Viagra: Medicine for Erectile Dysfunction

Viagra is a medication used to treat erectile dysfunction (ED) in men. The active ingredient in Viagra is sildenafil citrate, which helps to increase blood flow to the penis, resulting in an erection. Viagra is one of the most widely recognized medications for ED, and has been on the market for over 20 years.

Viagra was developed by Pfizer, a pharmaceutical company, in the 1990s. It was originally intended to be a treatment for high blood pressure and angina, but during clinical trials, it was found to be more effective at treating ED. In 1998, the United States Food and Drug Administration (FDA) approved Viagra for use in the treatment of ED.

Since its approval, Viagra has become one of the most widely prescribed medications for ED. It is estimated that over 20 million men have used Viagra to treat their ED. In addition to its use in treating ED, Viagra has also been used to treat pulmonary arterial hypertension (PAH), a condition in which there is high blood pressure in the arteries that supply the lungs.

Viagra works by relaxing the smooth muscle cells in the walls of blood vessels in the penis, allowing more blood to flow into the penis when a man is sexually aroused. This increased blood flow results in an erection. However, it is important to note that Viagra does not cause an erection on its own – sexual stimulation is still necessary for an erection to occur.

Viagra is typically taken 30 minutes to an hour before sexual activity. The recommended dose is 50mg, although this can be adjusted based on individual needs and tolerance. It is important to follow the instructions of a healthcare provider when taking Viagra, as taking too much or too little can have negative effects.

One potential side effect of Viagra is a headache, which can occur in up to 16% of men who take the medication. Other side effects can include flushing, indigestion, nasal congestion, and changes in vision. In rare cases, Viagra can cause more serious side effects, such as a sudden decrease or loss of vision or hearing, or an erection that lasts longer than four hours. If any of these side effects occur, it is important to seek medical attention immediately.

Viagra should not be taken by men who are taking nitrates, which are medications used to treat chest pain. Combining Viagra with nitrates can cause a dangerous drop in blood pressure. Viagra should also not be taken by men who have severe liver or kidney disease, or by men who have had a recent heart attack or stroke.

While Viagra has been shown to be effective in treating ED, it is not a cure for the condition. It is important for men with ED to address any underlying medical or psychological issues that may be contributing to their condition. This may include treating conditions such as diabetes or depression, or seeking counseling for relationship or stress-related issues.

In addition to Viagra, there are other medications available for the treatment of ED, including Cialis and Levitra. These medications work in a similar way to Viagra, but may have different side effects or dosing instructions. It is important for men with ED to discuss their treatment options with a healthcare provider to determine the best course of action.

In conclusion, Viagra is a medication used to treat erectile dysfunction in men. It works by increasing blood flow to the penis, resulting in an erection. While Viagra has been shown to be effective in treating ED, it is important to follow the instructions of a healthcare provider and address any underlying medical or psychological issues that may be contributing to the condition. If you are experiencing ED, speak with your healthcare provider to determine the best course of treatment for you.

Here are some common questions about Viagra:

How does Viagra work?

Viagra works by increasing blood flow to the penis, which results in an erection. The active ingredient in Viagra, sildenafil citrate, relaxes the smooth muscle cells in the walls of blood vessels in the penis, allowing more blood to flow into the penis when a man is sexually aroused.

How long does Viagra last?

The effects of Viagra can last up to four hours. However, the duration of the effects can vary depending on factors such as age, overall health, and dosage.

Can women take Viagra?

Viagra is not approved for use in women. While some studies have investigated the use of Viagra in women with sexual dysfunction, the results have been inconclusive.

Is Viagra safe?

Viagra is generally safe when taken as directed by a healthcare provider. However, there are some potential side effects, such as headaches, flushing, indigestion, and changes in vision. In rare cases, Viagra can cause more serious side effects, such as a sudden decrease or loss of vision or hearing, or an erection that lasts longer than four hours.

