chronic hypersensitive airway - bronchial asthma

hypersensitive airway aka bronchial asthma prevalence increasing worldwide especially amongst children.

environment vs genetic factors blamed for the rise.

various stimuli (allergen) can trigger bronchospasm of the hypersensitive airway.

May 5 annually is World Asthma Day

This year theme is " YOU CAN CONTROL YOUR ASTHMA"

lastest GINA guidelines 2008 showed the following:-

replacing the following, found in their GINA 2002 guidelines

reference:-

1) http://en.wikipedia.org/wiki/Asthma

2) http://www.who.int/respiratory/asthma/en/

3) http://www.nhlbi.nih.gov/health/public/lung/index.htm#asthma

4) http://www.nationalasthma.org.au/cms/index.php

5) http://www.nationalasthma.org.au/content/view/249/639/

6) http://www.asthma.org.uk/

7) http://www.ginasthma.com/Guidelineitem.asp??l1=2&l2=1&intId=60

8) http://www.patient.co.uk/showdoc/40000622/

Curable infectious disease on the rise - tuberculosis

- 20mil active cases worldwide

- 50 to 100 mil children

- mortality 3mil annually

- 80% in developing countries

- since 1989 Malaysia detected average 11 to 12 thousand cases annually

- diagnosis: clinical + radiological + / - bacteriological

The tuberculin or Mantoux test has some role in the diagnosis of tuberculosis especially in paediatric cases and cases of extra-pulmonary tuberculosis.

The Mantoux test is used in Malaysia using the strength of 10 IU PPD. The result is read after 72 hours.

THE AIMS OF TREATMENT ARE:

1. To cure patients and render them non-infectious

2. To reduce morbidity and mortality

3. To prevent relapse and emergence of resistant tubercle bacilli.

Basic investigations:-

1.Sputum D/S x 3,

2.sputum culture AFB if D/S negative,

3.renal profile,

4.liver functions,

5.visual test (if ethambutol is used ),

6.blood sugar,

7.HIV test when indicated.

Treatment:-

isoniazid (H) 100mg / tab

rifampicin (R) /cap

pyrazinamide (Z) 250mg or 500mg/tab

streptomycin (S) im

ethambutol (E) 400mg/tab

1. daily intensive phase (at least 2/12) SHRZ or EHRZ

INH 5mg/kg/day (max 300mg daily)

rifampicin 10mg/kg/day (max 600mg daily)

pyrazinamide 25mg/kg/day (max 2000mg daily)

+/-

streptomycin 15mg/kg/day (max 1000mg daily; omit in elderly)

ethambutol 15 to 25 mg/kg/day (max 1200mg daily)

2. biweekly phase (4/12) eg S2H2R2

INH ] max 1000mg biweekly

rifampicin ] 15mg/kg/ biweekly max 600mg biweekly

streptomycin ] max 1000mg biweekly

reference:-

1) CPG on Management if Tuberculosis. Ministry of Health Malaysia.

heart defect at birth - congenital

heart defects at birth can be grouped into electrophysiological defects, structural defects or functional defects. It affects 1 in 125 births.

2types:

a) cyanotic heart disease

b) non-cyanotic heart disease

cyanotic heart disease:-

a) Triology of Fallot, Eisenmenger, Ebstein's anomaly (Right Ventricular enlargement)

b) Tricuspid atresia (Left Ventricular enlargement)

c) Transposition of the great vessels & truncus arteriosus (biventricular enlargement)

d) Tetralogy of Fallot ( no ventricular enlargement)

non-cyanotic heart disease

a) Atrial septal defects, pulmonary stenosis (Right Ventricular enlargement)

b) Patent ductus arteriosus, coarctation, Aortic stenosis (Left Ventricular enlargement)

c) Ventricular septal defect (biventricular enlargement

d) any mild lesion or dextrocardia ( no ventricular enlargement)

+Aortic stenosis, coarctation of the aorta and pulmonary stenosis are not associated with shunting of blood from the left side to the right.

Commonest : Ventricular Septal Defects (VSD) - 1/5 of all congenital heart defects

reference:-

1) http://www.doctorslounge.com/cardiology/diseases/congenital.htm

2) http://en.wikipedia.org/wiki/Congenital_heart_disease

3) http://en.wikipedia.org/wiki/Atrial_septal_defect

4) http://en.wikipedia.org/wiki/Atrioventricular_septal_defect

5) http://emedicine.medscape.com/article/890991-overview

6) http://emedicine.medscape.com/article/351705-overview

Cost of Living - how much money do you need worldwide 2008

1) the gap between the most expensive and least is widening.

2) Yvonne Traber, a principal and research manager at Mercer, commented: "Current market conditions have led to the further weakening of the US dollar which, coupled with the strengthening of the Euro and many other currencies, has caused significant changes in this year's rankings.

