tag:blogger.com,1999:blog-40487442924286242022024-03-14T16:33:20.331+08:00Primary Health StationDISCLAIMER: All the content in this blog are for general information only. No warranty is made that the information provided are correct, accurate or up-to-date. The information is not intended to diagnose or treat any diseases, and not a substitute for professional medical advice or consultation. If you have doubts, please consult your personal healthcare provider.Bryanhttp://www.blogger.com/profile/13569420354631343642noreply@blogger.comBlogger43125tag:blogger.com,1999:blog-4048744292428624202.post-87161963721914045542013-09-16T13:04:00.003+08:002013-09-17T12:30:49.103+08:00Nose Bleeding In Children: Why?<div style="text-align: justify;">
It can be a worrying experience if your child has bleeding from nose (epistaxis). However, most of the time the nose bleeding is not caused by serious problems.</div>
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Nose bleeding usually occurs on one side of the nostril. It is commonly due to injury to the inner lining (mucosa) of the front part of the nose, such as:</div>
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<ul>
<li style="text-align: justify;">nose picking (esp with sharp fingernails)</li>
<li style="text-align: justify;">nose blowing & rubbing</li>
<li style="text-align: justify;">nose inflammation / infection</li>
<li style="text-align: justify;">foreign body in the nose</li>
<li style="text-align: justify;">nose trauma (eg. from a blow on the face)</li>
</ul>
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The bleeding point is most likely at the front part of the nose septum (Little's area) where the blood vessels are most abundant. You may see this area if the nose bleeding is not too profuse. </div>
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<i> Little's area</i></div>
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When the bleeding occur, sit the child upright and tilt his/her head forward to prevent the blood from flowing backwards into the mouth. Then pinch the nose with your thumb and index finger for at least 5-10 minutes to compress the bleeding point at Little's area. If the bleeding does not stop and you are worry, it is wise to bring your child to a doctor.</div>
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Nose bleeding can be recurrent, especially in children with underlying allergic condition such as allergic rhinitis. Besides, dry air or dry weather can cause nasal mucosa irritation and increase the chance of nose bleeding.</div>
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Very rarely, nose bleeding in children can be caused by more serious disorders especially when:</div>
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<li style="text-align: justify;">there are bleeding elsewhere other than the nose (gum bleeding, bruises, bloody stool etc)</li>
<li style="text-align: justify;">the bleeding does not stop or takes a longer than usual time to stop</li>
<li style="text-align: justify;">very frequent nose bleeding episodes</li>
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A few more serious causes of nose bleeding in children include:</div>
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<li style="text-align: justify;">blood coagulation disorder (congenital or acquired)</li>
<li style="text-align: justify;">low or abnormal platelet function</li>
<li style="text-align: justify;">blood cancer (leukemia etc)</li>
<li style="text-align: justify;">nose tumour</li>
</ul>
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Nose bleeding in children is usually harmless. If you are in doubt, please consult your doctor for confirmation.</div>
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Bryanhttp://www.blogger.com/profile/13569420354631343642noreply@blogger.com0tag:blogger.com,1999:blog-4048744292428624202.post-41686419526068793972013-09-11T16:30:00.001+08:002013-09-19T18:10:12.559+08:00Jaw Pain: Is It TMJ Disorder?<div style="text-align: justify;">
Jaw pain can be irritating and persist for a long time. You can't eat properly and you can't laugh out loud. If you have jaw pain on only one side, it can be due to the problem within the joint (temporomandibular joint - TMJ) or other structures around the joint.</div>
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TMJ is a joint that is involved in opening and closing our mouth. You can locate the joint by placing your finger directly in front of your ear and then open and close your mouth. The movement you feel is your TMJ in action.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5T2w9cRMX5xNrddJcndgb-iWeFDrAc9LrTV4LEj1f1Krha6AZgLt-IhOi4W4YLrDGJqb6WPjHI1RPUQ3UMvlip11I1sijX-NNE8exp2jlVD47QWf6EuQ6zC_WJuR65AWm486RqZsQ2gI/s1600/TMJ.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5T2w9cRMX5xNrddJcndgb-iWeFDrAc9LrTV4LEj1f1Krha6AZgLt-IhOi4W4YLrDGJqb6WPjHI1RPUQ3UMvlip11I1sijX-NNE8exp2jlVD47QWf6EuQ6zC_WJuR65AWm486RqZsQ2gI/s1600/TMJ.jpg" /></a></div>
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<i> Temporomandibular joint</i></div>
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The problems within the TMJ that cause pain may arise from the joint itself, the bones that make up the joint, and the surrounding muscles/tendons. It is simply referred as TMJ disorder. In most cases, the joint is "damaged" and becomes sore and stiff due to various reasons. These reasons are usually associated with overuse or "abuse" of the TMJ, such as:</div>
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<ul>
<li style="text-align: justify;">habitual teeth grinding</li>
<li style="text-align: justify;">habitual fingernails biting</li>
<li style="text-align: justify;">excessive gums chewing</li>
<li style="text-align: justify;">always chew on one side</li>
<li style="text-align: justify;">misaligned teeth</li>
<li style="text-align: justify;">open the mouth too wide frequently</li>
<li style="text-align: justify;">aging of joint (arthritis)</li>
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This is the pure TMJ disorders and the pain is usually felt when you use your TMJ such as opening your mouth. When you do not move your mouth, there is usually no pain. The pain may be worse when you open your mouth after a long period of time resting it. Sometimes you can feel the clicking sound from the TMJ when you open your mouth. It can also be accompanied by headache, giddiness or ear pain.</div>
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As the causes of these TMJ disorders are overuse/abuse of the TMJ, you should identify the reason and try to correct or avoid it. Rest your jaw by avoid excessive chewing, chewing hard food or opening the mouth too wide. Cold & heat application and some regular jaw exercise by opening and closing your mouth gently may help to prevent stiffness and improve the pain.</div>
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The pain can improve and diminish within few days or weeks but sometimes it can last for months or years. You should seek advice from your doctor if in doubt.</div>
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However, if you have recent serious trauma or injury to your face, then the pain at TMJ could be due to fracture of the bone or dislocation. In this case, you should see your doctor for a scan.</div>
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Other reasons that can cause pain around the TMJ include:</div>
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<li style="text-align: justify;">Toothache or tooth abscess - in this case the pain is usually persistent and accompanied by swelling around the area or fever. The pain may be worse when you knock on the problematic tooth. See a dentist if you suspect this.</li>
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<li style="text-align: justify;">Ear infection - pain is usually persistent and may be aggravated by moving the jaw, as the external canal and middle ear are just next to the TMJ. Associated symptoms include ear discharge, hearing loss and tinnitus (ringing sound). A check into the ear by your doctor can confirm this.</li>
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<li style="text-align: justify;">Headache - headache can cause pain around the TMJ area, but usually you will have pain at other area of the head too.</li>
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<li style="text-align: justify;">Trigeminal neuralgia - this nerve disorder can cause severe pain that mostly originate from the jaw area and radiate towards your forehead, nose and chin. Touching the face may make the pain worse.</li>
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Of course there are other causes of jaw pain which are not mentioned here. You should consult your doctor if you think that the jaw pain is not a pure TMJ disorder.</div>
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Bryanhttp://www.blogger.com/profile/13569420354631343642noreply@blogger.com0tag:blogger.com,1999:blog-4048744292428624202.post-84671895104466994482013-08-25T12:13:00.002+08:002013-08-25T12:26:27.354+08:00High Triglycerides: Mostly Lifestyle Related<div style="text-align: justify;">
Triglycerides (TG) is a form of fat in the body. People with extremely high triglycerides level may have higher risk of heart attack, especially for those with low HDL-cholesterol / high LDL-cholesterol level or those with other risk factors such as diabetes mellitus, hypertension and smoking. </div>
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National Cholesterol Education Program has given a guideline for normal & high triglycerides level:</div>
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<li style="text-align: justify;">Normal : < 1.7 mmol/L (150 mg/dl)</li>
<li style="text-align: justify;">Borderline high : 1.7 - 2.3 mmol/L (150-199 mg/dl)</li>
<li style="text-align: justify;">High : 2.3 - 5.6 mmol/L (200-499 mg/dl)</li>
<li style="text-align: justify;">Very high : >5.6 mmol/L (> 500 mg/dl)</li>
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Some of the causes of high triglycerides:</div>
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<li>Genetics</li>
<li>Obesity/overweight</li>
<li>Diabetes Mellitus</li>
<li>Alcohol</li>
<li>High carbohydrates/fat diet especially refined carbohydrates</li>
<li>Hypothyroidism (though more on high cholesterol)</li>
<li>Nephrotic Syndrome (though more on high cholesterol)</li>
<li>Some drugs (thiazides, estrogen, tamoxifen, steroids, isotretinoin)</li>
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High TG level below 11.3 mmol/L (1000 mg/dl) usually does not produce any signs and symptoms. If the level is above 11.3 mmol/L, it may give rise to recurrent abdominal pain (chylomicronemia), skin lesion (eruptive xanthomas) and increased risk of acute pancreatitis. Hypertriglyceridemia is also related to fatty liver which may cause mild discomfort at the right upper abdomen.</div>
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<i> Eruptive xanthomas: yellow papules on red base</i></div>
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The serum level of TG is well-known to be labile and may fluctuate a lot depending on a person's diet and lifestyle prior to the test. Blood test for TG usually is done together with cholesterol level and fasting of at least 10-12 hours is ideal. Excessive alcohol or high carbohydrates/fat intake for the last 2 weeks prior to the blood test may affect its result. </div>
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If your TG level is high (>5.6 mmol/L), doctors will usually prescribe a medicine to lower it. Medical treatment available currently includes fibrates, high dose niacin and high dose omega3. Level above 11.3mmol/L must be treated in order to reduce the risk of acute pancreatitis.</div>
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If TG level is at the high but less than 5.6 mmol/L, then the treatment will depend on the presence of other secondary causes and the cholesterol profile. If the cholesterol (HDL/LDL) level is not favourable, then cholesterol lowering medicine (statin) may be given priority. If secondary cause is identified (such as alcohol, diabetes, obesity etc), then it should be managed or treated accordingly first.</div>
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Diet & lifestyle control can do marvel in controlling TG level. Weight reduction, regular exercise, reduce/stop alcohol intake, reduce fat & refined carbohydrates (sugar/white flour) intake can help to improve TG level.</div>
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So it is not just too much fat, too much bad carbohydrates/sugar will also raise your TG level.</div>
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<br />Bryanhttp://www.blogger.com/profile/13569420354631343642noreply@blogger.com0tag:blogger.com,1999:blog-4048744292428624202.post-60697242421624399692013-05-25T00:00:00.000+08:002013-07-30T14:38:38.897+08:00Chest Pain: Is It Digestive Tract?<div style="text-align: justify;">
<b><u>Chest Pain: Is It Digestive Tracts?</u></b></div>
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Pathology in the upper digestive tract which are the esophagus and stomach can give rise to chest pain, though they are most commonly felt at the lower chest or upper abdomen area (epigastrium). </div>
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Common associated symptoms in esophagus disorders include dysphagia (difficulty in swallowing) & odynophagia (pain when swallwong), while in stomach disorders, abdominal bloating, nausea, vomiting, indigestion are common related symptoms.</div>
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<b>Gastroesophageal Reflux Disease (GERD)</b></div>
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This condition is caused by back-flow of acidic stomach content back into the lower part of esophagus. There is a muscular "valve" between the lower esophagus and stomach which allows only one-way flow of food content from the esophagus towards the stomach. However, due to some condition, the "valve" does not function properly and allows the food to flow backwards.</div>
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There are many condition which can give rise to GERD, such as:</div>
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- pregnancy</div>
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- obesity</div>
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- prolonged/excessive straining over abdomen (coughing/vomiting/physical exertion)</div>
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- certain foods</div>
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- smoking</div>
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- hiatal hernia</div>
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The chest pain caused by GERD is typically referred to "heartburn", where the pain is "burning" in nature and radiate upwards towards the neck/throat. It may be accompanied by bitter taste in the mouth.</div>
