Frank’s sign is a diagonal crease in the lobule of the auricle

“The sensitivity of Frank’s sign reaches 75%, its specificity 57.5% and its positive predicting value 80.3%. The prevalence of Frank’s sign increases progressively with age: 42% in the 30-39 age group and 75.8% in the 60-69 age group.

Frank’s sign is considered as a marker of the coronary disease, independent of risk factors but frequently associated with them. If its absence does not permit in any way to exclude the diagnosis of coronary disease, its presence corresponds in three quarters of the cases to an established coronary disease within a symptomatic population.”

Extracted from Darren’s blog

Frank’s sign is a diagonal crease in the lobule of the auricle :

Grade 3 – a deep cleft across the whole earlobe
Grade 2a – crease more than halfway across the lobe
Grade 2b – crease across the lobe, but superficial
Grade 1 – lesser degree of wrinkling

Filariasis (Philariasis) is a parasitic tropical disease, caused by a thread-like parasitic worm of the type of nematode. Some of examples are Wuchereria bancrofti and Brugia malayi. These parasites are transmitted by mosquitoes.

The common presentation of filariasis is elephantiasis. It is the thickening of the skin and tissues due to the present of parasites in the lymphatic system. Elephantiasis mainly affects legs, but also can affect ears and mucus membranes. W. bancrofti can affect legs, arms, breats and vulve.

Life cycle
Life cycle of W. bancrofti (male – around 5cm, female – around 10 cm)
The human being serve as definitive host while the mosquitoes as intermediate hosts. Microfillaria would reside in the lymphatic circulation and constantly migrate between the deep (during the day) and peripheral circulation (at night). And the worm is transferred into a vector (mosquitoes). Inside the mosquitoes, they would mature into motile larvae and be ingested into the blood stream of another human. The larvae will then moves to the lymph nodes (mostly in the legs or genital area) and develop into an adult worm in a year.
Pathogenesis of W.bancrofti

After infection, the worms will mature in 6-8 months. There is an asymptomatic phase and then an inflammatory phase where the antigens of the worms cause inflammatory responses and disrupt the flow which causes lymphedema. There will be symptoms of fever, chills, skin infections, painful lymph nodes and tender skin of lymphedematous extremity. An obstructive phase after that marks the development of lymph varices, hydrocele and elephantiasis.
This disease is endemic in Asia, Africa, Central and South America. A diagnosis can be made by identifying the microfilariae on a Giemsa stained thick blood film. The blood is drawn at night when the parasites circulate. PCR can also be use as a tool for diagnosis.
Treatment
Albendazole, ivermectin and diethylcarbamazine. Doxycycline had been suggested to treat elephantiasis as well.

The issue of Melamine tainted milk from China had been up for some time but I was surprised by the fact that not many medical students know it and there are even more that simply do not care or mind to find out. Here is a small article on the basic knowledge of Melamine and hopefully this would help you to more or less grasp the severity of this problem.

Melamine is an organic base which contains some 66% of nitrogen by mass. Melamine is use in producing durable thermosetting plastic and polymeric cleaning products. Some of the end products are glues, erase boards, counter tops, fabrics and flame retardants. It is also used in making high-resistance concrete and fertilizers.

Melamine derivatives of arsenical drugs are used in the treatment of African trypanosomiasis!

Due to it’s high content of nitrogen, some manufacturers added melamine into milk and infant formula to fool the government in the protein content tests. With that, the protein content of the food will appear higher than the normal value.

When melamine is consumed, it can combine with cyanuric acid (which is permitted to be present in some non-protein nitrogen additives used in drinking water) can form insoluble melamine cyanurate, which could crystallize in the renal microtubules. It would damage the renal cells and in the end cause kidney failure. Other than that, it could also lead to reproductive damage, kidney and bladder stones.

In 22 September, nearly 53,000 people had become ill and almost 12,000 people hare hospitalized, affecting mostly babies and kids who consume these milk and infant formula products.

Русcкий : Множественная Миелома

It is a cancer of the plasma cells, which are the immune system cells in bone marrow that produces antibody.

.

.

.

.

(Xray below)

This elderly man was admitted with complains of nausea, vomiting, pain abdomen and was in a state of delirium. He has also been losing weight for a while. Here is the xray of his skull.

A skull xray showing multiple lytic lesions. This xray is classical of these lesions.

The cause of his symptoms was hypercalcemia.

The symptoms are classical description of hypercalcemia: bones, groans and psychic moans.

