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Gestational diabetes (GDM)

Gestational diabetes (GDM)   Mothers should control their blood sugar levels to be as close to normal as possible. This can be achieved by controlling the intake of starchy and sugary foods, but if this is not possible, insulin injections may be necessary to control blood sugar levels. Gestational diabetes (GDM), which occurs mainly in the third trimester of pregnancy, can be classified into two severity levels:    Class A1 (glucose intolerance), which accounts for 90% of pregnant women with GDM and is treated through diet control.   Class A2 (Overt DM), which means fasting hyperglycemia, i.e. blood sugar levels greater than 105 mg/dL, and is treated with insulin injections.   Principles of controlling carbohydrate-rich foods:   Avoid large meals in one sitting and divide them into 3 main meals and 3 snacks. Consume foods that provide energy from protein, good fats, or complex carbohydrates, such as brown rice and whole wheat bread. Increase protein-rich foods (meat) and leafy vegetables, as they are high in dietary fiber and vitamins. For milk, it is recommended to consume skim milk or low-fat milk, and avoid or limit fruits that have a very sweet taste, such as durian, rambutan, longan, and lychee. Maintain a healthy weight and avoid becoming overweight.   For pregnant mothers with diabetes, in most cases, their blood sugar levels will improve on their own after giving birth. However, pregnant women with high blood sugar levels have a higher risk of developing diabetes in the future than those with normal pregnancies, so they should monitor and control their diet regularly, reduce their intake of sweets, sweetened drinks, and desserts, and have their blood sugar levels checked every year.   Risks to the fetus when the mother is unable to control blood sugar:   Birth defects or miscarriage (for mothers with diabetes before pregnancy)   High blood sugar in the fetus   Poor fetal nervous system development   Risks to the newborn after birth   Large fetal size, weighing more than 4,500 grams   Low blood sugar in the newborn   Premature birth   Breathing difficulties   Increased risk of obesity and diabetes.  

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Recommendations for COVID-19 vaccination

Recommendations for COVID-19 vaccination The elderly group with age of ³ 60 years old and those with 7 chronic diseases are considered eligible target groups to start the first batch of COVID-19 vaccination in June 2021. According to registering through the “Mohpromt” system is quite popular among Thai people, we would like to answer those important questions and concerns. Moreover, for the most effective performance of the vaccine and low risks, side effects, and adverse reactions from vaccination, the recommendations for vaccination against COVID-19 are summarized as follows:   Before receiving the COVID-19 vaccine -  2 days before and after vaccination, refrain from vigorous exercise or weightlifting and should get enough sleep.   -  In case of illness or discomfort, vaccination is not recommended. You must heal for at least 2 days before vaccination.   -  On the day of injection, drink at least 500-1,000 cc of water.   -  Abstain from caffeinated beverages such as tea, coffee, soft drinks, and alcoholic beverages for at least 1 day.   -  Eat regular meals.   During receiving the COVID-19 vaccine -  On the appointment date, you should arrive at the injection area at least 30 minutes before the scheduled time. Please prepare your ID card, health information, and registration information via Line "MohPromt" on your mobile phone.   -  Strictly maintain basic prevention: wear a mask, keep a distance, carry alcohol gel, wear clothes that are convenient for vaccination.   -  Measure body temperature and blood pressure before vaccination.   -  Inject at the arm that is not a dominant side. After two days of injection, do not use that arm. Don't use it to lift heavy things.   -  You should take the congenital medicine as normal. If you need to take thrombolytic drugs, you should press at the injection site for 1 minute after the injection.   -  If you have a congenital disease or need to take medication, especially immunosuppressants or drugs that cause vasoconstriction, such as migraine drugs (ergotamine group), you should consult a doctor or notify a nurse before vaccination.   After receiving the COVID-19 vaccine -  Observe side effects at the hospital 30 minutes before returning home. If there are abnormal symptoms such as limb weakness, numbness in half, distorted mouth, slurred speech, please inform the nurse or doctor immediately.   -  2 days after injection, do not use the injected arm, or lift heavy objects.   -  If you have a fever or aches and pains that are unbearable, you can take 500 mg of paracetamol one tablet. You also can repeat if necessary. It should be 6 hours apart. Do not take or avoid drugs such as Brufen, Arcoxia, or Celebrex. If it is necessary, an advice from a doctor should be sought.   - After returning home, self-assessment should be continued for another 48-72 hours. In some cases, side effects may appear. Most of them are local side effects such as pain, swelling at the injection site and mild side effects such as low fever, fatigue or urticaria. After 30 minutes to 2 hours after vaccination, the symptoms will gradually decrease, but if you have the high fever, the limbs weakness, numbness on half body, crooked mouth, and unclear speech, you should go back to the hospital or call 1669 to assess the symptoms immediately.   -  Covid vaccination should be injected apart from influenza at least 1 month.   The contraindication and cautions of vaccination against COVID-19 All types of vaccines have contraindication as follows: allergies to the constituents of the vaccine. Since these vaccines are novel, it has less scientific information about allergic reactions. In the first stage, you should be injected in the hospitals or healthcare clinics where can immediately provide assistance for severe reactions and should be monitored symptoms after injection for at least 30 minutes.   If you have the following symptoms after vaccination, you must go to see a doctor at a hospital nearby your home or call 1669 for emergency medical services.   High fever Chills Severe headache Chest tightness and difficulty breathing or choking Vomit more than 5 times Whole body rash, peeling skin Many spots of bleedings. Crooked face or crooked mouth Limbs and muscle weakness and imbalance Enlarged lymph nodes Convulsions or loss of consciousness The regulations are considered to strictly follow. To reduce side effects from the COVID-19 vaccination, after the first dose of vaccination, you should be prepared for an appointment for the second dose of vaccination. Everyone will continue to wear masks, maintain social distancing, and wash their hands before, during and after vaccination.     Reference: Ministry of Public Health  