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<b>Esophagitis</b></div>
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Infection or inflammation of the esophagus can cause pain along the chest area. The pain may be made worse after food when the food bolus pass through the inflammed area.</div>
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<b>Esophagus spasm</b></div>
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Either irregular or regular esophagus spasm can cause pain, mostly after food intake. It is not common and the cause is unknown. The pain is usually intermittent and can be severe.</div>
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<b>Esophageal cancer</b></div>
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Esophageal cancer most commonly occurs at the lower part of esophagus and pain is not a usual symptom. Most sufferers will complain of dysphagia or food stuck at the lower part of the esophagus. More advanced case can give rise to poor appetite and weight loss, as in all type of cancers.</div>
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<b>Peptic ulcer disease</b></div>
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This is a common disorder and is highly related to Helicobacter pylori infection, regular use of NSAIDs and blood-thinning drugs. The ulcers can be at the stomach or upper portion of the small intestines (duodenum). Besides pain over the chest (heartburn) or upper abdomen especially between meals and at night, sufferers may also complain of bloating, nausea & vomiting.</div>
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Peptic ulcers can be life-threatening if it is bleeding profusely. Thus, in case of chest discomfort accompanied by vomiting blood (hematemesis) or passing black stool (melena) or anemia (pale), the patient has to seek medical attention immediately.</div>
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<b>Gastritis</b></div>
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Gastritis is a term used to described inflammation or irritation of stomach lining. It is a common diagnosis made by doctors for upper abdominal pain. The pain can be felt at chest area as heartburn with abdominal bloating, nausea & vomiting. The causes and symptoms of gastritis are similar to peptic ulcer disease. Doctors can only differentiate both of them by doing an oesophageal-gastro-duodenal-scopy (OGDS).<br />
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<a href="http://primaryhealthstation.blogspot.com/2013/02/chest-pain-how-to-differentiate.html" target="_blank">Click here for clues on how to differentiate chest pain.</a></div>
<br />Bryanhttp://www.blogger.com/profile/13569420354631343642noreply@blogger.com0tag:blogger.com,1999:blog-4048744292428624202.post-56270426127626035092013-04-07T17:55:00.001+08:002013-04-07T18:46:13.161+08:00Children With Foot Pain At Night: Growing Pain?<div style="text-align: justify;">
It is very worrying for parent whose child suddenly wakes up in the middle of the night crying and complaining of leg or foot pain, and it recurs few other nights. Young children may not describe the pain and locate the pain accurately, this makes the parent even more anxious.</div>
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It's not easy to diagnose leg/foot pain in children. The most important thing to do is to rule out serious illness or disorder associated with the pain.</div>
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There is a condition often referred to "growing pain", which is completely harmless and is a diagnosis of exclusion. The typical features for a growing pain are:</div>
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<li style="text-align: justify;">Pain in foot or leg (one or both sides) mostly occurs at night only</li>
<li style="text-align: justify;">Occurs intermittently and not on every night</li>
<li style="text-align: justify;">Pain lasts for few minutes and the child can go back to sleep</li>
<li style="text-align: justify;">No swelling, redness over the pain area</li>
<li style="text-align: justify;">Not worsening by touching/pressing the pain area</li>
<li style="text-align: justify;">Completely well in the morning, without pain and limping</li>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyuUulc_7xKKVqs_R6VG2285lqEhE2iC4lvf8XkdH_GwB_54j_dVahtJReQrzYAL-DeJ1j_aZW2py98rs93zB0Oqy_N4bmVDBac6Ah8I8xB-EC55IkPpuVpD1vcLzLCIws_2XQeNSQgWs/s1600/DSC00440.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyuUulc_7xKKVqs_R6VG2285lqEhE2iC4lvf8XkdH_GwB_54j_dVahtJReQrzYAL-DeJ1j_aZW2py98rs93zB0Oqy_N4bmVDBac6Ah8I8xB-EC55IkPpuVpD1vcLzLCIws_2XQeNSQgWs/s320/DSC00440.JPG" width="320" /></a></div>
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By using our common sense, if it is something more serious, it should be:</div>
<ul>
<li style="text-align: justify;">Pain during both daytime and night time, almost everyday</li>
<li style="text-align: justify;">Pain getting worse and worse with time</li>
<li style="text-align: justify;">There is swelling or redness at the pain area</li>
<li style="text-align: justify;">The child resists someone from touching the pain area</li>
<li style="text-align: justify;">The child has other symptoms other than pain</li>
<li style="text-align: justify;">The child has limp and discrepancy in leg length</li>
</ul>
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There are a few conditions to consider for foot or leg pain in children</div>
</div>
<div>
<div style="text-align: justify;">
<br /></div>
</div>
<div>
<div style="text-align: justify;">
<u>Injury (bony fracture, ligament sprain, muscle strain)</u></div>
</div>
<div>
<ul>
<li style="text-align: justify;">does the child has recent fall or trauma?</li>
<li style="text-align: justify;">pain exists all day long, not just night time</li>
<li style="text-align: justify;">there can be swelling, skin lesion and especially pain to touch</li>
<li style="text-align: justify;">limping is likely</li>
</ul>
<div>
<div style="text-align: justify;">
<u>Arthiris (juvenile idiopathic arthritis)</u></div>
</div>
</div>
<div>
<ul>
<li style="text-align: justify;">typically having morning stiffness </li>
<li style="text-align: justify;">commonly affects more than one joint</li>
<li style="text-align: justify;">can occur in any body parts</li>
<li style="text-align: justify;">pain may continue in daytime</li>
<li style="text-align: justify;">may have swelling in the joints</li>
<li style="text-align: justify;">may have other symptoms such as fever & skin lesion</li>
</ul>
<div>
<div style="text-align: justify;">
<u>Tumour (benign or cancer)</u></div>
</div>
</div>
<div>
<ul>
<li style="text-align: justify;">pain during day and night time, though typically worse at night</li>
<li style="text-align: justify;">pain wosening with time</li>
<li style="text-align: justify;">can feel the swelling in later stage</li>
<li style="text-align: justify;">may have limp and discrepancy in leg length</li>
<li style="text-align: justify;">more common on long bones - femur, tibia (not foot)</li>
</ul>
<div>
<div style="text-align: justify;">
<u>Kohler's disease</u></div>
</div>
</div>
<div>
<ul>
<li style="text-align: justify;">avascular necrosis of a bone in the foot (navicular bone)</li>
<li style="text-align: justify;">rare and benign condition</li>
<li style="text-align: justify;">may have pain during day and night time</li>
<li style="text-align: justify;">may have swelling</li>
</ul>
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Thus, if your child with foot pain (either one foot or both feet) at some nights and is completely well during the rest of the day, with no swelling or deformity, then it is likely a "growing pain". It is also important to check whether your child has a normal foot arch.</div>
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<div style="text-align: justify;">
Growing pain is believed to be a muscular pain and more common in age 2-8 years old. Though it is harmless, it is really painful to the child. You can massage or stretch the pain area or apply warm towel to try to relieve the pain. If the pain is intense, analgesics can be given for short term relief. </div>
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However, it is possible that there is actually no pain but the child is just trying to seek parent's attention.</div>
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If you are not sure what is happening to your child with foot/leg pain, please consult your doctor. The doctor is likely to ask you the questions above and examine your child. In some cases, an X-ray may be required.</div>
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Bryanhttp://www.blogger.com/profile/13569420354631343642noreply@blogger.com0tag:blogger.com,1999:blog-4048744292428624202.post-39439308626195729052013-03-19T16:17:00.001+08:002013-03-19T16:17:39.877+08:00Heel Pain When You Step: Likely Plantar Fasciitis<div style="text-align: justify;">
There are many people complaining of foot pain when they make their first few steps after getting down from bed. If you have this problem, then you may have a condition calls "plantar fasciitis".</div>
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<div style="text-align: justify;">
Plantar fasciitis is the commonest cause of foot pain or heel pain. The pain is sharp and can be so severe until you can't put your foot on the floor. </div>
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Plantar fascia is flat sheet of ligament that supports our foot arch from toes to heel. When this fascia is inflamed, it will cause pain. There are many reasons for inflammation of plantar fascia, and almost all of them are related to injury to the fascia, especially at the heel area where the pain is commonest.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxMGpb0QtBJ_Z1S72W7I3qEcc_mqiYs0FPQnPuoaRKaYopZ8RU-UkblauZ03pKI1s3WPEfmbjOk1wGCetab47D0XUytPGWrlTFAOhAg4YhTF0FMHaC-1JVhxEGdsB0Lx5nvEs7R3ga_aQ/s1600/plantar+fas.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxMGpb0QtBJ_Z1S72W7I3qEcc_mqiYs0FPQnPuoaRKaYopZ8RU-UkblauZ03pKI1s3WPEfmbjOk1wGCetab47D0XUytPGWrlTFAOhAg4YhTF0FMHaC-1JVhxEGdsB0Lx5nvEs7R3ga_aQ/s1600/plantar+fas.jpg" /></a></div>
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The injury to plantar fascia is likely to be caused by repeated minor trauma to the foot. The risk factors include</div>
<div>
<ul>
<li style="text-align: justify;">overweight</li>
<li style="text-align: justify;">prolonged standing</li>
<li style="text-align: justify;">frequent walking, running, jumping esp on hard surface or bare-footed</li>
<li style="text-align: justify;">wearing ill-fitting or inappropriate shoes</li>
<li style="text-align: justify;">abnormal foot arch</li>
<li style="text-align: justify;">previous foot injury</li>
<li style="text-align: justify;">tight calf muscles</li>
</ul>
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<br /></div>
<div style="text-align: justify;">
In many cases, the cause of plantar fasciitis is multiple factors.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgN2R3jxzUmVZ5CJPQZJpl3AB4VQBbLwGTMYCnjRRYD4_1kxY-UmS7-zBI0QsZY_tk5BZdSIilekVpohcELyHO8Q_aD2UslNJ5qCzgSXxM7RsOKWh2jFjSXyJnOmpXfHd5kxWidEihBj94/s1600/foot+arch.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgN2R3jxzUmVZ5CJPQZJpl3AB4VQBbLwGTMYCnjRRYD4_1kxY-UmS7-zBI0QsZY_tk5BZdSIilekVpohcELyHO8Q_aD2UslNJ5qCzgSXxM7RsOKWh2jFjSXyJnOmpXfHd5kxWidEihBj94/s1600/foot+arch.jpg" /></a></div>
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The heel pain is more obvious when you start walking after the foot does not bear weight for some time, such as after sleep or prolonged sitting. It may be worse when climbing stairs or at the end of the day.</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
Nevertheless, not all heel pain is plantar fasciitis. Sometimes it can be due to other reasons such as foot bone fracture, nerve entrapment, bone pathology etc. Thus, a foot X-ray is sometimes essential when the diagnosis is in doubt.</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
As plantar fasciitis occurs after prolonged repetitive trauma, it also takes quite a long time to recover, as the damaged ligament takes time to heal. The healing time takes longer because we are unable to rest the plantar fascia completely for it to heal as we still need to walk everyday.</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
To facilitate healing or to relieve the heel pain, you may take the measures listed below, depends on what your problems are. If you wish to prevent plantar fasciitis before you have it, you may also do these.</div>
<div>
<ul>
<li style="text-align: justify;">lose weight</li>
<li style="text-align: justify;">avoid prolonged standing</li>
<li style="text-align: justify;">reduce exercise intensity (walking, running, jumping)</li>
<li style="text-align: justify;">avoid exercise on hard surface</li>
<li style="text-align: justify;">avoid bare-footed on hard surface</li>
<li style="text-align: justify;">wear proper shoes</li>
<li style="text-align: justify;">replace worn-out shoes</li>
<li style="text-align: justify;">put proper shoes in-sole</li>
</ul>
</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
Other methods to relieve heel pain</div>
<div>
<ul>
<li style="text-align: justify;">ice therapy (for 15 min/day)</li>
<li style="text-align: justify;">stretching </li>
<ul>
<li style="text-align: justify;">toe stretching (extend the toes with your hand and hold for 30 sec)</li>
<li style="text-align: justify;">calf stretching (hands against wall with affected side knee straight & other side knee bend, hold for 30 sec)</li>
</ul>
<li style="text-align: justify;">orthoses - custom made shoes or insole</li>
<li style="text-align: justify;">night splinting - ankle fixed at 90 degree</li>
<li style="text-align: justify;">medication</li>
<ul>
<li style="text-align: justify;">oral anti-inflammatory drugs (NSAIDs, steroids)</li>
<li style="text-align: justify;">steroids injection</li>
</ul>
<li style="text-align: justify;">surgery</li>
</ul>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuHbohyqbK9wQLyvB8_sNnTuVomXm1NQ2_AHeGH7EYdSrBqY3RAhXZDh9aX_t8xHaLVjcRJHv5AnoAMmUQFmey8lC_SN0E0ThyA9K_dIzwIGHke9BSba8JAN5h7-8sInMqgNguMIwU9rU/s1600/calf+stretch.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuHbohyqbK9wQLyvB8_sNnTuVomXm1NQ2_AHeGH7EYdSrBqY3RAhXZDh9aX_t8xHaLVjcRJHv5AnoAMmUQFmey8lC_SN0E0ThyA9K_dIzwIGHke9BSba8JAN5h7-8sInMqgNguMIwU9rU/s320/calf+stretch.gif" width="320" /></a></div>
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<div style="text-align: justify;">
The first few methods to do are usually ice therapy and stretching exercise for 6 weeks, apart from those preventive measures. If the pain does not get any better, then you can add in orthoses, night splinting & medication. If nothing works for a period of 12 months, then you may consider surgery.</div>
<div style="text-align: justify;">
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<div style="text-align: justify;">