Can I take Viagra with alcohol?

It is generally recommended that alcohol be avoided when taking Viagra, as it can increase the risk of side effects such as dizziness and low blood pressure.

Can I take Viagra with other medications?

Viagra should not be taken with nitrates, which are medications used to treat chest pain. Combining Viagra with nitrates can cause a dangerous drop in blood pressure. Viagra should also not be taken with alpha-blockers or other medications used to treat high blood pressure, as this can also increase the risk of low blood pressure. In short, patients with cardiac disease should avoid using viagra.

Can Viagra cure ED?

Viagra is not a cure for ED. While it can be effective in treating the symptoms of ED, it does not address any underlying medical or psychological issues that may be contributing to the condition. It is important for men with ED to address any underlying issues and work with their healthcare provider to determine the best course of treatment.

COVID 19 Vaccines

 COVID-19 vaccination is the process of administering a vaccine to an individual to protect them from COVID-19, a contagious respiratory illness caused by the SARS-CoV-2 virus. There are currently several COVID-19 vaccines that have been authorized for emergency use by various regulatory agencies around the world.

The COVID-19 vaccines work by teaching the body's immune system to recognize and fight the SARS-CoV-2 virus. They contain a small piece of the virus, known as the spike protein, which the immune system recognizes as foreign and produces an immune response against. This immune response allows the body to fight off the virus if it is encountered in the future.

The COVID-19 vaccines have been shown to be highly effective in preventing severe illness, hospitalization, and death from COVID-19. Vaccination is currently recommended for all eligible individuals, which varies depending on the country and region. The COVID-19 vaccines are typically administered in two doses, several weeks apart, although there are some single-dose vaccines available.

It is important to note that while the COVID-19 vaccines are highly effective, they are not 100% effective at preventing COVID-19. It is still possible to contract and spread the virus after vaccination, although the risk is significantly reduced. It is also important to continue practicing other preventive measures, such as wearing masks and social distancing, even after being vaccinated.

Types of covid-19 vaccine

There are several types of COVID-19 vaccines that have been authorized for emergency use around the world. Here are some of the COVID-19 vaccine latest and main types:

mRNA vaccines: These vaccines use a small piece of genetic material from the SARS-CoV-2 virus, called messenger RNA (mRNA), to teach the body's immune system to recognize and fight the virus. The Pfizer-BioNTech and Moderna vaccines are both mRNA vaccines.

Viral vector vaccines: These vaccines use a harmless virus, such as adenovirus, to deliver a piece of genetic material from the SARS-CoV-2 virus into the body. This genetic material teaches the immune system to recognize and fight the virus. The AstraZeneca, Johnson & Johnson, and Sputnik V vaccines are all viral vector vaccines.

Inactivated or killed virus vaccines: These vaccines use a virus that has been inactivated or killed to teach the immune system to recognize and fight the virus. The Sinovac and Sinopharm vaccines are both inactivated virus vaccines.

Protein subunit vaccines: These vaccines use a small piece of the SARS-CoV-2 virus, called a protein subunit, to teach the immune system to recognize and fight the virus. The Novavax vaccine is a protein subunit vaccine.

All of these vaccines have been shown to be safe and effective at preventing COVID-19. The specific vaccines available in different countries may vary, depending on regulatory approval and availability. It's important to follow the guidance of local health authorities and get vaccinated with a vaccine that is authorized in your area.

 

Top 10 Medical Products Purchased on Amazon in America

Healthcare is essential for individuals, communities, and society as a whole. It encompasses the prevention, diagnosis, treatment, and management of illness, injury, and other health conditions. Healthcare plays a crucial role in maintaining and improving the overall health and well-being of individuals and society.

A lot of medical products are bought online. Based on historical data and customer reviews, top 10 popular medical products that are frequently purchased on Amazon in America are:

Blood Pressure Monitor: A device that measures blood pressure and is often used by individuals with hypertension.

