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Kidney/renal failure

Kidney/renal failure For types of kidney failure and the causes, you can read here.   There are two types of 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 failure             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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Diabetic nephropathy

Diabetic nephropathy            People, who have had diabetes for many years, will have complications of different organs. Importantly, the blood vessels throughout whole body become hard and thick, causing the decreasing of blood supply to the body. If diabetes is poorly controlled, complications will occur earlier than usual. Normally, kidney disease tends to occur more than 10 years later of diabetes. Read for more details.   Diabetic nephropathy   People, who have had diabetes for many years, will have complications of different organs. Importantly, the blood vessels throughout whole body become hard and thick, causing the decreasing of blood supply to the body. If diabetes is poorly controlled, complications will occur earlier than usual. Normally, kidney disease tends to occur more than 10 years later of diabetes. If it shows swelling in the arms, legs, face, and body, it is an indication of the onset of kidney dysfunction. Early detecting of kidney disease in diabetic patients is high blood pressure or protein leakage in the urine. When the kidneys begin to deteriorate, a blood test will be required to check kidney function. The level of urea nitrogen (BUN) and creatinine are higher than normal people.   Kidney complications in diabetes patients   cystitis Swelling Infectious nephritis Sudden kidney failure Chronic renal failure   Risk factors for diabetic nephropathy   Kidney disease is found approximately 30 - 35 % of diabetic patients. Risk factors for kidney disease include:   Male gender Heredity High sugar level High blood pressure Protein leakage in the urine Smoking   How do you know if you have diabetic nephropathy?   Pale Swelling High blood pressure Body itching Loss of appetite and weight loss Exhaustion, nausea, and vomiting in the last stage   However, the incidence of diabetic nephropathy often shows additional symptoms from chronic kidney failure patients, which are complications caused by diabetes include:   Numbness of hands and feet Chest pain Amblyopia Limb weakness Chronic ulcers on the skin and feet   Diabetes care to prevent kidney disease Annual urine testing for protein Control the sugar levels in the blood close to normal Control blood pressure Avoid using harmful drugs or substances to the kidneys, such as anti-inflammatory drugs, analgesics, and contrast agents Observe and provide treatment for other conditions that cause kidney dysfunction, such as urinary tract infections   Caring for patients with diabetes and kidney disease Annual urine testing for protein for the function of the kidneys Take the medicines prescribed by the doctor in a row and see the doctor as scheduled. Abstain from smoking and alcohol, which affect blood vessels. Take painkillers or other drugs under the advice of a doctor and pharmacist. Avoid salty, spicy, pickled, and canned food when there is swelling Control blood pressure and take medicine regularly Be careful with the food that contains high cholesterol Eat more vegetables and fish Examine other organs, such as the eyes, heart, lungs Examine the skin and feet without chronic wounds Consume less meat and salty food during treatment with hemodialysis Strictly control blood sugar levels   Examples of high fat foods to be aware   1. High cholesterol diet Seafood Beef – Pork Shrimp Shellfish Durian Butter   2. High triglyceride diet Starchy food Dessert Sweet fruit Alcoholic beverages     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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Eye function

Eye function           The way people can see clearly is caused by the light passing through the cornea and the lens of the eye, and then it is reflected on the retina. If anything blocks the light reflection on the retina, it can lead to an unclear vision, which can be called abnormal eyesight (refractive error).   Abnormal eyesight can be classified as   Nearsightedness (Myopia): light enters the eyes and focuses in front of the retina, which leads to distant blurry vision. Congenital farsightedness (Hyperopia): light enters the eye and focuses beyond the retina, which leads to distant clear vision, but near blurry vision. Astigmatism: light enters the eye and focuses different points in each plane, which leads to both far and near blurry vision. Elderly presbyopia: lenes of the eyes are stiff with age and the muscles of the eyes used for near vision are fatigue, which leads to near blurry vision.   Vision correction: use a principle of light convergence to focus on the retina. Glasses are the easiest and safest way to correct abnormal vision. However, some people have limitations to use glasses, for example, people with different problems in two eyes, athletes or those who have some occupations that are not suitable for using glasses.   Contact lenses, nowadays, are designed to be comfortable to wear. It is clear for vision and good quality, which can be another option for those who do not like to wear glasses. However, using contact lenses requires proper cleaning and takes time to wear, remove, and wash. In addition, some people have problems from using contact lenses such as eye inflammation and corneal infection. In addition, there must be the high cost for lenses and lens cleanser. Therefore, Refractive Surgery may be a better option for you.   LASIK light laser: All abnormal eyesight, including nearsightedness, farsightedness, and astigmatism, can be corrected by LASIK, based on a principle that adjusts the curvature of the cornea so that light can hit and focus exactly on the retina. For example, nearsightedness with too convex cornea, it will be flattened. Farsightedness with too flat cornea, it will be risen. Astigmatism with crooked corneas will be adjusted. Presbyopia may not be directly corrected via LASIK, but LASIK can help for near vision better.   Basic Principle of Excimer Laser Excimer Laser is a UV light (193 nm) with a light source from Argon Fluoride gas. This light is very accurate in the Micron region (See the illustration in Basic LASIK.ppt. It is an image of letters on hair carved by an Excimer Laser.) Excimer Laser has developed from the first models to the current model as follows:   First Generation: Broad Beam Laser is the use of a large beam of light in one time. However, there is a problem with the stability of the energy in the light. If the shot is distorted, it will distort (Decenter) to the entire large area. Therefore, it is developed into the second model.   Second Generation: Slit Scanning Beam Laser, which has a smaller beam size, but it is still not detailed enough, so it has been improved to the next model.   Third Generation: Free Flying Spot Scanning Laser, whose beam size can be reduced to approximately 0.8-2.0 mm. The smaller spot size results in the more homogenous energy control. Moreover, the random shooting can reduce the decentration errors.   Fourth Generation: We are familiar with this model more and more. No one gives an exact definition, but it generally refers to the use of a new technology known as Wavefront System (Customized or Wavefront guided LASIK)   Thank you Reference: http://www.wavefrontthai.com/

