Furuncle , Boil or Pigsa

A 20 year old ,male , consulted for a swollen firm area in the left buttocks with associated pain and tenderness of 3 days duration. A day prior to consultation, there was passage of pus and blood. Patient also complained that the problem was recurrent wherein the last episode was about a year ago.

Patient was given Cloxacillin 500mg capsules every 6 hours(4xday), for 10 -14 days and advised to apply Povidone 10% soln(Betadine) 2-3xday. Mefenamic acid 500mg capsule 3xday was given for inflamation and pain management.

The patient's condition is known as Furuncle, Furunculosis, Skin Boil, Pigsa. It usually starts as an infection of the hair follicle that spreads to deeper tissue or can be a walled-off nodule of purulent infection. When there is a coalition or a group of furuncles , it is called Carbuncle, which has a deeper and extensive involvement.
Risk factors includes increase weight or obesity, diabetes mellitus, impaired neutrophil function, or sometimes prolonged intake of corticosteroids. The most common etiologic agent or cause is Staphylococcus aureus,but may also be caused by Streptococcus or mixed bacterial infection.
Usual management includes a trial of warm compress for small abcess but considerable size may require incision and drainage.Recurrent condition warrants giving oral antibiotics ,while opened lesion may necessitate application of Povidone I2 10% solution or application of Mupirocin cream. Some clinicians give high doses of ascorbic acid 1gm daily if they suspect an impaired neutrophil function.
It should also be emphazised that proper and careful hygiene is very important.Clean draining lesions or boils often and wash hands after touching a boil since it is contagious and can be transferred to other parts as well as other individuals.



(image from graphicshunt.com)

Bell's Palsy or Facial Nerve Paralysis

A 34 year old Male,sales clerk, came to the clinic complaining of difficulty closing his right eye for 3 days prior to consultation. The symptom just appeared after waking up and he also noted that his smile and the lines in his forehead appears "uneven". He also said that his right eye feels dry and irritated.
A complete blood count and urinalysis was unremarkable . Further physical examination was done and patient was diagnosed as having Bell’s Palsy or Facial Nerve Paralysis. Patient was immediately given 30 mg Prednisone twice a day for 5 days, then 20mg 2xday for the next 5 days. Vitamin B complex was also given as well as Hypromellose Eye drops (EyeMo Moisturizing Formula) to relieve irritation and dryness of the affected eye.

Bell’s Palsy was named after Sir Charles Bell(1774-1842) who first described the syndrome and is characterized by a temporary paralysis of the facial nerve.There is a loss of facial creases and naso labial fold ,with associated incomplete closure of eyelid,decreased production of tears.The corner of the mouth may show considerable drooping and no furrow or lines over forehead.Facial sensation is usually preserved.

Bell's palsy is a form of temporary facial paralysis resulting from damage or trauma to one of the facial nerves. It is the most common cause of facial paralysis. Generally, Bell's palsy affects only one of the paired facial nerves and one side of the face, however, in rare cases, it can affect both sides. Symptoms of Bell's palsy usually begin suddenly and reach their peak within 48 hours. Symptoms vary from person to person and can range in severity from mild weakness to total paralysis. These symptoms include twitching, weakness, or paralysis, drooping eyelid or corner of the mouth, drooling, dry eye or mouth, impairment of taste, and excessive tearing in the eye. Bell’s palsy often causes significant facial distortion. Most scientists believe that a viral infection such as viral meningitis or the common cold sore virus -- herpes simplex-- can cause the disorder when the facial nerve swells and becomes inflamed in reaction to the infection.(National Institute of Neurological Disorders and Stroke)