Study shows that 90% of plantar fasciitis cases can heal within 12 months. It can heal by itself if you give your foot enough chance to rest. </div>
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Bryanhttp://www.blogger.com/profile/13569420354631343642noreply@blogger.com0tag:blogger.com,1999:blog-4048744292428624202.post-59185760794408944252013-03-18T15:55:00.001+08:002013-03-19T11:10:15.631+08:00Chicken Pox: How Does It Looks Like?<div style="text-align: justify;">
Chicken pox is a very common childhood virus infection. It is caused by varicella zoster virus and is extremely contagious. The virus spreads through droplets (exhaled air, coughing, sneezing) and contact with fluid from skin lesion (direct contact, sharing towel etc). The virus can survive outside human body in the environment for few hours.</div>
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<br /></div>
<div style="text-align: justify;">
Once you know that your child's schoolmate has chicken pox with skin rash, it is usually too late to avoid infection to your child unless there is no real close contact between them. This is because the infected child is able to spread the virus even 2 days before the rash appears.</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
If after contact with a chicken pox child for one week and your child still seems alright, it still does not mean that your child is not infected, as the incubation period for the virus is between 10-21 days. Usually the first symptoms to appear are rather non-specific such as mild fever, body ache, minor cough or flu symptoms. Most people only aware of the infection after the body rash appears.</div>
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<div style="text-align: justify;">
Chicken pox rash is quite obvious and there are generally three stages. The first rash to appear is like a red dot, which will then progress to blisters that will eventually burst and become crusted (scabs). Typically the rash appears in crops, which means that at one time these three types of rash will appear together.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAMK8DoxZ5VsTuy33fqqEkGZqJwp2cceS_7WrKiAvkZSOWvy9wvM_npWxbkouikY9bEkZQEP0ZxkP7QAHfmAOmrqhgYXPyD6_D3P7LbZqWQ4wluJFrMTqM7FaeWpKhKkPNSsDO2YX8KSI/s1600/chicken-pox.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="208" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAMK8DoxZ5VsTuy33fqqEkGZqJwp2cceS_7WrKiAvkZSOWvy9wvM_npWxbkouikY9bEkZQEP0ZxkP7QAHfmAOmrqhgYXPyD6_D3P7LbZqWQ4wluJFrMTqM7FaeWpKhKkPNSsDO2YX8KSI/s320/chicken-pox.jpg" width="320" /></a></div>
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<i> Rash appears in crops</i><br />
<br /></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhz4om8lTLgFyEti8UK-3ZSU6KDW2zal-LBxOhPy8DPkUPWUTRlO3R_GmZan9zfTnQa0XsWjAGj-t3YCDiez4NQmT6nn5ZM1Q5uezpyCkq5kIFgwLPcpzYrYihcGe4ngkHYSE6vg38DitQ/s1600/chickenpox.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="217" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhz4om8lTLgFyEti8UK-3ZSU6KDW2zal-LBxOhPy8DPkUPWUTRlO3R_GmZan9zfTnQa0XsWjAGj-t3YCDiez4NQmT6nn5ZM1Q5uezpyCkq5kIFgwLPcpzYrYihcGe4ngkHYSE6vg38DitQ/s320/chickenpox.jpg" width="320" /></a></div>
<div style="text-align: justify;">
<i> Typical chicken pox rash</i></div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
Chicken pox rash usually will last for 5 days. The infected child is considered non-contagious once all rashes have become scabs (dry). The infected child usually can return to school/nursery 1 week after the rash first appears.</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
There is no specific treatment for chicken pox other than symptomatic relief for fever/pain and itchiness. Antiviral is indicated only in some special circumstances such as in immuno-compromised child or when complication occurs.</div>
<div style="text-align: justify;">
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<div style="text-align: justify;">
Chicken pox can be prevented through vaccination. Young children can get the vaccine after 12 months old. For children more than 12 years old or adult, two doses given 6-10 weeks apart is recommended. </div>
Bryanhttp://www.blogger.com/profile/13569420354631343642noreply@blogger.com0tag:blogger.com,1999:blog-4048744292428624202.post-75253782489008548342013-02-26T12:34:00.001+08:002013-07-30T14:38:05.015+08:00Chest Pain: Is It Muscles?<div style="text-align: justify;">
Though chest pain can be very serious, most of the time it's not. One of the most common cause of chest pain is related to the musculoskeletal system.</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
Generally, chest pain involving the muscles, ligaments, bones & joints is usually localized to a specific area. It is also reproducible by applying pressure on the pain area. The pain is usually sharp and aggravated by moving the affected area such as when moving the body/arm or taking a deep breath (chest wall moves up and out).</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
There are a few reasons for musculoskeletal chest pain:</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
- muscle strain or ligament sprain : after strenuous exercise or work (carry heavy things etc), trauma, after heavy coughing, even after one night of improper sleeping posture etc.</div>
<div style="text-align: justify;">
- bone: fracture (obvious severe trauma), cancer (rare)</div>
<div style="text-align: justify;">
- ribs cartilages or joints (costochondritis): trauma, infection, unknown cause</div>
<div style="text-align: justify;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-tL50PBkl3y__exfGvVZfslE1pzxkH-s09daiY29dx92CYKpCmCdOT0EDoANzns7Ttq3gJjuaC4xhwjA8VlRqpx12NKK0XTbXzo-BBuAOgzOSYOGQpQgxdp3b0X66zjjqJJ-0wlfmzsE/s1600/costo.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-tL50PBkl3y__exfGvVZfslE1pzxkH-s09daiY29dx92CYKpCmCdOT0EDoANzns7Ttq3gJjuaC4xhwjA8VlRqpx12NKK0XTbXzo-BBuAOgzOSYOGQpQgxdp3b0X66zjjqJJ-0wlfmzsE/s1600/costo.jpg" /></a></div>
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<br /></div>
<div style="text-align: justify;">
Chest pain with musculoskeletal origin is usually harmless and will resolve by itself in a few days. Some pain-killer and anti-inflammatory medicine may help to relieve the pain.<br />
<br />
<a href="http://primaryhealthstation.blogspot.com/2013/02/chest-pain-how-to-differentiate.html" target="_blank">Click here for clues on how to differentiate chest pain.</a></div>
Bryanhttp://www.blogger.com/profile/13569420354631343642noreply@blogger.com0tag:blogger.com,1999:blog-4048744292428624202.post-70066113691208872862013-02-21T09:30:00.003+08:002013-05-25T13:09:02.968+08:00Chest Pain: How To Differentiate?<div style="text-align: justify;">
When we have chest pain, almost all of us will ask: Am I having a heart attack?</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
Of
course there are lots of causes for chest pain. The pain around the
chest can originate from any organs or structures beneath the chest wall
such as:</div>
<div style="text-align: justify;">
<br />
-<a href="http://primaryhealthstation.blogspot.com/2013/02/chest-pain-is-it-heart-problem.html" target="_blank"> heart</a>/aorta</div>
<div style="text-align: justify;">
- <a href="http://primaryhealthstation.blogspot.com/2013/02/chest-pain-is-it-lungs-problem.html" target="_blank">lungs</a>/trachea</div>
<div style="text-align: justify;">
- <a href="http://primaryhealthstation.blogspot.com/2013/05/chest-pain-is-it-digestive-tract.html" target="_blank">esophagus/stomach</a></div>
<div style="text-align: justify;">
- <a href="http://primaryhealthstation.blogspot.com/2013/02/chest-pain-is-it-muscles.html" target="_blank">muscle</a>/bone/ligament/skin</div>
<div style="text-align: justify;">
- gallbladder/pancreas/liver<br />
<br />
There are many types of chest pain, such as dull, sharp, tight, stabbing, pressing, burning etc. It is not easy to determine the cause of chest pain in most circumstances. However, doctors will ensure that the chest pain is at least not the type which is life-threatening and require immediate medical attention, such as heart attack, pneumothorax, aortic dissection, pulmonary embolism, acute pancreatitis etc.<br />
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<br />
<br />
When assessing chest pain, there are a few information which are important:<br />
<br />
<u><b>Location of chest pain:</b></u><br />
<br />
- center of chest: heart, trachea, esophagus, musculoskeletal<br />
- left or right of chest: lungs, musculoskeletal<br />
- lower chest: stomach, gallbladder, pancreas, liver<br />
<br />
The location of pain alone is not the only criteria to diagnose a chest pain. The pain of heart attack although commonly occurs in the center, but it may also be felt at the side of chest wall or the epigastric area (lower chest/upper abdomen).<br />
<br />
<u><b>Distribution of chest pain:</b></u><br />
<br />
- radiate to the left chest/left arm/jaw: heart (angina, heart attack)<br />
- radiate to the back: aorta (dissection), pancreas<br />
- radiate to right shoulder: gallbladder<br />
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<i> Typical angina pain distribution</i><br />
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<u><b>Nature of the pain:</b></u><br />
<br />
- tight, gripping, pressing: heart (angina, heart attack) <br />
- sharp, stabbing: lungs (pneumothrax, pulmonary embolism), aorta (dissection), musculoskeletal<br />
- colicky: gallbladder (stone)<br />
- burning: stomach (ulcer, gastritis), esophagus (reflux)<br />
<br />
<u><b>Onset of pain:</b></u><br />
<br />
- sudden: heart (angina, heart attack), aorta (dissection), lungs (pneumothorax, pulmonary embolism), musculoskeletal<br />
- gradual: any other causes<br />
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<u><b>Duration of pain:</b></u><br />
<br />
- comes and goes and infrequent and well in between: usually not so serious condition (musculoskeletal, gallstone, gastritis etc)<br />
- continuous but mild: may indicate more serious condition (pneumonia, cancer etc)<br />
- continuous and severe or worsening: may indicate more serious conditions that require medical attention immediately (heart attack, pneumothorax, pulmonary embolism, perforated gastric ulcer)<br />
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<u><b>Pain aggravation:</b></u></div>
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- aggravated during inspiration: lungs (pleural), heart (pericardium), muscoloskeletal</div>
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- aggravated by food: stomach, gallbladder, esophagus</div>
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- aggravated by moving the arms: musculoskeletal</div>
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- aggravated by cough: lungs (pleural), heart (pericardium), muscoloskeletal</div>
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- aggravated by laying flat (supine): pericardium, pancreas</div>
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- aggravated by pressing: musculoskeletal, pleural </div>
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<u><b>Severity of pain:</b></u></div>
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- Severity of pain is very subjective and varies from each individual. Generally the more severe the pain, the more serious the condition, such as in heart attack, aortic dissection, perforated gastric ulcer etc. However, some gastritis, gallstone, musculoskeletal pain may give rise to severe pain, even though they are not life-threatening.</div>
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<u><b>Associated signs & symptoms:</b></u></div>
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This may be the most important information in determining the cause of chest pain.</div>
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- cough: lungs (infection, pneumothorax, cancer, embolism)</div>
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- shortness of breath: lungs (any cause), heart (heart attack)</div>
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- fever: infection, inflammation</div>
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- indigestion: stomach, esophagus, gallbladder</div>
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- nausea/vomiting: stomach, esophagus, heart (heart attack) </div>
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- palpitation: heart, lungs (pulmonary embolism)</div>
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The information above is not intended for self-diagnosing of chest pain. Please seek medical attention if you have a chest pain.</div>
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Bryanhttp://www.blogger.com/profile/13569420354631343642noreply@blogger.com0tag:blogger.com,1999:blog-4048744292428624202.post-45149489198473673192013-02-20T14:21:00.000+08:002013-07-30T14:37:33.532+08:00Chest Pain: Is It Lungs Problem?<div style="text-align: justify;">
<u><b>Chest Pain: Is It Lungs?</b></u></div>
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Chest pain arising from lungs/respiratory tract usually will be accompanied by symptoms such as shortness of breath & cough.</div>
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<b>Lungs infection (pneumonia/lung abscess) </b></div>
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In the case of lung infection, chest pain is usually not the main complaint. Initially fever and cough are the likely problems. When the infection gets worse, shortness of breath may occur as more lung volume is involved.</div>
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<i>Pneumonia: common lungs pathology but chest pain not common</i></div>
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<b>Pneumothorax</b></div>
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This is a condition where air gets into the pleural cavity (space between the outer lungs and inner chest wall), causing the lung to collapse. This can occur during trauma/injury to the chest or spontaneously. </div>
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In pneumothorax, shortness of breath is usually the first and most prominent symptom. In trauma case, of course the sufferer will have obvious chest injury and pain. In spontaneous case (without trauma), chest pain may be felt which may be worse when breathing in.</div>
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Pneumothorax is potentially fatal and sufferer should get immediate medical attention.</div>
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<b>Pleuritis</b></div>
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Pleuritis is inflammation of the pleural which line the lungs and inner chest wall. Typically the pain is felt more when taking a deep breath in, as the pleural rub against the chest wall more during a deep breath.</div>
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<i> Pathology involving pleural will cause pleuritic pain (pain aggravated by breathing)</i></div>