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What Heart failure ➤ Know the causes, symptoms, and treatment 【Latest update 2022】is heart failure?

Heart failure ➤ Know the causes, symptoms, and treatment 【Latest update 2022】   What is heart failure? Heart failure is a condition where the heart cannot pump enough blood to nourish the various parts of the body or may refer to a condition where the heart cannot relax or expand properly to accommodate blood, leading to increased blood pressure in the lungs and increased blood pooling in the lungs. This can cause fatigue and may result in body swelling.   Causes: Coronary artery disease, high blood pressure, rheumatic heart disease, or congenital heart defects, heart attack, anemia, excessive alcohol consumption, irregular heartbeat, viral infections, exposure to certain chemicals or drugs, and some sleep disorders.   Factors that can exacerbate heart failure include sudden coronary artery blockage, high blood pressure, respiratory infections, a fast or slow heartbeat, excessive fluid intake, irregular medication intake, excessive salt intake, and some medications such as painkillers and steroid drugs.   Symptoms of heart failure include fatigue, which may occur during rest or physical activity, chest tightness, difficulty breathing, inability to lie flat at night, and possibly having to sit up to breathe. Other symptoms may include coughing, palpitations, swelling in the legs or abdomen, and weakness or weight loss if the condition persists.   Diagnosis involves taking a medical history and identifying any risk factors that may contribute to the development of heart disease. A physical examination by a doctor is also necessary.   Further testing may involve: Chest X-ray to determine if the heart is enlarged and if there is any fluid buildup in the lungs. Electrocardiogram (ECG) to look for evidence of an enlarged heart or signs of coronary artery disease or arrhythmia. Echocardiography, which uses sound waves to examine the functioning of the heart muscle, including whether it is contracting and relaxing properly, and whether there are any structural abnormalities. Blood tests to measure levels of certain minerals, hormones, and other markers that may indicate heart disease, including BNP or NT pro BNP (Brain Natriuretic Peptides), which are known to increase in heart failure. These tests help diagnose heart failure and track its treatment.   Treatment: 1. General treatment: Control and manage risk factors that can cause heart failure Provide education for patients to take care of themselves after leaving the hospital Control water intake, not exceeding 1.5 liters per day Limit salt intake to no more than 2 grams per day (about half a teaspoon) Weigh oneself daily or at least twice a week to check for excess body water. If the weight is more than 2 kilograms over 3 days, consider using a diuretic or seeing a doctor Control weight, if overweight, reduce weight, but if underweight, it may indicate malnutrition, severe and chronic heart failure Exercise with a suitable exercise program and avoid exercises such as weightlifting or playing sports that strain the body Take precautions to avoid getting colds or infections easily Avoid drinking alcohol and smoking Control fat intake Sexual activity is possible if able to climb one flight of stairs without feeling exhausted Get adequate sleep and rest Travel cautiously and avoid high altitudes, thin air, and overly humid weather   2. Treatment with medication: Newer drugs or those used in emergency and acute conditions are not discussed here   3. Treatment using special tools: Implantable Cardioverter Defibrillators (ICD) are tools that are implanted into patients to treat irregular heartbeats, which are often found in severe cases of heart failure. The device diagnoses the heart's rhythm and automatically shocks it to correct it, reducing the rate of sudden death. Cardiac Resynchronization Therapy (CRT) pacemakers are devices implanted in patients with severe heart failure with abnormal electrical conduction, resulting in a lack of synchronization of heart contractions. By improving the electrical conduction of the heart, it helps the heart to contract more effectively, improving symptoms and reducing hospitalization and mortality rates. This device may also have a defibrillation function as in 3.1, called a CRT-defibrillator.   4. Treatment by surgery: Treatment by surgery refers to cardiac transplantation, which is used in cases where there is no other way to treat the heart using the methods mentioned above.  

