double-strength” DS. The standard generic sodium bicarbonate tab (325 milligrams, like an adult aspirin) is about 4 mEq.
I know that people often hesitate when a doctor reaches for a prescription pad. I tell my patients that potassium citrate is more like a vitamin, not a drug. Potassium and citrate are in all of your cells, and all the fruits and vegetables you eat. Both are normally found in urine in significant amounts because we take in more than we need. You can't be allergic to these minerals, though rarely people are allergic to dyes in the preparations. If your blood potassium is in the normal range you should not have a problem: the extra potassium is excreted by the kidneys. The occasional heartburn or other GI symptoms can usually be overcome by taking them with meals, which doesn't diminish their absorption or effect on the urine. Sodium citrate or bicarbonate may be a problem for people with decreased heart function, kidney function, or high blood pressure, and can increase urinary cystine levels, but like eating salty pretzels should not cause problems for most otherwise healthy people. I wouldn't be concerned about taking these “supplements” or about giving them to children. I view these medications as safe and effective, though inexplicably expensive.
Monday, March 15, 2010
Soft Drink Consumption Linked to Pancreatic Cancer
http://cme.medscape.com/viewarticle/717006?src=cmemp&uac=104510MK
Warning to all people who loves soft drink very much. Your habits may lead to a rather nasty disease, it's a "may". Main problem as mentioned in the article is that excessive consumption of sweet drinks can lead to serious problem.
Below is from the link:
February 16, 2010 — The regular consumption of sugar-laden soft drinks could boost a person's risk of developing pancreatic cancer. The results of a new study found that individuals who consumed 2 or more soft drinks per week had an 87% increased risk for pancreatic cancer, compared with those who did not.
Even after taking factors such as smoking, caloric intake, and type 2 diabetes mellitus into account, the authors found that consuming soft drinks might play an independent role in the development of pancreatic cancer.
The finding is reported in the February issue of Cancer Epidemiology, Biomarkers & Prevention.
Both soft drinks and fruit juices have a high glycemic load relative to other foods and drinks, and it has been hypothesized that both are risk factors for pancreatic cancer. The high levels of sugar can increase levels of insulin in the body, and this can contribute to pancreatic cancer cell growth, the researchers explain.
Association Not Seen With Fruit Juice
However, this study did not find an association between consumption of juice and an increased risk for pancreatic cancer.
"There are several plausible explanations why fruit juice was not significantly associated with pancreatic cancer," said first author Noel Mueller, MPH, a research associate at Georgetown University Medical Center in Washington, DC.
One reason is that the finding was based on a relatively small number of cases, so there might have been too few cases to detect an effect with fruit juice, he explained. Another is that there are differences between soft drinks and fruit juice — fruit juice is lower in sugar, includes many nutrients, and is typically served in smaller portion sizes.
A third explanation is that fruit juice intake is associated with healthier lifestyle characteristics than soft drink intake, he said.
The consumption of soft drinks coincided with a number of other unhealthy lifestyle characteristics, making it somewhat difficult to separate smoking, caloric intake, body weight, and type 2 diabetes mellitus from soft drink consumption. "But the findings from our study suggest that soft drinks may play an independent role in the development of pancreatic cancer," Mr. Mueller told Medscape Oncology.
"The influence of soft drink intake on the risk of pancreatic cancer remained virtually unchanged after adjustment for smoking status, energy intake, body weight, and type 2 diabetes mellitus," he added.
Results Statistically Significant for Soft Drinks
The current study examined the association between the consumption of soft drinks and juice and the risk for pancreatic cancer among Chinese people residing in Singapore. The data came from the Singapore Chinese Health Study (n = 60,524), and information regarding the consumption of soft drinks, juice, and other dietary items, along with lifestyle factors and environmental exposures, was collected at recruitment to the study. The participants were followed for up to 14 years.
At the start of the study, 9.7% of the participants consumed at least 2 soft drinks per week and 10.2% consumed at least 2 servings of juice per week. The authors note that, compared with those who did not consume soft drinks, those who consumed 2 or more soft drinks per week were younger, were more likely to be men, and were more likely to smoke cigarettes. They also had higher levels of education, alcohol consumption, and total energy intake; lower levels of physical activity; and consumed more total carbohydrates, fat, added sugar, and red meat.
Individuals who reported consuming 2 or more juice drinks a week had lifestyle and dietary habits that were similar to those who consumed soft drinks. However, there was no association between juice intake and cigarette smoking, and body mass index (BMI) was comparable across different categories of soft drink and juice consumption.
