Alzheimer’s disease

http://news.sinchew.com.my/node/337060


When people getting older and older, they tends to have memory loss which may affect their personal life . Lots of people tends to use Alzheimer’s disease to refer to memory loss.
Actually the correct term for memory loss and thinking skills which disturb daily living is dementia. Alzheimer’s disease is just part of the type of dementia. It is the main contributor for dementia.
What is Alzheimer’s disease?
Alzheimer’s disease is the commonest form of dementia. It is the degenerative brain disorder. It worsen as it progress. It is common among people over 65 years of age.

What is the symptom of Alzhimer’s disease?
Early symptom of Alzheimer’s disease are memory problems however decline in other aspects of cognition, such as word-finding, vision issues, and impaired reasoning or judgment, may also signal the very early stages of Alzheimer’s disease.

As Alzheimer’s disease progresses, memory loss worsens, and changes in other cognitive abilities are evident. Problems can include, for example, getting lost, trouble handling money and paying bills, repeating questions, taking longer to complete normal daily tasks, using poor judgment, and having some mood and personality changes.

What causes Alzheimer’s disease
It is likely that the causes include some mix of genetic, environmental, and lifestyle factors.


How to diagnose Alzheimer’s disease?
Alzheimer’s disease may diagnose like checking memory and ability to carry out normal activity plus doing urine test and blood test with brain CT to rule out other possible causes of memory problem.

Commit suicide and depression

http://www.thestar.com.my/News/Nation/2013/11/28/Doctor-commits-suicide-after-killing-son.aspx
 Psychological problem like depression is become a common problem in urban world.

What is depression?
Depression is a state of low mood that can affect person's thoughts, behavior, feelings and sense of well-being.

How common is the depression ?
Depression in Malaysia is about 11-12 % among rural area. It is much higher in city.

What is the presentation of depression?
If you got depression, you will got difficulty of sleep or excessive sleep, poor appetite, feeling hopeless,low mood, lost of interest, reduce body weight and later with feeling worthless to live or even suicidal idea eventually commit suicide.

What to do if I got the symptom?
You should seek treatment from doctor if urgent need psychiatric attention.

Is there a treatment for depression?
There is  treatment for depression . Medication group like  selective serotonin reuptake inhibitors (SSRIs), serotonin–norepinephrine reuptake inhibitors(SNRIs), tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) works well as antidepressent.

What is the risk factor for diabetes ?

http://www.bernama.com/bernama/v7/newsindex.php?id=992117

As mentioned in this article , diabetes among young people is on the rising trend. Have you wondered why our during 1986 era diabetes over 30 in malaysia is only around 4% and now is about 12 %.

What is the risk factor for diabetes?
Is the family history contributing to diabetes?

Before the question is answer, I will give a brief account for diabetis.
Diabetes means sugar in urine. In the modern era, doctor identify diabetes by high sugar in blood because sugar in urine is less accurate( need higher sugar in blood to be identified).

Diabetis may cause disease to the heart, brain, kidney, nerve and even dead if poorly controlled. In fact more than 60% of dialysis patients is due to diabetes!

Family history do contribute to diabetes - If your sibling or parents got diabetes , you got higher risk of getting diabetes.

Race affect your changes of getting diabetes. Asian , hispanic , afro. Indian is the highest risk among Malaysian to get diabetes

Do lifestyle affect diabetes?
Yes, the less active the more risk to get diabetes. Activity uses up glucose as energy and makes your cells more sensitive to insulin

Is increased sugar intake increase risk of diabetes?
Increased sugar have been linked to overweight and obesity but recent study found that an additional 150 calories from sugar per person per day – the equivalent of just one 12-ounce soda drink – increased the prevalence of diabetes by 1% in that population

Is diabetes during pregnancy increased riskof diabetes?
Yes , the women who have diabetes during pregnancy have higher risk of getting diabetes in later life.

Disclaimer
All advice and information on this news is given in good faith and is based on sources believed to be reliable and accurate at the time of release on the article. I do not accept legal liability or responsibility for the content of the advice or information or any consequences arising from its use.
The information provided on this news is provided for information purposes only. If you are a patient reading the news, you should seek assistance from a health care professional when interpreting these materials and applying them to your individual circumstances.

