Health

  Breakfast Egg Sandwich with Avocado and Chipotle Mayo  2008-05-02, 05:50:00

  Signs of myocardial ischaemia after injection of oxytocin: a  2008-04-11, 00:00:00

  Predicting death and readmission after intensive care discha  2008-04-11, 00:00:00

  Plasma concentrations and sedation scores after nebulized an  2008-04-11, 00:00:00

  Different small-dose sufentanil blunting cardiovascular resp  2008-04-11, 00:00:00

  
Questions:
1) What has been learned about this entity since 1982?
2) Should he be rechallenged with penicillin and kept on long-term antibiotic prophylaxis.
3) What role does "hypersensitivity" to bacterial exotoxins play in the dermatitis.
4) Does anyone have magic for cases such as this?
5) Allergic contact dermatitis will be ruled out by patch testing.

Comment: My plan at the moment is to "clean up" any residual infection, consider prophylactic antibiotics and work on the dermatitis. I will refer him to a lymphedema center, if possible, for evaluation. Aggressive management of his leg swelling will help. He was told not to bathe the leg and I think this sets him up for infection. Your thoughts will be greatly appreciated. This man's life revolves around his leg. He is a keen student, a political scientist and in his later years he must focus exclusively on a leg. Let's give him "a leg to stand on!"

Reference:
Recurrent cellulitis after saphenous venectomy for coronary bypass surgery.
Baddour LM, Bisno AL.
Ann Intern Med. 1982 Oct;97(4):493-6.

We describe a previously unreported complication of coronary artery bypass
grafting, recurrent cellulitis. Five patients had 20 episodes of acute
cellulitis, each occurring in the lower extremity in which saphenous venectomy
had been done. The cases were striking because the patients presented with high
fever and considerable systemic toxicity. The appearance of the lesions, presence
in one case of obvious associated lymphangitis, and prompt response in three
instances to therapy with penicillin alone all suggest group A streptococcal
infection. In one case, a beta-hemolytic, bacitracin-susceptible Streptococcus
strain was isolated from the lesion. The pathogenesis of this syndrome remains
obscure but, based on our understanding of postsurgical erysipelas, this
cellulitis likely results from the interplay of several factors, including local
compromise of lymphatic drainage, direct bacterial invasion, and acquired
hypersensitivity to streptococcal exotoxins.">A Leg to Stand On  2008-04-04, 00:46:00

  
Diagnosis: Non-healing erosions etiology unclear. One always considers factitial disease in health care professionals with atypical skin lesions and this man also has free access to needles as a diabetic. In a year, the scalp lesion has shown no tendency to improve.

Further Treatment: He was treated with topical corticosteroids in case this was erosive pustular dermatitis of the scalp (no response) and imiquimod in case erosion might have been hypergranulation tissue. (no response) We ordered Duoderm dressings, but they were too expensive for the patient.

Questions: Where would you go from here? Diagnostic and therapeutic suggestions.">Stumped...  2008-04-16, 12:14:00

  who will Triage the health system?  2008-04-24, 08:43:21

  supression of public health information.  2008-04-26, 05:47:07

  JPA scholar  2008-03-23, 16:56:00

  Good news doc  2008-03-30, 05:48:00

  
So, what happen if someone owns a gun but doesn't have bullets?

Here are some questions and answers related to my posting:

What is the hottest topic among health care providers these few days until even LKS and Malaysia Today blog about it?
The dispensing rights between the doctors and pharmacists.

What is dispensing (medicine)?
To give out or to distribute (medicine).

Who has the rights to dispense in Malaysia currently?
1) Doctors. 2) Pharmacists.

What has the pharmacists been demanding for the past 20 years and now?
The exclusive rights to dispense medicine, no one else.

Why is the rights so important?
Pharmaceutical industry is an extremely profitable business. There is a huge market out there. One can become rich (like doctors?) with such rights. This can be equate to automobile companies with APs (exclusive rights to import certain cars).

Who are practicing separate dispensing currently?
1) All the government hospitals and clinics in Malaysia (Actually not entirely true as many of the dispensing role are done by "dispensers" because there are shortage of pharmacists in the country).
2) All the private hospitals in Malaysia.

Who are not practicing separate dispensing?
All private General Practitioner clinics and most of the individual Specialist Clinics.

Why are they not practicing it?
1) There are not enough pharmacists.
2) Smaller clinics could not afford to hire pharmacists to dispense.

Why are pharmacists unhappy about it?
They are losing income or business for not been able to get enough prescriptions for them to dispense. That is why they are resorting to selling all sort of stuffs (like supermarket), such as health supplements, milk powder, self-grooming stuffs and even food stuffs like mineral water.