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<b>Lung cancer</b></div>
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Depends on the size and site of the cancer, lung cancer can give rise to chest pain but not very common. Other associated symptoms are cough, cough out blood, shortness of breath, loss of weight/appetite.</div>
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<b>Pulmonary embolism</b></div>
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Pulmonary embolism occurs when a blood clot from the veins of lower part of body travel to the lungs and block the blood supply to a portion of the lung. This can cause sudden sharp chest pain, accompanied by shortness of breath. If the clot is large, it is potentially life-threatening.</div>
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<b>Asthma</b></div>
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Obviously in asthma, sufferer will have shortness of breath and wheezing, and they may feel tightness in the chest as well.</div>
<br />
<a href="http://primaryhealthstation.blogspot.com/2013/02/chest-pain-how-to-differentiate.html" target="_blank">Click here for clues on how to differentiate chest pain.</a>Bryanhttp://www.blogger.com/profile/13569420354631343642noreply@blogger.com0tag:blogger.com,1999:blog-4048744292428624202.post-2731034065198931642013-02-15T15:46:00.000+08:002013-07-30T14:36:55.527+08:00Chest Pain: Is It Heart Problem?<div style="text-align: justify;">
</div>
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<b><u>Chest Pain: Is It Heart?</u></b></div>
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<b>Angina - precursor to "heart attack"</b></div>
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Angina is caused by narrowing of the coronary artery (which supply blood to heart muscle) which leads to temporary lack of blood/oxygen supply to the heart muscle when the demand for oxygen increases (during exertion). Thus, it is a condition of increased demand but limited supply of blood/oxygen.</div>
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<i>Narrowing of coronary artery causing angina</i></div>
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Typical angina is described as "pressing", "gripping", "tight" chest pain located at the center of chest which may radiate to the neck/jaw/left upper arm. This pain usually comes on exertion (physically or emotionally) and disappears during rest, and usually last <5min. This is referred as "stable angina".</div>
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<div style="text-align: justify;">
If this is the first time you encounter this type of pain, you should see a doctor to have further evaluation on the pain. Doctor will usually arrange an appointment for exercise stress test / CT angiogram / percutaneous angiogram depends on your risk factors & preference.</div>
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If you are already known to have coronary heart disease, you can take the medicine under the tongue (nitroglycerin). If the pain is not relieved by the medicine, or last longer, or is more severe or more frequent than it used to be, you should go to hospital immediately for treatment as this may indicate more advance artery occlusion. This is referred as "unstable angina".</div>
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<b>Myocardial infarction - true heart attack</b></div>
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<div style="text-align: justify;">
Heart attack means that the already-narrowed coronary artery is suddenly blocked 100% (usually by a clot) causing heart muscle to die. In this case, more & more heart muscles are dying every second and that's why time is very crucial. The faster the sufferer gets treatment to open up the blockage, the higher the chance of survival and the better the outcome.</div>
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<i>Total occlusion of coronary artery causing heart attack</i></div>
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<div style="text-align: justify;">
The nature of chest pain of heart attack is similar to angina but it is usually more severe and is commonly associated with other symptoms such as sweating, shortness of breath, dizziness, fainting, nausea etc. It can occur during exertion or even suddenly at rest (eg during sleep). However, sometimes the pain can be atypical and some elderly or diabetic patients may not feel the pain at all.</div>
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If you suspect yourself to have heart attack, please get someone else to drive you to nearest hospital as soon as possible, as every seconds count.</div>
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<div style="text-align: justify;">
<b>Aortic dissection</b></div>
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<br /></div>
<div style="text-align: justify;">
Another rare but important cause of chest pain is aortic dissection. It is important as it is life-threatening. In aortic dissection, the wall of aorta (which transport blood out of the heart to other body parts) is torn or seperated. Thus, it is usually described as severe "sharp" & "tearing" chest pain which may radiate to the back. </div>
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<i> Tearing of aortic wall</i></div>
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If the chest pain you experience is not the same as described above, it doesn't mean that it is not originating from the heart. When you are in doubt, always seek for medical attention.<br />
<br />
There are other causes of chest pain related to the heart, such as infection or inflammation of the 3 layers of heart wall - endocarditis, myocarditis & pericarditis. <br />
<br />
<a href="http://primaryhealthstation.blogspot.com/2013/02/chest-pain-how-to-differentiate.html" target="_blank">Click here for clues on how to differentiate chest pain.</a></div>
<br />Bryanhttp://www.blogger.com/profile/13569420354631343642noreply@blogger.com0tag:blogger.com,1999:blog-4048744292428624202.post-34911267658074164802012-12-07T19:20:00.000+08:002012-12-07T19:20:43.486+08:00Passing Bloody Stool: Why?<div style="text-align: justify;">
Passing bloody stool (per rectal bleeding) means that there is bleeding somewhere along the digestive tract, from the esophagus, stomach, small intestine, large intestine to anus.</div>
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There are many possible causes for passing bloody stool. the more common causes include (not a comprehensive list):</div>
<div style="text-align: justify;">
- hemorrhoids/piles (may be the most common one)</div>
<div style="text-align: justify;">
- anal fissure/fistula</div>
<div style="text-align: justify;">
- tumour/cancer in lower part of the bowel (everyone is afraid of this)</div>
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- massive bleeding from upper part of the bowel (stomach ulcer/varices/cancer)</div>
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- inflammatory bowel disease esp ulcerative colitis</div>
<div style="text-align: justify;">
- diverticulitis (in the elderly)</div>
<div style="text-align: justify;">
- angiodysplasia (in the elderly)</div>
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It's important to note that massive per rectal bleeding from any cause can be life threatening. If someone suspected or known to suffer from per rectal bleeding and is very unstable (giddy, breathless, fainted), then he/she must be sent to a hospital without delay.</div>
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<div style="text-align: justify;">
<em>Hemorrhoids: common cause of PR bleeding</em></div>
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<br /> </div>
<div style="text-align: justify;">
To find out the cause of bleeding, first we need to consider the nature of the blood. Because of gravity, bleeding occurs at any part of the digestive tract will eventually pass out through the anus. The important points about the nature of the blood are:</div>
<div style="text-align: justify;">
- the colour of the blood</div>
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- the amount of blood</div>
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- is the blood mixed with stool or seperated from stool</div>
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The shorter the time the blood in the digestive tract before being passed out, the fresher/more red the blood will be. Thus, if the bleeding point is at the lower part of digestive tract (large intestine, rectum, anus), the fresher the blood will be. The more massive the bleeding is (large volume of blood will flow faster), the fresher the blood will be. The blood will turn dark/black the longer it remains in the digestive tract due to oxidation of iron within the blood.</div>
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<div style="text-align: justify;">
Example of lower digestive tract bleeding that may give you fresh blood are hemorrhoids, anorectal fistula/fissures (anus/rectum), ulcerative colitis, diverculitis, angiodysplasia, colorectal cancer (large bowel).</div>
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Example of massive/heavy bleeding from upper part of digestive tract which may give "not so fresh" bloody stool are stomach/duodenal ulcer or variceal bleeding.</div>
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For most bleeding from the upper digestive tract (esophagus, stomach, small bowel), the blood will become black & tarry when being passed out (melena).</div>
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<em>melena stool: black & tarry</em></div>
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For bleeding from the lower part of the large bowel (rectum, anus), the blood usually do not mix with the stool and we can see blood dripping onto the toilet bowl.</div>
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For bleeding from higher up from the upper part of large bowel, the blood will usually mix with the stool.</div>
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After this, it is important to know whether there are other signs & symptoms accompanying the per rectal bleeding:</div>
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- pain when passing stool (usually due to anus fissure, hemorrhoids)</div>
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- tenesmus (persistent feeling of wanting to pass stool - usually due to tumour in the rectum)</div>
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- change in bowel habit (could be due to ulcerative colitis, tumour)</div>
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- abdominal discomfort/bloatedness (could be due to ulcerative colitis, diverticulitis, tumour)</div>
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- unexplained weight loss (could be due to ulcerative colitis, diverticulitis, tumour)</div>
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- anemia/pale (indicate either chronic little blood loss or sudden massive blood loss)</div>
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<em>Colonoscopy: Colon cancer which is bleeding</em></div>
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From the information gathered above, we can have an idea of where is the bleeding and what cause the bleeding. To confirm the diagnosis, an endoscopy is neccessary. If hemorrhoids or anal fissure is suspected, a proctoscopy should be enough. For lesion in the large bowel, a sigmoidoscopy/colonoscopy will be done. For lesion in the small bowel where the scope can't reach, an X-ray or CT scan with contrast can be done. Whereas for lesion high up in the stomach, duodenum & esophagus, a gastroscopy is a must.</div>
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If you have per rectal bleeding, you are advised to seek medical attention from your doctor.</div>
<br />Bryanhttp://www.blogger.com/profile/13569420354631343642noreply@blogger.com0tag:blogger.com,1999:blog-4048744292428624202.post-53019578943498832022012-11-09T11:48:00.003+08:002012-11-09T12:02:54.096+08:00Sudden Face Weakness: Do I Have Stroke?<div style="text-align: justify;">
If someone suddenly has one-sided facial weakness, this is usually due to problems within the nervous system that send electrical message to the group of affected facial muscles. It can be either the brain or the facial nerve.</div>
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Facial weakness may also cause difficulty in closing eyes, chewing, eating, drinking, talking and may lead to dry eye and dry mouth.</div>
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When we see someone who suddenly develop asymmetry face, most of us will straight away think that he/she must be suffering from stroke. However, there are also other reasons such as Bell's palsy, brain tumour etc.</div>
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<em> Facial nerve & facial weakness</em></div>
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Bell's palsy is not life-threatening. In Bell's palsy, the facial nerve is swollen but the reason is not clearly known though it is related to some viral infection. As the facial nerve run through a tight space around the skull, it will get compressed and injured when it is swollen. Thus, it loses its function and results in weakness of the muscles it controls.</div>
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The severity of facial weakness in Bell's palsy differs from mild to severe. It is most obvious when the sufferer is asked to show his/her teeth. It may take weeks to months to recover its strenght depending on the severity. The sooner it improves, the higher the chance that the sufferer will regain full facial muscle strenght. If the weakness persists for months, then there is higher chance that the weakness may not recover fully.</div>
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Another more worrying cause of sudden one-sided facial weakness is stroke. Stroke is either caused by blockage of blood vessel that supply the brain (ischemic stroke - more likely) or bleeding in the brain. In stroke, not only the facial nerve is affected, it often involves other muscle groups in the head and limbs as well. Thus, the stroke sufferer may also have one-sided weakness in his/her arm & leg.</div>
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<div style="text-align: justify;">
<em>Ischemic stroke</em></div>
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<br /></div>
<div style="text-align: justify;">
Tumour in the brain or around the facial nerve may compress the nerve and cause facial weakness. As tumour (also bleeding in the brain) will occupy some space in the skull, it will increase the pressure within the skull and produce symptoms such as headache, vomiting, visual disturbance, altered concious level and even coma. This is life threatening and the patient should get immediate medical attention.</div>
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<em> Brain tumour in a CT scan</em></div>