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Recommendations for a COVID-19 vaccination in diabetes patients

Recommendations for a COVID-19 vaccination in diabetes patients   1. Why should people with diabetes get vaccinated? If people with diabetes have their poorly controlled sugar levels, there is more chance to have a severity of the infection than the normal one. The vaccine can prevent infection, reduce the severity and death rate from COVID-19 by more than 90 percent.   2. Patients receiving antiplatelet drugs or anticoagulants They can be vaccinated by pressing at the injection site firmly for at least 2 minutes and informing the staff before receiving the vaccine. *Those who take warfarin, which is an anticoagulant drug, should consult with a doctor to measure the level of blood clotting properly before vaccination.   3. COVID-19 vaccine and blood sugar levels After vaccination, there may increase blood sugar levels. The fingertip glucose measurement should be investigated regularly within 48 hours after injection. If there is high sugar level, you should inject medicines to reduce it to normal level or take a medication followed by a physician advise.   4. Self-care after vaccination Other approaches to prevent and reduce the risk of COVID-19 infection in patients with diabetes   Regularly check your fingertip sugar level and take medicine to control your blood sugar level to normal. drink enough clean water. Rest and take care of your body and relax your mind for your good health.

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Blood donors must assess the risk of transmission of the COVID-19

Blood donors must assess the risk of transmission of the COVID-19 virus before donating blood to obtain the quality blood: A B O AB.   Safe from the original source (the blood donor) and the destination (the patient).   1. Fever, cough, sore throat, runny nose, panting, scentless, tasteless.   2. Returned from abroad within 14 days.   3. Work in a place where there is a risk of infection within 14 days   4. Go to an entertainment place or crowded places within 14 days   5. Close contact with a patient infected with COVID-19 within 14 days.   6. Just recovered from COVID-19 within 14 days   If you meet any of the criteria, refrain!!! blood donation.   Confidence and safety, we will go through the COVID-19 crisis together.     Reference: Blood Service Center, Thai Red Cross Society

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Advice...how to prepare yourself before and after vaccination against COVID-19

Advice...how to prepare yourself before and after vaccination against COVID-19   Must be sure that you are not in a high-risk group, who cannot receive vaccination, before the injection, for example, being pregnant, undergoing treatment for a serious symptom, having a high fever, and severe diarrhea. If you have a history of vaccine or drug allergies, you must inform staffs before vaccination. You must get enough resting. Do not skip food before vaccination. After the injection, the staff will ask you to sit and wait to see the symptoms in the injection area for 30 minutes. If you have a fever or aches and pains that are unbearable, you can take 500 mg of paracetamol one tablet. You also can repeat if necessary. It should be 6 hours apart. Do not take or avoid drugs such as Brufen, Arcoxia, or Celebrex. If it is necessary, an advice from a doctor should be sought. COVID-19 vaccination should be spaced at least 14 days to 1 months apart from influenza vaccines. Completing of the COVID-19 vaccination should be done first because it is more dangerous. You can normally take thrombolytic drugs. However, when you are injected the COVID-19 vaccine, you should press at the injection site for 1 minute.   Reference: COVID-19 Information Center