Thermometer: A device used to measure body temperature and can be useful for detecting fever, a symptom of many illnesses.

First Aid Kit: A collection of medical supplies that can be used to treat minor injuries and illnesses.

Pulse Oximeter: A device used to measure oxygen saturation in the blood, which can be helpful for individuals with respiratory problems.

TENS Unit: A device that uses electrical stimulation to provide pain relief for conditions such as back pain, arthritis, and other chronic pain conditions.

Nebulizer: A device used to deliver medication directly to the lungs for individuals with respiratory conditions such as asthma or COPD.

Blood Glucose Monitor: A device used to measure blood sugar levels for individuals with diabetes.

Hearing Aids: Devices that can help individuals with hearing loss to hear better.

Orthopedic Supports: Devices such as knee braces, back braces, and ankle braces that can help support joints and alleviate pain.

3M Littmann Classic IIIStethoscope: A common device used by doctors to hear heart sounds.

Please note that the above top 10 medical products are subject to change over time and may not represent the current top medical sales on Amazon. It is always recommended to conduct your research and consult with a medical professional before purchasing any medical product.

Keywords: top 10 medical products, top ten medical products, medical devices, amazon, 

Artificial Intelligence in Healthcare and Challenges

Artificial intelligence (AI) is a rapidly developing technology that has the potential to revolutionize healthcare. Artificial intelligence in healthcare refers to the use of computer algorithms and machine learning to analyze large amounts of data and generate insights that can help improve patient outcomes, streamline workflows, and reduce costs. In this essay, I will discuss some of the ways that AI is being used in healthcare, as well as some of the challenges and ethical considerations associated with this technology.

One of the most promising applications of artificial intelligence in healthcare is in the area of medical imaging. Radiology is a field that generates large amounts of image data, and AI algorithms can be trained to analyze these images and identify abnormalities that might be missed by human radiologists. For example, AI algorithms can be used to detect early signs of breast cancer in mammograms or identify lesions in brain scans that might indicate the presence of a tumor. AI can also be used to help radiologists prioritize their workloads and improve the accuracy of their diagnoses.

Another area where AI is being used in healthcare is in the development of personalized treatment plans. AI algorithms can analyze large amounts of patient data, including genetic information, medical histories, and treatment outcomes, to identify patterns and make predictions about which treatments are most likely to be effective for individual patients. This can help doctors make more informed decisions about treatment and improve patient outcomes.

AI is also being used to improve patient engagement and education. Chatbots and other AI-powered tools can be used to answer patient questions, provide information about medications and treatment options, and even offer support for mental health issues. This can help patients feel more empowered and engaged in their healthcare and can improve adherence to treatment plans.

However, there are also some challenges and ethical considerations associated with the use of AI in healthcare. One of the biggest challenges is ensuring that the algorithms used by AI systems are accurate and reliable. The effectiveness of AI algorithms depends on the quality and quantity of the data that is used to train them, and there is a risk of bias or inaccuracies in the data that can lead to errors or misdiagnoses.

Another challenge is ensuring the privacy and security of patient data. AI systems require access to large amounts of patient data to be effective, and there is a risk that this data could be used for unauthorized purposes or accessed by hackers. It is important to implement robust security measures and data governance policies to protect patient data and ensure that it is used ethically and responsibly.

Finally, there are ethical considerations around the use of AI in healthcare, particularly when it comes to decisions about patient care. There is a risk that AI algorithms could be used to make decisions that are not in the best interests of patients, or that could result in discrimination or bias. It is important to ensure that AI is used in a way that is transparent, accountable, and ethical, and that patients are fully informed about how AI is being used in their care.

In conclusion, artificial intelligence in healthcare system has the potential to transform healthcare by improving patient outcomes, streamlining workflows, and reducing costs. However, there are also challenges and ethical considerations that must be addressed to ensure that AI is used in a responsible and ethical manner. As AI continues to evolve and become more integrated into healthcare, it will be important to maintain a balance between the benefits and risks of this technology and to ensure that it is used in a way that prioritizes patient safety and well-being.