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How to differentiate between Bell's palsy, stroke and brain tumour when someone has one-sided facial weakness?</div>
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As a rule of thumb:</div>
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<br /></div>
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If the weakness involves other part of the body other than the face, ie limbs, then it is <strong>NOT</strong> Bell's palsy, but could be stroke or brain tumour.</div>
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<div style="text-align: justify;">
If no other part of body is involved other than the face, it could be Bell's palsy, brain tumour but <strong>UNLIKELY</strong> to be stroke.</div>
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<div style="text-align: justify;">
If there are symptoms of persistent vomiting, visual disturbance and altered mental status, then it is <strong>NOT</strong> Bell's palsy, but could be stroke or brain tumour. Generally in stroke, the symptoms occur suddenly but for brain tumour, the symptoms develop gradually. Only a brain scan (CT scan) can differentiate both.</div>
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<div style="text-align: justify;">
If there is only pure one-sided facial weakness and nothing else (except may be some mild headache), then it is <strong>LIKELY</strong> to be Bell's palsy.</div>
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If you are not sure, see your doctor for proper examination.</div>
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For Bell's palsy, doctors may prescribe steroids (prednisolone 1mg/kg or 60mg/day) for 6 days, then taper down the dose for 10 days. This has been shown to reduce facial nerve swelling, reduce the duration and increase the chance of full recovery. It is most effective if taken within 3 days of onset of facial weakness. However, those who do not take steroids also have a chance to recover fully.</div>
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Anti-viral drugs can be prescribed together with prednisolone but its effectiveness is still not clear. Eye drops and eye patch can be used especially during sleep to relieve dry eyes.</div>
Bryanhttp://www.blogger.com/profile/13569420354631343642noreply@blogger.com0tag:blogger.com,1999:blog-4048744292428624202.post-3996861452129778232012-09-07T15:04:00.000+08:002012-09-07T15:12:18.168+08:00Sudden Red Patch On Eye White<div style="text-align: justify;">
You wake up in the morning and look into a mirror and notice that one of your eye is red like a monster. Your friend looks curiously into your eye and ask you why your eye is so red but you are not aware of it. How could your eye turn red without you even knowing it?</div>
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There are a lot of causes for red eyes, some can be serious and some are not. If there is no preceding trauma/injury to the eye, and no symptoms such as eye pain, blur vision, fever, dry eye, itchiness or major eye discomfort, then there is a high chance that the red eye could be due to subconjunctival hemorrhage.</div>
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Conjunctiva is a thin & transparent membrane that cover the sclera (white part of eye) and inner sides of eyelids. It contains small blood vessels which are usually not clearly visible. When the conjunctiva get irritated, infected & inflamed, the vessels will become prominent as shown in conjunctivits. If the vessels break and bleed, it will lead to subconjunctival hemorrhage.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhU9Ez5u5IXfQHB56h4mEYHh3iocC92d48rnFOd_mO-QryFo-r7zTNXLQHOjRjIcSpL2CY_RpIqPszDAjarinxpZPG9LNAC3_8vP8UQLKese6VGXE3skIEB1JMCEljPTLAb8uaM3N0N39Y/s1600/Subconj+hem.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhU9Ez5u5IXfQHB56h4mEYHh3iocC92d48rnFOd_mO-QryFo-r7zTNXLQHOjRjIcSpL2CY_RpIqPszDAjarinxpZPG9LNAC3_8vP8UQLKese6VGXE3skIEB1JMCEljPTLAb8uaM3N0N39Y/s320/Subconj+hem.jpg" width="320" /></a></div>
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<i> Subconjunctival hemorrhage</i></div>
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There are a few causes for subconjunctival hemorrhage.</div>
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- spontaneous without a reason</div>
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- due to increased pressure: coughing, sneezing, straining, vomiting, hypertension</div>
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- due to eye injury or trauma, eye-rubbing</div>
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- due to bleeding tendency: bleeding disorders, blood thinning medicine</div>
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Other than a bright red patch with clear margin, subconjunctival hemorrhage DOES NOT come with eye pain or change in vision (except in trauma). If you have eye pain, eye discharge, blur vision, then it could be something else which could be more serious. If you have eye trauma/injury, you should see a doctor to make sure that there is no other injury. If you have multiple red patches on both eyes, then it could be due to underlying systemic disorder such as bleeding disorder.</div>
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Subconjuctival hemorrhage is generally regarded as harmless. There is no particular treatment and it can cure by itself. The red patch will turn smaller and more pale with time, and usually heal without scar in 1-2 weeks time. If the red patch lasts for more than 2 weeks, or if you have any doubt, then it is advisable to seek medical attention.</div>
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<br />Bryanhttp://www.blogger.com/profile/13569420354631343642noreply@blogger.com0tag:blogger.com,1999:blog-4048744292428624202.post-22354956695562373052012-06-01T15:28:00.000+08:002012-06-01T15:33:14.348+08:00High Uric Acid: Do You Need Treatment?<div style="text-align: justify;">
Gout is a disease caused by disturbance in uric acid metabolism which gives rise to high uric acid level in the blood (hyperuricemia).</div>
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Gout can affect mainly two body parts:</div>
<ul style="text-align: justify;">
<li>joints (gouty arthritis)</li>
<li>kidneys (urate nephropathy) -which can cause kidney stones and kidney failure</li>
</ul>
<div style="text-align: justify;">
Normal uric acid level in the blood varies between male and female:</div>
<ul style="text-align: justify;">
<li>male < 420 mmol/L (7 mg/dl)</li>
<li>female < 360 mmol/L (6 mg/dl)</li>
</ul>
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If your uric acid level is high, then you have a higher chance of getting gout. The higher the level, the higher the risk, generally.</div>
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What if your uric acid level is slightly higher than normal limit? Do you need to get treatment to lower your uric acid level to prevent gout? </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdVsXoaOh9ECV5YbwnZBNObNyAbjGz9ATZ8G15k3pPCIwmu8yRo9B4jH7ukC6ZeBUKBTA0xgugFcckYD3u4v7v-tL-qtY6be_9r_e_meGtlMAoYiKyHUTNpJXosgk2rUL4uWKCEbiU6HI/s1600/uricacidcrystals.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdVsXoaOh9ECV5YbwnZBNObNyAbjGz9ATZ8G15k3pPCIwmu8yRo9B4jH7ukC6ZeBUKBTA0xgugFcckYD3u4v7v-tL-qtY6be_9r_e_meGtlMAoYiKyHUTNpJXosgk2rUL4uWKCEbiU6HI/s320/uricacidcrystals.jpg" width="320" /></a></div>
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<i> uric acid needle-like crystals </i></div>
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The most popular medicine to lower uric acid is allopurinol. This medicine can have serious side effects (hypersensitivity, though rare) and may react with other medicines you take concurrently. If you start the allopurinol treatment, you need to continue for your whole life to prevent gouty arthritis and renal impairment.</div>
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There are other treatment option like probenecid and an emerging new drug called feboxostat which has shown promising effect. However, the most cost-effective choice is still allopurinol at the moment.</div>
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<div style="text-align: justify;">
The simple guide to determine whether you need drug treatment to lower your uric acid are:</div>
<ul style="text-align: justify;">
<li>Persistent sky high uric acid level > 770mmol/l (13mg/dl) for male and >600mmol/L (10mg/dl) for female</li>
<li>Three or more episodes of acute gouty arthritis in a year</li>
<li>Presence of urate nephropathy (urate kidney stones / kidney damage)</li>
<li>Presence of tophi (chronic tophaceous gout)</li>
<li>Presence of erosive gouty arthritis (from clinical or X-ray)</li>
</ul>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFBGRMN1CfmftdDXKxbJ2lpuhLxmy38IByD1Z_2qePfDJ7Pj52bRtCUmM9dagqdSpE5qCXBg-Vl4hh11sGG14kxsDNA_kHqZkIPHtBPjB6VQvxgrLPaAREHxsbBSDq8JUYlXLhV_AyTPI/s1600/acute+gout.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFBGRMN1CfmftdDXKxbJ2lpuhLxmy38IByD1Z_2qePfDJ7Pj52bRtCUmM9dagqdSpE5qCXBg-Vl4hh11sGG14kxsDNA_kHqZkIPHtBPjB6VQvxgrLPaAREHxsbBSDq8JUYlXLhV_AyTPI/s320/acute+gout.jpeg" width="320" /></a></div>
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<i> Acute gouty arthritis: red, swollen & extremely painful</i></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsIaaaky-okQu18zEbkaNyOr09333V7fuFi-mMi1bNMaacpjSLtJTHoubgLdZxBkpaa-zBFrGop902rr6LurcEHzWP-UUZY7-nev7p_ZRxK5kXspgdF863MuJZ8sysrrU74nihbkw68N8/s1600/gout+podagra.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="208" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsIaaaky-okQu18zEbkaNyOr09333V7fuFi-mMi1bNMaacpjSLtJTHoubgLdZxBkpaa-zBFrGop902rr6LurcEHzWP-UUZY7-nev7p_ZRxK5kXspgdF863MuJZ8sysrrU74nihbkw68N8/s320/gout+podagra.jpg" width="320" /></a></div>
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<i>Most common site: first metatarsal phalangeal joint (podagra)</i></div>
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<div style="text-align: justify;">
If you have one of these conditions, then you will probably benefit from treatment to lower your uric acid level. If not treated, you stand a higher risk of irreversible joint damage and kidney failure. </div>
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<div style="margin-bottom: 0in; text-align: justify;">
Please take note that not any joint pain is related to gout. The commonest joints involved in gout is: base of big toe →
forefoot → ankle → knee → wrist → elbow → fingers</div>
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<i> Tophus on toe</i></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_u7hPq1G__2EaKr3Ftw2O1Nun357tT5kivJwfPLj0HlElOsmGOem_JtSrOsYfKT9qb1UQjA5TS8DnF43m2IUQyiFMsav5V_F4S4sIyTOX3XLc0cplonZORFfr1s_-nttR6NWyti0oTj8/s1600/tophi+hands.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="184" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_u7hPq1G__2EaKr3Ftw2O1Nun357tT5kivJwfPLj0HlElOsmGOem_JtSrOsYfKT9qb1UQjA5TS8DnF43m2IUQyiFMsav5V_F4S4sIyTOX3XLc0cplonZORFfr1s_-nttR6NWyti0oTj8/s320/tophi+hands.jpg" width="320" /></a></div>
<div style="margin-bottom: 0in; text-align: justify;">
<i>Multiple tophi on hands</i></div>
<div style="margin-bottom: 0in; text-align: justify;">
<br /></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvqwHsU0SyJ-cczZxM8Ax-9OeGk-tVhQS0fQDLoBDAIi9JA8gmpCGOuoy9EqHGqH2GP83GaZAQs0U5eEgAJ_VDhNM1QT81QNEgfHh7FaBog5j5u7NvEByDHeylOqG7zrfvaJVMRDnKXUk/s1600/pinna+tophi.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvqwHsU0SyJ-cczZxM8Ax-9OeGk-tVhQS0fQDLoBDAIi9JA8gmpCGOuoy9EqHGqH2GP83GaZAQs0U5eEgAJ_VDhNM1QT81QNEgfHh7FaBog5j5u7NvEByDHeylOqG7zrfvaJVMRDnKXUk/s320/pinna+tophi.jpg" width="232" /></a></div>
<div style="margin-bottom: 0in; text-align: justify;">
<i> Tophi on pinna of the ear</i></div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
You need to see a doctor to commence allopurinol, as it may precipitate gout attack. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
Apart from taking medication, lifestyle changes should not be overlooked:</div>
<ul style="text-align: justify;">
<li>Restrict high purine diet: meat, seafood, animal organs</li>
<li>Restrict high fructose junk food: soft drinks etc </li>
<li>Weight reduction</li>
<li>Plenty of fluids intake: 2-3L/day</li>
<li>Alcohol restriction</li>
<li>Control co-morbidity (gout-related illness): hypertension, high lipids, high blood sugar </li>
</ul>Bryanhttp://www.blogger.com/profile/13569420354631343642noreply@blogger.com0tag:blogger.com,1999:blog-4048744292428624202.post-4695378145369528302012-04-21T12:02:00.000+08:002012-06-01T15:29:04.762+08:00Corticosteroids Equivalent DoseEquivalent
<u>anti-inflammatory</u> doses of different oral corticosteroids<br />
<br />
<b>Prednisolone </b>5mg<br />
is
equivalent to <b>betamethasone </b>750 mcg<br />
is equivalent to <b>cortisone acetate</b>
25 mg<br />
is equivalent to <b>dexamethasone </b>750 mcg<br />
is equivalent
to <b>deflazacort </b>6mg<br />
is equivalent to <b>hydrocortisone </b>20mg<br />
is
equivalent to <b>methylprednisolone </b>4mg<br />
is equivalent to <b>traimacinolone
</b>4mg<br />
<br />
<br />
Note that mineralocorticoid side effects are
most marked with <b>fludrocortisone</b>, but are significant with cortisone, hydrocortisone,
corticotropin, and tetracosactide (tetracosacrtin). Minerlacorticoid actions are
negligible with the high potency glucocorticoids, betamethasone and dexamethasone,
and occur only slightly with methylprednisolone, prednisolone, triamcinolone.<br />
<br />
<br />
<b><u>Topical corticosteroids: </u></b><br />
The potency of topical corticosteroids is determined by<br />
<ul>
<li>the extent to which it inhibits inflammation </li>
<li>the specific modification (esterification) of the steroid molecule
e.g. - hydrocortisone (acetate) 1% is mild but hydrocortisone butyrate
0.1% is a potent preparation <b> </b></li>
<li>the formulation</li>
<li>presence of other ingredients such as urea or salicylic acid which may increase the absorption of the drug </li>
<li>occlusive dressings or increasing hydration of the stratum corneum (increases steroid absorption) </li>
</ul>
<b>POTENCY EXAMPLES</b><br />
<ul>
<li> <b>mild</b>
<ul>
<li>hydrocortisone 0.1-1% </li>
</ul>
</li>
</ul>
<ul>
<li> <b>moderate
</b> <ul>
<li>clobetasone butyrate 0.05% </li>
</ul>
</li>
</ul>
<ul>
<li>
<b>potent</b> <ul>
<li>hydrocortisone butyrate </li>
<li>betamethasone valerate
0.1%<br /> <br /> </li>
</ul>
</li>
<li><b>very potent </b> <ul>
<li>clobetasol propionate
0.05%</li>
</ul>
</li>
</ul>
<br />Bryanhttp://www.blogger.com/profile/13569420354631343642noreply@blogger.com0tag:blogger.com,1999:blog-4048744292428624202.post-61454891535894930542012-02-03T09:23:00.003+08:002012-02-08T21:49:47.515+08:00Adult Immunization Schedule 2012<div style="text-align: justify;">The Advisory Committee on Immunization Practices (ACIP) of United States of America recently release the latest Immunization schedule for adult in 2012.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><b><u><i>* As of February 2012 </i></u></b></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><br />