Is the ECG stress test able to detect symptoms before sudden death happened ?

http://www.malaysia-chronicle.com/index.php?option=com_k2&view=item&id=183571:25-year-old-woman-dies-after-running-10km-marathon&Itemid=4#axzz2jmTSqt87

A 10 km run which killed a 25 year old young lady make you wonder whether you should participate in the upcoming Penang bridge run which range from 10 km to 42 km. Is the stress test a must prior to participation ? Is the stress test can avoid such issue happening to you and your loved one.

The answer is yes and no !

Yes, For people with chest pain, a positive result can determine whether the problem is heart-related. Stress tests can also evaluate heart risk before a surgery or after a heart attack. Stress tests can effectively show whether the heart's arteries are 70% narrowed or more. Most of the patients got heart attack when artery to the heart is 70-75% blocked
But heart attacks can arise from arteries that are less than 50% blocked ! The answer is no as it wont detect 50% blockage.

Stress test is only 60% accurate meaning they miss 40% of the diagnosis ! Women got less accuracy compared to man as smaller branch of artery are affected when woman got heart disease. Breast tissue can trigger false negative.

The false positive and false negative bring potential problem as it give extra security or more invasive procedures and the unnecessary use of medications.

U.S. Preventive Service Task Force does not recommend treadmill testing for those with a low risk.

2nd question will arise after reading this is why 50% or lower plaque will cause heart attack ?
The heart attack occurred when vulnerable plaque rupture. Vulnerable plaque rupture causing thrombosis of artery . A small plaque with thin core is easily rupture then the big plaque with thick core. Small vulnerable plaque is higher risk compared to big plaque.


What is the definite strategy of  detecting ischemic heart disease?
The gold standard is angiogram ( invasive procedure where a thin tube is inserted into the artery of the heart) . The procedure is needed when symptom suggestive of heart disease and risk of heart disease is present . The risk of heart disease are high blood pressure, fa,mily history of sudden death , diabetes, obesity and high cholesterol.

Back to the above news, is the patient died of heart disease?
The answer is yes but not heart attack (coronary artery blockage). The cause of death for young athletes is mainly hypertrophic cardiomyopathy. Hypertrophic cardiomyopathy is a congenital condition in which a portion of heart muscle is thickened . It can be detected by ECG but definite test would be echocardiogram and cardiac MRI.

Disclaimer
All advice and information on this news is given in good faith and is based on sources believed to be reliable and accurate at the time of release on the article. I do not accept legal liability or responsibility for the content of the advice or information or any consequences arising from its use.
The information provided on this news is provided for information purposes only. If you are a patient reading the news, you should seek assistance from a health care professional when interpreting these materials and applying them to your individual circumstances.

dengue fever

Dengue fever

http://www.bharian.com.my/bharian/articles/Kesdenggimembimbangkan/Article/

Our local paper (http://www.bharian.com.my/bharian/articles/Kesdenggimembimbangkan/Article/)

showed that increasing number of reported dengue cases which lead me to discuss about dengue in details. 

Dengue fever is a common topical illness including Malaysia. It is caused by dengue virus.

Dengue is transmitted by mosquito within the genus Aedes, principally Aedes aegypti. The virus has four different types which is DEN I , II , III and IV. Infection with one type usually gives lifelong immunity to that type, but only short-term immunity to the others. Subsequent infection with a different type increases the risk of severe complications which is dengue hemorrhagic fever.

Symptom of dengue fever are fever, muscle pain, joint pain, headache and characteristic skin rash(redness). Dengue fever may presented with more severe presentation which is dengue haemorrhagic fever which if overlooked may progress to dengue shock syndrome.Incubation (disease stay inactive) period lasting 4-10 days.Acute fever phase lasting 2 to 7 days, a critical phase beginning around the time of defervescence (fever subsiding) and lasting 1 to 2 days, and a recovery phase lasting 2 to 3 days.

Dengue fever diagnosed with combination of disease symptom, history of recent fogging, physical examination of rash, bleeding tendency , postural drop blood pressure and confirm by dengue serology test and complete blood test.

Treatment involve fluid therapy which is IV drip and encourage orally, fever control with antipyrexia and proton pump inhibitor if gastrointestinal symptom presents. Severe hemorrhagic condition may need blood product transfusion.

FAQ:

Does antibiotic play any role in dengue fever ?

