Using the internet to make self-diagnoses.

The internet has become the main self-empowering tool for people nowadays. It enable patients to surf for the information they needed using their browser.

Not to mention, it also helps doctors in diagnosing difficult cases.

There have been a few cases of patients or their relatives successfully using the internet to make rare diagnosis.

Actually it is not as easy as it sounds as symptoms are often common to many illnesses and symptoms by themselves are not the only clue to illnesses.

For example, epigastric pain could symptom of gastritis or maybe symptom of acute pancreatitis and etc.

People tend to forget, in diagnosing a disease, does not mean all depends on just symptoms. There are also clues in other aspect of the history and physical examination which patients often do not appreciate on their own.

That’s why it is uncommon to see patients jumping to conclusions these days after researching their symptom on the net.

A medically trained person would be more accustomed to using these tools which may be helpful in listing differential diagnoses. One should appreciate that diagnoses are not only derived from symptoms but also various aspects of history taking, physical examination and appropriate tests where necessary. At this point in time, the Internet is not going to replace the basic diagnostic work-up.

Patients can and should use the internet to search for information but they should be best guided by their doctor.

Information from the Internet is however useful for patients to help them understand their illnesses. The 15 or even 30 minute consultation with their doctor is often insufficient. How much information can the doctor give in such a limited time? If on the other hand, patients take the trouble to read about their illnesses, the greater understanding will benefit them and help in the management.

Finally my GATCO sharpening system arrived..

Bought this GATCO sharpening system from ebay with the price of approximately RM245 which is equal to ~USD40 + delivery USD 40 last March 24. As usual it takes 10 days to reach me.

What is so special about this thing?

Well….

To maintain angle with certain degree while sharpening your knife with sharpening stone seems like impossible….but with this system it can…I never thought I would only take 2 minutes to sharpen my leatherman and spyderco knives …It’s not 2 minutes both…It’s 2 minutes each knive..

I give 5/5 for this sharpening system…

What is this system all about?

GATCO® Edgemate
Professional Knife Sharpening System

This is the professional knife sharpening system that will sharpen all kitchen, sport, and utility cutlery including knives and cutting tools with serrated blades. Never before has a sharpening system done so much! This specialty product utilizes the GATCO ® exclusive knife clamp/angle guide to insure that all cutting tools can be easily sharpened to a precise razor-like edge.

THIS SYSTEM CONTAINS:

1.Extra-Coarse, Coarse, Medium & Fine sharpening hone

2.Serrated knife sharpening hone

3.Scientifically formulated honing oil

4.Custom carrying case with instructions permanently
affixed to lid

5.GATCO® exclusive knife clamp/angle guide

What can it do?

Sharpens all sizes and types of kitchen, sport, and utility cutlery

SPORT & UTILITY CUTLERY
• Serrated pocket knives
• Plain edge pocket knives
• Serrated sport knives
• Hunting knives
• Skinning Knives
• Tactical Knives
• Survival knives
• Razor knives
• Fillet knives
• Gut hook knives
• Hook bill carpet knives
• Swiss Army knives
• Multi-tool knives

KITCHEN CUTLERY
• Chef’s knives
• Paring knives
• Butchers’ steaking knives
• Serrated bread knives
• Boning knives
• Meat slicing knives
• Serrated utility knives

To know more about this product, you can visit GATCO.

What exercise is safe during pregnancy?

According to American Congress of Obstetricians and Gynaecologists pregnant women are recommended to do at least 30 minutes of moderate exercise most days of the week.

Advantages of exercises :

1. prevents excess weight gain.

2. helps or prevents gestational diabetes.

3. being more fit makes labor and recovery a bit easier.

4. helps with the aches and pains of pregnancy and insomnia.

5. helps reduce constipation,bloating and swelling.

6.Increases your energy.

7.Improves your mood.

8.Improves your posture.

9.Helps you sleep better.

It is essential that you check with your doctor before starting an exercise program to make sure that the exercise won’t give a negative impact to your pregnancy.

Should you have been exercising regularly, it is fine to continue it except for contact and extreme sports.

In the 1st trimester you can do whatever exercise you can. In the 3rd trimester, you should focus on non weight-bearing execise like swimming.If you want to know the best exercise that suits you, you can visit ACOG.

Many women find that prenatal yoga and pilates are beneficial during pregnancy. It can ease the labour.

Stop exercising and call your doctor if you get any of these symptoms:

·         Vaginal bleeding

·         Dizziness or feeling faint

·         Increased shortness of breath

·         Chest pain

·         Headache

·         Muscle weakness

·         Calf pain or swelling

·         Uterine contractions

·         Decreased fetal movement

·         Fluid leaking from the vagina

Drink plenty of water and do not overeat. Excessive weight gain can cause labor and health problems to you and your baby.