</div><div class="separator" style="clear: both; text-align: justify;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhO2lPV2NCus0X2M6bf1u12W164T7s4LTE0S2emfRChqaf4bcsrp8GgQbmvaJugVYeY-7-VzvzWeFKohK-Ws9hWZalLzn3WNqxd9MHZ6X-ze1exBnepUsKX3-10a04r1TnecBaz6dAEDXU/s1600/Immun+US.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="385" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhO2lPV2NCus0X2M6bf1u12W164T7s4LTE0S2emfRChqaf4bcsrp8GgQbmvaJugVYeY-7-VzvzWeFKohK-Ws9hWZalLzn3WNqxd9MHZ6X-ze1exBnepUsKX3-10a04r1TnecBaz6dAEDXU/s400/Immun+US.jpg" width="400" /> </a></div><div class="separator" style="clear: both; text-align: justify;"><br />
</div><div class="separator" style="clear: both; text-align: justify;"><br />
</div><div class="separator" style="clear: both; text-align: justify;">For adults with special medical condition:</div><div class="separator" style="clear: both; text-align: justify;"></div><div class="separator" style="clear: both; text-align: justify;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhajwh14zRYA6xf4SDubZiqE0PmavxR7sexwDevRrTY50agokmwGf_o_Bj72gUWFNwgG0ikcowrzcjWr6Cna6CdFPI_3M2mPJ6329rH4207_7D8UmRI_48Ve0GT7OnWrjxJ0f3Nni0BJ9A/s1600/Immun+US+Med.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhajwh14zRYA6xf4SDubZiqE0PmavxR7sexwDevRrTY50agokmwGf_o_Bj72gUWFNwgG0ikcowrzcjWr6Cna6CdFPI_3M2mPJ6329rH4207_7D8UmRI_48Ve0GT7OnWrjxJ0f3Nni0BJ9A/s400/Immun+US+Med.jpg" width="397" /></a></div><div class="separator" style="clear: both; text-align: justify;"></div><div class="separator" style="clear: both; text-align: justify;"><br />
</div><div class="separator" style="clear: both; text-align: justify;">These schedules will be updated annually, and may differ between every countries. Please consult your local doctors regarding the immunization schedule in your country.</div>Bryanhttp://www.blogger.com/profile/13569420354631343642noreply@blogger.com0tag:blogger.com,1999:blog-4048744292428624202.post-87550945202560819872011-12-23T19:15:00.002+08:002011-12-23T19:20:22.710+08:00Common Causes of Vaginal Discharge<div style="text-align: justify;">When a female has symptoms of abnormal vaginal discharge & odor, vaginal pain & itchiness, and/or burning sensation when passing urine, she may be infected by one of these organisms: bacteria, fungus or protozoa parasite.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Bacteria infection in the vagina is called bacterial vaginosis. It is most commonly caused by <i>Gardnerella vaginosis</i>, or less commonly by <i>Bacteroides</i>, <i>Fusobacterium, Ureaplasma, Mycoplasma </i>etc, when the balance of good & bad bacteria in the vagina is disrupted. Besides vaginal irritation, bacterial vaginosis typically produces fishy-smell thin gray/white homogenous vaginal discharge which is adherent to the vaginal wall. It is not considered as a sexually transmitted disease as sexually inactive female can still be infected. However, the risk of infection increases with multiple sexual partners and douching. </div><div style="text-align: justify;"><br />
</div><div class="separator" style="clear: both; text-align: justify;"><a href="http://1.bp.blogspot.com/-5tw6VHPBYng/TvRhaQU1Q6I/AAAAAAAAAHs/1L86o1nB0CI/s1600/Bac+vag.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="318" src="http://1.bp.blogspot.com/-5tw6VHPBYng/TvRhaQU1Q6I/AAAAAAAAAHs/1L86o1nB0CI/s320/Bac+vag.jpg" width="320" /></a></div><div style="text-align: justify;"> <i> Bacterial vaginosis: white thin discharge, with fishy smell</i></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Vaginal candidiasis is a fungal infection in vagina usually caused by yeast <i>Candida albicans.</i> Certain amount of yeast live in the normal vaginal tract with other bacteria. When the amount of yeast overgrow other bacterias, such as when broad-spectrum antibiotics are taken or poor immunity, vaginal candidiasis can occur. The vaginal discharge is white and curd-like but lack odor. It is quite common and is not considered a sexually transmitted disease.</div><div style="text-align: justify;"><br />
</div><div class="separator" style="clear: both; text-align: justify;"><a href="http://4.bp.blogspot.com/-N0UA-ZcAF7k/TvRgpCNegBI/AAAAAAAAAHU/cvN9HV3_SzI/s1600/vaginal-candida.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="238" src="http://4.bp.blogspot.com/-N0UA-ZcAF7k/TvRgpCNegBI/AAAAAAAAAHU/cvN9HV3_SzI/s320/vaginal-candida.jpg" width="320" /></a></div><div style="text-align: justify;"> <i> Candidiasis: White thick curd-like discharge</i></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Trichominiasis is caused by infection of a protozoa called <i>Trichomonas vaginalis</i>. It typically produces greenish & yellowish foul-smelling vaginal discharge and causes significant pain during sexual intercourse. It is a sexually transmitted disease and can affect male as well. It is said that 70% of infected female have no symptoms though.</div><div style="text-align: justify;"><br />
</div><div class="separator" style="clear: both; text-align: justify;"><a href="http://4.bp.blogspot.com/-n0uBQGh2mKg/TvRiCyrll4I/AAAAAAAAAH4/mkujRJpeHwk/s1600/straw+cerv.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="293" src="http://4.bp.blogspot.com/-n0uBQGh2mKg/TvRiCyrll4I/AAAAAAAAAH4/mkujRJpeHwk/s320/straw+cerv.jpg" width="320" /></a></div><div class="separator" style="clear: both; text-align: justify;"></div><div style="text-align: justify;"> <i> Strawberry Cervix: typical in Trichomoniasis</i></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">All three types of infection can occur during pregnancy, and are known to increase the risk of preterm labour and low birth weight. To know what type of organism it is, vaginal fluid/discharge can be taken and study under a microscope. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Bacterial vaginosis is the commonest cause of vaginitis, followed by candidiasis and trichomoniasis. Sometimes it is not easy to differentiate them without lab tests.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">These infection can be treated when the type of culprit is identified or suspected:</div><ul style="text-align: justify;"><li>Bacterial vaginosis: </li>
<ul><li>oral metronidazole 500mg twice a day for 7 days OR</li>
<li>oral metronidazole 2g as single dose OR </li>
<li>oral clindamycin 300mg twice a day for 7 days OR</li>
<li>topical clindamycin (cream/suppository) at bedtime for 3 nights</li>
</ul></ul><div style="text-align: justify;"></div><ul style="text-align: justify;"><li>Vaginal candidiasis: all types of anti-fungal (oral OR topical - in the vagina)</li>
<ul><li>oral fluconazole 150mg single dose OR</li>
<li> oral itraconazole 200mg twice a day for one day OR</li>
<li>anti-fungal cream/suppository at bedtime usually for 3-7 days</li>
</ul></ul><div style="text-align: justify;"></div><ul style="text-align: justify;"><li>Trichomoniasis: </li>
<ul><li>oral metronidazole 500mg twice a day for 7 days OR</li>
<li>oral metronidazole 2g as single dose</li>
</ul></ul><div style="text-align: justify;"><br />
Most infection can recur after treatment. Sometimes sexual partners have to be treated as well. For treatment during pregnancy, please consult your doctor.</div>Bryanhttp://www.blogger.com/profile/13569420354631343642noreply@blogger.com0tag:blogger.com,1999:blog-4048744292428624202.post-28682239442673317812011-10-30T21:41:00.001+08:002011-10-30T21:43:05.739+08:00Urethral Discharge: Is it Urethritis?<div style="text-align: justify;">Urethritis is typically a sexually transmitted infection, but not always. It can be divided into gonococcal urethritis (GU) and non-gonococcal urethritis (NGU).</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Gonoccal urethritis is caused by the bacteria <i>Neiserria gonorrhea</i>, while NGU can be caused by other bacterias include <i>Chlamydia</i>, <i>Ureaplasma</i>, <i>Mycoplasma </i>and even syphilis etc.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><br />
</div><div class="separator" style="clear: both; text-align: justify;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxzPsf-1fCcXudnesLkTm8RvrNxcYGNeJV4I3onYDRnKqoK5WeydxdpM4M48MXNR488xI4WtgNvmEYDziLclJZapoPi7pHBth6GV8O3xDTmRj12ZaHGVJ8YjqbRqKgL6vWDNkGpmkf59U/s1600/Neisseria-gonorrhoeae.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxzPsf-1fCcXudnesLkTm8RvrNxcYGNeJV4I3onYDRnKqoK5WeydxdpM4M48MXNR488xI4WtgNvmEYDziLclJZapoPi7pHBth6GV8O3xDTmRj12ZaHGVJ8YjqbRqKgL6vWDNkGpmkf59U/s320/Neisseria-gonorrhoeae.jpg" width="320" /></a></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Both GU and NGU usually produce similar symptoms, though some infected people does not have any complains. The most common symptoms are:</div><ul style="text-align: justify;"><li>urethral /vaginal discharge</li>
<li>urethral/ vaginal itchiness / pain</li>
<li>dysuria (pain when passing urine)</li>
</ul><div style="text-align: justify;"><br />
Due to certain sexual practice, patients may also have symptoms (pain and discharge) at the pharynx, anus or rectum.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Sometimes the infection may spread to the adjacent organs such as bladder (cystitis), testis (orchitis), epididymis (epididymitis), cervix (cervicitis), ovary (oophroritis) etc.</div><div style="text-align: justify;"><br />
</div><div class="separator" style="clear: both; text-align: justify;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEge7McDwyXec2EDBrWNqKy_hevAv5tBtHKU7gbWanVe5GJ7kyUNanTOKM8UDiwTM2SJNqCRJb4umQvGE6y_zKOwUnhjnc-B5F2eR71kzQDcm-5aD8zaCFw37HV5O7KYDKpgfP6wzdTcggA/s1600/image_gallery.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEge7McDwyXec2EDBrWNqKy_hevAv5tBtHKU7gbWanVe5GJ7kyUNanTOKM8UDiwTM2SJNqCRJb4umQvGE6y_zKOwUnhjnc-B5F2eR71kzQDcm-5aD8zaCFw37HV5O7KYDKpgfP6wzdTcggA/s1600/image_gallery.jpg" /></a></div><div style="text-align: justify;"><i> Urethral discharge from tip of penis</i></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Useful investigation:</div><ul style="text-align: justify;"><li>urethral discharge swab</li>
<ul><li>gram stain (GU - intracellular gram negative diplococci)</li>
<li>culture & sensitivity (modified Thayer Martin culture)</li>
<li>nucleic acid amplification test (NAAT)</li>
</ul><li>urine</li>
<ul><li> FEME/culture (not very useful)</li>
</ul></ul><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Treatment (CDC 2010 guidelines):</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Since GU and NGU commonly co-exist. It is preferable to cover both condition when treatment for urethritis is give. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u>Uncomplicated GU</u></div><ul style="text-align: justify;"><li>IM ceftriaxone 250mg single dose OR</li>
<li> T cefixime 400mg single dose OR</li>
<li>T cefuroxime 1g single dose</li>
</ul><div style="text-align: justify;"><u>Plus (for NGU)</u></div><ul style="text-align: justify;"><li>T azithromycin 1g single dose OR</li>
<li>T doxycycline 100mg bd for 7 days</li>
</ul><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Contact tracing should be done. Those who has recent sexual contact with patients should be treated, even if they are asymptomatic.</div>Bryanhttp://www.blogger.com/profile/13569420354631343642noreply@blogger.com0tag:blogger.com,1999:blog-4048744292428624202.post-83590112188305021212011-10-22T12:29:00.000+08:002011-10-22T12:29:42.596+08:00Various Types of Hair Loss<div style="text-align: justify;">Normal human hair grows in a cycle consists of 2 phases: growth phase and rest phase.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">In growth phase (anagen) which lasts for 2-3 years, the hair grow about 1cm a month. After that, it enters rest phase (telogen) which lasts for 3-4 months. During rest phase, hairs stop to grow. At the end of rest phase, the hairs will fall and a new cycle of growth phase will begin. A person normally shed 50-100 hairs a day.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Causes of hair loss:</div><ul style="text-align: justify;"><li><b><u>aging</u></b></li>
<ul><li>40% of men by 35 years old and 65% of men by 60 years old have noticeable hair loss </li>
<li>50% of women by 50 years old have noticeable hair loss</li>
</ul></ul><div style="text-align: justify;"></div><ul style="text-align: justify;"><li><b><u>genetic </u></b></li>
<ul><li>more prone to develop hair loss if one of your immediate family has it </li>
</ul></ul><div style="text-align: justify;"></div><ul style="text-align: justify;"><li><u><b>poor nutrition</b></u></li>
<ul><li>iron, zinc or protein deficiency </li>
</ul></ul><ul style="text-align: justify;"><li><u><b>medication</b></u></li>
<ul><li>warfarin, fibrates, anti-acne, ACE-inhibitor, calcium-channels blockers, allopurinol, anti-thyroid drugs, epilepsy drugs, birth control pills etc</li>
</ul></ul><div style="text-align: justify;"></div><ul style="text-align: justify;"><li><u><b>male-pattern baldness (androgenic alopecia)</b></u></li>
<ul><li>hair loss at both temporal areas & the top</li>
<li>treated with oral finasteride / topical minoxidil</li>
</ul></ul><div class="separator" style="clear: both; text-align: justify;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkp3NwMUrzjt7AKDnYe8Qb8P73sQUgMaR4Q7V3RDMPCDXsNe299TXRlAwzWQNQ6xe2JifC9u8WYskrA57tWXM2afSbKGM_5B92SVM_g0pjC5Fv2uNzqipSDYH-fYZkO5N2iSmd2AF8ZEE/s1600/male-pattern1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkp3NwMUrzjt7AKDnYe8Qb8P73sQUgMaR4Q7V3RDMPCDXsNe299TXRlAwzWQNQ6xe2JifC9u8WYskrA57tWXM2afSbKGM_5B92SVM_g0pjC5Fv2uNzqipSDYH-fYZkO5N2iSmd2AF8ZEE/s320/male-pattern1.jpg" width="320" /></a></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"></div><ul style="text-align: justify;"><li><b><u>female-pattern baldness (androgenetic)</u></b></li>
<ul><li>hair thinning at the mid-line top</li>
<li>treated with oral anti-androgen / topical minoxidil</li>
</ul></ul><div class="separator" style="clear: both; text-align: justify;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgy10I95Saqudhniot6xt0qYzRQYxNqpi-KH704xaMzz095-kwr-Xy4YBUhq1x0T16laQBUmYrsXcJzCKKNzP6_XvTmcqKftAnvjuvfYWT9g3sXlypqjiTVBoxU138Gpqnji4xCcBnU7dw/s1600/female-adrogenetic-alopecia.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgy10I95Saqudhniot6xt0qYzRQYxNqpi-KH704xaMzz095-kwr-Xy4YBUhq1x0T16laQBUmYrsXcJzCKKNzP6_XvTmcqKftAnvjuvfYWT9g3sXlypqjiTVBoxU138Gpqnji4xCcBnU7dw/s1600/female-adrogenetic-alopecia.jpg" /></a></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"></div><ul style="text-align: justify;"><li><u><b>telogen effluvium </b></u></li>
<ul><li>hair growth enters into telogen phase prematurely, triggered by body insult / stress such as: emotional/physical stress, surgery, starvation, high fever, serious illness, extreme diets, childbirth etc</li>
<li> hair loss starts 3-4 months after the stress event</li>
<li>reversible after the stress factors subside</li>