An easy mnemonic to remember Multiple Myeloma is CRAB

Calcium (hypercalcaemia)

Renal failure

Anaemia

Bone lesion (lytic lesion/pepper pot skull)

Electronic fetal Monitoring (EFM) will be use to monitor the status of the fetus when the labour is condired to be of ‘high risk’.  Such group would include hypertension during pregnancy, meconium stained liquor, abnormal FHR (Fetal Heart Rate) and can also be use during active period of labour.

Today we are going to talk about CTG (Cardiotocography) and how to interprate a CTG strap.

First of all, one of the transducer shall be put over the fundus of the uterus, while another at the place where the fetal heart beat is best heard. And then the FHR and Uterine Contraction will be recorded. These are few principles that one should know in order to interprete the CTG.

Baseline FHR- It is the mean of the peaks and depressions. Normal would be 110-150bpm (beats per minute)

Baseline variability - It is the oscillation of baseline FHR excluding acceleration and deceleration. Normal would be 10-25bpm

Acceleration – It is the increase of FHR for more at least 15seconds. Normal would be 2 in 20min

Deceleration – It is the decrease of FHR below the baseline by 15bpm or more. Normal would be none or early.

The deceleration pattern could be early, late and variable.

Early deceleration means the FHR begins to slow down at the beginning of UC. The lowest point of deceleration conincides with the peak of UC.

Late deceleration means the FHR begins to slow down after the onset of the contraction. The lowest point is thus after the UC and usually FHR would return to normal before the next contraction.

Variable deceleration means all other patterns of FHR slowing which not necessarily related to UC.

Lag time is the time taken for the FHR to reach the lowest point (nadir) from the peak of UC.

Sinusoidal pattern is the stable baseline FHR without any acceleration. This is usually associated with fetal anaemia, feto-maternal hemorrhage and fetal hypoxia.

That’s all for this time. Read this and try to find more articles online. Hopefully you wouldn’t be so blur when the teacher shows you the CTG in the future!

SVT is a narrow complex tachycardia (narrow QRS) with HR of 140-250/min.

Symptoms include pounding chest, chest pain, shortness of breath (SOB), dizziness and loss of consciousness.

One has to recognize this ECG and perform immediate management.

Non-pharmacological maneuver:

1. Vagal stimulation ( effective in 25% of cases)
2. Valsava maneuver
3. Cold water immersion

(google it yourself)

Pharmacological :

1. Adenosine 6mg stat. Follow by 12mg after 5min and another 12mg after 5min (effective in 80%)

**The ECG showed that adenosine (effects that last for about 20s) that stuns the AV node (transient blockade) with widening of the QRS complex for a short period of time before the heart rate returns to normal at the rate of 75 beats perminute with the normal atrial sinus taking back the normal activity**

During treatment(pharmacological):

Post-treatment:

Ladies, (especially all u lazy BUMs out there!!) its THT time of the month…
1st scene…
You just got back from class…u’re feeling oh so tired…oh so weak…and the lovely comfy bed is just infront of ur eyes…oh so inviting….Do you jst pop on the bed and take a nap…or do you run to the bathroom and get urself  “cleaned”??
OR…
2nd scene…
you’re in between classes…and the toilet in the university is jst so unpleasant, awful, atrocious, revolting…n jst to enter the toilet gets u thinking a million and one time…
Ladies, never ever hesitate to even think…pls by all means GO GET URSELF CLEANed up!!
DID YOU KNOW>>>
tht the usage of tampons and sanitary pads for a duration of more then 3 hours will  cause the genital area to be prone to bacterial action (like duh~~)which may result in CERVICAL CANCER or even other complications!!
HERE’s the SCOOP >>>
Basically sanitary pads and tampons aren’t made out of REAL 100% cotton (for ur info…). Ever wonder made popular brands so “free” and light and carefree?…well here’s the bit….
Sanitary pads aren’t even made out of 100% cotton…they’re jst a layer or CELLULOSE gel, and tampons?? ABESTOS!!
Tampons and sanitary pads contain two things that are potentially harmful: Rayon (for absorbency), and dioxin (a chemical used in bleaching the products). The tampon industry is convinced that we, as women, need bleached white products in order to view the product as pure and clean. The problem here is that the dioxin, which is produced in this bleaching process, can lead to very harmful problems for a woman. Dioxin is potentially carcinogenic cancer-associated)and is toxic to the immune and reproductive systems.
Rayon contributes to the danger of tampons and sanitary pads and dioxin because it is a highly absorbent substance. Therefore, when fibers from the tampons are left behind in the vagina (as usually occurs), it creates a breeding ground for the dioxin. It also stays in a lot longer than it would with just cotton tampons. This is also the reason why TSS (toxic shock syndrome) occurs.
So What are the alternatives??>
Dun be such a SLACK!!  Bring an extra sanitary pad (it ain’t tht heavy…come on’)and change it in between classes…(even though the toilets may suck just so badly!! )
Never hesitate to change…though the amount may be “little” or it maybe “absolutely clean”….!!!  Just,puh…leese…DO NOT….i repeat…DO NOT re-use them again….and again…and again…!! Its not just dangerous…its basically unhygienic…and thoroughly DISGUSTIN!! Urgh.

