Diabetic Foot Ulcer Treatment

diabetic foot ulcer treatment

Diabetic foot ulcer is the most common non traumatic foot injury that end up as lower extremity amputation. Many factors are considered to be causes of diabetic foot ulcer such as infection, foot deformity, mechanical changes, atherosclerotic peripheral arterial disease, and peripheral neuropathy. 

Risk factors of diabetic foot ulcer

According to American Academy of Family Physicians, there are some risk factors for lower extremity amputation in the diabetic foot:

• Obesity
• Diabetic retinopathy (impaired vision)
• Arterial insufficiency
• Foot deformity resulting in focal areas of high pressure
• Absence of sensation because of peripheral neuropathy
• Limited joint mobility
• Uncontrolled diabetes mellitus
• Poor footwear that causes skin breakdown
• Previous history of diabetic foot ulcer

Diabetic foot ulcer staging
According to PubMed, it is important to be aware of the natural history of the diabetic foot ulcer that can be divided into five stages:

1. Stage 1 : normal foot
2. Stage 2 : high risk foot
3. Stage 3 : ulcerated foot
4. Stage 4 : infected foot
5. Stage 5 : necrotic foot

Diabetic foot ulcer treatment 

Diabetic foot ulcer treatment needs multidisciplinary management to control all aspects of healing: mechanical, microbiological, vascular, metabolic, and also educational aspects. The first thing that should be done is a good control of blood glucose, lipid profile, and blood pressure.

1. Stage 1. Goal of therapy is to prevent the development of ulcers and to promote healthy footware habit and foot care. Diabetic patients should be encouraged to use the suitable diabetic footwear and control his blood glucose, lipids, and blood pressure.
2. Stage 2. Stage 2 is when the foot has one or more these risk factors for ulceration: ischaemia, neuropathy (sensory loss), foot deformity, swelling, and callus. The presence of callus should be agressively treated.
3. Stage 3. The foot is neuropathic and neuroischaemic. Diabetic foot ulcers in stage 3 need mechanical control (relief of pressure), wound control (wound dressing, wound toilet, debridement), and may also need vascular control.
4. Stage 4. Infected foot needs antibiotics as microbiological control, and urgent wound control (surgical drainage and debridement). The goal of therapy in stage 4 is to prevent severe infection that will progress to necrosis.
5. Stage 5. Necrotic foot can be divided into wet and dry necrosis. Wet necrosis needs intravenous antibiotics, surgical care, and vascular reconstruction. Proper management of diabetic foot ulceration will reduce the number of amputations in diabetic patients. 

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Nasopharyngeal Cancer Symptoms

nasopharyngeal cancer symptoms

Nasopharyngeal cancer is the most common cancer found in the ear, nose, and throat area. It is a malignant cancer originated from nasopharynx tissue. What is nasopharynx? The nasopharynx is an area behind the nose and also the upper part of the throat. Throat or pharynx, is a tube with 5 inches long that starts behind the nose and ends at the top of esophagus (a tube connecting throat to stomach) and trachea (wind pipe). Each side of the nasopharynx leads into an ear. Nasopharynx is an area consists of squamous cells that make it likely probable to have malignant cancer.

Nasopharyngeal cancer is associated with some risk factors as listed below.

• Epstein-Barr virus exposure. Many studies show that this virus is closely related with certain cancers such as lymphomas and also nasopharyngeal cancer.
• Asian or Chinese ancestry.

Nasopharyngeal cancer symptoms 

There are main symptoms of nasopharyngeal cancer you have to pay attention, and please consult your physician when you find these:

• A chronic sore throat
• Followed by a lump in the nose or neck area
• Nosebleeds
• Trouble in speaking or breathing
• Hearing loss from mild to severe
• Otalgia (ear pain), or ringing ear
• Chronic headache

How to diagnose nasopharyngeal cancer?