Antibiotic play no role in dengue fever unless there is bacteria infection associated with dengue fever.

Does dengue fever can cause mortality ?

Yes, it is dangerous if fluid replacement (IV drip) not given accordingly especially after fever subsided. Critical period normally is 2 days after fever subsided.

How long should I Stay in hospital ?

It may be lasted 7 to 9 days depending on which phase you are presented.

Can I have dengue fever by skin contact?

No, It is spread via mosquito bites.

Disclaimer

All advice and information on this news is given in good faith and is based on sources believed to be reliable and accurate at the time of release on the article. I do not accept legal liability or responsibility for the content of the advice or information or any consequences arising from its use.

The information provided on this news is provided for information purposes only. If you are a patient reading the news, you should seek assistance from a health care professional when interpreting these materials and applying them to your individual circumstances.

Phyton and snakes bites

 The NST news (http://www.nst.com.my/nation/general/python-caught-in-oil-palm-plantation-1.388026?cache=03D163D03edding-pred-1.1176%252F%253FpFpentwage63Dp%253A%252Fhe3D03Dn63Frea-rti3D19.3D163D03edding-pred-1.1176%252F%253FpFpentwage63Dp%253A%252Fhe3D03Dn63Frea-rti3D19.111w5ii%25%2F7.478218%2F7.478218)regarding  Phyton echoed me to give my patients education regarding the snake bite . Before I become the doctor , I always hear people said about when poisonous snake bite you. You need to tourniquet so that the venom (poison ) won’t reach the heart and kill you. Is it the myth or the facts ?
Let me explain to you regarding the type of snake and how they prey on their victim before I elaborate further.

Snake naturally can be divided into venomous or non venomous snake
-Non venomous snake kill his prey by swallowing alive or kill by constriction. Phyton is a constricting snake.

-Venomous snake  kill prey by injecting venom .
Venomous snake mainly can be divided into 3 types-
Type 1 - Elapidae - commonly family of the snake is Cobra.
They kill their prey by  injecting neurotoxin. Some may produce cytotoxin. Neurotoxin may paralyses our breathing muscle and eye muscle. Human bitten by this snake may died of breathing difficulty. Earliest symptom of neurotoxin is drooping of eye lid.
Cytotoxin is toxin that may destroy cell. Severe venom injection may end up victim loss their hand or leg.

Type 2-Viperidae- commonly type of the snake is viper (ular kapak).
Viper kill their prey by injecting  hemotoxin which may cause serious bleeding problem which may cause bleeding problem and died.

Type 3-Sea snake
Contain both neurotoxin and hemotoxin . One of the most poisonous snake type as may cause both type of problem.

FAQ
What should you do when snake bites you?
You should go to nearest hospital or clinic.

Can I suck out the venom after tourniquet the wound?
It is not encouraged to do so as any small ulcer or injury in mouth may let the venom enter your body and cause poison effect . It is better to have one person save the others that injured by snake than having 2 person in similar trouble.


What the hospital Doctor would do?
They need to admit you and monitoring for potential toxin effect by doing examination and close observation. Severe toxin effect which affect the clotting of blood or nervous system may warrant antivenom.

Why do not every patient receive antivenom?
Antivenom is made of horse serum which carry the risk of causing severe anaphylaxis (allergy) reaction to patient. The usage of it need to be justified. Do no harm is the motto of treatment to patient.

I think with this piece of news and info may help you in understanding snake bites better. Hope it will enlighten you on the study.

Dr Khoo Kah Fang
Tanjung medical Centre.

Disclaimer
All advice and information on this news is given in good faith and is based on sources believed to be reliable and accurate at the time of release on the article. I do not accept legal liability or responsibility for the content of the advice or information or any consequences arising from its use.
The information provided on this news is provided for information purposes only. If you are a patient reading the news, you should seek assistance from a health care professional when interpreting these materials and applying them to your individual circumstances.

To stop or not to stop antithrombotic during dental procedure in Ischemic stroke patient?

This is the question. ACP intern weekly http://www.acpinternist.org/weekly/archives/2013/6/4/index.html#1 summarised various procedure possibly, no need to stop during various procedure. In the article, aspirin or warfarin do not need to be stop during dental procedure .  During tooth extraction, advice should be given to minimise extensive surgery and using firm sutures or postoperative packs.