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Human Papilloma Virus (HPV) Vaccine for cervical cancer in women

Human Papilloma Virus (HPV) Vaccine for cervical cancer in women The most common cause of cervical cancer is HPV 16 and HPV 18, which account for about 70% of cervical cancer cases. Stimulating the body to build immunity against HPV infection is one way to protect the cervix from HPV infection.   Efficacy and Safety of HPV Vaccine Results of the efficacy and safety study of the HPV 16/18 vaccine showed that the HPV 16/18 vaccine has a high potential for stimulation of immune system.   It has high safely and has no serious side effects. Moreover, it shows high effecacy against persistent HPV 16/18 infection and prevention of HPV 16/18-induced precancerous cervical lesions.   Recommended age for HPV Vaccine The HPV vaccine's efficacy is the highest in women who are not HPV-infected, so it should be vaccinated before the age of sexual intercourse or before the first time to prevent HPV infection and subsequent lesions. The HPV vaccine is currently safe and have high immune-stimulating potential for preventing HPV infection and genital lesions in women with age of 9-26 years.   For women over 26 years of age, there is no data on the effectiveness of HPV infection and lesion prevention. For the booster vaccine, it also has no information about an appropriate period. Currently available data show that antibody levels remain protective against HPV infection for at least 5 years.   HPV Vaccine Injections The HPV vaccine is intramuscularly injected for 0.5 ml three times as follows: 1st time: inject on the selected day 2nd time: Inject in the 1-2 month after the first injection 3rd time: injection on the 6th month after the first injection   Indications for HPV Vaccine Injections To prevent HPV infection with the same strain of the injected vaccine To prevent female genital lesions and cancer caused by HPV infection with the same strain of the injected vaccine   Contraindications for HPV Vaccine Injections People with hypersensitivity against vaccine constituents, such as yeast and adjuvants People with symptoms from the condition of hypersensitivity after the first injection of the HPV vaccine   Advice before the HPV Vaccine injection The vaccination recipient should be explained as follows: The HPV vaccine injection is not a substitute for cervical cancer screening. The HPV vaccine might not prevent infection with HPV precancerous lesions and cervical cancer. The HPV vaccine cannot prevent abnormal Pap smear results and cannot be used to treat precancerous lesions of the cervix. The HPV 16/18 vaccine does not prevent infection or lesions caused by other HPV strains except HPV 16/18. The HPV vaccine does not protect against diseases caused, such as vaginal discharge or venereal disease, etc. In HPV vaccine in low immunity women, antibody levels may be lower than in normal women. After injection of the HPV vaccine, you shouldn't have promiscuous sex. Preventive sex against HPV should also be practiced. Three doses of vaccination should be completed.   Side Effects of HPV Vaccine Injections In general, the HPV vaccine is very safe. Serious side effects are not found. However, possible side effects include: Side effects at the vaccination site, such as pain, swelling, redness and itching, are usually mild. It is temporary and will be disappeared. General symptoms may be found, such as fever found about 10% with a mild symptom and disappear on their own, headache, nausea, vomiting, fatigue, and rash all over the body. These symptoms are mild and disappear on their own.   Cervical cancer screening before and after HPV Vaccine injection A Pap smear before vaccination depends on sexual history and cervical cancer screening. If you haven't had sex yet, a Pap smear is not required prior to vaccination. If you have had sex, If you have never done a Pap smear before or if it is irregular, it is recommended to do a Pap smear to screen for cervical cancer first. If the results are normal, the vaccine can be administered. and should come for cervical cancer screening according to the doctor's recommendation. If the result is abnormal, the standard treatment is needed. If cured, they may provide information and advice about the HPV vaccine for women to consider. If you have done a Pap smear regularly and the results are normal every time, you can be vaccinated After HPV 16/18 vaccine injection, cervical cancer screening should be done regularly because HPV 16 and HPV 18 are responsible for approximately 70% of cervical cancer.   HPV detection before the HPV Vaccine injection There is no need to check for HPV (HPV test) before HPV vaccine injecting because HPV testing cannot determine whether you have been infected or not. If the results are positive, it can only inform that HPV infection is present. HPV antibody detection is not yet practical. Therefore, it is not recommended to check. Testing for HPV before the HPV vaccine injection increases the cost of vaccination.   Women who have had sex Women who have had sex before can get the HPV vaccine. Women who have an abnormal Pap smear or a positive HPV test should receive standard care and treatment. However, they can be vaccinated but it should be advised that the efficacy of the vaccine is reduced if previously infected with HPV. After HPV vaccine injection, you still have to come for cervical cancer screening regularly as well.   Women who have had pre-cervical lesions Women, who have had CIN before, can receive HPV vaccine if they are treated, but they must come for regular follow-up examinations by a doctor. It must be emphasized that if a woman has already been infected with HPV 16/18, the injection of the HPV 16/18 vaccine is not curative and may have low benefit in HPV 16/18 prevention.   Pregnant women and women who are breastfeeding The HPV vaccine is classified as category B and is not recommended for pregnant women. Although no teratogenicity has been reported in laboratory animals, if you are pregnant while you haven't completed your 3 doses of vaccination, you can complete the next dose in the postpartum period. It is currently unknown whether the antigens of the HPV vaccine and the antibodies produced by the body are transferred through breast milk, but the HPV vaccine contains virus-like particles of HPV that are not infectious. Therefore, has no safety implications for both the mother and the baby.   Women with low immunity Immunocompetence is not a contraindication to HPV vaccine administration, but the immunization response may be less than in immunocompromised women.   Thai Society of Colposcopy and Cervical Pathology (TSCCP)  