At 14 years and a cumulative 648,387 person-years of follow-up, 140 incident pancreatic cancers developed in people who were cancer free at baseline. After adjustment for confounders such as BMI, type 2 diabetes mellitus, and fruit juice intake, the authors found that those consuming 2 or more soft drinks per week experienced a statistically significant increased risk for pancreatic cancer (hazard ratio [HR], 1.87; 95% confidence interval [CI], 1.10 - 3.15).
Although people who consumed 2 or more juice drinks a week had an increased risk for pancreatic cancer of approximately 30%, elevated HR was not statistically significant after adjustment for variables.
However, in an age-adjusted analysis, smoking was also a risk factor. After excluding former smokers, the authors found that current smokers had a 49% increased risk for pancreatic cancer, compared with never smokers (HR, 1.49; 95% CI, 0.98 - 2.27). This risk factor remained unaffected after adjustment for diabetes and BMI.
Can Be Extrapolated to United States and Europe
Singapore is a highly industrialized nation with lifestyle and nutritional patterns reminiscent of many westernized countries. In that sense, these findings could be extrapolated to the United States and Europe, explained Mr. Mueller. Soft drinks are the leading source of added sugar in the American diet, the authors note.
"However, there are inherent differences between Singaporean Chinese and Caucasians, which is why one must be cautious when generalizing these results to the United States and Europe," he said. "But it is important to note that other studies in Caucasian populations have suggested that soft drink intake may increase risk for pancreatic cancer."
Because pancreatic cancer is a relatively rare disease, the number of cases in this study was relatively small, the authors point out. This limited the statistical power of the study. Another limitation was the inability to collect repeated dietary measurements during the course of the study; therefore, they could not account for changes in consumption of soft drinks and juices.
However, this study adds to the evidence that soft drink consumption plays a role in the development of pancreatic cancer, they conclude, and that "clinical studies examining biomarkers for glycemia and insulinemia and taking a mechanistic approach to the question of soft drink consumption and pancreatic cancer are warranted."
There is "still much to understand on the link between sugar-sweetened beverages and pancreatic cancer," the authors write.
The study was supported by a grant from the National Cancer Institute. The researchers have disclosed no relevant financial relationships.
Cancer Epidemiol Biomarkers Prev. 2010;19;447-455. Abstract
---Clinical Context
Carcinoma of the pancreas has high metastatic potential and poor prognosis because of lack of good treatment options and late presentation, with a 5-year survival time of less than 5% and no specific primary preventive strategies available. Smoking, obesity, and diabetes mellitus have been reported as risk factors for pancreatic cancer. Also, high glycemic foods that may predispose to diabetes may predispose to pancreatic cancer.
This is a prospective, 14-year cohort study of Chinese people living in Singapore to examine the association between consumption of soft drinks and fruit juice and the risk for the development of pancreatic cancer.
Study Highlights
The Singapore Chinese Health Study is a population-based, prospective cohort study of diet and cancer risk conducted in permanent residents from government-built housing estates where 86% of the population resided.
This study involved 2 dialect groups: the Hokkien and Cantonese originating from the southern part of China.
Participants were men and women aged 45 to 74 years without preexisting pancreatic cancer.
Recruitment was by letter, and staff went from door to door inviting participation with each subject.
A trained interviewer then interviewed the participants face-to-face using a structured scanner-readable questionnaire.
The interviewer asked subjects about demographics, lifestyle, diet, and medical history.
Diet was elicited with a semiquantitative 165-item food frequency questionnaire.
The questionnaire included commonly eaten food from Singapore, with 3 portion sizes and frequency in 8 categories ranging from never or hardly ever to 6 or more times daily.
Photographs of foods were presented to identify the food groups.
The questionnaire was validated against 24-hour recall in at least 1000 participants.
Soft drink portions were defined as 1 glass.
1 glass was designated as 237 mL and was equivalent to 1 cup.
Juices were categorized into specific drinks that included sugarcane, honeydew melon, apple, watermelon, carrot, pineapple, star fruit, and lemon juices.
The Singapore Food Composition Table was developed to analyze the nutritional content of food types.
Other risk factors for pancreatic cancer were assessed, including BMI, smoking, and physical activity.
Pancreatic cancer cases were ascertained by linkage to the population-based cancer registry and registry of births and deaths.
142 incident cases were identified, of which 56.4% were histologically confirmed, 38.8% were by clinical and radiologic findings, and 4.8% were identified by death certificates.
Rate of loss to follow-up was only 0.03%.
Mean age was 56 years, 55% were women, mean BMI was 23 kg/m2, 30% were ever-smokers, and 10% had type 2 diabetes.
At baseline, 9.7% of participants consumed at least 2 soft drinks per week and 10.2% consumed at least 2 servings of juice per week.
Those who consumed 2 or more soft drinks or juices weekly were likely to be younger, men, smoke, have higher levels of education, consume alcohol, and have higher energy intake and lower physical activity vs those who consumed no soft drinks or juices.