 

How to Prepare for Earthquake?

An earthquake is a natural disaster that occurs when the earth's surface experiences sudden and violent shaking. It is caused by the sudden release of energy from within the earth's crust or upper mantle, typically resulting from tectonic plate movements. Earthquakes can occur anywhere in the world, and their intensity can range from mild tremors to catastrophic events that cause widespread destruction and loss of life.

The magnitude of an earthquake is measured on the Richter scale, which ranges from 1 to 10. An earthquake with a magnitude of 1 to 3 is generally not felt, while an earthquake with a magnitude of 7 or higher can cause severe damage and loss of life. The intensity of an earthquake can also be described using the Modified Mercalli Scale, which measures the amount of shaking felt at a particular location.

Earthquakes can cause significant damage and loss of life, but there are measures that can be taken to protect people and property. Here are some ways to mitigate the effects of earthquakes:

Building codes: Implementing and enforcing building codes that require structures to be designed and constructed to withstand seismic activity can reduce the risk of building collapse and other damage during an earthquake.

Retrofitting: Retrofitting existing buildings with seismic upgrades can improve their ability to withstand earthquakes. This includes adding structural reinforcements, bracing, and other modifications to strengthen the building's foundation and walls.

Emergency preparedness: Developing emergency response plans, including evacuation procedures and drills, can help people know what to do in the event of an earthquake.

Education: Educating people on earthquake safety, including how to prepare their homes and workplaces, how to respond during an earthquake, and what to do in the aftermath of an earthquake, can help reduce the risk of injury or death.

Infrastructure protection: Protecting critical infrastructure, such as hospitals, schools, water treatment facilities, and power stations, can help ensure that essential services continue to function in the aftermath of an earthquake.

Hazard mapping: Creating hazard maps to identify areas that are most at risk of earthquakes can help inform land use planning and building design to reduce exposure to seismic hazards.

Early warning systems: Installing early warning systems that can detect seismic activity and provide advance warning of an earthquake can give people more time to prepare and take protective measures.

Overall, taking proactive measures to protect people and property from earthquakes is essential. By implementing building codes, retrofitting structures, educating people on earthquake safety, and protecting critical infrastructure, the impact of earthquakes can be reduced, and lives can be saved.

 

Touchless, Forehead Thermometers for all Ages

Fast and easy-to-use touchless forehead thermometer, touchless infrared thermometer, no contact infrared thermometer, touchless digital thermometer or touchless fmedical thermometer is popular in these days of COVID-19 pandemic in order to record temperature. Touchless forehead thermometers are used to record temperature of the patients suffering from fever without touching the persons. These touchless forehead thermometers are being used in hospitals, big markets, shops, schools and hotels. It has become vital to use touchless thermometers all over the world in order to prevent the spread of the deadly highly contagious viral diseases like coronavirus disease 2019 or COVID-19. You just point and press the button to use touchless forehead thermometers, and the reading for fever is on the digital screen before you.

Here, I searched and found a number of easy-to-use fast touchless forehead thermometers which are available online. The salient features of these touchless forehead thermometers include easy-to-handle, fast and accurate reading with alarm, multifunctional, convenient memory feature. You can use these touchless infrared thermometers for all ages including babies, toddlers, young, adults, and the elderly.

 If you buy one of these touchless infrared thermometers, you will get one touchless forehead thermometer, two triple-A batteries, one pouch and one manual to read instructions. For further information, read the following pros and cons based on the users’ experience.

Pros:

Easy to use, fast and accurate: You need to point the device to forehead and press the button to get the fast and accurate fever readings.

Multifunctional: The touchless forehead thermometer can be used to record fever in babies, infants, adults and the elderly people. You can record temperature not only of human beings, but also of objects. Moreover, you can record temperature in centigrade as well as in Fahrenheit degrees with touchless infrared thermometer.

