Few days ago , a guy walk in to my consultation room with pain and swelling of his right foot for 3 months.He says the pain comes on and off, but the swelling is always there.He gave history of kicking a bunch of oil palm's leaves , and hence the leg became painfull the next day.He has no history of gout or family history of gout.
He had minor aberation on the foot, which is bloodless and heal up in two days.He ignores it, didn't get any treatment from any doctor.A week or two later, he had some discharge from the site of aberation wound.It heals after he cleans up the wound.Yet it comes again after a week or two later.
When i saw him, there was a small wound and discharge on the dorsal of the right foot.It was painfull.I assure him there was something inside the wound. He allows me to do some digging work.There was a piece of oil palm's 'torn' as big as rice seed at the end of the 'tunnel'.
It was common to see oil palm's torn punctured through under the skin and left behind unnoticed.it is because they are very very brittle, yet sharp at the end of it so when enough force applied it can punctured through the skin, and snapped.Un suspecting medical personnel can missed it and the patient will suffer of non healing wound.Some how the body will attack this foreign body and produce puss ,as a mechanism of rejecting it.
Usually, after the foreign body removed, the wound cleanned, and some antibiotic given, the wound will healed up in a few days.Pain killer may help the patient , to keep up in mobility.
Wednesday, January 21, 2009
Sunday, January 18, 2009
Chikugunya Fever
I fall sick for almost three weeks now. It was started as fever and body ache when i was in Beijing.That day we just visiting the tianmen square and the forbidden city. Our tour guides says we walked past 7 kilometer that day.No wonder i was dead tired.
The next day we tried to buy fever medicine from the pharmacy around the corner.However we cannot find any medicine on English labels. All in Mandarin.We end up buying fever medicine with strange name . We I took it ,it doesn't cure my fever, yet it caused my heart to run faster.The moral of the story is, next time, when you travel, bring along some medicine with you. just in case you need it.
My fever was never subsided when I reach home. The whole body become painful. My joints also painful.I feel nauseated and felt very dry. I can't swallow anything,I can't move around so i just choose to sleep.There was rashes on my both hands and feet.But starangely there was no sweat at all.Usually when i got fever, sweat will come after I took some paracetamol.I choose to treat my ownself. [well, being a doctor, I always thought i know more about my self]
Chikugunya fever is a viral infection. The virus was distributed by mosquitoes[ aedis agepty], ie the same mosquitoes that distribute denggi fever.In medicine, we call it vector.Last months was the highest incidence of chikugunya fever in our country. Probably i got infected when i was at my kampong. Our neighbour claimed there were almost everybody in the village get the same symptoms of fever joint pain and rashes.
Unfortunately there is no specific treatment for chikugunya fever.We give paracetamol to reduce the fever, alot of water, pain killer, and prednisolone and most importance is to have bed rest.I found it is releiving after drinking air zam zam[ holy water usually taken along by hajj pilgrimage]. i don't have enough stock, but i managed to buy from petronas petrol station along the kesas highway.So my advice for those who have the same symptom like me, buy zamzam water, and drink it as much as you can.It may cure you..
The next day we tried to buy fever medicine from the pharmacy around the corner.However we cannot find any medicine on English labels. All in Mandarin.We end up buying fever medicine with strange name . We I took it ,it doesn't cure my fever, yet it caused my heart to run faster.The moral of the story is, next time, when you travel, bring along some medicine with you. just in case you need it.
My fever was never subsided when I reach home. The whole body become painful. My joints also painful.I feel nauseated and felt very dry. I can't swallow anything,I can't move around so i just choose to sleep.There was rashes on my both hands and feet.But starangely there was no sweat at all.Usually when i got fever, sweat will come after I took some paracetamol.I choose to treat my ownself. [well, being a doctor, I always thought i know more about my self]
Chikugunya fever is a viral infection. The virus was distributed by mosquitoes[ aedis agepty], ie the same mosquitoes that distribute denggi fever.In medicine, we call it vector.Last months was the highest incidence of chikugunya fever in our country. Probably i got infected when i was at my kampong. Our neighbour claimed there were almost everybody in the village get the same symptoms of fever joint pain and rashes.
Unfortunately there is no specific treatment for chikugunya fever.We give paracetamol to reduce the fever, alot of water, pain killer, and prednisolone and most importance is to have bed rest.I found it is releiving after drinking air zam zam[ holy water usually taken along by hajj pilgrimage]. i don't have enough stock, but i managed to buy from petronas petrol station along the kesas highway.So my advice for those who have the same symptom like me, buy zamzam water, and drink it as much as you can.It may cure you..
Monday, November 10, 2008
Sensitivity and specificity
This definition of medical test is always a puzzle to me.I always get confused when trying to explain to another person.