Bulutong Tubig , Chicken Pox or Varicella Zoster

A 30 year old female consulted for low grade fever 2 days prior to consultation with associated muscle pain, sore throat and lack of appetite. A day before she developed pruritic rashes, starting from the face and scalp down to the chest and abdomen.
On examination patient had fever ,38.2 Centigrade, with red papular rashes,"tear drop",vesicles on face, trunk and in the upper extremities.Patient also had generalized lympadenopathies " kulani" and admitted that a household member exhibited similar symptoms about two weeks ago.She was diagnosed with Chicken pox or Varicella Zoster, or Bulutong Tubig
Patient was given Diphenhydramine 50mg cap, an Anti-histamine 3x day to relieve itchiness. Ascorbic acid 500mg , for faster wound healing,was also given as well as Paracetamol 500mg Tab every 4 hours for fever, in some cases Ibuprofen 400mg or Mefenamic acid 500mg may be given for pain relief. In cases where the rashes develop within 24 hours prior to consultation, anti virals, like Acyclovir 800 mg tab 5x a day for 7 days,maybe given to shorten the time of viral shedding,lessens appearance of new lesions,reduce duration of fever and for faster healing. Acyclovir cream may also be applied to lesions 5x a day , especially in the facial area, to lessen discomfort and scarring. Oral rehydrating salts (Hydrite, Glucolyte etc.) may also be given to prevent dehydration.
Varicella, commonly known as "bulutong" or chickenpox, is caused by the varicella-zoster virus. The disease is generally regarded as a mild, self-limiting viral illness with occasional complications. Usual complications are acute respitatory infections, infected skin lesions while the most serious complications are varicella pneumonia and encephalitis which are associated with a high mortality rate.
Varicella spreads primarily by airborne droplets. The infectious particles are cell-free virus particles derived from skin lesions or the respiratory tract. The disease is infectious a day before the rash appears. The incubation period is typically 10-14 days, although it may extend to 21 days.
The best option to prevent Varicella or Chikenpox is thru vaccination which is available but a bit expensive(Varilrix, Okavax, V-Z Vax).The first dose should be given when the child is 12 - 15 months old.Children should receive the second dose when they are 4 – 6 years old. However, the second dose can be given before age 4, as long as as 3 months have passed since the first dose.
People 13 and older who have not received the vaccine and have not had chickenpox should get 2 doses 4 to 8 weeks apart while people 13 and older who have had a previous dose and have not had chickenpox should receive a second dose.

Reminder: Article was written as a physician's personal experience and should be viewed for information and guide only, and was not intended to replace actual consultation with a medical practitioner.

Bird Flu or Avian Influenza

Bird flu or Avian Influenza is a contagious disease of birds ranging from mild to severe form of illness.

The outbreaks affecting some Asian countries caused by influenza A/H5N1 virus may also cause severe infection in humans.

Bird Flu is transmitted to humans through inhalation or contamination with infected discharges or feces of sick chicken.

Signs and Symptoms
Fever
Body weakness or muscle pain
Cough
Sore throat
Sore eyes and/or diarrhea
In severe cases, difficulty of breathing in a week’s time from onset


Treatment
Treatment of Bird Flu in humans is the same as the treatment for other influenza viruses. Antiviral drugs like Oseltamivir halt the progress of the illness if given within the first two days from the onset of fever.

Prevention
Wash hands thoroughly with soap and water before and after handling live and dressed chicken.
Cook chicken thoroughly.
Do not put live chicken, ducks, and pigs together in one cage or pen area.
Do not catch, get near or keep in captivity wild birds.
Do not handle sick or dead birds with bare hands. Use facial masks, goggles, and gloves or plastic material for the hands.
Report to the nearest agricultural or veterinary office any unusual death or illness of chicken and other birds.
Report to the nearest local health centers any case of respiratory illness with history of exposure to sick chickens and other birds.

CM, GMANews.TV

Source: Department of Health

Canker Sores or "Singaw" (Aphthous Stomatitis)

 Canker sores, "Singaw"or Aphthous stomatitis is a benign autoimmune condition that is usually due to nutritional deficiencies arising from lack of Iron, Vitamin B12 or Folic Acid.
Aphthous stomatitis are among the most common oral mucosal lesions physicians and dentists observe. Recurrent aphthous ulcer is a disorder of unknown etiology that can cause clinically significant morbidity. One or several discrete, shallow, painful ulcers are visible on the unattached mucous membranes. Individual ulcers typically last 7-10 days. Larger ulcers may last several weeks to months and can scar when healing.

Management usually begins with good oral hygiene and by avoiding toothpaste containing Sodium Lauryl SO4.Chlorhexidine Gluconate[Orahex] mouhwash preferably alcohol free can also help lessen the severity and course of the discomfort.
Multivitamins with iron are recommended but do not have any clear benefit unless the patient has laboratory-confirmed hematinic deficiency.Vitamin B12 and Folic Acid may also be prescribed if patient shows signs of deficiency or malnutrition.