When you find suspected symptoms of nasopharyngeal cancer, you should go to the physician, especially an ENT specialist. These procedures may be done to make a definite diagnosis of nasopharyngeal cancer:

• Physical examination: about the lymph node enlargement, abnormal condition of ear, nose, throat
• Neurological examination: to check the function of brain and nerve.
• CT-scan: it is a detailed imaging of suspected cancer area.
• Biopsy: it is a gold standard of nasopharyngeal cancer diagnosis. Small cells will be removed and examined under a microscope to check for cancer signs and also cancer staging. 
• Laboratory tests: it may include blood and urine tests, or other necessary substances in the body. The goal of laboratory test is to help diagnose, know about cancer metastase, and plan the proper treatment according to cancer staging.

Nasopharyngeal cancer treatment

Nasopharyngeal cancer treatment options and its chance of recovery depend on these factors:

• Cancer stage (known by biopsy)
• Cancer type (known by biopsy)
• The patient's age and underlying medical condition
• The size of cancer

Generally, there are five specific treatments to cure nasopharyngeal cancer:

1. Surgery
2. Radiotherapy
3. Chemotherapy
4. Immunotherapy
5. IMRT (Intensity-modulated radiation therapy)

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Adderall Dosage For Adults Chart

adderall dosage for adults chart

Adderall is a brand name of amphetamine-salt based drug that  manufactured by Shire US Inc, indicated for the treatment of Attention Deficit Hyperactive Disorder (ADHD) and narcolepsy.

According to MIMS, a diagnosis of ADHD marked by the presence of hyperactive, impulsive and inattentive symptoms that were present before the age of seven years old. ADHD consists of symptoms that can cause a significant impairment such as in social, occupational, academic ability, etc.  There are lack of attention to details, lack of sustained attention, failure to follow orders, poor listener, poor organization, easily distracted, and forgetful. For the hyperactive and impulsive type, at least 6 of these following symptoms must be presented for 6 months or more: leaving seat, inappropriate climbing and/or running, difficulty with quiet activities, fidgeting, excessive talking, blurting answers, intrusive, can't wait turn, etc. The combined type needs both hyperactive impulsive and inattentive criteria to be found.

Adderall is indicated as a part of holistic treatment program for ADHD that consists of psychological, educational, and social therapy. Drug treatment only are not indicated for all ADHD children. Appropriate educational placement and psychosocial treatment is very needed. The decision to prescribe Adderall depends on the physician's assessment on the severity and chronicity of the symptoms. There is no sufficient data to support the long term use of Adderall.

Adderall dosage for adults chart

Adderall should be administered at the individual dosage, e.g. the lowest effective one and must be reviewed and adjusted depends on the therapeutic needs and patients' respond.

• ADHD: not recommended for children under 3 years old.
• For 2-5 years old : start with 2.5 mg daily, and may be raised slowly
• More than 6 years: start with 5 mg once or twice daily
• Narcolepsy: start with 5 mg daily.

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Herpes Simplex Virus Infection Symptoms

herpes simplex virus infection symptoms

Herpes simplex virus infection can occur at the mouth, face, buttocks, skin, anal and genital area. Most of herpes simplex virus infection symptoms are not specific, and may be asymptomatic. But in some cases, it appears as painful blister located at the port d'entree (area where the virus entered the body). Those blisters usually heal spontaneously complete but can reappear again in the future, in the same location when least expected. Between two attacks, the virus resides deep in the nerves that supply the involved area. People often refer herpes simplex virus infection as "cold sores" or "fever blisters", because the most common infected area is around the mouth and lips.

Once you're affected by the virus, it can hide in the body for years. Many things are considered as trigger for herpes simplex virus reinfection, include:

• Decreased immune system
• Having another viral infection such as influenza, common cold, etc
• Exposure to the sun
• Menstrual period
• Psychical stress

Herpes simplex virus infection can rapidly spread between persons. Infected saliva is a common means of virus transmission. Transmission via towels, washclothes, and surfaces are actually impossible. The most common area of cold sores are lips, under the nose, chin, and another facial area. Healing time needs 7-10 days without scarring.