Why are doctors refuse to give away their rights?
Primary care or General Practice in the private sector is very profitable (one can not denied) and very competitive as well. Many GPs resort to lower their consultation fees in order to get the patient volumes and gain from dispensing medicines. Take for example, many GPs lower the cost to charge per patient (in a package of consultation plus medications) in order to get accepted as "panel" for many companies. This lowers the cost of health care.

What happen if doctors loose the rights?
Many will close shops due to competition as they will never get enough from consultation alone in view of so many private GP clinics out there.

While it is really not of my concern about who gets to dispense, because I work in the government hospital, what curious me is, why is the MOH so eager to bring up the issue and to go ahead of such implementation (of separate dispensing)?

Indirectly, this may have to do with stopping more outflux of doctors to the private sector as it may not be profitable anymore to earn a living as GPs in future.

In few years to come, with so many medical graduates coming from every corner of the country and overseas, there will be a time where the market is saturated and doctors would need to start begging to get employed in MOH.

While John Chang and Dr. Khoo Kah Lin can go and debate who and why pharmacists should be or not given the exclusive rights, I am more concern if implementation would be successful if ever the pharmacists won the rights.

This patient has been buying the above three medications from the pharmacy for the past two years without a doctor's consultation and prescription for frequent joint pains.

My few concerns:
1) Will patients ever understand the danger of not consulting the doctors for their problems and to buy medicine from the pharmacies because they are cheaper?
2) Will enough enforcement be there to make sure pharmacists only dispense medicine with only prescription from doctors?
3) Will patients willing to spend more on separate prescription and dispensing (higher cost of health care)?

Meanwhile, few possibilities I could imagine if doctors and pharmacists want to cooperate to share the pie:
1) Doctors to hire pharmacists and pay them accordingly to dispense in the clinics.
2) Doctors and pharmacists to open joint venture and share the profit accordingly.

Related links:
MMR
">Gun without bullets  2008-03-31, 14:29:00

  
Here was some interesting quotes I read in the ">Back home  2008-03-07, 10:03:00

  Study Uncovers Health Disparities in Cancer Diagnosis  2008-02-27, 07:55:07

  Painful Edematous Plaques  2008-02-27, 14:18:00

  project N: from little things big things grow.  2008-02-26, 09:28:15

  Your Way to a Healthy Smile  1970-01-01, 02:00:00

  Safety and tolerability of single intravenous doses of sugam  2008-02-14, 00:00:00

  Forced convective head cooling device reduces human cross-se  2008-02-14, 00:00:00

  Perioperative tobacco use interventions in Japan: a survey o  2008-02-14, 00:00:00

  Evaluation of a decision support system to predict preoperat  2008-02-14, 00:00:00

  Why do Australian kids need their teeth pulled?  1970-01-01, 02:00:00

  Ginger-y Cranberry Walnut Scones (No Elephants were Harmed f  2008-02-14, 20:50:00

  
Today, the state health department held a public talk and a medical camp in the district level to educate the public. We were invited to participate.
A voluntary worker today.

This month, other than the CNY and Valentine's day, the medical community also commemorate,
World Cancer Day, 4th February 2008.
World Childhood Cancer Day, 16th February 2008.

Next month:
World Kidney Day, 13th March 2008.
World Down Syndrome Day, 21st March 2008.
World Tuberculosis Day, 24th March 2008.
">Celebration  2008-02-16, 17:41:00

  Periodontal Disease  1970-01-01, 02:00:00

  Umbilical Erosions  2008-02-08, 23:58:00

  Happy New Rat Year  2008-02-07, 08:18:00

  organ donation stopped by the Coroner.  2008-02-05, 11:25:22

  Effects of norepinephrine and glyceryl trinitrate on cerebra  2008-01-22, 00:00:00

  Queensland fluoridates water  1970-01-01, 02:00:00

  Introduction Of Fluoridated Water For Queensland  1970-01-01, 02:00:00

  How Do Dentists Treat Tooth Decay?  1970-01-01, 02:00:00

  Tooth decay rampant among children: survey  1970-01-01, 02:00:00

  Resolve to be better in 2008  1970-01-01, 02:00:00

  Oral Health Leads to Overall Health  1970-01-01, 02:00:00

  Simple Test at the Dentist for Breast Cancer  1970-01-01, 02:00:00

  Labor Digs its Teeth into HIV Dental Help  1970-01-01, 02:00:00

  Pets Need Dental Care Just Like People  1970-01-01, 02:00:00

  Your Health: Time to See the Dentist!  1970-01-01, 02:00:00

  
Exam: 1/3/08: There were 40 - 60 6 - 8 mm in diameter erythematous papules on torso, upper and lower extremities and to a lesser extent face. No lesions on doubly covered areas. After treatment with topical steroids this improved, but then flared around a week later.
1/10/08: Many new papules, neck, torso, extremities. No longer "breakfast, lunch and dinner" distribution.