Oral evening primrose oil and borage oil for eczema

Eczema is an allergic condition to the skin. Although these condition may be controlled but there is no cure. Some patient fear of the conventional medical products may switch to complementary alternative like evening primrose oil.
Bamford et al. written on Cochrane review looking at 27 studies (19 study evening primrose oil and 8 study on Borage oil). All study failed to improve global eczema symptom compared to placebo.

Blood pressure lowering efficacy of coenzyme Q10 for primary hypertension

Coenzyme Q10 has been studied as a potential treatment for hypertension, a common medical condition.

A systematic review was conducted to try and use all available data to answer this question. Databases of clinical trials were searched for any studies that tested the effects of coenzyme Q10 on patients' blood pressure compared to a placebo.
 Three trials with a total of 96 participants were found in which coenzyme Q10 was used in patients with high blood pressure. The patients took coenzyme Q10 or a placebo daily for up to 8-12 weeks. Weighted data analysis showed that the systolic blood pressure was reduced by 11 mmHg and the diastolic blood pressure was lowered by 7 mmHg compared to placebo.

Cochrane author concludes that- uncertain if coenzyme Q10 could be a useful hypertension treatment, and more studies are needed

(Reference Cochrane Library)

Statin for Primary Prevention . Is it worth ?

The tasty of food and the rising of western food in The Malaysian comunity has make rising cholesterol an epidermic. The cholesterol has go up higher and higher in normal population on medical check up. Is statin is beneficial become an major thing to discuss.

Cochrane review showed that in the eight trials that reported on total mortality, none of the individual trials showed strong evidence of a reduction in total mortality, but when the data were pooled, a relative risk reduction of 17% was observed with statin treatment.No excess in combined adverse events, cancers, or specific biochemical markers were found. current systematic review highlights the shortcomings in the published trials of statins for primary prevention. They say that in people at high risk of cardiovascular events (>20% 10-year risk), "it is likely that the benefits of statins are greater than potential short-term harms, although long-term effects (over decades) remain unknown."
 recent meta-analysis from the Oxford group, published late last year, which showed a clear reduction in events with statin therapy in primary-prevention patients.

With the published of the cochrane and contraditing effects of Statin, therapy should be individulised. Patient with high risk of cardiovascular events (>20% in 10 years) worth for primary prevention. Whereas patient not fulfill the high risk Cv events, these need to be discussed with patient and decide .

Does eating standing up give you indigestion? Medical Myth

When you look at the causes of indigestion or functional dyspepsia, as it’s called in the medical literature, eating standing up doesn’t feature on the list. When likely causes such as stomach ulcers and gastritis have been ruled out, the management of dyspepsia can include changes to lifestyle, but this means eating a healthy diet, giving up smoking and reducing alcohol and coffee consumption. It doesn’t mean sitting down when you eat.
In fact doctors even recommend the opposite, if the pain is caused by acid reflux, when acid from the stomach comes back up into the oesophagus. This is where gravity can help; remaining upright during and after eating can keep the acid down in the stomach where it belongs. For the same reason, patients with reflux are advised to tip the head of their bed up, so that they sleep on a slant.
There are very few studies comparing fast and slow eaters, partly because it wouldn’t be easy to randomise people into eating at a particular speed and then to enforce that at every meal. A study from 1994 did include questions about eating speed in a survey of dietary habits. They found the speed at which you believed you ate had no relationship with the frequency of indigestion.  Research conducted in 2010 found the same, but these two studies rely on our ability both to judge our eating speed accurately, and to report it honestly.  
Professor Marc Levine, a radiologist at Hospital of the University of Pennsylvania x-rayed the stomach of a speed-eating champion after eating 36 hot dogs in ten minutes. The participant was happy to continue after eating 36, but the decision was made to terminate the study for his own safety. He didn’t have indigestion, while the unlucky man who’d volunteered to act as a control, felt sick after seven hot dogs and had to stop.  The x-ray showed that the speed-eater had trained his stomach to expand to such an extent that he no longer felt full when he’d eaten.
 This brings us to what could be the problem with eating fast – it’s not indigestion, butthe disruption of the usual mechanism that makes you feel full. But even here the evidence is inconsistent. Some studies foundthat eating fast leaves you feeling hungrier, causing you to eat more. Other studies have shown the opposite.
 Conclusion :Whether sitting or standing doesn't matters as long as it doesn’t make you feel ill at the time, there doesn’t seem to be any harm in it.  