They also had a higher consumption of total carbohydrates, sugar, and red meat.
After 14 years and 648,387 person-years of follow-up, invasive exocrine pancreatic cancer developed in 140 persons .
Smokers had a 49% increased risk for pancreatic cancer.
BMI and a history of diabetes were not associated with an increased risk for pancreatic cancer.
Results for all risks were similar for men and women, and analysis was combined for the 2 sexes.
Drinking 2 or more soft drinks per week was associated with more than 80% increase in risk for pancreatic cancer after adjustment for other risks (HR, 1.87).
This risk was independent of diabetes and smoking and persisted after excluding those who had pancreatic cancer within 5 years of baseline.
After adjustment, juice intake of 2 or more drinks per week overall was not associated with increased risk, but when smokers were excluded, there was an association between juice intake and pancreatic cancer risk (HR, 1.60).
The authors concluded that soft drink consumption was positively associated with pancreatic cancer risk but that juice consumption was associated with risk among nonsmokers only.
---Clinical Implications
--Consumption of 2 or more soft drinks weekly is associated with an increased risk for pancreatic cancer in the Chinese population.
--Consumption of 2 or more fruit drinks weekly is not associated with an increased risk for pancreatic cancer overall, but the risk is increased in nonsmokers.
Warning to all people who loves soft drink very much. Your habits may lead to a rather nasty disease, it's a "may". Main problem as mentioned in the article is that excessive consumption of sweet drinks can lead to serious problem.
Below is from the link:
February 16, 2010 — The regular consumption of sugar-laden soft drinks could boost a person's risk of developing pancreatic cancer. The results of a new study found that individuals who consumed 2 or more soft drinks per week had an 87% increased risk for pancreatic cancer, compared with those who did not.
Even after taking factors such as smoking, caloric intake, and type 2 diabetes mellitus into account, the authors found that consuming soft drinks might play an independent role in the development of pancreatic cancer.
The finding is reported in the February issue of Cancer Epidemiology, Biomarkers & Prevention.
Both soft drinks and fruit juices have a high glycemic load relative to other foods and drinks, and it has been hypothesized that both are risk factors for pancreatic cancer. The high levels of sugar can increase levels of insulin in the body, and this can contribute to pancreatic cancer cell growth, the researchers explain.
Association Not Seen With Fruit Juice
However, this study did not find an association between consumption of juice and an increased risk for pancreatic cancer.
"There are several plausible explanations why fruit juice was not significantly associated with pancreatic cancer," said first author Noel Mueller, MPH, a research associate at Georgetown University Medical Center in Washington, DC.
One reason is that the finding was based on a relatively small number of cases, so there might have been too few cases to detect an effect with fruit juice, he explained. Another is that there are differences between soft drinks and fruit juice — fruit juice is lower in sugar, includes many nutrients, and is typically served in smaller portion sizes.
A third explanation is that fruit juice intake is associated with healthier lifestyle characteristics than soft drink intake, he said.
The consumption of soft drinks coincided with a number of other unhealthy lifestyle characteristics, making it somewhat difficult to separate smoking, caloric intake, body weight, and type 2 diabetes mellitus from soft drink consumption. "But the findings from our study suggest that soft drinks may play an independent role in the development of pancreatic cancer," Mr. Mueller told Medscape Oncology.
"The influence of soft drink intake on the risk of pancreatic cancer remained virtually unchanged after adjustment for smoking status, energy intake, body weight, and type 2 diabetes mellitus," he added.
Results Statistically Significant for Soft Drinks
The current study examined the association between the consumption of soft drinks and juice and the risk for pancreatic cancer among Chinese people residing in Singapore. The data came from the Singapore Chinese Health Study (n = 60,524), and information regarding the consumption of soft drinks, juice, and other dietary items, along with lifestyle factors and environmental exposures, was collected at recruitment to the study. The participants were followed for up to 14 years.
At the start of the study, 9.7% of the participants consumed at least 2 soft drinks per week and 10.2% consumed at least 2 servings of juice per week. The authors note that, compared with those who did not consume soft drinks, those who consumed 2 or more soft drinks per week were younger, were more likely to be men, and were more likely to smoke cigarettes. They also had higher levels of education, alcohol consumption, and total energy intake; lower levels of physical activity; and consumed more total carbohydrates, fat, added sugar, and red meat.
Individuals who reported consuming 2 or more juice drinks a week had lifestyle and dietary habits that were similar to those who consumed soft drinks. However, there was no association between juice intake and cigarette smoking, and body mass index (BMI) was comparable across different categories of soft drink and juice consumption.
