Posted by FaDhLi on Friday, February 04, 2011
Seven Primary Masquerades (John Murthagh)
1. Depression
2. Diabetis Mellitus
3. Drugs
- iatrogenic
- self abuse (alcohol, narcotics, nicotine, others)
4. Anaemia
5. Thyroid and other endocrine disorders
- hyperthyroidism
- hypothyroidism
6. Spinal dysfunction
7. Urinary Tract Infection (UTI)
Read more »
Posted by FaDhLi on Wednesday, February 02, 2011
Keep diabetis under good control and do not smoke.
Check your feet daily. Report any sores, infection, or unusual signs.
Wash your feet daily.
Use lukewarm water (beware of scalds)
Dry thoroughly, especially between toes
soften dry skin, especially around the heels, with ?lanoline
apply methylated spirits between toes to help stop dampness
attend to toenails regularly
clip them straight cross
do not cut them deep into the corners or too short across
wear clean cotton or wool socks daily; avoid socks with tight elastic tops
exercise the feet each day to help the circulation in them
avoid injury to the foot
wear good-fitting, comfortable leather shoes
shoes must not be too tight
do not walk barefoot, especially ot of doors
do not cut your own toenails if you have difficulty reaching them or have poor eyesight
avoid home treatments and corn pads that contain acids
be careful when you walk
do not use hot water bottles or heating pads on feet
do not test the temperature of water with your feet
take extra care when sitting in front of an open fire or heater
Posted by jh on Tuesday, January 25, 2011
Treatment of scabies
topical medications:
1. topical benzyl benzoate lotion
- (25% for adults, 12.5% for children aged 3 to 12)
- 3 applications at 24-hour intervals
- 2 applications for 8 hours
3. topical permethrin 5% lotion
- single application, washed after 8 hours
4.
crotamiton cream (eurax) repeat nightly for 3 to 5 nights
5. sulphur in calamine lotion: useful in pregnant or nursing mother and neonates
oral medication
Procedures
- apply the entire skin from neck below
- pay special attention to the groin, fingerwebs, toewebs
Adjuvant therapy
- antihistamine for relief of itch
- topical corticosteroids
Environment measures
- treatment of all close contacts even if asymptomatic
- wash all bed linens, towels and clothes that were worn in the 2 days before each application. use hot water.
source: if not mistaken it's from the dermato lecture
Posted by FaDhLi on Thursday, November 04, 2010
DEFINITION FEVER
elevation of body temperature that exceeds the normal daily variation and occurs in conjunction with an increase in the hypothalamic set point—for example, from 37C to 39C (shift of the set point from “normothermic” to febrile levels)
CHILLS
a sensation of coldness
RIGORS
exaggerated shivering
how all of these related?
fever comes with abnormally high body temperature, but why the patient can has chills and rigors (or shivering)?
read more below
Posted by medik-ukm on Wednesday, November 03, 2010
heart rate
respiratory rate
blood pressure
temperature
pain score
i'm not very sure whether pain score is still the vital sign, but in 2008, KKM add in the 5th vital sign which is PAIN SCORE.
Posted by alvisto on Monday, July 26, 2010
There are 2 conditions which can cause this :
1. Somogyi Effect
2. Dawn Phenomenon
1. Somogyi Effect
- Also known as "rebound hyperglycemia"
- Usually due to:
- missed night meals despite taking insulin regularly
- a person who takes long-acting insulin without supper
- night/ long-acting insulin dose too high
- Relative Insulin Excess-> Early morning (2-3am) hypoglycemia -> Body's counter-regulatory mechanism activated -> Hormones (cortisol, glucagon, epinephrine) released to counter insulin effect -> Morning Hyperglycemia
2. Dawn Phenomenon
- Can occur in normal person
- Exaggerated response in diabetics
- In a normal human physiology, counter-regulatory hormones (cortisol, glucagon, epinephrine) are released during early morning hours to sustain blood glucose level without food. These hormones also antagonize insulin effect, hence there is a relative higher insulin resistance during the night.
