Medicine Hack

We usually use the serological test ( anti H. Pylori anti bodies ) to test for the presence of the micro organism in our setting. But unfortunately this least expensive method is also the least accurate one. The sensitivity of this test is 85% while its specificity is only 79%. The more accurate tests with a sensitivity and specificity of around 95% include: 1) Urea breath test, 2) Fecal antigen test. N.B: Sensitivity refers to the % of ill persons who are correctly identified as having a particular disease. Specificity refers to the % of healthy persons who are correctly identified as not suffering from a particular disease. Treatment: Eradication treatment that we usually use includes a PPI (proton pump inhibitor) and 2 antibiotics for 14 days, the regimen with the greatest proven efficacy. It includes: 1) Cap Omeprazole 20 mg B.D + 2) Tab Clarithromycin 500 mg B.D + 3) Cap Amoxicillin 1 g B.D or Tab Metronidazole 500 mg B.D if allergic to amoxicillin.

Microalbuminuria is defined as a level of 30-300 mg of albumin in the 24 hr urine sample. Usually albumin is not present in urine. Instead of 24 hr urine, the simpler test we do in casualty is urine dipstick in a spot sample of urine. If we get a result of 1+ to 3+ it is considered as microalbuminuria. The clinical implication of this is that it indicates early renal damage in the HBP patients. So don't forget urine dipstick in HBP patients.

A person can be labelled as prediabetes patient if he has: 1) A Fasting Plasma Glucose (FPG) of 5.6-6.9 mmol/L or 2) An Oral Glucose Tolerance Test (OGTT) of 7.8-11.0 mmol/L or 3) An HbA1c of 5.6-6.4%. The implication of this group of persons is that in the next 5 yr, it has 40% chance to get into the diabetic group. A good diet, regular exercise, weight loss, control of blood pressure is recommended for these patients.

It is also called as thyroid dermopathy. It is characterised by localised skin lesions in the pretibial region. This is due to the deposition of hyaluronic acid in the dermis. O/E: Lesions are usually asymmetrical, bilateral, firm and non-pitting type of edema.

It refers to the hyperglycemia that occurs by counter regulatory hormones in response to hypoglycemia induced by insulin. This is most commonly observed as morning hyperglycemia. The problem with this phenomenon is that we will have a tendency to increase the evening dose of insulin to try to decrease the morning hyperglycemia but in doing so we will induce more severe hypoglycemia at night and it will be detrimental for the patient. The counter regulatory hormones include: 1) Glucagon 2) Epinephrine 3) Cortisol 4) Growth hormone. Another cause of morning hyperglycemia is hypoinsulinemia resulting from the dawn's phenomenon.

If you diagnose a rare disease, you are rarely correct. . .

Studies showed that a 2-day course of dexamethasone is as effective as a 5-day course of prednisolone in the treatment of mild to moderate asthma. Both drugs have the same bioavailability (fraction of an administered dose of unchanged drug that reaches the systemic circulation) but the half life of prednisolone varies between 8-24 hr while that of dexamethasone ranges between 32-72 hr.