At 14 years and a cumulative 648,387 person-years of follow-up, 140 incident pancreatic cancers developed in people who were cancer free at baseline. After adjustment for confounders such as BMI, type 2 diabetes mellitus, and fruit juice intake, the authors found that those consuming 2 or more soft drinks per week experienced a statistically significant increased risk for pancreatic cancer (hazard ratio [HR], 1.87; 95% confidence interval [CI], 1.10 - 3.15).
Although people who consumed 2 or more juice drinks a week had an increased risk for pancreatic cancer of approximately 30%, elevated HR was not statistically significant after adjustment for variables.
However, in an age-adjusted analysis, smoking was also a risk factor. After excluding former smokers, the authors found that current smokers had a 49% increased risk for pancreatic cancer, compared with never smokers (HR, 1.49; 95% CI, 0.98 - 2.27). This risk factor remained unaffected after adjustment for diabetes and BMI.
Can Be Extrapolated to United States and Europe
Singapore is a highly industrialized nation with lifestyle and nutritional patterns reminiscent of many westernized countries. In that sense, these findings could be extrapolated to the United States and Europe, explained Mr. Mueller. Soft drinks are the leading source of added sugar in the American diet, the authors note.
"However, there are inherent differences between Singaporean Chinese and Caucasians, which is why one must be cautious when generalizing these results to the United States and Europe," he said. "But it is important to note that other studies in Caucasian populations have suggested that soft drink intake may increase risk for pancreatic cancer."
Because pancreatic cancer is a relatively rare disease, the number of cases in this study was relatively small, the authors point out. This limited the statistical power of the study. Another limitation was the inability to collect repeated dietary measurements during the course of the study; therefore, they could not account for changes in consumption of soft drinks and juices.
However, this study adds to the evidence that soft drink consumption plays a role in the development of pancreatic cancer, they conclude, and that "clinical studies examining biomarkers for glycemia and insulinemia and taking a mechanistic approach to the question of soft drink consumption and pancreatic cancer are warranted."
There is "still much to understand on the link between sugar-sweetened beverages and pancreatic cancer," the authors write.
The study was supported by a grant from the National Cancer Institute. The researchers have disclosed no relevant financial relationships.
Cancer Epidemiol Biomarkers Prev. 2010;19;447-455. Abstract
---Clinical Context
Carcinoma of the pancreas has high metastatic potential and poor prognosis because of lack of good treatment options and late presentation, with a 5-year survival time of less than 5% and no specific primary preventive strategies available. Smoking, obesity, and diabetes mellitus have been reported as risk factors for pancreatic cancer. Also, high glycemic foods that may predispose to diabetes may predispose to pancreatic cancer.
This is a prospective, 14-year cohort study of Chinese people living in Singapore to examine the association between consumption of soft drinks and fruit juice and the risk for the development of pancreatic cancer.
Study Highlights
The Singapore Chinese Health Study is a population-based, prospective cohort study of diet and cancer risk conducted in permanent residents from government-built housing estates where 86% of the population resided.
This study involved 2 dialect groups: the Hokkien and Cantonese originating from the southern part of China.
Participants were men and women aged 45 to 74 years without preexisting pancreatic cancer.
Recruitment was by letter, and staff went from door to door inviting participation with each subject.
A trained interviewer then interviewed the participants face-to-face using a structured scanner-readable questionnaire.
The interviewer asked subjects about demographics, lifestyle, diet, and medical history.
Diet was elicited with a semiquantitative 165-item food frequency questionnaire.
The questionnaire included commonly eaten food from Singapore, with 3 portion sizes and frequency in 8 categories ranging from never or hardly ever to 6 or more times daily.
Photographs of foods were presented to identify the food groups.
The questionnaire was validated against 24-hour recall in at least 1000 participants.
Soft drink portions were defined as 1 glass.
1 glass was designated as 237 mL and was equivalent to 1 cup.
Juices were categorized into specific drinks that included sugarcane, honeydew melon, apple, watermelon, carrot, pineapple, star fruit, and lemon juices.
The Singapore Food Composition Table was developed to analyze the nutritional content of food types.
Other risk factors for pancreatic cancer were assessed, including BMI, smoking, and physical activity.
Pancreatic cancer cases were ascertained by linkage to the population-based cancer registry and registry of births and deaths.
142 incident cases were identified, of which 56.4% were histologically confirmed, 38.8% were by clinical and radiologic findings, and 4.8% were identified by death certificates.
Rate of loss to follow-up was only 0.03%.
Mean age was 56 years, 55% were women, mean BMI was 23 kg/m2, 30% were ever-smokers, and 10% had type 2 diabetes.
At baseline, 9.7% of participants consumed at least 2 soft drinks per week and 10.2% consumed at least 2 servings of juice per week.