Herpes simplex virus infection symptoms

• Some patients may have prodrome symptoms such as burning sensation that precedes the appearance of blisters.
• The most characteristic symptoms of herpes simplex virus is a group of blister on a red base. The blisters dry up shortly and leave scabs that last anywhere for days, depending on its severity and the host's immune system. What makes it different from another skin infection is, if something lasts for weeks, it is unlikely to be herpes simplex virus infection. 
• Area affected is itchy, dry and crusty. 

Herpes simplex virus infection: treatment

• There is no specific cure for herpes simplex virus infection.
• Cold sores often clear spontaneously without treatment
• The goal of herpes simplex virus treatment is to relieve symptoms and shorten an outbreak. 
• You can buy OTC drugs to relieve discomfort, such as paracetamol, benzocaine and L-lysine, and apply them to the blisters.
• Avoid sun exposure and stress.
• Put ice on the blister.
• Some drugs prescribed are antiviral groups and they can treat both types of herpes simplex infection. The can lessen the severity infection, frequency of relaps, and prevent viral transmissions:
• Acyclovir
• Famciclovir
• Valacyclovir

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Chronic Inflammatory Demyelinating Polyneuropathy CIDP

chronic inflammatory demyelinating polyneuropathy cidp

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired, rare,  and autoimmune disorder of nerve the peripheral nerves, characterized by gradually increasing weakness of the lower extremities and, to a lesser extent, the upper extremities. It is also called chronic inflammatory demyelinating polyradiculoneuropathy. 

Chronic inflammatory demyelinating polyneuropathy is caused by myelin damage. Myelin is nerve's cover. The weakness happens at least two month or more. The exact cause of CIDP is auto immune disorder in which the body's immune system recognizes myelin as foreign substance and attacks it. 

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) : Signs and symptoms

There are some symptoms of suspected CIDP:

• First complain: walking difficulty which worsens progressively. Sensory function may be altered if the patients' sensory nerve myelin is damaged. 
• On physical examination: decreased or loss of reflexes, such as knee and ankle reflexes
• Electromyography (EMG): slowing of conduction of electrical signals and in worse condition, it may be totally blocked conduction
• Cerebrospinal fluid (CSF) analysis: elevated protein levels with normal CSF white cell count.
• Blood and urine tests: to define the causes of CIDP and if there is any underlying diseases.
• Nerve biopsy: to establish the diagnosis.
• MRI. It is a useful tool to support the diagnosis criteria of CIDP.
• Holistic evaluation of genetic neuropathy.

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) : Treatment and Management

Basically, the treatment for all kinds of autoimmune disease is slightly similar. Here are several protocols to manage patient with CIDP:

• Steroid. The goal of steroid is reduce inflammation. It can be used for initial treatment because it can improve strength, can be taken orally, and relatively cheap. Please be careful of the side effects of long term steroid.
• Intravenous Immunoglobulins (IVIG). It is a blood protein that taken from healthy individuals, given through arm vein 
• Plasmapheresis or plasma exchange. The goal is removing harmful antibodies that found in plasma. CIDP patient's blood will be removed, and the blood cells returned without its plasma.

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Autism Spectrum Disorder Symptoms In Children

autism spectrum disorder symptoms in children

What is autism? And what is Autism Spectrum Disorder?

Autism is a very complex developmental disabilities that cause problems with communication and social interaction. Signs and symptoms of autism start at 18 months old and then will cause delays in social developmental from infancy to adulthood. 

According to National Institute of Child Health and Human Development, people with autism have variable different symptoms so health care providers conclude autism as a "spectrum" disorder: a group of disorders with similar features. One children may show mild symptoms but another may have very serious symptoms. But both of them have an autism spectrum disorder. There are three categories of autism spectrum disorder:

1. Classic autism or autistic disorder
2. Asperger syndrome
3. Atypical autism or Pervasive Developmental Disorder Not Otherwise Specified, or shortened as pervasive developmental disorder.

So we use terminology "autism spectrum disorder" and "autism" to mean the same disorder.

Autism spectrum disorder symptoms in children

There are three main points of autism spectrum disorder:

• Communication disorder: both verbal and non verbal communication. There are difficulties in speaking, pointing, smiling, eye contact, etc.
• Social interaction incapability, such as how to give empathy, sharing emotions to others, how others think and feel, and how to hold a conversation
• Routines or repetitive behaviors disorder, such as playing in repetitive ways, repeating actions or words, obsessively following certain routines.