Other question regarding Glycemic index and glycemic load

Is complex carbohydrate always have higher than the sweet food ?

It's true most of the time but some starchy foods like potatoes or white bread score even higher than honey or table sugar (sucrose)!

WHY glycemic Index Important ?

The higher the glycemic index , the greater the rate of blood sugar rises . in response the faster the insulin release. With these faster insulin response you may feel an initial elevation in energy and mood as your blood sugar rises, but this is followed by a cycle of increased fat storage, lethargy, and more hunger!

What is glycemic load ?

(Net Carbs are equal to the Total Carbohydrates minus Dietary Fiber)

It will bring more problem to diabetic patient as diabetes type ii have difficulty in insulin response to bring down the blood glucose level.

GL = GI/100 x Net Carbs

Your glycemic response can be controlled by consuming low-GI foods and/or by restricting your intake of carbohydrates

Glycemic Indexes and Glycemic Loads for Common Foods

(reference http://nutritiondata.self.com/topics/glycemic-index)
Glycemic index of 55 and below - low
Glycemic index 70 and above high
Glycemic  load 10 or below -low
Glycemic load 20 or above -high

GI and GL for Common Foods
Food	GI	Serving Size	Net Carbs	GL
Peanuts	14	4 oz (113g)	15	2
Bean sprouts	25	1 cup (104g)	4	1
Grapefruit	25	1/2 large (166g)	11	3
Pizza	30	2 slices (260g)	42	13
Lowfat yogurt	33	1 cup (245g)	47	16
Apples	38	1 medium (138g)	16	6
Spaghetti	42	1 cup (140g)	38	16
Carrots	47	1 large (72g)	5	2
Oranges	48	1 medium (131g)	12	6
Bananas	52	1 large (136g)	27	14
Potato chips	54	4 oz (114g)	55	30
Snickers Bar	55	1 bar (113g)	64	35
Brown rice	55	1 cup (195g)	42	23
Honey	55	1 tbsp (21g)	17	9
Oatmeal	58	1 cup (234g)	21	12
Ice cream	61	1 cup (72g)	16	10
Macaroni and cheese	64	1 serving (166g)	47	30
Raisins	64	1 small box (43g)	32	20
White rice	64	1 cup (186g)	52	33
Sugar (sucrose)	68	1 tbsp (12g)	12	8
White bread	70	1 slice (30g)	14	10
Watermelon	72	1 cup (154g)	11	8
Popcorn	72	2 cups (16g)	10	7
Baked potato	85	1 medium (173g)	33	28
Glucose	100	(50g)	50	50

Glycemic Index

What is glycemic Index ?

Glycemic Index is  Index that ranks carbohydrates based on their rate of glycemic response (i.e. their conversion to glucose within the human body). Glycemic Index uses a scale of 0 to 100, with higher values given to foods that cause the most rapid rise in blood sugar. Pure glucose serves as a reference point, and is given a Glycemic Index (GI) of 100.In Other word , the faster the blood sugar rise the higher the GI

I

Treatment of diabetes

When talking about the treatment of diabetes. The first impression would be medication and injection. To be honest treatment of diabetes starting from patient itself.
Yes, you are not hearing it wrong, it started from you (diabetic patient). Your attitude and understanding of the disease contributing to your success of diabetes.
First is understanding of the disease. The understanding of the disease is important for compliance to diet, healthy lifestyle and taking medication if needed.
Low or no sugar diet is important to diet control . Patient should take low or no sugar with minimal carbohydrate diet, moderate protein and fat diet. The ratio is carbohydrate 55%, protein 20-30%, fat 15-20%. If possible , try to take low glycemic index carbohydrate. High fibre diet for those interested.

Healthy lifestyle including exercise at least 30 minute per day if cannot at least 5 day a week. Brisk walking, cycling, swimming all depends on your preference.