Today i just read again the definition of it. It may give some help to you.
Sensitivity:
definition:probability of a positive test when the disease is present.
application:if the test has a high sensitivity, it will identify patients with the disease, and therefore a negative result indicates that the patient doest not have the disease.
Specificity:
definition:probability of a negative test when the disease is absent.
application:if the test has a high specificity, a negative result identifies people who do not have the disease , and therefore a positive result indicates that the patient has the disease.
Today i just read again the definition of it. It may give some help to you.
Sensitivity:
definition:probability of a positive test when the disease is present.
application:if the test has a high sensitivity, it will identify patients with the disease, and therefore a negative result indicates that the patient doest not have the disease.
Specificity:
definition:probability of a negative test when the disease is absent.
application:if the test has a high specificity, a negative result identifies people who do not have the disease , and therefore a positive result indicates that the patient has the disease.
Tuesday, October 7, 2008
WHAT IS MELAMINE
Oleh chekamala"(Copy and paste)
Given below are some clarification on the recent milk adulteration in China and how you can detect China made products.
Questions and Answers on melamine:
Melamine is an organic base chemical most commonly found in the form of white crystals rich in nitrogen.
What is melamine generally used for?
Melamine is widely used in plastics, adhesives, counter-tops, dishware, whiteboards and fertilizers.
Why was melamine added into milk and powdered infant formula?
In China , where adulteration has occurred, water has been added to raw milk to add to its volume. As a result of this dilution the milk will have a lower protein concentration. Companies using the milk for further production (e.g. of powdered infant formula) would normally check the protein level through a test measuring nitrogen content. Therefore the addition of melamine - because of its rich nitrogen content - could increase the level of nitrogen, which again masquerade as falsely high protein levels as the standard protein test only measures nitrogen content. This means that the adulterated milk would have an artificially high nitrogen level, which would be interpreted erroneously as a 'normal' or 'high' protein level.
Addition of melamine into food is not approved by the FAO/WHO Codex Alimentarius (food standard commission), or by any national authorities.
Has melamine been found in other food products?
In 2007, melamine was found in pet feed manufactured in China and exported to the United States which caused the death of a large number of dogs and cats due to kidney failure.
In the present event, melamine contamination has been found in a number of different brands of powdered infant formula, in one brand of a frozen yogurt dessert and in one brand of canned coffee drink. All these products were most probably manufactured using ingredients made from melamine contaminated milk.
What are the health effects of melamine consumptions in humans?
While there are no direct human studies on the effect of melamine on humans, extrapolation from animal studies can be used to estimate adverse health effects. When combined with another chemical (e.g. cyanuric acid which is also present in melamine powder) melamine can form crystals which can give rise to kidney stones.These small crystals can also block the small tubes in the kidney potentially stopping the production of urine, kidney failure and in some cases death.
Melamine has also been shown to have carcinogenic effects in animals.
What are the symptoms and signs of melamine poisoning?
Irritability, blood in urine, little or no urine, signs of kidney infection, high blood pressure.
What is the cure for kidney failure?
Patients may receive various types of treatment, depending on the severity of kidney failure. Treatment may include infusion of fluids and urine alkalinisation, administration of sodium bicarbonate and insulin, blood and peritoneal dialysis, or surgical removal of kidney stones.
With more and more milk products from China and Taiwan having problem. We really got to check where the things are produced. Here is a way to differentiate Taiwan made products and China made products : by looking at first three digits of its Bar Code.
If the 1st 3 digits are 690, 691 or 692 - China made
If the 1st 3 digits are 471 – Taiwan made
Given below are some clarification on the recent milk adulteration in China and how you can detect China made products.
Questions and Answers on melamine:
Melamine is an organic base chemical most commonly found in the form of white crystals rich in nitrogen.
What is melamine generally used for?
Melamine is widely used in plastics, adhesives, counter-tops, dishware, whiteboards and fertilizers.
Why was melamine added into milk and powdered infant formula?
In China , where adulteration has occurred, water has been added to raw milk to add to its volume. As a result of this dilution the milk will have a lower protein concentration. Companies using the milk for further production (e.g. of powdered infant formula) would normally check the protein level through a test measuring nitrogen content. Therefore the addition of melamine - because of its rich nitrogen content - could increase the level of nitrogen, which again masquerade as falsely high protein levels as the standard protein test only measures nitrogen content. This means that the adulterated milk would have an artificially high nitrogen level, which would be interpreted erroneously as a 'normal' or 'high' protein level.
Addition of melamine into food is not approved by the FAO/WHO Codex Alimentarius (food standard commission), or by any national authorities.
Has melamine been found in other food products?
In 2007, melamine was found in pet feed manufactured in China and exported to the United States which caused the death of a large number of dogs and cats due to kidney failure.