Autism spectrum disorder treatments

• As quoted from Center for Disease Control, there is no single best treatment for all children with autism spectrum disorders.
• The most important of treatment program is structured teaching of specific skills.
• Regular medical and dental examination should also be included in the treatment program.
• Three basic treatments:

1. Behavioral therapy, based on Applied Behavior Analysis (ABA). Speech therapy can help autism children improve their communication ability. Occupational therapy can help children adjust tasks to match their needs and abilities. Physical therapy is also important to build motor control and improve posture and balance.
2. School-based options. Public schools are required to provide appropriate public education from age 3 until high school. Parents should consult to the teachers, school psychologists, and child developmental specialists to design an individual plan for their children.
3. Medication. There are no medications that can cure autism spectrum disorder symptoms in children. SSRIs (Selective Serotonin Reuptake Inhibitor), anti psychotics, stimulants, tricyclics, and anti anxiety are often prescribed. A hormone that helps digestion called secretin is not recommended as autism spectrum disorder treatment.

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Heat Stroke Symptoms And Treatment

heat stroke symptoms and treatment

One of true medical emergency that can be fatal and needs proper treatment is heat stroke. It is one kind of hyperthermia which the body temperature is rapidly increased, accompanied by nervous system disturbances. In extreme heat, the body temperature can dramatically raises, it can reach 42 C and may be higher. Heat stroke can be caused by dehydration. As quoted from MedicineNet, a dehydrated person may not be able to dissipate heat, which causes the body temperature to rise. Infants, high activities people (such as athletes), people who work under the sun, and elderly people are very susceptible to heat stroke. 

Heat stroke symptoms and treatment

Symptoms and signs of rapidly heat stroke are:

• Nausea and vomiting
• Brain and nervous system disorders: dizziness, disorientation anxiety, unconsciousness, seizure, confusion, severe restlessness, until coma
• Difficulty of breathing, from moderate to severe
• Increased heart rate until cardiac arrythmia
• A rectal temperature over 40 C (104 F)
• Red, hot, and very dry skin
• Muscle cramps

When you find someone with suspected heat stroke, please remember that he must receive immediate treatment to prevent permanent organ damage. Here are some steps of heat stroke treatment.

• Find a help, call 911
• Remove the victim from heat
• Begin cooling: apply cool water to the skin, place ice packs under groins and armpits, give him cool water to drink
• Monitor body temperature, especially by rectal temperature examination
• In most cases, victims must be hospitalized.

Heat stroke management in a medical facility (taken from American Academy of Family Physicians)

• Continue cooling until core temperature of 38 C (100.4 F)
• Laboratory tests to rule out other entities, such as: electrolyte imbalance, hyperthyroid storm, neuroleptic malignant syndrome, phechromocytoma, etc
• Monitor renal function 
• Caution patient about re-exposure

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How To Lower Androgenic Hormones

how to lower androgenic hormones

Androgenic hormones are steroid hormones that control the development and maintenance of masculine characteristics. The main source of androgenic hormones in the body is the testes. Androgenic hormones are also the original anabolic steroids and also precursors for female sex hormones called estrogens. Testosterone is the most famous androgen that has profound effects throughout the body. Testosterone also plays a role in governing behaviors such as risk taking, aggression, territoriality, and mitigating depression.

Androgenic hormones can be stimulated by such things below.

• Physical exercises, such as sprinting and resistance training, but avoid overtraining.
• Have a good night sleep everyday. It will reduce cortisol levels and directly promote testosterone levels. 
• Take a relaxation during your busy time. Take time to go out with friends, read some books, etc.
• Eat dairy and animal products. Be sure you choose the clean and natural ones.
• Eat more essential fatty acids, such as peanuts, avocado, fish, and healthy oils like flax seed, canola, and olive. As we've known, cholesterol is the basic material to make testosterone. High fiber diet tends to lower androgenic hormones, so sometimes we have to make it balanced.
• Take vitamin D supplement and more activity under the morning sun.
• Take zinc supplement. Zinc deficiency will lower androgenic hormones.
• Reduce alcohol consumption.
• In females, reduce soy intake because it increases estrogen levels and lowers androgenic levels.
• Increase sexual activity can also stimulates androgenic hormones.  