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Drug-resistant tuberculosis

Drug-resistant tuberculosis           You can read articles from Bureau of AIDS, Tuberculosis and Sexually Transmitted Diseases, Department of Disease Control, Ministry of Public Health About drug-resistant tuberculosis here.   Drug-resistant tuberculosis (TB)             Drug-resistant TB in Thailand has been a long-standing problem since the TB control program began almost 50 years ago. Because TB in Thailand is difficult to control, this causes frequent drug shortages and drug resistance. In the past, before 1985, a short-term 6-month drug treatment was used in tuberculosis patients. The problem of drug-resistant tuberculosis is not severe, and drug resistance has mainly been identified with resistance to isoniazid and streptomysin. The patients were still successfully cured using a rifampicin-containing regimen. The situation of drug-resistant tuberculosis persists after the application of short-term drug treatment. Last decade reported about the new drug-resistant TB, namely High multidrug resistance tuberculosis (MDR-TB), which can be found in many health cares or hospitals. The main cause of MDR-TB is that short-term drug treatment based on DOTS strategy is not effective. The problem with MDR-TB is likely to increase and become more complex due to the shortage of backup drug systems. Sometimes, patients in this group have ineffective behaviors for medication. Therefore, public health personnel caring for TB patients should have a good understanding of this issue.   Related definitions   Primary drug resistance is defined as resistance in untreated patients. Acuquired drug resistance is defined as resistance in treated or ongoing patients. MDR-TB is defined as resistance to at least two TB drugs, especially INH and Rifam, with or without other drug resistance DOTS-Plus for MDR-TB is a TB care intervention to resolve and mitigate MDR-TB by using 2 linedrug (Cat4) under the DOTS system with drug susceptibility test results for consideration.   Who is likely to be MDR-TB? Principles of finding patients with suspected MDR-TB and determination of whether multidrug-resistant tuberculosis are important.   Patients who tend to be multidrug-resistant TB include:              Patients with possibility of multidrug-resistant TB before treatment: AIDS-infected patients, patients with a history of exposure with MDR-TB patients, including medical personnel. Border prison patients   Patients with possibility of multidrug-resistant TB during treatment: On treatment for cat 1, symptoms worsened with non-negative sputum at the end of the 2nd month, and after 1 month of four-drug treatment, sputum remained positive. On treatment of cat 1, results in treatment fail with the regular drug treatment, especially treatment with DOTS. This group is at high risk of MDR-TB. On treatment of cat 2, the sputum results are not negative at the end of the 3rd month of treatment. On treatment of cat 2, the sputum results are not negative at the end of the 5th month of treatment, the TAD that had returned and positive result in sputum.   Diagnosis of MDR-TB is essential to diagnose sputum or specimen with results indicating drug resistance. To support diagnosis, there are steps to operate as follows: TB drugs should be discontinued 2 days before sending specimens for drug susceptibility test (DST). To test drug sensitivity, the examination items or specimens should be sent from the hospital to be cultured for tuberculosis at the Office of Disease Prevention and Control for 2 days. The results will be informed on website.   The primary care will be provided while waiting for DST in cases multidrug resistance is suspected. In the case of patients who tend to be multidrug-resistant tuberculosis, you should do the following: Send sputum culture for DST. While waiting for the results of the DST, the following guidelines should be followed: 2.1 In case of being treated with the cat1 drug system and the treatment result is failure, there are 2 options as follows: 2.1.1 Consider changing the drug system to a second-line drug system, that is, treatment with empiric cat4(1) drug system (Section 6.1). Treat with the current cat1 drug system (H and R) and wait for DST results.   If treatment failure from the cat1 system and regular medication by DOT system is found, the cat 2 system should not be switched due to the low cure effect.   Guidelines for determining to comply with items 2.1.1 or 2.1.2, five criterias can be used to consider the possibility of multidrug-resistant TB as follows: Clinical responses (cough, fever, changes in body weight) Changes in sputum during treatment (Fall and rise) History of receiving DOT in the previous treatment Lung radiographs at the date of diagnosis of Cat 1 systemic treatment failure. Having a history of risk factors for multidrug-resistant TB before treatment.   In case of treatment with the cat2 system and treatment failure during DST, there are two alternative approaches: consider changing the system to a second line system, i.e., treatment with empiric Cat4(2) system. (Section 6.2). The cat2 (HR, R and E) system is applied first and wait for the DST result. For other cases, the patient's current medication system should be given first and DST results should be awaited.   3. When DST results are returned, there are guidelines for applying DST results to modify the drug system as follows:   In case of items 2.1 and 2.2, if treatment while waiting for the DST results still uses the same drug system, the drug should be adjusted according to the DST results. In case of items 2.1 and 2.2, if an empirical Cat 4(1) or empirical Cat 4(2) dosing system has already been initiated during waiting for the DST results, the drug should be adjusted according to the DST results based on sputum response during complementary second-line anti-TB therapy. It is sometimes possible to continue with the empirical Cat 4(1) or empirical Cat 4(2) regimen. Other cases besides items 2.1 and 2.2 If the DST result is MDR-TB, the DST results of the 7-drug system or the basic drugs will be used for treatment together with the DST-based drug system using the principles in item 7 (Treatment for MDR cases). If the DST result is not MDR-TB, the clinical response and sputum direct smear results should be considered while waiting for the DST result. In some cases, the previous drug system can be used without switching to TB medication line 2.   If DST results, clinical response, and direct smear results are not related, a history of regular medication, the clinical response, and direct smear results will be mainly considered for determining which drug system should be used. In the case of using line 2 TB drugs, item 7 should be applied. DOT should be done by health officers or doctor.   Thank you Bureau of AIDS, Tuberculosis and Sexually Transmitted Diseases, Department of Disease Control, Ministry of Public Health.