Those who consumed 2 or more soft drinks or juices weekly were likely to be younger, men, smoke, have higher levels of education, consume alcohol, and have higher energy intake and lower physical activity vs those who consumed no soft drinks or juices.
They also had a higher consumption of total carbohydrates, sugar, and red meat.
After 14 years and 648,387 person-years of follow-up, invasive exocrine pancreatic cancer developed in 140 persons .
Smokers had a 49% increased risk for pancreatic cancer.
BMI and a history of diabetes were not associated with an increased risk for pancreatic cancer.
Results for all risks were similar for men and women, and analysis was combined for the 2 sexes.
Drinking 2 or more soft drinks per week was associated with more than 80% increase in risk for pancreatic cancer after adjustment for other risks (HR, 1.87).
This risk was independent of diabetes and smoking and persisted after excluding those who had pancreatic cancer within 5 years of baseline.
After adjustment, juice intake of 2 or more drinks per week overall was not associated with increased risk, but when smokers were excluded, there was an association between juice intake and pancreatic cancer risk (HR, 1.60).
The authors concluded that soft drink consumption was positively associated with pancreatic cancer risk but that juice consumption was associated with risk among nonsmokers only.
---Clinical Implications
--Consumption of 2 or more soft drinks weekly is associated with an increased risk for pancreatic cancer in the Chinese population.
--Consumption of 2 or more fruit drinks weekly is not associated with an increased risk for pancreatic cancer overall, but the risk is increased in nonsmokers.
Saturday, March 6, 2010
Capnocytophaga canimorsus and Dog Bites
Capnocytophaga canimorsus is a Gram-negative bacillus (rod-shaped) bacterium, in which it can harbor potentially dangerous complication if an asplenic patient was bitten by a dog[1]. This bacterium actually can be found on not just dog bites, but can also be found on those bitten by cats[2]. Clinical infections by C. canimorsus generally appear as fulminant septicemia, peripheral gangrene or meningitis[2].
Management of dogbite is as follows:
In initial treatment, thorough history should be taken with risk of rabies infection (can lead to serious manifestation), the time of the injury, whether the animal was provoked, and the general health, immunization status and current location of the animal, tetanus immunization status, current medications and allergies must be noted in the record. During the physical examination, the measurement and classification of the wound (laceration, puncture, crushing or avulsion), and the range of motion of the affected and adjacent areas should be documented. Nerve, vascular and motor function, including pertinent negative findings, should be recorded. Diagrams and photographs are useful, especially in cases with irregular wounds or signs of infection, and in cases that may involve litigation, such as a wound inflicted by an unleashed dog.
Interestingly, only 15 to 20 percent of dog bite wounds become infected, with Pasteurella multocida and Staphylococcus aureus are the most common aerobic organisms, occurring in 20 to 30 percent of infected dog bite wounds. C. canimorsus is aerobic organism too itself. Treatment with prophylactic antibiotics for three to seven days is appropriate for dog bite wounds, unless the risk of infection is low or the wound is superficial. Amoxicillin-clavulanate potassium (Augmentin) is the antibiotic of choice for a dog bite. For patients who are allergic to penicillin, doxycycline (Vibramycin) is an acceptable alternative, except for children younger than eight years and pregnant women. Erythromycin can also be used, but the risk of treatment failure is greater because of antimicrobial resistance. Other acceptable combinations include clindamycin (Cleocin) and a fluoroquinolone in adults or clindamycin and trimethoprim-sulfamethoxazole (Bactrim, Septra) in children. When compliance is a concern, daily intramuscular injections of ceftriaxone (Rocephin) are appropriate[3].
Specifically for C. canimorsus, you can visit the site: http://hopkins-abxguide.org/pathogens/bacteria/capnocytophaga_canimorsus.html?&contentInstanceId=255804
Prevention is very important to prevent from being bitten by dogs[4].
Before you bring a dog into your household:
-Consult with a professional (e.g., veterinarian, animal behaviorist, or responsible breeder) to learn what breeds of dogs are the best fit for your household.
-Dogs with histories of aggression are not suitable for households with children.
-Be sensitive to cues that a child is fearful or apprehensive about a dog. If a child seems frightened by dogs, wait before bringing a dog into your household.
-Spend time with a dog before buying or adopting it. Use caution when bringing a dog into a household with an infant or toddler.
If you decide to bring a dog into your home:
-Spay/neuter your dog (this often reduces aggressive tendencies).
-Never leave infants or young children alone with a dog.
-Don’t play aggressive games with your dog (e.g., wrestling).
-Properly socialize and train any dog entering your household.
-Teach the dog submissive behaviors (e.g., rolling over to expose the abdomen and giving up food without growling).