</ul></ul><div class="separator" style="clear: both; text-align: justify;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4e10pVsQZPO684FqdzMdjpmgWJnO3tFJNN3QXxR1ACLiQC55bXlUC-OdjmokFoQpe0nUU8HPnFlm_wpXhb8wBk-w0l_Ut9IhcJcJOWUzhzHWYN7Rrdhebn-8Ms2LpzQTsXEeWbqwaLmM/s1600/telogen_effluvium.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4e10pVsQZPO684FqdzMdjpmgWJnO3tFJNN3QXxR1ACLiQC55bXlUC-OdjmokFoQpe0nUU8HPnFlm_wpXhb8wBk-w0l_Ut9IhcJcJOWUzhzHWYN7Rrdhebn-8Ms2LpzQTsXEeWbqwaLmM/s1600/telogen_effluvium.jpg" /></a></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"></div><ul style="text-align: justify;"><li><u><b>anagen effluvium</b></u></li>
<ul><li> caused by chemotherapy drugs where actively growing hairs at anagen phase are most affected</li>
</ul></ul><div style="text-align: justify;"></div><ul style="text-align: justify;"><li><u><b>tinea capitis (scalp fungal infection / ringworm)</b></u></li>
<ul><li>itchy red scaly scalp with patchy hair loss</li>
<li>treated with topical anti-fungal </li>
</ul></ul><div class="separator" style="clear: both; text-align: justify;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhT31FzRZosQsX79siOmK9z_SE3BOwBlG9keruRbN4nTr7e5061QE45osdv4RGQ7QlQhMW7y2JTHyBG70JiNtXqu1_PiVSVg7VBKwt7Kp010dHbvDUgua_G4RKlya9WUsmBhSly6yp-Ock/s1600/DCTineaInfections1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhT31FzRZosQsX79siOmK9z_SE3BOwBlG9keruRbN4nTr7e5061QE45osdv4RGQ7QlQhMW7y2JTHyBG70JiNtXqu1_PiVSVg7VBKwt7Kp010dHbvDUgua_G4RKlya9WUsmBhSly6yp-Ock/s320/DCTineaInfections1.jpg" width="320" /></a></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"></div><ul style="text-align: justify;"><li><b><u>alopecia areata</u></b></li>
<ul><li>autoimmune disorder with exact cause unknown </li>
<li>non-scarring patchy hair loss</li>
<li>may regress (hair grow back), recur or progress to total baldness</li>
<li>treated with topical steroids/minoxidil or monthly steroid injection</li>
</ul></ul><div class="separator" style="clear: both; text-align: justify;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhkWYwKSEXvIZGx4okdgwBwX2gqu9-OXdW-UEhxpgAZ-DPcTRrp0Q6P3VkF8LEgI-bdPpJh9TllHIbvs9FWChGq3HkKtBPsx4R9RN7ZUNS65UFiZh3vRjMRV27ygE1OFIHFsYs1gajCHuw/s1600/alopecia_areata1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhkWYwKSEXvIZGx4okdgwBwX2gqu9-OXdW-UEhxpgAZ-DPcTRrp0Q6P3VkF8LEgI-bdPpJh9TllHIbvs9FWChGq3HkKtBPsx4R9RN7ZUNS65UFiZh3vRjMRV27ygE1OFIHFsYs1gajCHuw/s1600/alopecia_areata1.jpg" /></a></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"></div><ul style="text-align: justify;"><li><u><b>cicatricial alopecia (scarring)</b></u></li>
<ul><li>caused by inflammation and damage to hair follicles</li>
<li>patchy and permanent hair loss</li>
<li>associated with SLE and lichen planus</li>
</ul></ul><div class="separator" style="clear: both; text-align: justify;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGBVy-kCO868OnmC21uKC6sWPDzVlwdNhYXKb2GwEMeAgI7LTaet2Sh0xGoV31MuUJltWd8-YrZzqx8FbjlbnHItMFeHHWgIEAlAkTUxR5e9ELS4thbNjLhnyOFel1oAkhSht0XocAQFw/s1600/scarring.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGBVy-kCO868OnmC21uKC6sWPDzVlwdNhYXKb2GwEMeAgI7LTaet2Sh0xGoV31MuUJltWd8-YrZzqx8FbjlbnHItMFeHHWgIEAlAkTUxR5e9ELS4thbNjLhnyOFel1oAkhSht0XocAQFw/s1600/scarring.jpg" /></a></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"></div><ul style="text-align: justify;"><li><u><b>traction alopecia </b></u></li>
<ul><li>caused by regular use of hairstyles that tightly pulling the hair</li>
<li>patchy hair loss and non-permanent hair loss</li>
</ul></ul><div style="text-align: justify;"></div><ul style="text-align: justify;"><li><u><b>hormonal changes</b></u></li>
<ul><li>hyper- or hypothyroid</li>
<li>diabetes</li>
<li>childbirth / menopause</li>
</ul></ul><div style="text-align: justify;"></div><ul style="text-align: justify;"><li><u><b>excessive hair styling</b></u></li>
<ul><li> chemicals used & over-styling</li>
</ul></ul><div style="text-align: justify;"></div><ul style="text-align: justify;"><li><u><b>trichotillomania</b></u></li>
<ul><li>a mental disorder with irresistible hair-pulling</li>
<li>patchy bald areas</li>
</ul></ul>Bryanhttp://www.blogger.com/profile/13569420354631343642noreply@blogger.com0tag:blogger.com,1999:blog-4048744292428624202.post-3729049667933945562011-10-21T13:37:00.002+08:002011-10-21T13:59:02.124+08:00Abnormal Menstrual Bleeding<div style="text-align: justify;">An ideal menstrual cycle lasts for 28 days, with the first day calculated from the onset of menstrual bleeding and ovulation is at day-14 of the cycle. Normal menstrual cycle has a mean interval of 21-35 days, with a duration of 2-7 days and 30-80ml menstrual bleeding. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Anything outside these range may be viewed as abnormal. These can be:</div><ul style="text-align: justify;"><li><b>menorrhagia:</b> excessive (>80ml/day) or prolonged (>7 days) bleeding</li>
<li><b>polymenorrhea:</b> menstrual bleeding interval <21 days</li>
<li><b>oligomenorrhea:</b> menstrual bleeding interval >35 days</li>
<li><b>metrorrhagia:</b> irregular and more frequent menstrual bleeding</li>
<li><b>metromenorrhagia:</b> irregular, more frequent and excessive bleeding</li>
<li><b>dysmenorrhea:</b> excessive menses pain</li>
<li><b>amenorrhea:</b> absent of menstrual bleeding for >6 months</li>
<li><b>intermenstrual bleeding:</b> bleeding/spotting in between regular menstrual cycles</li>
<li><b>postmenopausal bleeding:</b> bleeding after >6 months menopause</li>
</ul><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Important causes of abnormal menstrual bleeding that need to be ruled out:</div><ul style="text-align: justify;"><li><u><b>Pregnancy and its related complication</b></u></li>
</ul><div style="text-align: justify;"></div><ul style="text-align: justify;"><li><u><b>Gynecological pathology</b></u></li>
</ul><div style="text-align: justify;"></div><ul style="text-align: justify;"><ul><li>Benign lesion</li>
<ul><li> uterine fibroid/polyp</li>
<li>cervical polyp</li>
<li>adenomyosis </li>
<li>polycystic ovary syndrome </li>
</ul></ul></ul><div style="text-align: justify;"></div><ul style="text-align: justify;"><ul><li>Non-benign lesion</li>
<ul><li> uterine cancer</li>
<li>ovarian cancer</li>
<li>cervical cancer</li>
<li>vaginal cancer</li>
<li>endometrial cancer</li>
<li>endometrial hyperplasia</li>
</ul></ul></ul><div style="text-align: justify;"></div><ul style="text-align: justify;"><ul><li>Pelvic inflammatory disease</li>
<ul><li> cervicitis</li>
<li>salpingitis</li>
<li>endometritis</li>
</ul></ul></ul><div style="text-align: justify;"></div><ul style="text-align: justify;"><ul><li>Trauma</li>
<ul><li> cervix</li>
<li>vagina</li>
<li>vulva</li>
</ul></ul></ul><ul style="text-align: justify;"><li><u><b>Endocrine disorders</b></u></li>
<ul><li>Hyperthyroidism</li>
<li>Hypothyroidism</li>
<li>Hyperprolactin</li>
</ul></ul><ul style="text-align: justify;"><li><u><b>Blood clotting disorders</b></u></li>
<ul><li> Thrombocytopenia</li>
<li>Von-Willebrand's disease</li>
<li>Coagulopathy</li>
</ul></ul><ul style="text-align: justify;"><li><u><b>Iatrogenic</b></u></li>
<ul><li>Oral contraceptive pills</li>
<li>Intrauterine contraceptive devices</li>
<li>Medication</li>
<ul><li>anti-coagulants</li>
</ul></ul></ul><ul style="text-align: justify;"><li><b><u>Dysfunctional uterine bleeding </u></b>(diagnosis of exclusion in the absence of organic disease)</li>
<ul><li>Stress / Excessive exercise etc.</li>
</ul></ul><div style="text-align: justify;"><br />
</div><div class="separator" style="clear: both; text-align: justify;"></div><div style="text-align: justify;"></div><br />
<div style="text-align: justify;">Dysfunctional uterine bleeding is more common in the extremes of reproductive age, which are the first 2 years after the onset of menses (menarche) and a few years before the termination of menses (menopause). About 90% of the abnormal bleeding is anovulatory, in which there is no ovulation within the cycle because of certain disruption in the hypothalamus-pituitary-ovary axis.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Important investigations for abnormal uterine bleeding</div><ul style="text-align: justify;"><li>pregnancy test</li>
<li>pelvis ultrasound scan</li>
<li>blood test: platelet, coagulation, thyroid function, prolactin</li>
<li>hysteroscopy</li>
<li>endometrial sampling/biopsy</li>
</ul><div style="text-align: justify;"><br />
</div><div class="separator" style="clear: both; text-align: justify;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVQ7lAHHaXUWzHYEZmouqKmQDu_LBFrLDk2J0wsY51hf_Kh4kT-9OVTskb5Q69V2kdWEeYd2RGAnRpxQZNyxXUQUfHZPOHRQErWw_DQq6Ntigyd5taNL87RUi9H7R6Pt1MhoWIFOjaenM/s1600/Endometrial-biopsy-.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVQ7lAHHaXUWzHYEZmouqKmQDu_LBFrLDk2J0wsY51hf_Kh4kT-9OVTskb5Q69V2kdWEeYd2RGAnRpxQZNyxXUQUfHZPOHRQErWw_DQq6Ntigyd5taNL87RUi9H7R6Pt1MhoWIFOjaenM/s1600/Endometrial-biopsy-.gif" /></a></div><div class="separator" style="clear: both; text-align: justify;"></div><div style="text-align: justify;"> <i> Endometrial biopsy</i></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">The treatment depends on the underlying cause of abnormal bleeding. If no organic disease can be found (dysfunctional uterine bleeding), treatment available includes:</div><ul style="text-align: justify;"><li>Tranexemic acid</li>
<li>NSAIDs</li>
<li>Danazol (ethisterone)</li>
<li>GnRH agonists</li>
<li>Combined oral contraceptive pills</li>
<li>Progesterone only pills</li>
<li>Intrauterine devices with progesterone</li>
<li>Endometrial ablation (if future pregnancy not wanted)</li>
<li>Hysterectomy (if future pregnancy not wanted)</li>
</ul>Bryanhttp://www.blogger.com/profile/13569420354631343642noreply@blogger.com0tag:blogger.com,1999:blog-4048744292428624202.post-13232412257135163372011-10-13T12:47:00.002+08:002011-10-13T13:10:18.493+08:00Why is My Platelet Count Low?<div style="text-align: justify;">Sometimes you just go for a routine blood test and you are told that your platelet count is abnormally low. The doctor may ask you whether you have easy bruising, red dots on your skin (petechiae), delayed blood clotting or spontaneous bleeding. You may or may not have these problems. What actually cause your platelet to be low?</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"></div><div style="text-align: justify;">Platelet is one of the 3 major types of blood cells produced in the bone marrow, besides red blood cells and white blood cells. Platelet is important in the process of blood clotting. If your platelet count is too low or not functioning, then you may have easy bleeding problem. The medical term of low platelet is thrombocytopenia.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><br />
</div><div class="separator" style="clear: both; text-align: justify;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjo8Hdn7KwWrbBCyibEIVI-rYohwk_RFj24tspI6o5_ohOigDPDV9GDjTcsRXMIvm7pzxmNLZUttgWb7zMf857DmJHsvhUegreExpg-UTWuPE-xnyqaAQ52D9fFk55VJfXaiCgr51KM_J0/s1600/bloodcells.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="208" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjo8Hdn7KwWrbBCyibEIVI-rYohwk_RFj24tspI6o5_ohOigDPDV9GDjTcsRXMIvm7pzxmNLZUttgWb7zMf857DmJHsvhUegreExpg-UTWuPE-xnyqaAQ52D9fFk55VJfXaiCgr51KM_J0/s320/bloodcells.jpg" width="320" /></a></div><div style="text-align: justify;"> <i> red cell, platelet, white cell</i></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Normal range of platelet count is between 150,000-450,000/mcL. If you find that your platelet count is low for the first time and you do not have any symptoms, you can repeat the test as sometimes during blood taking and processing, the platelets may clump. If 10 platelets clump together, the machine may read it as only one platelet.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Though platelet count <150,000/mcL is considered low, it usually will not cause bleeding problem as long as their function is not affected. Spontaneous bleeding may be a concern if the count is <20,000/mcL.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">There are many possible causes of thrombocytopenia. They can be classified into 3 large groups.</div><ol style="text-align: justify;"><li>Reduced production in bone marrow</li>
<li>Increased destruction (by immune system or not)</li>
<li>Splenic sequestration (due to enlarged spleen)</li>
</ol><div style="text-align: justify;"><br />
The list below are not comprehensive, only the important and common ones listed.</div><ul style="text-align: justify;"><li> Reduced production in bone marrow</li>
</ul><ul style="text-align: justify;"><ul><li>some viral infection (HIV, EBV, parvovirus, mumps, rubella, varicella, dengue)</li>
<li>some medication (thiazides, phenytoin, valproate)</li>
<li>alcohol </li>
<li>chemotherapy</li>
<li>radiation to the marrow</li>
<li>leukemia</li>
<li>lymphoma</li>
<li>cancer infiltrating the bone marrow </li>
<li>vitamin B12/Folic acid deficiency </li>
</ul></ul><ul style="text-align: justify;"><li>Increased destruction</li>
</ul><div style="text-align: justify;"></div><ul style="text-align: justify;"><ul><li> Idiopathic Thrombocytopenic Purpura (ITP)</li>
<li>Autoimmune diseases (Systemic Lupus Erythemathosus) </li>
<li>Drugs-induced (heparin, sulfonamides antibiotics, quinine, quinidine, carbamazepines, digoxin, paracetamol / acetaminophen)</li>
<li>Sepsis (severe systemic infection)</li>
<li>Disseminated Intravascular Coagulation (DIVC) </li>
</ul></ul><ul style="text-align: justify;"><li>Platelet sequestration</li>
</ul><div style="text-align: justify;"></div><ul style="text-align: justify;"><ul><li> chronic liver disease (cirrhosis)</li>
<li>leukemia</li>
<li>lymphoma</li>
</ul></ul><div style="text-align: justify;"><br />
If you have thrombocytopenia, you should check the numbers of your red and white blood cells. If they are normal, then it is less likely that the whole bone marrow is affected. The doctor will ask you some questions to find out any relation to the causes listed above, such as the medication you take, whether you have recent infection, your alcohol consumption, hepatitis status and other associated symptoms etc. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><br />