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Malaria

Malaria   Disease characteristics           Malaria is a contagious disease. Anopheles mosquito is a carrier of Plasmodium, which is a single cell in the class of Sporozoa. It has a life cycle that can be found in both vertebrates and mosquitoes. Malaria is a very important public health problem. Thirty six percent of the population of more than 90 countries around the world live in malaria-endemic areas. For Thailand, malaria remains a major public health problem as well. Although this disease has a low morbidity and mortality rate, since 1996, the morbidity and mortality rate has tended to increase.   Cause           There are four types of Plasmodium that cause disease in humans: P.falciparum, P.vivax, P.malariae, and P.ovale. P.ovale. In Thailand, P.falciparum and P.vivax are mostly found. Mosquito vectors found in Thailand are Anopheles dirus, An.minimus, An. maculatus, An. sundaicus, An. aconitus and An. pseudowillmori.   Transmission           When an infected with malaria female Anopheles mosquito bites a human, mosquitoes release malaria (sporozoites) from their salivary glands into the human bloodstream. The infection then travels to the liver where asexual cell division takes place, producing thousands of merozoites. The liver cells then mature and burst, releasing merozoites into the bloodstream. At this stage, patients will begin to show symptoms of the disease, such as fever, chills, and headache. For P.vivax and P.ovale, some of the bacteria remain in the liver cells called "hypnozoites", causing relapsing.   After the merozoite enters the bloodstream, the organism then travels to erythrocytes where it grows into trophozoites and divides again into 6-30 merozoites. When hemolysis occurs, merozoites travel to other erythrocytes and repeat the cell division. Some merozoites are transformed into gametocytes. When a female Anopheles mosquito bites a person with gametocytes in the bloodstream, these bacteria fertilize to form a zygote that develops into an oocyst, and then implants in the mosquito's stomach. After that, it divides into sporozoites to the salivary glands for the next bites.   Incubation period   P.falciparum: about 7-14 days. P.vivax and P.ovale: about 8-14 days. P.malariae: about 18-40 days.   Transmission period           Mosquitoes that bite humans can be infected as long as the person has gametocytes in their blood. In inadequately treated patients with P.malariae, it may be a source of infection for up to 3 years, or 1-2 years in P.vivax, ot not over 1 year in P.falciparum.   Signs and symptoms           The signs and symptoms of malaria are not unique. In most cases, symptoms are similar to those of a cold: low fever, headache, body and muscle pain. There may be nausea and loss of appetite as well. These symptoms are short-term for days depending on the incubation period of the infection, type of infection, number of sporozoites infected by the patient, patient's immunity to malaria, and a condition of infected patient that has previously received antimalarial drugs or have already received some malaria medication.   Fever, the hallmark symptom of malaria, consists of three phases: the trembling phase, the heat phase, and the sweating phase. At present, the characteristics of all 3 phases are rarely found. Patients will have a high fever all the time, especially in patients with first time malaria infection. However, in the early stages of malaria infection, the infection may not grow to a mature phase at the same time. This may be the result of being infected at different times and cause many stages of infection. Therefore, hemolysis is not simultaneous. As a result, early malaria patients may have high fevers throughout the day. After a while, simultaneous hemolysis occurs, therefore, the patient was seen to have a fever and chills for a time.   Epidemiology of the disease          Malaria spreads widely between latitude 640 north and latitude 320 south and covers areas up to 400 m below sea level, such as the Dead Sea, to areas up to 2,600 m above sea level, for example Kenya. Currently up to 2.02 billion people from more than 90 countries are located in the area with a risk of malaria.   •           Malaria falciparum is common in Africa, South America, Asia, and can be found in both tropical and subtropical regions. In cold regions, it is rarely found.   •           Malaria vivax is found in tropical and subtropical Latin America, Turkey, China, and central India. It is rarely found in Africa, especially West Africa.   •           Malaria ovale is common in Africa, especially the Western part of the continent.   •           Malaria malariae is found in both tropical and subtropical regions, especially in East Africa and West India.   In Thailand, the source of malaria is in the border forests of the country, especially around the Thai-Myanmar border and Thai-Cambodian. Provinces that have always seen the highest cases are Mae Hong Son, Tak, Kanchanaburi, Ratchaburi, Prachuap Khiri Khan, Ranong, Sa Kaeo, Trat, and Chanthaburi. In the middle of the country, few cases of malaria were found and no infection was found in Bangkok and its vicinity. Malaria patients are distributed in all age groups, especially in the age group of 10-35 years. The ratio of male patients is about 2 times higher than that of female patients. Patients can be found throughout the year but will be found a lot during the rainy season.   Treatment           Treatment for malaria is divided into three categories:   Specific treatment           The specific treatment is schizontocide medication, which can eradicate schizont malaria, asexual stages in red blood cells. Choosing the kind of medicine depends on the efficacy against malaria and the drug resistance characteristics of malaria in different areas.   Treatment of symptoms and complications           Treatment of symptoms and complications is the treatment of symptoms and other complications that occurred while the patient was still infected with malaria or after the malaria infection, especially in patients infected with falciparum malaria. If patients get treatment late, there will be serious complications.   Prevention of disease transmission           Prevention of transmission is the use of gametocytocide to kill gametocyte stage of malaria infection.   Details of the use of antimalarial drugs can be found in Guidelines for Infectious Disease Practice Volume 1. Communicable Diseases. Department of Communicable Disease Control. Ministry of Public Health 2001 Experience in infectious disease in Thailand Infectious Disease Society of Thailand 1999