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Side effects after vaccination against COVID-19

Side effects after vaccination against COVID-19   Mild symptoms   - low fever, headache   - Nausea, vomiting   - exhaustion   - Pain at the injection site     Severe symptoms   - high fever   - Lots of bleeding spots   - A rash all over the body   - Vomited more than 5 times   - convulsions/loss of consciousness   - crooked mouth, muscle weakness   - severe headache   - chest tightness, shortness of breath   If you have any following symptoms, you should see a doctor immediately or contact to a hospital nearby.   Reference: Ministry of Public Health

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What vaginal discharge can tell you about your health

What vaginal discharge can tell you about your health Don't be alarmed if you have experienced vaginal discharge. The color of the discharge can be white, yellow, or green and can indicate an underlying health condition. It's important for women to know about the different types of vaginal discharge. Vaginal discharge, also known as "leukorrhea," is a common condition that many women experience and often seek medical advice for. This condition can result from normal hormonal responses in women or from chronic or severe medical conditions. Therefore, it's important to be aware of this condition. Vaginal discharge is any fluid that flows out of the birth canal that is not blood. It is mainly produced by the birth canal, the cervix, and surrounding organs. The characteristics of vaginal discharge can vary depending on changes in the body during normal or disease states.   What is normal vaginal discharge and how does it occur?   Normally, in women who are in their reproductive age (also known as women who still have their periods or have fully developed female hormones), there will be changes in hormone levels that occur according to the menstrual cycle.   These changes can affect the characteristics of the fluid produced by the reproductive organs in the female body, such as during the middle of the menstrual cycle or near ovulation. At this time, estrogen hormone levels are high, causing the discharge to be clear and more abundant than at other times. During other times of the menstrual cycle, the discharge may appear white and slightly opaque, similar to wet flour.   In addition, normal vaginal discharge should not be itchy or have an odor. If your discharge has the characteristics mentioned above, it is considered normal and there is no need for treatment.   However, each woman's amount of discharge may vary. Some women may have a lot of discharge that stains their underwear for several days each month, while others may have so little discharge that they do not even notice it.   Furthermore, hormones in women of reproductive age cause cells in the vaginal canal to be complete and produce a type of starch-like substance called glycogen. This substance is converted into a mild acid by a certain type of bacteria, which helps prevent the growth of other harmful bacteria and the occurrence of abnormal conditions.   What are the causes and characteristics of abnormal vaginal discharge? There are two major causes of abnormal discharge: infection and non-infectious factors. Abnormal discharge caused by infection can be caused by viruses, bacteria, fungi, or parasites in the reproductive tract. This type of discharge may have specific characteristics depending on the type of infection.   1. Viral infections: Some viral infections are sexually transmitted and may not have obvious symptoms. For example, herpes is a lifelong disease that can cause small, clear blisters that eventually break and become painful sores. Yellow, foul-smelling discharge may accompany the first outbreak.   2. Bacterial infections: This type of discharge may be yellow or green and may cause itching in some individuals. Some bacterial infections may cause a fishy odor, particularly after sexual intercourse. In the case of a gonorrhea infection, the discharge may be thick and yellow and may be accompanied by painful urination.   3. Fungal infection: The cause of white discharge is due to a fungal infection. Fungal infections in the genital area often cause white, small lumps that resemble milk curds and itching in the genital area. This type of discharge usually does not occur from sexual intercourse. The common causes of this type of discharge are the use of contraceptives or vaginal douches that contain antibiotics, or in cases where the patient has a weak immune system, such as patients with diabetes or those taking immunosuppressant drugs.   4. Parasitic infection: White discharge caused by a parasitic infection in the genital area. This type of infection is a sexually transmitted infection that often appears yellowish, may have a frothy appearance, itching in the genital area, and may have a slightly sour odor. Non-infectious causes of abnormal discharge include changes in hormonal levels or chemical irritation from products such as douches or perfumed soaps. It's important to see a healthcare provider if you experience any unusual discharge, particularly if it's accompanied by other symptoms such as pain, itching, or discomfort.   What would you do in case of experiencing vaginal discharge?   If you experience normal vaginal discharge as described above, you do not need to do anything special, but you should see your gynecologist for an annual pelvic exam, including a Pap test for cervical cancer.   However, if you have abnormal vaginal discharge, such as discharge that is discolored or has a foul odor, or if you experience itching, you should be examined and treated appropriately for the underlying cause.   This is because treating the underlying cause will help the condition to heal more quickly. For example, if the discharge is due to a yeast infection, the doctor may prescribe an antifungal medication such as clotrimazole. If it is due to a bacterial infection in the genital tract, oral medication such as metronidazole may be necessary.   Secondly, abnormal vaginal discharge may sometimes be a symptom of gynecological cancer. This condition should be treated urgently.   Finally, if your vaginal discharge is caused by a sexually transmitted infection, you should be tested and treated for the infection as well as any other types of sexually transmitted infections that may be present.   Both you and your partner should be tested and treated to avoid complications and future reoccurrences of the disease.     General Asst. Prof. Dr. Thanaboon Julayamitborn   Lecturer, Department of Obstetrics and Gynecology, Phramongkutklao College of Medicine, Assisted reproductive unit and gynecological endocrinology, Division of Obstetrics and Gynecology Phramongkutklao Hospital Consultant Obstetrician, Vibhavadi Hospital