Awesome memory feature: The touchless infrared thermometer has awesome memory feature as it can store up to 35 temperature readings.

Cons:

Some of the users complain of certain issues related to touchless infrared forehead thermometers such as non-convenient (some touchless thermometers may make you wait for 30 minutes in an environment to take accurate readings), wrong or inaccurate temperature readings, and costly.

Some of the touchless forehead thermometers are shown below which you can buy online.

1. GoodBaby touchless forehead thermometer

2. LPOW forehead thermometer foradults

3. Pwlahhas 2020 New Touchless Thermometer-Forehead Thermometer with Fever Alarm

4. Braun BFH-125 Forehead Thermometer

5. iHealth Wireless No-Touch Thermometer for Adults

Keywords: Touchless thermameter, Forehead thermameter, Infrared thermameter for adults, No contact thermameter, Forehead digital thermameter, Touchless thermometer for fever

What is Migraine and its Treatment?

What is migraine headache?
Migraine is a type of headache like tension type headache or cluster headache. Migraine pain is a severe form of headache and feels like something is throbbing in head.
 

What are symptoms of migraine headache?
Migraine is a severe, recurrent and throbbing headache. It is associated with photophobia (extreme sensitivity to light), phonophobia (fear of sounds), and nausea lasting for 4 to 72 hours. The headache worsens with body movements and the patient feels calm in a quite, dark room. The patient may complain that he/she cannot brush his/her hair, wear earrings, or feels pain when he shaves. Migraine may lead to allodynia – central pain sensitization. Watch the video below.

 
 

 

What are four phases of migraine?
Migraine headache consists of four phases: prodrome, aura, attack and prostdrome. Prodrome refers to malaise, irritability and behavioral changes some hours to days before the onset of headache. About 20% patients with migraine experience aura. Aura refers to a number of symptoms the patient with migraine pain experiences just before the onset of headache. Migraine aura can be visual (shimmering silvery zigzag lines across the visual field or scotoma), sensory (tingling or numbness), motor or verbal.
 

What are the triggers of migraine headache?
There are several triggers of migraine headache. These triggers include estrogen containing oral contraceptive pills, stress, cheese, chocolate, red wine or alcohol, intercourse, missing a meal, lack of sleep or oversleeping.
 

What is the treatment of migraine?
Treatment of migraine headache includes avoidance of triggering factors and use of simple analgesia such as Aspirin, Paracetamol or NSAIDs (non-steroidal antiinflammatory drugs). Antiemetics can be used for nausea and vomiting. Triptans (e.g. sumatriptan) should be considered for severe attacks. Other drugs which can be used for migraine treatment are calcium channel blockers, beta-blockers, antidepressants and anti-epileptic drugs.
 

What is the prophylaxis of migraine?
When a patient experiences 3-4 attacks of migraine pain in a month, then prophylactic treatment for migraine is considered. Prophylactic treatment of migraine includes avoiding triggering factors of migraine and using drugs like calcium channel blockers, beta-blockers, antidepressants and anti-epileptic drugs calcium channel blockers, beta-blockers, antidepressants and anti-epileptic drugs.

Guidelines for Diabetic Patients in the Month of Ramadan

Fasting of Diabetic patients is a special concern as diabetes is a leading cause of disability and morbidity all over the world. In the month of Ramadan, if a diabetic patient wants to keep fast, special guidelines have been provided by the medical experts. Below are given some guidelines:
1. The patients with type-1 diabetes should not keep fast.
2. The patients with diabetes type-2 can keep fast provided that their blood sugar levels have been controlled at least for the last one month. If blood sugar levels are not controlled, better to avoid fasting.
3. If a patient takes only one tablet in the morning, he/she should take it in the evening (after the Aftaar).
4. If someone is on insulin thrice a day, he/she should skip the mid-day dose of insulin. Additionally, he/she should reverse the doses of morning and evening with some changes. It means, he/she should take the 2/3 of the routine morning dose in the evening after the Aftaar instead of in the morning, and half of the routine evening dose in the Sehri Time (morning) instead of in the morning.
5. More instructions can be given by your doctor.
6. If you know Urdu language, watch the video below:

Keywords: Diabetes, Fasting, Month of Ramadan, Fast, Roza, Sehri, Aftari, Muslims

Medical Videos | Subscribe Doctors Hub Channel

Doctors Hub is a medical videos channel. It regularly publishes medical videos. Most often, medical videos include medical examination videos, disease findings videos, public health messages videos or doctors videos.

You can subscribe this video channel.
In the video below, clinical method of examining ankle clonus has been demonstrated.

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Keywords: Doctors hub, Medical videos, Disease videos, Public health videos

YDA Nishtar Prostest Against Central Induction Policy

Young Doctors' Association (YDA) at Nishtar Medical University Multan fights for the rights of doctors as well as for the patients in Pakistan. Now-a-days, YDA is protesting against the policy called "Central Induction Policy" or CIP for post-graduation in Pakistan. According to YDA, CIP is a killer for the medical post-graduation in Pakistan. It is against the rights of doctors. Here are some recent videos of protest by YDA Nishtar against CIP implemented by Punjab Government.
YDA protest (YDA dharna) on jail road Multan...

YDA Multan protest against Nishtar Hospital Administration...

YDA Multan protest on jail road (Dr. Kabeer- Ex-president YDA Multan is addressing )...

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Keywords: YDA, CIP, Young doctors association, Central induction policy, Medical postgraduation, Doctors Protest, YDA Nishtar, YDA Multan, Chapters of YDA

Steroid Doses in Different Conditions

Derived from cholesterol, steroid drugs are used in a wide variety of diseases of human beings. Steroids were discovered in 1935, and used to treat Addison’s disease initially. However, steroids are used in many different conditions due to their anti-inflammatory and immune-modulating characteristics.

Dose of steroids drugs is different in different medical conditions. Below are some mentioned doses of steroids:

Dose of steroids in the patients with space occupying lesion (SOL):

In the patients with SOL, corticosteroids are usually started before surgery.

Dexamethasone 0.4–1.5 mg/kg/day, 6 hourly is given as it reduces vasogenic cerebral edema due to tumors, inflammation or infection, and has minimal mineralocorticoid activity. Steroids may be harmful in traumatic brain injury, ischemic lesions, subarachnoid hemorrhage (SAH) and cerebral malaria.

Dose of steroids in the patients with bacterial meningitis:

Dexamethasone 0.4 or 0.6 mg/kg per day in 4 divided doses for 4 days.

Steroid Dose in the patients with tuberculous meningitis:

Intravenous dexamethasone is given for 4 weeks followed by a tapered dose of oral dexamethasone for next 4 weeks.

•        First week: 0.4 mg/kg per day
•        Second week: 0.3 mg/kg per day
•        Third week: 0.2 mg/kg per day
•        Fourth week: 0.1 mg/kg per day
•        Fifth week: 4 mg/day
•        Sixth week: 3 mg/day
•        Seventh week: 2 mg/day
•        Eighth week: 1 mg/day

Keywords: Steroids drugs, Doses, Space occupying lesion, SOL, Bacterial meningitis, Tuberculous meningitis, TBM, Infections

Can a Doctor Earn Online?

Can a doctor earn money online? This is the question  may arise in your mind if you have medical skills and you are interested in medical-related writing or online clinic.

The answer to the above question is "Yes of course!" Being a doctor, there are many ways to earn money online. For example, writing medical content, medical papers, giving medical advice or online clinic, writing multiple choice questions (MCQs), writing eBooks, medical proofreading, review articles, synopses, dissertations and making presentations or lectures, and many more. There are several websites where employers post their projects and ask for bidders to place bid on their projects, and then pay to them on the completion of the work/assignments. Two of the top websites include Freelancer and Upwork. You can join Freelancer or Upwork if you intend to earn money online. Also, you can earn by making a Youtube Channel on health like mine "Doctors Hub".