In the present event, melamine contamination has been found in a number of different brands of powdered infant formula, in one brand of a frozen yogurt dessert and in one brand of canned coffee drink. All these products were most probably manufactured using ingredients made from melamine contaminated milk.
What are the health effects of melamine consumptions in humans?
While there are no direct human studies on the effect of melamine on humans, extrapolation from animal studies can be used to estimate adverse health effects. When combined with another chemical (e.g. cyanuric acid which is also present in melamine powder) melamine can form crystals which can give rise to kidney stones.These small crystals can also block the small tubes in the kidney potentially stopping the production of urine, kidney failure and in some cases death.
Melamine has also been shown to have carcinogenic effects in animals.
What are the symptoms and signs of melamine poisoning?
Irritability, blood in urine, little or no urine, signs of kidney infection, high blood pressure.
What is the cure for kidney failure?
Patients may receive various types of treatment, depending on the severity of kidney failure. Treatment may include infusion of fluids and urine alkalinisation, administration of sodium bicarbonate and insulin, blood and peritoneal dialysis, or surgical removal of kidney stones.
With more and more milk products from China and Taiwan having problem. We really got to check where the things are produced. Here is a way to differentiate Taiwan made products and China made products : by looking at first three digits of its Bar Code.
If the 1st 3 digits are 690, 691 or 692 - China made
If the 1st 3 digits are 471 – Taiwan made
Tuesday, July 29, 2008
Tenesmus
Tenesmus a term use to describe a complaint of pain in the anus while defecating.Pain can be due to trauma such as tear, puncture wound , inflammation on the mucosal surfaces or structure underneath. The cause of trauma can be due to hard stool get stuck on the way out or some hard object [ penis, dildo etc] inserted into the rectum.
A doctor would ask history including diet taken ,psychological problem, and sexual history of the patient when dealing this type of cases. On examination, doctor would have examine
1.if patient is in distress, due to pain or emotionally.
2.presence of hard stool in the left side of the abdomen.
3.any sign of injury,wound,tear, change of color, bruises,swelling,hardness,imbalance contour,pus discharge and pain on palpation.
4.any visible sign of trauma in the inside, visualized using proctoscope, magnifying glass. Bruises, scratch marked on any other site of the body could be seen if the victim, or attacker have to fight for it.
5.swab usually taken for culture and sensitivity. the normal flora found in the anus is e-coli, but with the presence of other organism could be due to infection.
6.in criminal case, the examining doctor should take any sample DNA possible from the anal region to look out DNA of assailant. the doctor also should look out for jelly, semen, blood , pubic hair, saliva or even massaging oil.
7.anus which is normal, not traumatized would give a good grip to the examining finger.while patient would jump ,cry, or even shout due to pain if recently get penetrated.
8.other clinical sign of pain will be remarkable such as raised heart rate, raised blood pressure, sweating, blush,and raised respiratory rate.
9.homosexual patient , patient with past history of anal surgery,usually had poor grip anus [loosen up], may have stool incontinence.
10.patient with chronic disease,sexual transmitted disease may have sign and symptom of the disease at the same time.
11.doctors usually would observe the way the patient walk in into the consultation room, and walk out;if he had pain at the anal region, buttock, or even the thigh, the gait will be odd,limping, dragging his leg, or at least walk slowly.
12.those who get pain at the buttock, may sit at the edge of the chair, to avoid pressure on the painful site.
A doctor would ask history including diet taken ,psychological problem, and sexual history of the patient when dealing this type of cases. On examination, doctor would have examine
1.if patient is in distress, due to pain or emotionally.
2.presence of hard stool in the left side of the abdomen.
3.any sign of injury,wound,tear, change of color, bruises,swelling,hardness,imbalance contour,pus discharge and pain on palpation.
4.any visible sign of trauma in the inside, visualized using proctoscope, magnifying glass. Bruises, scratch marked on any other site of the body could be seen if the victim, or attacker have to fight for it.
5.swab usually taken for culture and sensitivity. the normal flora found in the anus is e-coli, but with the presence of other organism could be due to infection.
6.in criminal case, the examining doctor should take any sample DNA possible from the anal region to look out DNA of assailant. the doctor also should look out for jelly, semen, blood , pubic hair, saliva or even massaging oil.
7.anus which is normal, not traumatized would give a good grip to the examining finger.while patient would jump ,cry, or even shout due to pain if recently get penetrated.
8.other clinical sign of pain will be remarkable such as raised heart rate, raised blood pressure, sweating, blush,and raised respiratory rate.
9.homosexual patient , patient with past history of anal surgery,usually had poor grip anus [loosen up], may have stool incontinence.