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Conjunctivitis

Conjunctivitis Viral conjunctivitis often happens, especially in young children and elementary school students. It is not a serious disease, However, if it is not treated since the beginning, it may be complicated by bacterial infection impaired vision.   How is conjunctivitis contagious?   The disease often spreads among people who live in crowded places. It can spread from direct contact with the tears, eye discharge of the patient but most often indirectly spread by:   Rub your eyes with germ-containing dirty hands. Sharing utensils, such as handkerchiefs, towels, glasses, water bowls, and other items with the person with the disease. Flies in the eyes   What are the symptoms of conjunctivitis? Approximately 24-48 hours after exposure to the virus, they will have eye irritation, eye pain, watery eyes, eye discharge, eyelid edema, conjunctivitis, inflammation, and redness. This can begin in either 1 eye first or both eyes at the same time. It may have a low fever, dread, or tingling pain in the limbs. Patients usually recover by themselves within 1-2 weeks if there is no complication of bacterial infection.   When you have conjunctivitis, how should you do?   When the symptoms mentioned above occur, you should see a doctor immediately. Doctor will prescribe antibiotic eye drops to prevent bacterial complications for 7 consecutive days. For some patients with fever, headache, they will use analgesic drugs to relieve pain according to the symptoms. If the symptoms are more severe, you need to see a doctor again.   You should rest your eyes, don't use your eyes too much.   Should stop studying or work for about 1-2 weeks or until the red eye symptoms are completely healed. Furthermore, you should not go to community places, such as cinemas, department stores, etc., because it may spread the disease to others.   Separate personal belongings of patients. Don't let other people use it.   Always wash your hands after touching your eyes and frequently wash hands.   Is there any way to prevent conjunctivitis?   The disease can be prevented by maintaining good personal hygiene, including:   Always wash your hands with soap and water. Do not rub your eyes with unwashed hands.   When dust gets into your eyes, do not rub them. You should rinse them with cooled boiled water.   Do not use items such as glasses, handkerchiefs, towels, hand towels, or eyewash cups, which is shared with others Especially when there is an epidemic of conjunctivitis. have to be more careful   Laundry clothes, towels, handkerchiefs, pillowcases, bed sheets, etc.   In crowded places, sufficient clean water should be provided for washing hands, washing face and bathing.     best wishes from Vibhavadi Hospital

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Kidney disease, how kidney failure causes damage to other organs, prevention, and treatment.