-Immediately seek professional advice (e.g., from veterinarians, animal behaviorists, or responsible breeders) if the dog develops aggressive or undesirable behaviors.
P/S: If you want to know more about vertigo, check out: http://www.bcm.edu/oto/studs/vertigo.html
References:
1. Janda JM, Graves MH, Lindquist D, Probert WS. Diagnosing Capnocytophaga canimorsus infections. Emerg Infect Dis [serial on the Internet]. 2006 Feb [date cited]. Available from http://www.cdc.gov/ncidod/EID/vol12no02/05-0783.htm
2. Mally M, Shin H, Paroz C, Landmann R, Cornelis GR (2008) Capnocytophaga canimorsus: A Human Pathogen Feeding at the Surface of Epithelial Cells and Phagocytes. PLoS Pathog 4(9): e1000164. Available from : http://www.plospathogens.org/article/info:doi/10.1371/journal.ppat.1000164
3. R. JOHN PRESUTTI. Prevention and Treatment of Dog Bites. American Academy of Family Physicians. 2001, April 15. Available from: http://www.aafp.org/afp/2001/0415/p1567.html
4. Centers for Disease Control and Prevention. Dog Bite Prevention. Atlanta. May 14, 2009[last reviewed]. Available from: http://www.cdc.gov/homeandrecreationalsafety/dog-bites/biteprevention.html
Management of dogbite is as follows:
In initial treatment, thorough history should be taken with risk of rabies infection (can lead to serious manifestation), the time of the injury, whether the animal was provoked, and the general health, immunization status and current location of the animal, tetanus immunization status, current medications and allergies must be noted in the record. During the physical examination, the measurement and classification of the wound (laceration, puncture, crushing or avulsion), and the range of motion of the affected and adjacent areas should be documented. Nerve, vascular and motor function, including pertinent negative findings, should be recorded. Diagrams and photographs are useful, especially in cases with irregular wounds or signs of infection, and in cases that may involve litigation, such as a wound inflicted by an unleashed dog.
Interestingly, only 15 to 20 percent of dog bite wounds become infected, with Pasteurella multocida and Staphylococcus aureus are the most common aerobic organisms, occurring in 20 to 30 percent of infected dog bite wounds. C. canimorsus is aerobic organism too itself. Treatment with prophylactic antibiotics for three to seven days is appropriate for dog bite wounds, unless the risk of infection is low or the wound is superficial. Amoxicillin-clavulanate potassium (Augmentin) is the antibiotic of choice for a dog bite. For patients who are allergic to penicillin, doxycycline (Vibramycin) is an acceptable alternative, except for children younger than eight years and pregnant women. Erythromycin can also be used, but the risk of treatment failure is greater because of antimicrobial resistance. Other acceptable combinations include clindamycin (Cleocin) and a fluoroquinolone in adults or clindamycin and trimethoprim-sulfamethoxazole (Bactrim, Septra) in children. When compliance is a concern, daily intramuscular injections of ceftriaxone (Rocephin) are appropriate[3].
Specifically for C. canimorsus, you can visit the site: http://hopkins-abxguide.org/pathogens/bacteria/capnocytophaga_canimorsus.html?&contentInstanceId=255804
Prevention is very important to prevent from being bitten by dogs[4].
Before you bring a dog into your household:
-Consult with a professional (e.g., veterinarian, animal behaviorist, or responsible breeder) to learn what breeds of dogs are the best fit for your household.
-Dogs with histories of aggression are not suitable for households with children.
-Be sensitive to cues that a child is fearful or apprehensive about a dog. If a child seems frightened by dogs, wait before bringing a dog into your household.
-Spend time with a dog before buying or adopting it. Use caution when bringing a dog into a household with an infant or toddler.
If you decide to bring a dog into your home:
-Spay/neuter your dog (this often reduces aggressive tendencies).
-Never leave infants or young children alone with a dog.
-Don’t play aggressive games with your dog (e.g., wrestling).
-Properly socialize and train any dog entering your household.
-Teach the dog submissive behaviors (e.g., rolling over to expose the abdomen and giving up food without growling).
-Immediately seek professional advice (e.g., from veterinarians, animal behaviorists, or responsible breeders) if the dog develops aggressive or undesirable behaviors.