Lab: CBC pending

Pathology: Consistent with arthropod bites or drug reaction. Will add photos later. Specimen shows parakeratosis, epidermal hyperplasia with focal eosinophilic exocytosis and a moderately dense superficial and mid perivascular interstitial lymphocytic infiltrate with scatterred eosinophils.

Diagnosis: Papular Urticaria (PU)

Questions: This woman is a competitive athlete. She does not want to take prednisone while racing. The lesions are very widespread and potent corticosteroid creams do not give much relief. Hydroxizine, too, will blunt her competitive edge. What would you recommend.

Reference: There was a good review of PU by Hernandez and Cohen in Pediatrics in 2006. "Insect bite-induced hypersensitivity and the SCRATCH principles: a new approach to papular urticaria." It is available in full-text: Hernandez/Cohen

Your thoughts and suggestions are welcome.">Papular Unticaria  2008-01-11, 12:44:00

  Happy New Year 2008  2008-01-01, 10:46:00

  Hot, hot now  2008-01-09, 18:05:00

  Dire Shortage of Dental Academic Teachers  1970-01-01, 03:00:00

  Dental Politics  1970-01-01, 03:00:00

Previous studies about garlic's impact on cholesterol were mixed, despite many alternative medicine publications suggesting a positive impact on cholesterol.

But a study that appeared yesterday in Archives of Internal Medicine concluded that garlic consumed almost daily for six months had no appreciable effect on cholesterol.

Dr. Christopher Gardner, assistant professor of medicine at Stanford University, told The Associated Press that he and colleagues were initially optimistic that garlic would reduce cholesterol.

Their study included 192 adults about 50 years old who had moderately elevated LDL or bad cholesterol levels. They were assigned to eat an average clove of garlic in raw form, or take garlic pills, six days a week for six months. In the double-blind study, part of the group was given dummy pills.

While more than half of the participants reported bad breath and body odor and some reported flatulence, there were no major side effects from eating garlic. But the study found virtually no effect on cholesterol levels in either group.

Calling the results disappointing, Dr. Gardner said it's still possible garlic might lower cholesterol when eaten in larger doses or by people with severe cholesterol problems. It also might have other characteristics that benefit heart health.

An Archives editorial said "the jury is still out" on whether garlic prevents cardiovascular diseases.

But advocates of herbal and nutritional remedies said people should continue consuming the herb.

Dr. Plank recommends consuming two cloves of raw garlic daily. She questioned whether the study's use of garlic pills, rather than raw garlic, accounts for the lack of impact on cholesterol. She said garlic thins the blood, which benefits heart health.

Other studies have concluded that garlic prevents prostate and gastric cancers, kills bacteria and even can alleviate mosquito bites.

Dr. Shivendra Singh, director of basic research, professor of pharmacology and urology, and leader of the Biochemoprevention Program at the University of Pittsburgh Cancer Institute, has been studying diallyl trisulfate, a chemical found in garlic that kills gastric and prostate cancer cells in dish cultures and animal models without affecting healthy cells.

He said he's developing the chemical as a cancer prevention, and soon will seek U.S. Food and Drug Administration approval to conduct human clinical trials on its safety and effectiveness.

Dr. Singh said research proves garlic consumption has beneficial effects on prostate cancer.

Diallyl trisulfate, he said, is just one of many chemicals in garlic that benefits health. Allicin, the chemical released when garlic is chopped, was purported to be the agent that reduced cholesterol.

Garlic's health benefits have been documented since 1400 B.C. Hippocrates, the famed Greek doctor, advocated its use for abnormal growth, which Dr. Singh said probably referred to cancer. Egyptian and Indian cultures also recommended garlic consumption to solve various ailments including growths.

Dr. Singh, who eats a clove of garlic daily, said the evidence is clear: "In terms of cancer, we know which chemical it is, how it works and how it inhibits cancer in animals."

He recommended eating a clove of garlic a day, which can be chopped, microwaved a brief period or mixed with honey.

Dr. Robert A. Schulman, author of "Solve It With Supplements" that recommends using herbal and nutritional supplements to help prevent and heal more than 100 common health problems, praised garlic, but warned that no herb or nutritional supplement is "a magic bullet."

"Herbs work in concert with other things," Dr. Schulman said. "Eating well, not eating junk food, exercising and getting a lot of sleep will make you live longer."