- Pulmonary Function Testing By : Dr. D.S. Merchant
Pulmonary Function Issues Related to Measured Values:
Overinflation of Lungs
Emphysema - COPD - Permanently
Asthma - Acutely
? RV + Ratio RV/TLC
FEV1/ FVC ratio falls below 80% - Also flow rates fall
With age (lungs less compliant)
Falls with obstructive diseases; e.g. asthma/bronchitis
Asthma - obstructive disease ? increased collapsing force of large airways
obstruction to expiratory flow ? lung volume
bronchodilators may return flow to normal
Early COPD - characterized by irreversible ? in small airway resistance that reduces expiratory flow
not very responsive to dilators
Severe COPD - ? small & large airway resist
severe flow limitations bronchodilators ? little help
chronic bronchitis and emphysema
Emphysema - loss of elastic recoil ? ? small airway collapse during expiration, thereby ? resistance
Max Expiratory Flow ?
Bronchodilators have no effect
? FRC + TLC - Sell Your Blog By : Roberto Bell
If anybody out there is in the same position, my advice is to let Michael Rogers sell your blog. It definitely worked for me. Thanks Michael Rogers , wherever you are! - Respiratory Disease and Lung Function By : Dr. D.S. Merchant
Data Collection:
Questionnaire data were collected by trained interviewers who gathered information on race/ethnicity, medical history, socioeconomic status, use of medication, and smoking history.
Participants were also asked whether they had taken any of the following pain medications in the last month and, if so, how often they had used each:
aspirin (including Anacin, Bufferin, Ecotrin, Ascriptin, or Midol), acetaminophen (including Tylenol, Anacin-3), and ibuprofen (including Advil, Nuprin, Medipren). - Guillain Barre Syndrome By : Dr. D.S. Merchant
Me score on the Glasgow Outcome Scale at eight weeks (a score of 5, indicating a favorable outcome, vs. a score of 1 to 4, indicating an unfavorable outcome).
The mortality rate among adults with acute bacterial meningitis and the frequency of neurologic sequelae among those who survive are high, especially among patients with pneumococcal meningitis. - Guillain Barre Syndrome By : Dr. D.S. Merchant
Me score on the Glasgow Outcome Scale at eight weeks (a score of 5, indicating a favorable outcome, vs. a score of 1 to 4, indicating an unfavorable outcome).
The mortality rate among adults with acute bacterial meningitis and the frequency of neurologic sequelae among those who survive are high, especially among patients with pneumococcal meningitis. - Hyponatremia by eHealthGuide.info By : Dr. D.S. Merchant
Hyponatremia:
Plasma Na < 135meq /L
Almost always due to ADH Secretion
Appropriate
Inappropriat
One Exception: Primary Polydipsia supression of ADH Secretion BUT still overwhelms kidneys diluting ability Free water retention & Hyponatremia
Epidemiology of Hyponatremia:
Hyponatremia is among the most common electrolyte disorders encountered in clinical medicine, with an incidence of 0.97% and a prevalence of 2.48% in hospitalized adult patients when plasma [Na+ ] concentration below 130 mEq/L is the diagnostic criterion.
Clinical Manifestations:
< 125 mEq/l
Malaise - Muscle cramps
Nausea, Vomiting, Headache
Hypotension Tachycardia
< 110 mEq/L
Confusion, convulsions, coma - Drug Resistance In Tuberculosis By : Dr. D.S. Merchant
Inadequate Prescribing Practice:
In 1995 25% of new cases of TB were initially treated with 2-3 drugs regimen
2 Surveys by AKUH among GP & Interns
Once resistance develops, prescribing errors, usually by inexperienced physicians can exacerbate situation.
Review of patients referred to National Jewish Hospital (Denver) for management of complex MDR-TB documented an average of 3.93 prescribing errors per patient. - Dexamethasone in Adults with Bacterial Meningitis By : Dr. D.S. Merchant
Methods:
a prospective, randomized, double-blind, multicenter trial of adjuvant treatment with dexamethasone, as compared with placebo, in adults with acute bacterial meningitis.
