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.