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Muscle Memory

Muscle Memory You may be familiar with the term “muscle”.   Memory, whether reading from golf magazines or general golf textbooks, is the word that often used for golf learning. If you want to be good in golfing, you have to practice until your muscles remember it without thinking about how to hit, how to turn around, or what kind of weight to transfer.   Muscle memory is a term that is widely used and understood. In medical or physiological term, it would be more accurate to use the word “motor memory” because the muscles literally have no memory. It only performs contraction and relaxation by receiving a controlling from the motor area of cerebral cortex and integrating from many other parts of the brain to allow the muscles to work delicately and automatically.   In medical aspect, surgery can help to transfer the muscle attachment to change its function, for example, in patients with radial nerve injury, patients who are unable to straighten their fingers. Surgical treatment by transferring the insertion of the flexor muscle with the ligaments of extensor muscles. Thus, the patient will be able to straighten his fingers. At first, you may need to practice the feeling of wrist flexion first and practice more often for controlling it to extend your fingers automatically. Moreover, the transferring of entire muscle that used to flex the knee in the inner thigh (Gracilis muscle) to the upper arm (in the case of a patient who cannot bend the elbow and cannot be applied by other treatments) is performed. Its origin is connected to the shoulder and the insertion is attached to the ligament of elbow flexor muscles. After that, the blood vessels and nerves are connected to this muscle (called Free Gracilis muscle transfer). When the nerve works well, this muscle can control to to the elbow flexion.   From above example, it can be clearly seen that the important function of the muscles is contraction from stimulation through the nervous system only. When muscles contract itself, it will pull both origin and insertion together. It doesn't matter where the muscles were originally or have any functions.   Memory             Memory has ability to store information and restore it back.   Process of memory It relies on the information that enters to the brain from various sensory receptors, such as images from the retina, sound through the organ of the inner ear (Organ of corti), recognizing the different positions of the limbs and joints in any position through proprioceptive sense. Memory storage depends on many areas of the brain, which includes the the consciousness to stimulate the brain function. Thus, it will be able to store the memory.   Type of memory   1.         Sensory memory: the ability to remember information sent in the brain for a short time, such as looking at an object and then shifting the eyes to another area. The image remains stable for approximately 250 ms, then it will be faded in less than 1 second, which is replaced by the incoming signal of new image. For the audibility, it is remembered for less than 5 seconds if there is no repeated stimulation. 2.         Short-term memory: it is a memory of 10 seconds to 2-3 minutes, such as remembering telephone numbers, reading reviews. It can be remembered in a short time if there is no repeated stimulation. 3.         Long term memory or permanent memory: it can be remembered for days or years, such as remembering one's name and familiar surroundings.   Mechanism of memory Short term memory From previous studies   1.         By using electrical stimulation of the cerebral cortex for 1 minute, it was found that the stimulated area still has an electrical potential for a period of time. After the stimulus has stopped, called a reverberating circuit, which is short-term memory, it will disappear when a new circuit has come. 2.         By stimulating the brain for 2-3 minutes and then repeat the stimulation again, the neuron intensely responds more than normal, known as post titanic potentiation, it appears temporary changes in neuronal synapse. This causes short-term memory.   Long term memory   1.         