- In patients with Type I diabetics esp, insulin production is low, hence there is an exaggerated Dawn phenomenon --> morning hyperglycemia
- It typically occurs (more often) in Type I diabetic patients during puberty or pregnancy due to marked production of counter-regulatory hormones (cortisol, glucagon, epinephrine, growth hormone), thus also causing exaggerated Dawn phenomenon.
How to differentiate then ?
Check blood sugar levels (Dextrostix) around 2 - 3 a.m. for several nights.
- If the blood sugar level is low at 2 a.m. to 3 a.m., suspect Somogyi effect (Rebound phenomenon).
- If the blood sugar level is normal or high at 2 a.m. to 3 a.m., it's most likely Dawn phenomenon.
(which is even more likely if the patient is a type I diabetic at early onset of puberty/ pregnancy, although Somogyi effect must be ruled out first)
How to prevent/treat ?
Somogyi effect
- Have regular meals and never skip them.
- Have a light snack (preferably protein) before bedtime.
- Go to bed with a glucose level slightly higher than usual.
- Bring your diabetic logbook (with your result of early morning 2am-3am blood glucose) while consulting your physician, in case your insulin dose may require adjustments.
Dawn Phenomenon
- Exercise later in the day. It may have more glucose-lowering effect throughout the night.
- Limit bedtime carbohydrates and try more of a protein/fat type of snack (nuts, peanut butter, cheese, or meat).
- Talk with your doctor of a possible medication adjustment (usually insulin) to control the higher fasting readings (common in DM Type I at onset of puberty).
- Eat breakfast to limit the dawn phenomenon’s effect. By eating, your body will signal the counterregulatory hormones to turn off. -> peliknya...
Why bother ?
Good blood glucose control is essential for diabetic patients. The adjustment of medication (insulin) dose depends on which is the culprit, as one needs to lower the blood glucose prior to bedtime (Dawn phenomenon) or increase the blood glucose level prior to bedtime (Somogyi effect).
Therefore, if the patient is having persistent morning hyperglycemia despite increased insulin dose, suspect Chronic Somogyi.
Thanks to Dr.Ngiu for asking us weeks ago.
Source : Wikipedia, 2 other internet sources (by Alvis Lee) -
July 26th, 2010
Edited by Wong Yee Ming -
May 15th, 2011
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Posted by medik-ukm on Tuesday, July 06, 2010
| RED (admit hospital) | YELLOW (FM specialist or OnG speacialist) |
| *Eclampsia *PE- ↑BP with urine alb 1+/symptomatic/ BP> 160/110mmHg *heart problem with symptoms(palpitation n dyspnea *dyspnea on light activities *uncontrolled GDM or urine ketone≥ 1+ *pervaginal bleed *AbN fetal HR ^FHR≤110bpm after 26w ^FHR≥160bpm after 34w *symptomatic anemia *premature contraction *PROM *severe asthmatic attack | *HIV +ve *Hep B +ve *BP 140-160/90-110 mmHg with –ve urine alb *GDM *post date >7days |
| GREEN (MO) | WHITE |
| *rhesus –ve *mother wt <45kg *current medical prob (psy or OKU) *past gynae surgery *on drugs abuse, alcoholism, or smoker *recurrent miscarriage ≥3x *past obs hx: ^LSCS or instrumental delivery ^Hx of PIH,PE,E,GDM ^Baby birth wt <2.5 or >4.0 kg ^retained placenta or PPH ^stillbirth *twin pregnancy *urine alb 1+ *wt >80kg or increase wt >2kg/week *AbN lie at ≥36w *head not engaged at ≥38w for primid | White I (hospital) *primid *age <18 and > 40 year old *grandmultipara *gap between birth <2 years or > 5years *mother prob (ht <145cm, ibu tunggal) White II(home/alternative birth centre) *gravid 2-5 *no past obs hx, no medical prob, no cx after delivery. *ht >145cm *mother age >18, < 40 year old *married mother with good family support *POA >37 w and < 41w *estimated birth wt >2.5-3.5kg |
source: buku merah (buku f/up antenatal)
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