How to lower androgenic hormones?

High level of androgenic hormones is bad for women, because it is associated with hirsutism, or unwanted hair growth. Here are some natural ways you can try.

• Dietary soy-phytoestrogens. Recent study concludes the beneficial effects of dietary phytoestrogens on regulatory behaviors (food/water intake, body weight, and locomotor activity), prostate enzyme activity, prostate weight, and reproductive hormon levels.
• Consume these natural remedies: herbal tea (like spearmint tea), black cohosh capsules, saw palmetto and chaste tree capsules.
• Consume natural supplement made from broccoli and cauliflower called DIM (Diindolylmethane). The dose is 120 mg daily
• Consult an acupuncturist to have a serial therapy to lower androgenic hormones.

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High Cholesterol Foods To Avoid

high cholesterol foods to avoid

Cholesterol is a waxy steroid, fat-like substance that is found in all the body cells. Body needs cholesterol to make hormones, vitamin D, enzyme, and other bio-substances. Body makes all cholesterol every time it needs. However, cholesterol is also found in foods we eat. Cholesterol from food travels through the bloodstream, so high cholesterol foods will give impacts on high cholesterol level in our blood. People with high cholesterol have a greater chance of getting heart attack or coronary artery disease. So it is very important for us to know about high cholesterol foods to avoid.

There are some high cholesterol foods to avoid and their cholesterol contents (mg/100 g edible food portion), taken from Healthaliciousness:

1. Egg yolk (fresh, raw, frozen, sugared, salted). It contains 900-1,100 mg cholesterol/100 g food
2. Caviar (fish roe). It contains 588 mg cholesterol/100 g food.
3. Liver, pate, foie gras. It contains 255 mg cholesterol/100 g food.
4. Butter, common in cookies, bread, cakes, etc. It contains 215 mg cholesterol/100 g food.
5. Shrimp and prawns. It contains 195 mg cholesterol/100 g food.
6. Fast foods. They contain 172 mg cholesterol/100 g food.
7. Fish oil. It contains 132-140 mg cholesterol/100 g food.
8. Cheese. It contains 123 mg cholesterol/100 g food.
9. Processed meats such as sausage, lamb, duck. They contain 158 mg cholesterol/100 g food.
10. Shellfish and oyster. They contain 105 mg cholesterol/100 g food.

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Androgenic Alopecia Treatment

androgenic alopecia treatment

Androgenic alopecia refers to absence of hair from areas where it is normally present. It is very common on both males and females. The incidence of androgenic alopecia is greater in males than females. Androgenic alopecia is not a threatening condition, it is more about cosmetic disorder.

Androgenic Alopecia Causes

The causes of androgenic alopecia may be both genetic and environmental factors. There are so many risk factors causing androgenic alopecia, but most of them are still uncertain. This kind of hair loss is proven related to hormones called androgens, particularly dihydrotestosterone. Androgens are physiologic substances that are important for normal men sexual development, before birth and during puberty. But this hormones also have functions as hair growth and sex drive regulator in both sexes.

Androgenic Alopecia Treatment

1. Pharmacological. There are two drugs that are approved by FDA:
• Minoxidil. It is a good androgenic alopecia treatment for recent onset and small areas of hair loss. The 5% solution of minoxidil is considered effective. Women give better respond compared to men.
• Finasteride. It is an oral drug and the use is limited on men only since it can cause amibguous genitalia in a developing male fetus. Finasteride is good in stimulating new regrowth in most patients.
2. Surgical. In the recent decades, so many surgery have performed to give a better cosmetic effect in androgenic alopecia patients. The results are often satisfactory but the problem is covering the bald area with donor hair sufficient in number to be effective. Micrografting technique gives a more natural result than the old transplanting technique.

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