The easiest home remedy is to apply hydrogen peroxide with a cotton swab on the canker sore (1 part hydrogen peroxide to 1 part water). Then dab a small amount of milk of magnesia on the canker sore 3-4 times a day. This is not only soothing, but it appears to help healing

What is Runner's Knee (Patellofemoral Pain Syndrome)?

Runners Knee is a condition characterized by pain behind or around the kneecap. Poor kneecap tracking is believed to be the main cause this condition. The kneecap (patella) slides over a groove on the thighbone (femur) as your knee bends and straightens. If, for example, the front thigh muscles (quadriceps) are weak or imbalanced, the resulting muscle imbalance can pull the kneecap to the left or right of the groove, causing pressure, friction, and irritation to the cartilage on the undersurface of the kneecap when the knee is in motion.
Runner's knee isn't really a condition itself. It's a loose term for several specific disorders with different causes. Runner's knee can result from:

Overuse. Repeated bending of the knee can irritate the nerves of the kneecap. Overstretched tendons (tendons are the tissues that connect muscles to bones) may also cause the pain of runner's knee.
Direct trauma to the knee, like a fall or blow.

Management: Medical
A.Relative rest
-Avoid squats and lunges
-Reduce Running mileage to painless distance
-Cross-train with biking, swimming, eliptical trainer
B.Pain relief
-NSAIDs (variable efficacy)eg. Mefenamic Acid, Ibuprofen, Naproxen etc.
-Ice Therapy
C. Patellofemoral Knee Exercises
D. Quadriceps strengthening
E.Lower extremity Stretching Exercises
1.Quadriceps Stretching
2.Quadriceps strengthening
a.Do not load knee at more than 45 degrees flexion
3.Hamstring stretches
4.Iliotibial Band stretches
5.Ankle stretches
F.Shoe modifications
-Replace excessively worn Running Shoes
G.Avoid provocative factors
1.Limit weight on a flexed knee
2.Consider cross-training activity
3.Reduce mileage and pace
4.Avoid uphill and downhill Running
H.Patellar Taping (inconsistent evidence of benefit)

Please watch the video from Shine at Yahoo.com by Susan Rinkunas that would help prevent runners knee

http://www.youtube.com/watch?v=zYt4AC9cn7c&feature=player_embedded
Susan Rinkunas is an associate editor at Runner’s World, a magazine (and website) that informs, advises, and motivates runners of all ages and abilities—and we mean it. Her blog on Yahoo! Shine offers tips on running technique, nutrition and weight loss, shoes and apparel, and balancing fitness and life.

Hand ,Foot and Mouth Disease

Hand-foot-and-mouth disease (HFMD) is a viral illness with a distinct clinical presentation of oral and characteristic distal extremity lesions. Most commonly, the etiologic agents are coxsackieviruses, members of the Picornaviridae family.
HFMD is a common viral illness of infants and children. The disease causes fever and blister-like eruptions in the mouth and/or a skin rash. HFMD is often confused with foot-and-mouth (also called hoof-and-mouth) disease, a disease of cattle, sheep, and swine; however, the two diseases are not related—they are caused by different viruses. Humans do not get the animal disease, and animals do not get the human disease.
Hand-foot-and-mouth disease (HFMD) is more severe in infants and children than adults, but generally, the disease has a mild course. Symptoms such as malaise, low-grade fever, and anorexia are often present. Occasionally, patients have high fever, marked malaise, diarrhea, and arthralgias.

Infection is spread from person to person by direct contact with infectious virus. Infectious virus is found in the nose and throat secretions, saliva, blister fluid, and stool of infected persons. The virus is most often spread by persons with unwashed, virus-contaminated hands and by contact with virus-contaminated surfaces. The viruses that cause HFMD can remain in the body for weeks after a patient's symptoms have gone away. This means that the infected person can still pass the infection to other people even though he/she appears well. Also, some persons who are infected and excreting the virus, including most adults, may have no symptoms.

Usually, no medical care is necessary for hand-foot-and-mouth disease (HFMD).The topical application of anesthetics is beneficial. Viscous lidocaine, dyclonine solution, or diphenhydramine (Benadryl) may be used to treat painful oral ulcers. Antipyretics may be used to manage fever, and analgesics may be used to treat arthralgias.