Dexamethasone (10 mg) or placebo was administered 15 to 20 minutes before or with the first dose of antibiotic and was given every 6 hours for four days.
The primary outcome measure was the score on the Glasgow Outcome Scale at eight weeks (a score of 5, indicating a favorable outcome, vs. a score of 1 to 4, indicating an unfavorable outcome).
The mortality rate among adults with acute bacterial meningitis and the frequency of neurologic sequelae among those who survive are high, especially among patients with pneumococcal meningitis. - Common Bleeding Disorders By : Dr. D.S. Merchant
Hemophilia in Pakistan:
A relatively young country, with an ancient past, Pakistan achieved independence from Britain on August 14, 1947, after its bloody partition from India.
Pakistan's health care system has crumbled: public hospitals are in appalling condition, even basic treatment unavailable for many common disorders.
Private hospitals-modern and fully equipped-foster the only available research, and provide the most advanced and comprehensive care for people with hemophilia, but are extremely expensive and beyond the reach of most.
No infrastructure currently exists to provide public and free care to people with this lifelong bleeding disorder.
Of the estimated 12,000 people with hemophilia in Pakistan, only 3,100 have been identified.
Until early 1980, hemophilia was not even known to exist within the country, and only a few patients were alive. In 1982 the first blood bank was formed.
Currently only five major cities-Karachi, Lahore, Rawalpindi-Islamabad, Peshawar Multan, Faisalabad and Quetta-now have facilities to provide plasma or cryo.
And treatment at its best in Pakistan is still primitive by Western standards. Virally inactivated high or intermediate purity factor concentrates are available only to the minority elite, who are wealthy enough to pay out of pocket. But the majority of patients, the poor, receive plasma or cryo. They most often receive inferior plasma, which is not always screened for HBV, HCV and HIV. - Chronic Obstructive Pulmonary Disease. COPD By : Dr. D.S. Merchant
A disease state characterized by airflow limitation that is not fully reversible. Airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. Symptoms, functional abnormalities, and complications of COPD can all be explained on the basis of this underlying inflammation and the resulting pathology. - Chronic Gastric Diseases By : Dr. D.S. Merchant
Overview:
Gastric Causes of Chronic Vomiting
- Chronic gastritis
Lymphocytic/plasmacytic
Eosinophilic
Associated with GHLOs
Parasitic
Reflux gastritis
- Gastric foreign body
- Gastric ulceration
- Gastric motility disorders
- Gastric neoplasia - COPD - Chronic Obstructive Pulmonary Disease By : Dr. D.S. Merchant
History:
SOB
Productive cough
Recurrent acute chest illnesses
Exerbation cold air, foggy weather, atmospheric pollution etc
Smoking:
Previous episodes
Details of previous admissions
Current treatment - Chronic Obstructive Pulmonary Disease - COPD By : Dr. D.S. Merchant
GOLD Staging Criteria:
GOLD Staging Criteria
Stage O: Normal spirometry; chronic sx
Stage 1 (Mild):
FEV1> 80%
Stage 2 (Moderate):
2A: FEV1 50-80% predicted
2B: FEV1 30-50% predicted
Stage 3 (severe):
FEV1/FVC < 70% AND:
FEV1 < 30% predicted and clinical evidence of R heart failure - Bronchiectasis By : Dr. D.S. Merchant
The bronchiectatic cavities may be lined by granulation tissue, squamous epithelium or normal ciliated epithelium. There may also be inflammatory changes in the deeper layers of the bronchial wall and hypertrophy of the bronchial arteries. Chronic inflammatory and fibrotic changes are usually found in the surrounding lung tissue. - Sleep Disorder By : Dr. D.S. Merchant
Risks and ComplicationsYou have the right to be informed that the surgery may involve risks of unsuccessful results, complications, or injury from both known and unforeseen causes. Because individuals vary in their tissue circulation and healing processes, as well as anesthetic reactions, ultimately there can be no guarantee made as to the results or potential complications. The following complications have been reported in the medical literature.
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