P/S: If you want to know more about vertigo, check out: http://www.bcm.edu/oto/studs/vertigo.html
References:
1. Janda JM, Graves MH, Lindquist D, Probert WS. Diagnosing Capnocytophaga canimorsus infections. Emerg Infect Dis [serial on the Internet]. 2006 Feb [date cited]. Available from http://www.cdc.gov/ncidod/EID/vol12no02/05-0783.htm
2. Mally M, Shin H, Paroz C, Landmann R, Cornelis GR (2008) Capnocytophaga canimorsus: A Human Pathogen Feeding at the Surface of Epithelial Cells and Phagocytes. PLoS Pathog 4(9): e1000164. Available from : http://www.plospathogens.org/article/info:doi/10.1371/journal.ppat.1000164
3. R. JOHN PRESUTTI. Prevention and Treatment of Dog Bites. American Academy of Family Physicians. 2001, April 15. Available from: http://www.aafp.org/afp/2001/0415/p1567.html
4. Centers for Disease Control and Prevention. Dog Bite Prevention. Atlanta. May 14, 2009[last reviewed]. Available from: http://www.cdc.gov/homeandrecreationalsafety/dog-bites/biteprevention.html
Wednesday, March 3, 2010
Neurology & DWI--Diffuse Weighted Imaging
I come across some interesting q&a sites. Check this out:
http://anatomy.med.umich.edu/nervous_system/infratemp_questions.html
Brain AVM (arteriovenous malformation)
http://brainavm.oci.utoronto.ca/malformations/brain_avm_index.htm
In arteriogram which you use to just visualize the blood vessel pattern, you would notice a mesh of blood vessels. That's what AVM is all about. It can occur anywhere and it has a certain genetic link. The condition can be silent, but when one's arterial pressure suddenly rise until the weak blood vessels can't tolerate, it will be very disastrous, especially if it occurs at the brain. The website I provided is very nice, as I found it. Should be a good reference to patients who want to know more about this condition.
I would like to share a type of scan called Diffuse Weighted Imaging (DWI)
Resources as shown below:
http://en.wikipedia.org/wiki/Diffusion_MRI
http://spinwarp.ucsd.edu/neuroweb/Text/br-710dwi.htm
A quite recent development and that very helpful in diagnosing and localizing lesions in the brain caused by insufficient perfusion to the brain region. For very technical perspective of this imaging, check this out: http://bjr.birjournals.org/cgi/reprint/77/suppl_2/S176.pdf
Some image study if you would like to know about brain aneurysm. http://www.brain-aneurysm.com/roiba.html
http://anatomy.med.umich.edu/nervous_system/infratemp_questions.html
Brain AVM (arteriovenous malformation)
http://brainavm.oci.utoronto.ca/malformations/brain_avm_index.htm
In arteriogram which you use to just visualize the blood vessel pattern, you would notice a mesh of blood vessels. That's what AVM is all about. It can occur anywhere and it has a certain genetic link. The condition can be silent, but when one's arterial pressure suddenly rise until the weak blood vessels can't tolerate, it will be very disastrous, especially if it occurs at the brain. The website I provided is very nice, as I found it. Should be a good reference to patients who want to know more about this condition.
I would like to share a type of scan called Diffuse Weighted Imaging (DWI)
Resources as shown below:
http://en.wikipedia.org/wiki/Diffusion_MRI
http://spinwarp.ucsd.edu/neuroweb/Text/br-710dwi.htm
A quite recent development and that very helpful in diagnosing and localizing lesions in the brain caused by insufficient perfusion to the brain region. For very technical perspective of this imaging, check this out: http://bjr.birjournals.org/cgi/reprint/77/suppl_2/S176.pdf
Some image study if you would like to know about brain aneurysm. http://www.brain-aneurysm.com/roiba.html
Saturday, February 27, 2010
Creutzfeldt-Jakob disease (CJD)
Creutzfeldt-Jakob disease, short-formed as CJD, is a nervous system disorder caused by prion (a kind of virus). Pathology slide of a brain infected by this disease is typically show spongiform encephalopathy, or what was called "bubble and holes".1
Of course taking a slide from a dead body is not something practical to do in terms of diagnosing a patient. Therefore, we should look for signs and symptoms as well as using a correct diagnostic tool to diagnose a case of CJD.
Just to provide a case from website about this disease: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2626364/
http://en.wikipedia.org/wiki/Creutzfeldt%E2%80%93Jakob_disease
One thing I want to point out is that this disease can cause dementia. The guy can be normal, and you can confuse patient with CJD to Parkinson, like I do. Looking for signs and symptoms as the presence of myoclonus. As such, one should look for a possibility of CJD since myoclonus isn't a part of Parkinson's disease. One characteristic diagnosis we can do is an electroencephalogram showing periodic high amplitude sharp wave http://www.websciences.org/cftemplate/NAPS/archives/indiv.cfm?ID=20060373 As quoted: In sporadic CJD (sCJD), the EEG exhibits characteristic changes depending on the stage of the disease, ranging from nonspecific findings such as diffuse slowing and frontal rhythmic delta activity (FIRDA) in early stages to disease-typical periodic sharp wave complexes (PSWC) in middle and late stages to areactive coma traces or even alpha coma in preterminal EEG recordings.2
The disease can be deadly and there is no treatment for this disease.