</div><div class="separator" style="clear: both; text-align: justify;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdFqcxD7LAvRff9nLgett-m_j_4GSgR7y7K0NW9jBF-cTKme0qVidlyLE_ki024-MSu0_U9yUWtZP25hrLAhHiI2V0monsD97KFAbrTxNCF-p5YtxeBsM3mIReujuwS1gkntUUa2G1L6I/s1600/petechiae.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdFqcxD7LAvRff9nLgett-m_j_4GSgR7y7K0NW9jBF-cTKme0qVidlyLE_ki024-MSu0_U9yUWtZP25hrLAhHiI2V0monsD97KFAbrTxNCF-p5YtxeBsM3mIReujuwS1gkntUUa2G1L6I/s320/petechiae.jpg" width="320" /></a></div><div style="text-align: justify;"> <i> petechiae can be a sign of low platelet</i></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">A peripheral blood film / full blood picture should be done to see the size, shape and characteristic of all 3 types of blood cells. Sometimes a bone marrow aspiration may be done to rule out abnormality in the marrow. If no cause can be found after extensive investigation, and the platelet count is persistently low, steroid treatment may be given as a trial. If the platelet count increase significantly after steroid treatment, then it is likely to be idiopathic thrombocytopenic purpura, where the low platelet count is caused by immune system mediated platelet destruction.</div>Bryanhttp://www.blogger.com/profile/13569420354631343642noreply@blogger.com0tag:blogger.com,1999:blog-4048744292428624202.post-76764444391700236332011-10-06T14:04:00.001+08:002011-10-06T14:09:26.614+08:00Urticaria: A Common Problem<div style="text-align: justify;">Urticaria, hives or wheals are raised, pink or red skin lesion that are usually associated with allergy. The lesion can be generalized or localized at certain body parts. It is a fairly common problem that everyone will experience in their lifetime. Some are mild, but some can be serious.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">When the mast cells are stimulated by allergens, they release certain chemical mediators such as histamine etc. These mediators result in the dilation of the small blood vessels in which fluid will leak out from the vessels into the tissues under the skin, causing the swelling in urticaria and the itchiness.</div><div style="text-align: justify;"><br />
</div><div class="separator" style="clear: both; text-align: justify;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkrjwB8-CtLAF79L0cKUPhl-hJPaNYjpv0mSRlKV1i3oe9D85pwahOAxxKAgCqrbrMtxEWQPNKKwNCat5U4F7kGKEYS3k_Qon4KO0TIXcCSATICxsTZRXXHy5w9Z7mMQpFB7p1v-54Vlc/s1600/urt.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="216" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkrjwB8-CtLAF79L0cKUPhl-hJPaNYjpv0mSRlKV1i3oe9D85pwahOAxxKAgCqrbrMtxEWQPNKKwNCat5U4F7kGKEYS3k_Qon4KO0TIXcCSATICxsTZRXXHy5w9Z7mMQpFB7p1v-54Vlc/s320/urt.jpg" width="320" /></a></div><div style="text-align: justify;"> <i>Urticaria rash</i></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Urticaria can be classified into a few types depends on its clinical manifestation</div><ul style="text-align: justify;"><li>acute (last<6 weeks)</li>
<li>chronic (last>6 weeks)</li>
<li>episodic (acute & intermittent)</li>
</ul><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Common causes of acute urticaria are allergy to certain foods or medication, insects bite and viral infection esp in children. The urticaria emerges within few minutes to few hours after the contact with allergens and typically goes away within a day.</div><div style="text-align: justify;"></div><div style="text-align: justify;"><br />
If the urticaria does not really goes away and persist for more than 6 weeks, then it is called chronic urticaria. The causes for chronic urticaria are more complex and may overlap with causes of acute urticaria. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Causes of chronic urticaria include:</div><ul style="text-align: justify;"><li>Physical</li>
<ul><li>dermatographism</li>
<li>pressure</li>
<li> cold </li>
<li>heat, exercise, stress (cholinergic)</li>
<li>sunlight</li>
<li>water (aquagenic)</li>
<li>vibration</li>
</ul></ul><div style="text-align: justify;"></div><ul style="text-align: justify;"><li>Food consumption (milk, nuts, eggs, seafood etc)</li>
</ul><div style="text-align: justify;"></div><ul style="text-align: justify;"><li>Insects bite/sting (scabies, bedbugs, fleas etc)</li>
</ul><div style="text-align: justify;"></div><ul style="text-align: justify;"><li>Contact urticaria (latex, animals, foods etc)</li>
</ul><div style="text-align: justify;"></div><ul style="text-align: justify;"><li>Medication and drugs</li>
<ul><li>aspirin</li>
<li>NSAIDs</li>
<li>ACE-inhibitors</li>
<li>opioids</li>
<li>alcohol</li>
</ul></ul><div style="text-align: justify;"></div><ul style="text-align: justify;"><li>Autoimmune conditions </li>
<ul><li>urticarial vasculitis</li>
<li>systemic lupus erythematosus (SLE)</li>
<li>autoimmune thyroid disorders</li>
<li>rheumatoid arthritis</li>
</ul></ul><div style="text-align: justify;"></div><ul style="text-align: justify;"><li> Infection</li>
<ul><li>hepatitis B</li>
<li> mycoplasma</li>
<li>streptococcus </li>
<li>herpes simplex virus</li>
<li>helicobacter pylori</li>
<li>mycobacterium tuberculosis</li>
</ul></ul><div style="text-align: justify;"></div><ul style="text-align: justify;"><li>Chronic idiopathic urticaria (no cause can be found)</li>
</ul><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">The actual cause for chronic urticaria is not easy to determine accurately. History from the patients is important and it can suggest physical, medication and food related urticaria. For example if the urticaria rash appears after a hot bath, then it is likely a cholinergic urticaria. Physical challenge can be done if physical cause is suspected.</div><div style="text-align: justify;"><br />
</div><div class="separator" style="clear: both; text-align: justify;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6KE4SRAcVeLvzYwd8HC9R8iKq7dIuCIXiMJzE2U7Fp0SzQWmKfbtp6Ah1GRJYtPPFrxJ-KPwNuz7Kr60c-u9zVgTXaP54fp-D4VmTUYniVqPv6SuvXb5XfsV5Klk7WNyLIKIDmF5lVhc/s1600/urticaria.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6KE4SRAcVeLvzYwd8HC9R8iKq7dIuCIXiMJzE2U7Fp0SzQWmKfbtp6Ah1GRJYtPPFrxJ-KPwNuz7Kr60c-u9zVgTXaP54fp-D4VmTUYniVqPv6SuvXb5XfsV5Klk7WNyLIKIDmF5lVhc/s320/urticaria.jpg" width="320" /></a></div><div style="text-align: justify;"> <i>Papular urticaria</i></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Laboratory tests are mainly done to rule out the presence of autoimmune disorders in chronic urticaria. Acute episode usually does not need any test. Tests that can be done include complete blood and differential count, ESR, CRP, IgE, ANA, RF, complement, thyroid function and its autoantibodies. Skin biopsy is beneficial only if urticarial vasculitis is suspected. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">The type of tests to be done depends on clinical evaluation by the doctor. If no cause can be found after thorough examination and investigation, the urticaria is referred to as chronic idiopathic urticaria.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Most common and useful treatment for urticaria is oral non-sedating anti-histamine (2nd or 3rd generation). If anti-histamines do not work well, other types of medication can be tried. If you know what is the most likely precipitating cause, then try your best to avoid it. Sometimes chronic urticaria may improve after a few years.</div>Bryanhttp://www.blogger.com/profile/13569420354631343642noreply@blogger.com0tag:blogger.com,1999:blog-4048744292428624202.post-60252624283477139452011-09-29T19:06:00.002+08:002011-09-29T19:10:43.839+08:00Blood Blister In The Mouth<div style="text-align: justify;">Sometimes you wake up in the morning and notice a black dot inside your mouth. You look closely into the mirror and notice that it looks like a blood-filled blister. Is it a serious problem?</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">It may be the first time you notice it, or it may have come and go for a few times before. Most likely the blood blister is caused by break of small blood vessels (capillaries) on the inner side of the mouth. If the bleeding continue, the lesion may enlarge. When the bleeding stops, the lesion will usually disappear within few days time. There may be slight pain or no pain at all.</div><div style="text-align: justify;"><br />
</div><div class="separator" style="clear: both; text-align: justify;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhL-1_D9gL2mnEDhDsE-FWlDx9kDBPfJKiCJFCE4a146XT-5ssVDkoAo3GTd2ObeG38a1Wsm2gtTpQhx2Q3eZOz9EoseHvwCcrCzH_ky9K2j8GhEDPbUx6Dq1J9eDh6yhVpI8yLEvjy7N0/s1600/Blood.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhL-1_D9gL2mnEDhDsE-FWlDx9kDBPfJKiCJFCE4a146XT-5ssVDkoAo3GTd2ObeG38a1Wsm2gtTpQhx2Q3eZOz9EoseHvwCcrCzH_ky9K2j8GhEDPbUx6Dq1J9eDh6yhVpI8yLEvjy7N0/s320/Blood.jpeg" width="180" /></a></div><div style="text-align: justify;"> <i>blood blister at inner cheek</i></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">This condition is usually benign, and is said to caused by minor trauma or injury to the oral mucosa. The trauma can be from chewing hard food, hot food, dentistry, brushing teeth, oral treatment, accidental self-biting during sleep etc. This condition is also called "angina bullosa hemorrhagica".</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Nevertheless, you need to rule out whether you bleed abnormally easily or not. You need to check whether you have blood blisters elsewhere in the body other than inside the mouth. If you have easy bruising, easy bleeding from gum or nose and your wound is slow to clot after injury, you might need to check your blood for platelet count and coagulation profile. Low platelet (thrombocytopenia) can cause easy bleeding, which is not very uncommon.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Sometimes the blood blister could be "pyogenic granuloma", which is actually a bunch of abnormal capillaries present as a red nodule and can bleed easily. Compare to angina bullosa hemorrhagica, pyogenic granuloma can occur on the skin all over the body. Its size can be large and may not heal even within weeks. Pyogenic granuloma is more common in children while angina bullosa hemorrhagica is more common in older adult. </div><div style="text-align: justify;"><br />
</div><div class="separator" style="clear: both; text-align: justify;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPrKblmH9H_IYANT_KBbvjYBHonI4eQh_Le17hP5hnu4p_y8KEm2stgeF1ULDNgCbpbKPsH8tHZHwMEqKzXyvlM35ncvlU90MiWzmFj8-7Z32vxMC8OpdEmMS2EGW8FisH3btP27pn0P0/s1600/pg.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPrKblmH9H_IYANT_KBbvjYBHonI4eQh_Le17hP5hnu4p_y8KEm2stgeF1ULDNgCbpbKPsH8tHZHwMEqKzXyvlM35ncvlU90MiWzmFj8-7Z32vxMC8OpdEmMS2EGW8FisH3btP27pn0P0/s1600/pg.jpg" /></a></div><div style="text-align: justify;"> <i>pyogenic granuloma</i></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">If the blood blister in your mouth come and go within few days, and you don't have any other problems such as fever or easy bleeding elsewhere, then it is probably angina bullosa hemorrhagica and is completely benign. If you are still worry, you should see a doctor and perhaps check your platelet and coagulation profile.</div>Bryanhttp://www.blogger.com/profile/13569420354631343642noreply@blogger.com0tag:blogger.com,1999:blog-4048744292428624202.post-84656496122564594652011-09-27T19:15:00.008+08:002011-10-02T14:13:30.715+08:00Hepatitis B in Pregnancy<div style="text-align: justify;">If you are a female and you are a hepatitis B carrier, is it alright to become pregnant?</div><div style="text-align: justify;"><br />
<div style="text-align: justify;">The answer is yes. However, you need to take extra precaution during pregnancy and delivery.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Hepatitis B is mainly transmitted through contact with blood, where it is present in high concentration. Other body fluids like saliva, semen, vaginal discharge etc contain less concentration of the virus.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><br />
</div><div class="separator" style="clear: both; text-align: justify;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5r5Xz8lLP1sfoK6iAMjZngpmsgUxl-7XrTdz09JDN8b09tI-HiVxnWnDnZtt0KbsjYRaGpbgKuSSuF_Z3ajgpVZSF83lKJq95auI6vIxKwQFKtHZRGEo-SSDRmGBeCXXHkSw9EzZoeP4/s1600/images.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5r5Xz8lLP1sfoK6iAMjZngpmsgUxl-7XrTdz09JDN8b09tI-HiVxnWnDnZtt0KbsjYRaGpbgKuSSuF_Z3ajgpVZSF83lKJq95auI6vIxKwQFKtHZRGEo-SSDRmGBeCXXHkSw9EzZoeP4/s1600/images.jpeg" /></a></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">First of all, the spouse of hepatitis B carrier need to check his hepatitis B virus and antibody status. If he is not a carrier and does not have the antibody, then he needs to get the 3 doses of hepatitis B vaccination at the interval of 0, 1, 6 months. When he gets the antibody, viral transmission during sexual intercourse with his carrier wife can be prevented. However, the antibody level may wean off with time and he should check its level regularly.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">When a woman who is also a hepatitis B carrier conceive, pregnancy is to continue as usual. Examination and blood test are done to make sure that she does not already reach the stage of chronic liver damage.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">If a woman with no known hepatitis B status first found to be infected during pregnancy, then the possibility of an acute infection need to be ruled out. If acute infection occurs in the first trimester, there is a 10% risk of transmission of virus to the baby. If it occurs in the third trimester, the risk is 80-90%. The incubation period of hepatitis B can range from 6 weeks to 6 months.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Generally, the risk of transmission of hepatitis B virus from a carrier mother to her baby is about 10-20%. If immunoprophylaxis (hepatitis B immunoglobulin - HBIG) is given to the baby soon after birth, the risk can be significantly reduced. Thus, every baby born by a hepatitis B carrier mother will receive a dose of HBIG and a dose of hepatitis B vaccine within 12 hours after birth. The vaccine need to be continued for another 2-3 doses later.</div><div style="text-align: justify;"></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Normal vaginal delivery does not significantly increase the risk of hepatitis B virus transmission to the baby compare to Cesarean section. Breast feeding should be allowed and encouraged, as long as the baby get the HBIG and vaccination.</div><div style="text-align: justify;"><br />
</div><div class="separator" style="clear: both; text-align: justify;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqdRLWdyPb86zeJmFxueI0TvdUAcE586YWNsToUNW1ZMUDtjjjf814oBEtmFjeMNGL9D3G8TtzmLxto9wJkN1VQyABXgyQf2u2hVG22O-CpkZbcogxhSBBBSYM_gd6EhaoLgWLbRSgl-Q/s1600/hepb.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="302" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqdRLWdyPb86zeJmFxueI0TvdUAcE586YWNsToUNW1ZMUDtjjjf814oBEtmFjeMNGL9D3G8TtzmLxto9wJkN1VQyABXgyQf2u2hVG22O-CpkZbcogxhSBBBSYM_gd6EhaoLgWLbRSgl-Q/s320/hepb.gif" width="320" /></a></div><div style="text-align: justify;"> <i> Hepatitis B virus</i></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">If unfortunately the newborn is infected with hepatitis B virus, there is a high chance (90%) that the baby will become a carrier. Not everyone infected will become a carrier. For children between 1-5 years old, the chance to become a carrier is 30%, while for adults, the chance is about 5%. Nevertheless, hepatitis B virus usually does not cause other problems such as malformation or organ malfunction to the infected baby. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">If you are not a hepatitis B carrier and would like to get hepatitis B vaccination during pregnancy, you can do so as the vaccine is reported as safe when given during pregnancy.</div></div>Bryanhttp://www.blogger.com/profile/13569420354631343642noreply@blogger.com0