You can read the original article at CNN health.

Additional reading : American Congress of Obstetricians and Gynaecologists

UD41,UD44,UD48,UD52,UD54 and JUSAs salaries: Just for doctors…

PENGIRAAN EMOLUMEN DAN ELAUN PEGAWAI PERUBATAN/PAKAR

Emolumen Gred
UD41 UD43/44 UD47/48 UD51/52 UD53/54
Base salary (MINIMUM) RM2,458.39 RM3,028.90 RM4,431.54 RM4,992.31 RM5,258.09
Public service allowance RM 300.00 - - - -
Entertainment allowance - RM 400.00 RM 550.00 RM 600.00 RM 800.00
COLA RM50-150 RM100-300
Housing allowance RM 210.00 RM 400.00 RM 700.00 RM 700.00 RM 900.00
Critical allowance RM 750.00
Specialist allowance - RM1,900.00 RM2,200.00 RM2,300.00 RM2,900.00
TOTAL W/O SPECIALIST ALLOWANCE - RM4,678.90 RM6,531.54 RM7,142.31 RM7,808.09
TOTAL RM3,768.39

(MINIMUM)

RM6,578.90 RM8,731.54 RM9,442.31 RM10,708.09

PENGIRAAN EMOLUMEN DAN ELAUN PEGAWAI PERUBATAN

(KELULUSAN SARJANA / DIPLOMA KESIHATAN AWAM)

Emolumen Gred
UD41 UD43/44 UD47/48 UD51/52 UD53/54
Base salary (MINIMUM) RM2,458.39 RM3,028.90 RM4,431.54 RM4,992.31 RM5,258.09
Public service allowance RM 300.00 RM 400.00 RM 550.00 RM 600.00 RM 800.00
COLA RM50-150 RM100-300
Housing allowance RM 210.00 RM 400.00 RM 700.00 RM 700.00 RM 900.00
Critical allowance RM 750.00
Public Health allowance RM1,040.00 RM1,120.00 RM1,360.00 RM1,440.00 RM1,760.00
TOTAL RM4,808.39

(MINIMUM)

RM5,798.90 RM7,891.54 RM8,582.31 RM9,568.09

PENGIRAAN EMOLUMEN DAN ELAUN PEGAWAI PERUBATAN

(KELULUSAN SARJANA/DIPLOMA PENTADBIRAN HOSPITAL)

Emolumen Gred
UD41 UD43/44 UD47/48 UD51/52 UD53/54
Base salary (MINIMUM) RM2,458.39 RM3,028.90 RM4,431.54 RM4,992.31 RM5,258.09
Public service allowance RM 300.00 RM 400.00 RM 550.00 RM 600.00 RM 800.00
COLA RM50-150 RM100-300
Housing allowance RM 210.00 RM 400.00 RM 700.00 RM 700.00 RM 900.00
Critical allowance RM 750.00
Public Health allowance RM 910.00 RM 980.00 RM1,190.00 RM1,260.00 RM1,540.00
TOTAL RM4,678.39

(MINIMUM)

RM5,758.90 RM7,721.54 RM8,402.31 RM9,348.09

EMOLUMEN DAN ELAUN PAKAR PERUBATAN

GRED KHAS C, B & A

Emolumen Gred
C B A
Base Salary RM6,595.99 RM7,064.26 RM7,766.66
Entertainment allowance RM2,150.00 RM2,650.00 RM3,300.00
Housing allowance RM1,300.00 RM1,600.00 RM2,000.00
Specialist allowance RM2,900.00
Special Incentive allowance RM400.00 RM600.00 RM1,000.00
Maid Allowance RM500.00
Fixed Allowance for Special grade and JUSA post RM810.00 RM1,200.00 RM2,000.00
House repair allowance

( yearly payment )

RM166.67
TOTAL RM15,822.66 RM16,680.93 RM19,633.33

PENGIRAAN EMOLUMEN DAN ELAUN PEGAWAI PERUBATAN

GRED ( KHAS ) JUSA C, B & A.

Emolumen Gred
C B A
Base Salary RM6,595.99 RM7,064.26 RM7,766.66
Entertainment allowance RM2,500.00 RM3,050.00 RM4,000.00
Housing allowance RM1,300.00 RM1,600.00 RM2,000.00
Special Incentive allowance RM500.00 RM750.00 RM1,250.00
Maid Allowance RM500.00
Fixed Allowance for Special grade and JUSA post RM1,000.00 RM1,500.00 RM2,500.00
House repair allowance

( yearly payment )

RM166.67
TOTAL RM12,562.66 RM14,630.92 RM18,183.32

Reference : PEMBANGUNAN KERJAYA KKM

For more info : view this!

Contrast in CT and MR Imaging: Applications and Contraindications.

WHAT IS CONTRAST AGENT?