The second highest leading cause of death from cancer amongst Malaysian Women, and worldwide, is CERVICAL CANCER, first being Breast Cancer. Cervical cancer, as the name implies, is the cancer of the cervix, which is the lower part of the uterus that connects to the vagina.

Cervical cancer is caused by certain high-risk type of Human Papillomavirus Virus (HPV). When a female becomes infected with this virus, it may causes abnormal cells to develop in the lining of the cervix, which can lead to precancerous cells, and if not discover early and treated, will lead to cancer.

Over the years, women with cervical cancer, had suffered from minor operations, hysterectomy (removal of the whole uterus), radiotherapy, chemotherapy and even death from cancer spread.

? How is HPV transmitted?
According to the Centers for Disease Control and Prevention, the only way you can totally protect yourself against HPV is to avoid any sexual activity that involves genital contact. In summary, abstinence is the ONLY way to prevent cervical cancer. And I am not talking about multiple partners. A single partner, let’s say your future spouse, can also cause cervical cancer to you. So, unless you are very sure that you can avoid sexual activity life long, I suggest you read on.

? How to prevent cervical cancer?
Thank God, now, researches had developed a vaccine against HPV (Human Papillomavirus Virus), the causative agents of cervical cancer = GARDASIL. HPV types 16 and 18 causes 70% of cervical cancer cases, and HPV types 6 and 11 causes 90% of genital warts cases. GARDASIL is so far the only vaccine that help guard against diseases caused by HPV type 6, 11, 16 and 18.
Note: Anyone who is allergic to the ingredients of GARDASIL should not receive the vaccine. Also, GARDASIL is not for women who are currently pregnant.

? Why am I telling you this now?
A research done on the effectiveness of GARDASIL was done on a population sample on those non-sexually active between 16-26 years old and the result was significant. In fact, the earlier you are vaccinated, the better it is. Therefore, since most of my friends and blog readers are among this age group, I would like to introduce this vaccine to you. It is recommended for girls between 9-26 years old.

? Do one still have to go for PAP smear after vaccinated?
YES. GARDASIL does not protect you 100% from cervical cancer. PAP smear is still the number one screening tool for cervical cancer. It is a cheap and simple procedure. Therefore, once you are sexually active, you still have to go for PAP smear anually (for 3 years, and if all previous smears were normal, screen every 3 yearly).

? Where can I get this and how much?
You can get yourself vaccinated at any local clinic. The price is about RM350 per dose, with a total of 3 dose altogether. Be aware that some vaccine only covers for 2 HPV. Make sure you asked your doctor for more information. Or else, just insist on GARDASIL which provides vaccination against the 4 HPV mentioned above.

? How effective is this vaccine?
As for all vaccine, vaccination with GARDASIL may not result in protection in all vaccine recipients. The efficacy of GARDASIL was assessed in 4 placebo-controlled, double-blind, randomized Phase II and III clinical studies. These studies evaluated 20451 women 16 to 26 years old of age at enrollment. The efficacy of GARDASIL against HPV 16- and 18-related CIN 2/3 or AIS was 100% in all four studies (Protocol 005, Protocol 007, FUTURE I and FUTURE II and combined protocols). The efficacy of GARDASIL against HPV 6,11,16 and 18 CIN was 100%, 100%, 90.7% and 95.2% respectively in studies : Protocol 007, FUTURE I and FUTURE II and combined protocols . While the efficacy of GARDASIL against HPV 6,11,16,18 genital lesions (eg warts, VIN, VaIN) was 100%,100%, 98.6% and 99.1% respectively.

? Possible side effects?
Commonly: Fever, redness, pain and swelling at injection site.
Sometimes: Pruritus (itchiness) and hemorrhage (bleeding) at injection site
Very Rarely: Bronchospasm, syncope

? Is it worth the money?
I shall leave it for you to decide. (It sucks right? When women have to suffer from a cancer spread by man. Sigh.. ) Thinking down the line, between a thousand and cervical cancer, if you have some extra savings to spare, why not?

I wanted to include some pictures of cervical cancer and cervical warts, but I was a bit worried that it might upset some readers, certainly not for the faint heart, and I do not know how to include spoilers in a blog… maybe, some other time, perhaps… or you could try googling for pictures, the internet makes it so convenient…