Prevention and treatment of kidney disease   Kidney Humans have 2 kidneys located at the back, under the ribcage, at the lumbar region, which is shaped like a bean with the length about 12 centimeters. • The kidneys compose of many capillaries called the “kidney unit” (nephron). • Kidney units will deteriorate with age.   What is the function of the kidneys? 1. Remove waste. 2. Absorb useful substances for the body. 3. Maintain the water balance of the body. 4. Maintain the electrolyte balance of the body. 5. Maintain the acid-base balance of the body. 6. Regulate blood pressure. 7. Produce hormones.   1. Remove waste, including urea and creatinine • When the body receives nutrients, it will decompose and use the useful substances. After that, it releases waste into the bloodstream, passing through the kidneys, which is excreted with urine. • Excrete drugs and other foreign substances.   2. Absorb useful substances for the body • Substances that are beneficial to the body will be reabsorbed by kidney cells such as water, phosphate, and protein.   3. Maintain the water balance of the body • If there is excess water than the body needs, kidneys will excrete water through the urine. • If the body is in a state of dehydration, kidneys will try to preserve water for the body. The urine will be small volume and concentrated.   4. Maintain the mineral salt balance of the body • Normal kidneys always excrete excess salt. • If kidneys are deteriorated, patients will be swelling when they eat too much salt.   5. Maintain the acid-base balance of the body • The body produces acids every day from protein metabolism. • If the kidneys function normally, there will be no acid retention. • if kidneys are dysfunction, the body will secrete acidic urine.   6. Regulate blood pressure • High blood pressure is caused by the water and electrolyte (salt) imbalance, including some certain substances. • Patients with kidney disease often have high blood pressure because the kidneys are stimulated to produce substances that cause high blood pressure. • If the blood pressure is very high, it will cause heart diseases or stroke, leading to paresis and paralysis at last.   7. Create hormones. • Normal kidneys can produce many types of hormones. • If you have kidney disease, hormone production will be impaired.   Hormones produced by the kidneys • Erythropoietin hormone acts to create red blood cells. Therefore, the patient will have paleness, weakness, lack of strength, heart workload, dizziness, faint, and tired. • Vitamin D (Calcitriol type) acts to help regulate calcium absorption. The low levels of vitamin D and calcium in blood lead to the hormone hypersecretion from parathyroid glands. It is a negative effect on many organs in the body, especially the bones.   Renal impairment causes negative effects on various organs.   Who is at risk for kidney disease? 1. Age over 60 years 2. High blood pressure 3. Heart disease, such as coronary artery disease 4. Stroke 5. Diabetes 6. Gout 7. Different types of nephritis, such as childhood nephritis, SLE nephritis, gallstones, tumors, and capillary inflammation 8. Family member with kidney disease 9. Infectious urinary tract disease 10. Using painkillers or exposing with chemicals for a long time   How do you know it's kidney disease? • Symptoms • Research   Symptoms of kidney disease 1. Swollen eyelids, face, feet, legs, and body, respectively 2. Abnormal urine such as cloudy, frothy, bloody, and dark brown 3. Abnormal urination such as frequent, burning, scrubbing, and small amount 4. Back pain, feeling a lump in the kidney area 5. High blood pressure 6. pale, tired, low energy 7. Flatulence, nausea, vomiting 8. Loss of appetite, taste changes 9. Headache, insomnia   Symptoms observation of kidney failure   Early stage of kidneys failure • Swelling • Pale • Fatigue • Tired easily • High blood pressure   Chronic Kidney failure • More pale • Loss of appetite • Irritation whole body   Symptoms observation of kidney failure 1. Swelling of the face and eyelids 2. Leg swelling 3. Swelling of the feet 4. Bloody urine   Kidney failure   Acute kidney failure             Kidney deteriorates rapidly within a day or a week. It shows much more symptoms and high death rate than in chronic kidney disease. However, if it is in non-severe, the kidneys can be normal.   Chronic kidney disease • The kidneys are permanently destroyed, causing the gradual shrinkage of kidneys. Although the symptoms are stable, but the kidneys will gradually deteriorate and eventually turn into chronic renal failure.   Causes of chronic kidney disease Currently, patients with kidney disease turn into late stage of chronic kidney disease with the causes as follows:   1. Diabetes. 2. High blood pressure and capillary nephritis, such as Systemic Lupus Erythematosus disease. 3. Other causes include • Kidney stones • Chronic nephritis due to infection. • Gout • Kidney disease due to continuous taking painkillers for a long time. • Hereditary polycystic disease   These various causes often cause disease on both kidneys at the same time.   Written by Prof. Dr. Leena Ongartyuth, Department of Nephrology, Department of Internal Medicine Faculty of Medicine Siriraj Hospital, President of the Kidney Association of Thailand

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