10.patient with chronic disease,sexual transmitted disease may have sign and symptom of the disease at the same time.
11.doctors usually would observe the way the patient walk in into the consultation room, and walk out;if he had pain at the anal region, buttock, or even the thigh, the gait will be odd,limping, dragging his leg, or at least walk slowly.
12.those who get pain at the buttock, may sit at the edge of the chair, to avoid pressure on the painful site.
Tuesday, June 17, 2008
Medical Certificate
Patients when come to see doctors always without fail will request for medical certificate.By enlarge it become the most importance reason for workers to come to see general practitioner.Workers absent without MC [medical certificate] can be taken on disciplinary action such as cut part of their salary, or even terminated from work. In Malaysia if workers fail to present MC for 3 or more days absent could be terminated by the employer.
1.Recently our Director General The Ministry of Health announce that MC given by GP [general practitioner] for more than 2 days continuously for cases like chicken pox is legal and there is no need to be endorse by Government Doctor.
2.Each MC should be lasted until 12 midnight.Those patient on shift duty or on flight should be given proper consideration.
3.According to The Malaysian Medical Act, 1971.the ordinary MC cannot be use for court proceeding.The proper MC must follow the format in the Medical Act 1971.{Certificate of Unfitness to attend court}. The MC had legally binding and we are accountable to it .
4.Endorsement of MC which was certified by other GP, only required when the company are on our panel.And can only be endorse after we satisfy the reasons [diagnosis] the patient given for the MC.The usual case are obstetric ,hospital admission and infectious diseases.
5.It is understandable for; workers is compulsory to informed the employer immediately after they were given the MC by the doctor and not to wait until he fit to come to work.
6.Workers are entitle to receive full salary during the MC period, until a specific quota days used up. Some company will give 22 days MC not including hospitalization, surgery, and terminal illness.Some company will give more.
1.Recently our Director General The Ministry of Health announce that MC given by GP [general practitioner] for more than 2 days continuously for cases like chicken pox is legal and there is no need to be endorse by Government Doctor.
2.Each MC should be lasted until 12 midnight.Those patient on shift duty or on flight should be given proper consideration.
3.According to The Malaysian Medical Act, 1971.the ordinary MC cannot be use for court proceeding.The proper MC must follow the format in the Medical Act 1971.{Certificate of Unfitness to attend court}. The MC had legally binding and we are accountable to it .
4.Endorsement of MC which was certified by other GP, only required when the company are on our panel.And can only be endorse after we satisfy the reasons [diagnosis] the patient given for the MC.The usual case are obstetric ,hospital admission and infectious diseases.
5.It is understandable for; workers is compulsory to informed the employer immediately after they were given the MC by the doctor and not to wait until he fit to come to work.
6.Workers are entitle to receive full salary during the MC period, until a specific quota days used up. Some company will give 22 days MC not including hospitalization, surgery, and terminal illness.Some company will give more.
Tuesday, June 10, 2008
Chlorox
i think chlorox is the cheapest anti septic available. it cost you about RM 3 perlitre.study shows it can kill bacteria, virus, fungal and others as much as 99%. Most of us using it without knowing the real benefit of it.Some of us using chlorox just for the purpose of to whitening the school shirt.There are so many brand beside chlorox in the market and at a very competitive price.
1. if you have anybody at home who had bacterial infection like impetigo, abscess, or infected wound, you should soak all the cloths in it for few minutes,it will kill all the bacteria.Just be aware that your colorful cloth might become white overnight.
2.if you have kitchen utensil which is very dirty or stained, just soak in a pale of water with added half a cup of chlorox. It will be clean as new, but don't forget to clean it again with a lot of water.
3.if you bathroom is dirty, you can clean it with spraying chlorox overnight.all the germ will be gone. the cleaning on next day also very much easier,and the bathroom smell nicer. Those who do cleaning service in the public toilet , at the airport, mosque, bus stations etc should use it more often because it is cost effective.
p/s. i am not selling chlorox . and not receiving any benefit from the sale of it.
2.
1. if you have anybody at home who had bacterial infection like impetigo, abscess, or infected wound, you should soak all the cloths in it for few minutes,it will kill all the bacteria.Just be aware that your colorful cloth might become white overnight.
2.if you have kitchen utensil which is very dirty or stained, just soak in a pale of water with added half a cup of chlorox. It will be clean as new, but don't forget to clean it again with a lot of water.
3.if you bathroom is dirty, you can clean it with spraying chlorox overnight.all the germ will be gone. the cleaning on next day also very much easier,and the bathroom smell nicer. Those who do cleaning service in the public toilet , at the airport, mosque, bus stations etc should use it more often because it is cost effective.
p/s. i am not selling chlorox . and not receiving any benefit from the sale of it.
2.
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