Structural changes in the synapse revealed that the terminal fibrils at the synapse have increased with age. However, the brain's neurons work less. For example, in blind animals, the number of terminal fibrils at the visual brain area is reduced. Previous studies suggest that the permanent memory mechanism is caused by the alteration of shape and number of synapses. It may change permanently. However, an increase the nerve synapses will transmit nerve signals more easily. The repetition of the memory results in the good memory and it is difficult to forget.   2.         Biochemical changes   2.1       Animal experiments showed that active neurons produce more protein and RNA. Administration of Actinomycin D, which inhibits RNA production, temporarily reduced memory in rats. 2.2       Growth hormone trial increases the ability to learn and influences to permanent memory.   2.3       Thyroid hormones affect memory formation. Importantly, children who lack this hormone will be mental retard.   There are two types of long-term memory.   1.         Reflexive (Implicit) memory is a memory that occurs automatically without thinking. This type of memory comes from training or often repetition. It is related to physical functioning skills (called muscle memory), such as playing sports, golfing, driving, and working in everyday life. 2.         Declarative (Explicit) memory is a memory that must be thought under consciousness and attention in order to retrieve the stored information and explain it in words, as well as describe, compare, or interpret.   Conclusion for Golfers   1.         You must research for information from reading golf textbooks, watching TV, or a golf instructor to get experiences and change the physiology of the brain (not just muscle part). 2.         You should practice frequently for effective learning. You should study with a golf instructor how to adjust your body for a better swing, such as stretching exercises, practice balancing, and strengthen muscles. 3.         You should practice for feeling remembering, such as golf landing, backswing, downswing, impact, and fall through. Moreover, you need to check each position by looking at the mirror or taking a VDO. Closing eyes practicing being able to perceive the feeling of different positions is also important (most of us receive the sensing from the eyes, so the perception of different parts of the body is quite low). You should practice in various positions until getting used to. 4.         You should practice step-by-step and repeat until short-term memory is achieved. The repeated practicing should be continued for at least 3-4 weeks and then practice for the next step. The disadvantage of those who do not understand about memory is that they practice many things at the same time and mix them together, resulting in a confused short-term memory. That makes playing golf unable to control the swing. 5.         Golf tips sometimes don't work, and it is dangerous for your swing. Some golfers have new tips that suggest the opposite information. Those can cause confusion and uncertainty. Many golf tips are not suitable for all golfers. Thus, we have to choose which one is really useful because the shape, strength, flexibility of each golfer are different. 6.         Frequent inappropriate practice will lead to getting used to it. This can make more difficult to correct. For example, a golfer who has been playing for a long time but has a bad swing, it will be more difficult to correct. They need to start again over each step until a short-term memory is achieved first. New corrections may not lead to play golf well as before. if there is intention, you should be patient and practice until you have the right swing and the results will be much better, such as Nidfaldo took 2 years for correcting his golf swing. 7.         You should always check the swing and practice regularly because there will be changes in the swing later, which is related to physical and mental condition. 8.         When a golfer has practiced to Reflexive Memory or Muscle Memory, you must plan the game about golf club choosing, golf ball position, and hitting. After that, muscle memory will be used. Thinking about swing or how to get score will loss muscle memory. If you practice routinely, it will lead to a memory about your swing that you can do it automatically. Finally, the result will be more certain than thinking about a swing that could be miss.   From Smart Golf Magazine