Compliance to medication prescribed by your physician. It may be oral medication or injection.
There is few group of medication.
Oral medication such as
 Biguanides-metformin (glucophage)
Sulfonylurea-gliclazide, glibenclamide
alpha glucosinase inhibitor-acarbose
meglitinides-repaglinides
Newer agents- DPP iv inhibitor- sitagliptin(januvia), saxagliptin (onglyza)

Injection medication:
Insulin - short acting, intermediate acting and long acting
GLP 1 analogue- exenatide, Liraglutide

This is the brief thing about management of diabetes.


Any Question Please contact drkhookf.tmc@gmail.com

Steps to maintain good sugar control in diabetes!

The rule of thumb is HEALTHY lifestyle!

Regular exercise ( prefer 30 minute for 5 days a week)
Healthy diet ( Low sugar, high fibre and low fat)
Lose weight (if overweight)
Stop smoking if you are amoker
NO alcohol
Take your medication as Dr request.
Regular visit to Dr.
Regular monitoring of blood sugar

Diabetes info

Many people do not know exactly what is diabetes ? They only know they need to take medication or some need injection? Is there consider serious if taking injection ?
Most of the diabetes in adult is type 2 diabetes. Type 1 Diabetes mainly among children.

How many people have type 2 diabetes?
Number of diabetes steadily increased each day ! More than 200 million people with type 2 diabetes  by 2010 and 380 million by 2025.

What is diabetes?
Diabetes defined as fasting blood glucose more than 7 mmol/L with symptom or 2 occasion fasting glucose more than 7 or 2 hour post 70 g sugar more than 11 mmol/L

Is no glusose in urine means I am free of diabetes ?
The answer is NO ! as described earlier , it is diagnosed by fasting blood sugar . As early diabetes , urine sugar may be NEGATIVE !

What is sign and symptom of diabetes ?
Initial diabetes may have no symptom . Some people may find out their diabetes from routine test or general medical checkup ! As result , 50% people undiagnosed ! If you have increased thirst, increased hunger, fatigue, increased urination, weight loss, blurred vision and unhealed sore, You may have diabetes

what is the risk factor ?
Age more than 40,  overweight, inactive lifestyle, poor diet (high sugar and carbohydrate), family history diabetes, smoking.

Why I should treat my diabetes ?
Study showed diabetes patient have higher risk to have stroke, ischemic heart disease, peripheral heart disease, kidney disease , eye disease and numbness of hand and foot. You don't want this damage to organ , you should treat the diabetes.

How do i know i have diabetes?
If you have the risk factor or symptom , please do the blood check by visiting your nearest Dr.



Any question please contact fangpenang@gmail.com or drkhookf.tmc@gmail.com

Chest Pain

What is chest pain?
Chest pain is pain in the chest.

What is the dangerous of chest pain?
As we all known, one of the most life threatening disease (No 1 Killer in lots of country ) is myocardial infarction or so called heart attack presented with chest pain.

Is every chest pain means heart attack?
Not necessary, it can be other disease like lung infection , heart burn (gastroesophageal reflux) , muscular pain , rib fracture or etc.

Should i see doctor if i got chest pain?
Yes, you do not want to miss heart attack although heart attack presented with severe chest pain radiate to left side but you won't know it for 100% unless ECG is done.

What should i do if got chest pain?
Go and see the physician early and as soon as possible. delay to see the dr may endanger your life.

Any question regarding health you may contact drkhookf.tmc@gmail.com

Ischaemic heart disease

ischemic heart disease (IHD) is a disease characterized by ischaemia (reduced blood supply) of the heart muscle, usually due to coronary artery disease (atherosclerosis of coronary artery ). Coronary artery is a artery supplied blood to heart. when artery blocked or narrowed the heart will got reduced blood supply then the chest pain may arise.

What is the risk factor of IHD?

hypertension, diabetes, family history of young ischemic heart disease, smoking and hypercholesterolemia is major risk factor. Lack of exercise , homocysteine and high working stress is minor risk factor.

what is the symptom of IHD?

chest pain which is crushing in nature , occasional may radiate to left arm, jaw ,neck or shoulder. Occasionally may present with epigastric pain.

Severe chest pain associated with nausea and vomiting with profuse sweating may suggests myocardial infarction (heart attack). Heart attack means total block of 1 to 3 heart (coronary) artery supply to heart.

How to diagnose IHD?

The easiest way is by ECG.

What to do if I got heart attack?

Came to hospital immediately. Time is myocardium (heart muscle)! The earliest the treatment the better the outcome.