1. Edward F. Goljan Rapid Review Pathology 2nd edi. Mosby Elsevier. 2007; 578-579
2. WIESER HG, SCHINDLER K, ZUMSTEG D. Clin Neurophysiol. 2006 [cited 2006 Jan 24] Available from: http://www.websciences.org/cftemplate/NAPS/archives/indiv.cfm?ID=20060373
Of course taking a slide from a dead body is not something practical to do in terms of diagnosing a patient. Therefore, we should look for signs and symptoms as well as using a correct diagnostic tool to diagnose a case of CJD.
Just to provide a case from website about this disease: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2626364/
http://en.wikipedia.org/wiki/Creutzfeldt%E2%80%93Jakob_disease
One thing I want to point out is that this disease can cause dementia. The guy can be normal, and you can confuse patient with CJD to Parkinson, like I do. Looking for signs and symptoms as the presence of myoclonus. As such, one should look for a possibility of CJD since myoclonus isn't a part of Parkinson's disease. One characteristic diagnosis we can do is an electroencephalogram showing periodic high amplitude sharp wave http://www.websciences.org/cftemplate/NAPS/archives/indiv.cfm?ID=20060373 As quoted: In sporadic CJD (sCJD), the EEG exhibits characteristic changes depending on the stage of the disease, ranging from nonspecific findings such as diffuse slowing and frontal rhythmic delta activity (FIRDA) in early stages to disease-typical periodic sharp wave complexes (PSWC) in middle and late stages to areactive coma traces or even alpha coma in preterminal EEG recordings.2
The disease can be deadly and there is no treatment for this disease.
1. Edward F. Goljan Rapid Review Pathology 2nd edi. Mosby Elsevier. 2007; 578-579
2. WIESER HG, SCHINDLER K, ZUMSTEG D. Clin Neurophysiol. 2006 [cited 2006 Jan 24] Available from: http://www.websciences.org/cftemplate/NAPS/archives/indiv.cfm?ID=20060373
Friday, February 26, 2010
Foville's syndrome
Category: Neuroanatomy.
When one half of the pons is injured involving the corticospinal tract (above the decussation of the pyramids), the facial nerve (CN VII) nucleus and/or facial nerve fibers, and the nucleus of CN VI (abducens) or the nearby paramedian pontine reticular formation (PPRF) fibers to CN VI, the resulting constellation of signs/symptoms includes: contralateral spastic weakness/paralysis (weakness, hypertonia, hyperreflexia and Babinski's sign), ipsilateral upper and lower facial weakness and loss of volitional abduction of the ipsilateral eye (horizontal gaze paresis).
From: http://en.wikipedia.org/wiki/Foville's_syndrome
Foville's syndrome is caused by the blockage of the perforating branches of the basilar artery in the region of the brainstem known as the pons.[1]
Structures affected by the infarct are the PPRF, nuclei of cranial nerves VI and VII, corticospinal tract, medial lemniscus, and the medial longitudinal fasciculus.
The syndrome is reported in http://www.nzma.org.nz/journal/119-1232/1928/ in which the case mentioned the syndrome on a suspected Wernicke’s encephalopathy.
There is another recorded case: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1143046/
When one half of the pons is injured involving the corticospinal tract (above the decussation of the pyramids), the facial nerve (CN VII) nucleus and/or facial nerve fibers, and the nucleus of CN VI (abducens) or the nearby paramedian pontine reticular formation (PPRF) fibers to CN VI, the resulting constellation of signs/symptoms includes: contralateral spastic weakness/paralysis (weakness, hypertonia, hyperreflexia and Babinski's sign), ipsilateral upper and lower facial weakness and loss of volitional abduction of the ipsilateral eye (horizontal gaze paresis).
From: http://en.wikipedia.org/wiki/Foville's_syndrome
Foville's syndrome is caused by the blockage of the perforating branches of the basilar artery in the region of the brainstem known as the pons.[1]
Structures affected by the infarct are the PPRF, nuclei of cranial nerves VI and VII, corticospinal tract, medial lemniscus, and the medial longitudinal fasciculus.
The syndrome is reported in http://www.nzma.org.nz/journal/119-1232/1928/ in which the case mentioned the syndrome on a suspected Wernicke’s encephalopathy.
There is another recorded case: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1143046/
Sunday, January 17, 2010
Happy New Year 2010
I just realized I made this blog idle for quite some time (My bad). Therefore I would like to just write an entry wishing all a wondeful new year of 2010. Hope everyone will have a good time this year, ya?
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