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Ultrasound examination

Ultrasound examination             Ultrasound is an examination with high-frequency sound waves by allowing a transducer transmit ultrasound waves to the skin, glands, or tissues with different properties. Those waves will be reflected and scattered back into the transducer (echo). Then, it is recorded, amplified, and adjusted before being sent to the display.   Ultrasound can be used to examine different parts of the body, including:   Head Used to examine young children under 2 years of age to check the abnormalities in the skull by examining through the fontanelles.   Neck Used to detect abnormalities and find lesions of the thyroid gland, salivary gland, parotid gland, and nodules at the neck area. Moreover, it can be used to examine the carotid artery.   Chest Used to examine for fluid in the pleural space (pleural fluid) or to check for lesions on the chest wall, such as tumors, etc.   Abdomen Used to examine abnormalities and find lesions of all internal abdominal organs.   Other parts Used to investigate abnormalities and lesions in other organs that are soft tissues or have fluid inside, such as muscles. It can also use a Doppler examination of the breast, legs, and large and medium size of blood vessels. Abnormalities of blood vessels, blood flow velocity, vessel blockages are investigated too.   For the head, neck, and thorax, they can be checked immediately without preparation. However, in some children, sedation may be required according to the doctor's orders.   Abdomen Upper Abdomen: abstain from water and food at least 6 - 8 hours before the examination. In children, abstain from food or milk for 1 meal in order to display organs clearly, especially the gallbladder.   Lower Abdomen: no need to abstain from water and food. (Unless prescribed by a doctor). Three hours before the examination, drink 4-5 glasses of water and hold the urine until the examination is complete (it requires full urination). This will show the uterus and organs in the lower abdomen clearly.   Whole Abdomen: abstain from food for 6-8 hours before the examination. Three hours before the examination, drink 4-5 glasses of water and hold the urine until the examination is complete (it requires full urination).   Other parts can be examined immediately. No preparation is required before the examination.   Advice Should abstain from water and food (N.P.O. = Nothing Per Oral) at least 6-8 hours before the examination (for young children, abstain from milk for only 4 hours). Reasons of water abstain is to avoid the air in the Gastro-intestinal tract. Air influences ultrasound images. In case of the patient with Bowel gas, it is best to wait 2-3 hours before. Reasons of food abstain is to avoid the occurrence of food illusions. Moreover, the oily food also causes the gall bladder contraction, which leads to be difficult to detect the gall bladder.

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Bone density measurement

Bone density measurement (Bone Mineral Density)   Diagnostic Radiology Department, Vibhavadi Hospital provides bone density measurement services with HOLOGIC's advanced bone densitometer every day. HOLOGIC densitometry uses two x-ray energy (DEXA), which can examine thick bones, such as the spine and hip joint. Why do we need to measure bone density?   Bone density measurement (Bone Mineral Density)   When people get older, the body produces less calcium (Ca), causing the fragile bones, called osteoporosis. A bone densitometer can check the amount of bone density and lead to the proper prevention and treatment planning.   What is osteoporosis?   It is a condition in which the bones have low bone density causing a chance of fracture. Normal bones have a fibrous structure with a mesh cavity in the bone. When bone is formed, the interfibrous cavity becomes larger, which can cause bone fractures easily. Moreover, when osteoporosis occurs in the spine, bones are unable to stand upright, and it shows abnormal spine curvature. Osteoporosis is generally found in people over the age of 50 and in postmenopausal women.   Osteoporosis causes   • Old age • menopause • Calcium (Ca) deficiency • Treatment with hormones or Steroid. • Family history of osteoporosis.   Osteoporosis Diagnosis   There are several methods, but the easiest one is using a bone densitometer. We can know the result immediately. Modern bone densitometry tools have details as follows: • Able to examine almost all parts of the body. • Spend less time for examination. • Provide high resolution and precision of images. • Provide low dose radiation.   Who has to check? • Patient with abnormal spine condition • Patient with hormonal problems such as hyperthyroid • Women with low estrogen levels and menopause • Skinny people • People with a family history of osteoporosis • People with insufficient exercise   What should alcoholism patients do if they have osteoporosis? • The doctor will explain an appropriate prevention and treatment methods. • Regular exercise will lead to calcium production. You should avoid drinking alcoholic beverages and refrain from smoking. Those will reduce the incidence of osteoporosis.   Preparation for examination • Eat normally • Inform the staff, if you take thyroid medication. • Inform the staff, if you take calcium. • Inform the staff, if you have done the Barium radiographic examination for an appointment. • Inform the staff, if you have done the kidney examination with contrast medium for an appointment. • Inform the staff, if you have done physical examination with radioactive substances at the area near the lumbar spine for an appointment.

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