A substance placed in the body to increase image differentiation of anatomical structures.
It increases the differentiation between the areas containing contrast media and the areas not containing contrast media.

WHY NEED TO USE CONTRAST AGENT?

1.To better differentiate between anatomical structures.
2.To increase detection of pathology.

CT CONTRAST AGENTS

POSITIVE CONTRAST AGENT:
Iodinated Contrast Media

IODINATED CONTRAST MEDIA – Ionic

High Osmolar Contrast Media (HOCM)
-Composed of salts which dissociate in water into anions (radiopaque) and cations (osmotically active).
-Osmolality up to 5x serum ? toxicity.
-Non-intravascular route – oral / rectal.
-Not for use in subarachnoid space.
E.g. Gastrografin, Urografin, Isteropac

IODINATED CONTRAST MEDIA – Non-ionic

Low Osmolar Contrast Media (LOCM)
-Non-dissociating.
-Only about 2x serum osmolality.
-Less side effects, less nephrotoxic.
E.g. Ultravist, Omnipaque
Iso-osmolar Contrast Media
-Osmolality approximately serum osmolality.
-Preferred in renal impaired patients.
E.g. Visipaque
Oily Contrast Media
-Currently not widely used
-Used for – chemoembolisation
E.g. Lipiodol Ultra Fluid

METHODS OF ADMINISTRATION:

A)Intravenous injection
1.     Highlight blood vessels.

2.    Enhance structure of organs.

3.    Rapidly eliminated by kidneys.

B) Oral administration

C)Rectal administration

For Oral and rectal–>

1.  Highlight gastrointestinal tract in the abdomen and pelvis.

2.  Positive contrast – iodinated CM(Gastrografin)

3.  Negative contrast
– water
– air (CT colonoscopy)

D)Intrathecal injection

E)Intra-articular injection

CONTRAINDICATIONS

Recognizing patients at risk of contrast media reaction

1.Proven/suspected hypersensitivity to iodine

2.Previous severe reaction to contrast media

3.Asthma/significant allergy history

4.Heart disease

5.Infants/children/elderly

6.Liver failure

7.Renal impairment (moderate-severe) – NIDDM on Metformin

8.Myelomatosis

9.Poor hydration

10.Sickle cell anaemia

11.Thyrotoxicosis

12.Pregnancy

13.Phaeochromocytoma

IN THESE GROUPS OF PATIENTS, LOCM SHOULD ALWAYS BE THE CHOICE OVER HOCM!!

Overall incidence of contrast media reactions

HOCM: 5-12%

LOCM: 1-3%

Mortality rates of contrast media reactions

HOCM: approx 1:40,000

LOCM: approx 1: 200,000

Types of Contrast Media Reactions

1. Anaphylactoid (idiosyncratic)

Urticaria, facial & laryngeal oedema, bronchspasm, hypotension – life threatening

2. Non-idiosyncratic

Direct effect on organs (nephrotoxicity, vasovagal attacks, arrythmias, MI)

3. Local reaction

Extravasation, phlebitis

Severity of Contrast Media Reactions

Mild: Hives, flushed feeling, metallic taste, nausea, vomiting

Moderate: Bronchospasm, laryngospasm, hypotension

Severe: Life threatening anaphylaxis

!! REACTION MAY BE DELAYED UP TO 1 WEEK !!

PATIENT PREPARATION

  1. Fasting 4-6 hrs
  2. Steroid cover  – allergy, asthma
  • T. prednisolone 50 mg 13, 7, 1 hr before examination
  • IV hydrocortisone 200mg stat

3. Renal impairment

  • N-acetyl cysteine 600mg the day before and 1 day after examination

MR CONTRAST AGENTS

Paramagnetic / Superparamagnetic
-Causes changes in the local magnetic field
–>shortened T1 relaxation time – increases signal intensity on T1-weighted images
–>shortened T2 relaxation time – decreases signal intensity on T2-weighted images
e.g.Gadolinium-DTPA (Magnevist)


Newer MRI contrast media
1.Liver-specific MRI agents
-Accumulates in the liver
e.g. Resovist, Primovist, MultiHance
2.USPIO (ultrasmall paramagnetic iron peroxide particles)
-Accumulate in macrophages in lymph nodes
-Currently undergoing clinical trials, no FDA approval as yet

COMPLICATIONS

1.Hypersensitivity reaction
2.Nephrogenic systemic fibrosis
-Recently reported serious late adverse reaction of gadolinium-based contrast.
-Seen in patients with renal failure and on dialysis.
-Fibrosis of skin and organs.
-Clinical symptoms developed 2-8 weeks after exposure to gadodiamide.
-Avoid in patient with creatinine clearance <15mL/min.

Source :
Dept of Biomedical Imaging UMMC

CT and MRI for non-radiologist Course