3) "Our research confirms the global trend in price increases for certain foodstuffs and petrol, though the rise is not consistent in all locations. This is partly balanced by decreasing prices for certain commodities such as electronic and electrical goods. We attribute this to cheaper imports from developing countries, especially China, and to advances in technology.

reference:

http://www.mercer.com/costofliving

pregnancy weight - gain does matters

Weight before, during and after pregnancy plays a vital role in pregnancy. Excessive weight gain is associated with risk of overweight child. - Dr. A. Baskaran

Maternal obesity found to be associated with gestational diabetes, proteinuric pre-eclampsia, induction of labour, delivery by emergency cesarean section, postpartum haemorrhage, genital tract infection, urinary tract infection, wound infection, birth weight above the 90th centile and intrauterine death. On the other hand, underweight mothers associated with miscarriages, anemia in pregnancy, pre-term delivery and infants with low birth weight (below the 5th centile).

reference:

1) BJOG 2001:108(1):61-6.

2) Wendy loo. Weight weighs heavily on pregnancy outcome, Medical Tribute 1-15May 2009.

21st century pandemic VS 1918 Spanish FLU - a reminder for "forgotten pandemic"

source: flu ward. http://www.slate.com/id/2127872/

1) A lapse of almost 9 decades of worldwide spread of a virulent influenza A H1N1. Once again influenza A H1N1 is making a come back. The spanish flu pandemic lasted from March 1918 to June 1920 (27 months). How long is this 16th April 2009 A H1N1 gonna last? 27 months, longer or shorter duration?

2) This time round, equipped with triple reassortment evolution (with pig + human + bird elements), are these viruses gonna make a big come back? or a smaller scale?

3) From history, we learned that, spanish flu 1918 killed approximately 2.5% to 5% world infected  population and infected more than 20% world population, ? 50millions. Also known as "the greatest medical holocaust in history". Till now, according to WHO, 5728 cases reported infected with AH1N1 in 33 countries. 

4) Another lesson we learned, it was initially misdiagnosed as cholera, dengue, typhoid. Are we gonna make the same mistake with such a massive advancement in medical technologies and knowledge as well as widespread of medical information that travels in the speed of light?

5) 2 genetic processes was postulated: genetic drift and antigenic shift has lead to this massive death toll. This was caused by an extremely high infection rate of up to 50% and severe complications of the infection due to cytokine storms. So which type of genetic mutation that as has lead to current influenza A H1N1? What are the factors that promotes these mutation to occurs? Fitness of survival theory?

6) Influenza A viruses are found in many different animals, including ducks, chickens, pigs, whales, horses, and seals.

Influenza B viruses circulate widely principally among humans, though it has recently been found in seals.

7) Spanish flu infected young healthy adults predominantly. Why is that so? Explanation is cytokine storm. The stronger immune system would potentially have a stronger overreaction. Could this AH1N1 reacting the same?

8) Another oddity in spanish flu was that the outbreak was widespread in summer and fall (in the Northern Hemisphere) hwoever normally influenza is usually worse in winter. Thus this explain the seasonal flu vs AH1N1 pandemic flu. 

9) In spanish flu, 2nd wave infection was much more deadlier than 1st wave flu infection. During the 1st wave, which begins in early March, the epidemic resembled typical flu epidemics.  Those at the most risk were the sick and elderly, and younger, healthier people recovered easily. But in August, when the second wave began in France, Sierra Leone and the United States, the virus had mutated to a much more deadly form. This has been attributed to the circumstances of the first World War.

10) Was spanish flu a form of biological warfare? Is this AH1N1 a form of biological warfare? Or may be just due to fitness of survival theory.

reference:-

1) 1918 flu pandemic.  http://en.wikipedia.org/wiki/1918_flu_pandemic

2) Kobasa, Darwyn; et al. (2007). "Aberrant innate immune response in lethal infection of macaques with the 1918 influenza virus". Nature 445: 319–323.

3) Aoki, FY; Sitar, DS (January 1988). "Clinical pharmacokinetics of amantadine hydrochloride". Clinical Pharmacokinetics 14 (1): 35–51.

4) Carrington, Damian (2000-05-11). "Seals pose influenza threat". BBC.

5) Gladwell, Malcolm. "The Dead Zone". The New Yorker (September 29, 1997): 55.

flaky scalp - a hyperkeratosis disorder

Seborrheic Dermatitis Triad:

1) individual susceptibility

2) sebum

3) malassezia (Malassezia globosa, Malassezia restricta, Malassezia furfur)

Reference:

Dandruff/Seborrheic Dermatitis: A New Descriptive Model,Tom Dawson, Jim Schwartz. Procter & Gamble.