Watch the video below:

It is real to earn money online. You can earn money if you have any skills with some knowledge about computer use. Follow the links above, create your profile, select your skills and place bids on the projects you are interested in. Don't worry, payment is 100% with milestones. So, always insist on milestones.

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Keywords: Doctor, Online earning, Freelancer, Upwork

Hepatitis D Suppresses Hepatitis B

Hepatitis D virus (HDV, delta agent) infection is a super-infection in the patients suffering from hepatitis B virus (HBV) infection. Hepatitis D virus suppresses hepatitis B virus and may lead to laboratory results with negative HBV and positive HDV. Remember, HDV is a defective agent which only replicates in the presence of HBV, affecting 20 million people round the world.

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Keywords: Hepatitis B, Hepatitis D, Super-infection, Hepatitis B antigen, Hepatitis D antigen

What is Euthanasia or Mercy-Killing?

Euthanasia or mercy killing refers to end of life of the patient in order to relieve his/her intractable suffering (Taqi, 2012). It has been and still to date is a controversial topic of discussion and has been described differently in different situations and at different places in terms of ethics as well as law. ‘Euthanasia’ or ‘mercy killing’ as an ‘act or practice of painlessly putting to death person suffering from painful and incurable disease or incapacitating physical disorder OR allowing them to die by withholding treatment OR withdrawing artificial life support measures (Encylopaedia Baritannica, 2015). On the other hand, physician-assisted suicide (PAS) refers to “the self-administration of lethal substance by a person prescribed by a physician” (Churchill, 1994). However, PAS negates the Hippocratic Oath “I will neither give a deadly drug to anyone if asked, nor will I make a suggestion to this effect” (Manthous, 2009). To date, a little number of countries (e.g. Netherlands, Belgium and Luxembourg) have legalized euthanasia (Pereira, 2011). In Netherland, it took about 30 years of debate in order to legalize euthanasia in the country in 2001 (Deliens & van der Wal, 2003). In United States, although PAS is legalized in some of the states; however, euthanasia is still illegal (Steinbrrok, 2008).

References

America- the National catholic Review. (2015). Euthanasia in California. Retrieved from: http://americamagazine.org/issue/euthanasia-california.

SB-128 End of life. (2015-2016). Retrieved from: https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB128.

Churchill, L.R. (1994). Physician-assisted suicide. Journal of the Royal Society of Medicine, 22(87), 44-45.

Deliens, L., vander Wal, G. (2003). The euthanasia law in Belgium and the Netherlands. Lancet, 362, 1239–40.

Encyclopaedia Britannica. (2015). Euthanasia (law). Retrieved from: http://www.britannica.com/topic/euthanasia.

Manthous, C.A. (2009). Why not physician-assisted death? Critical Care Medicine, 37(4), 1206-1209.

Pereira, J. (2011). Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls. Current Oncology, 18(2), e38–e45.

Steinbrook, R. (2008). Physician-assisted death—from Oregon to Washington State. The New England Journal of Medicine, 359, 2513–15.

Taqi, A. (2012). Euthanasia: is it really a bad idea? Anaesthesia Pain & Intensive Care, 16(3), 226-229.

Cryoglobulinemia: Images of the Patient

Cryoglobulinemia refers to a clinical syndrome of systemic inflammation due to the presence of cryglobulin-containing immune complexes. Most commonly affected organs are skin and kidneys. Cryoglobulinemia is closely associated with hepatitis C.
Here is presented a 30-year old married male who presented with blackened tip of nose, tips of fingers and toes (images). The patient is also positive for hepatitis C virus. Vasculitic lesions are shown in images.

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Keywords: Cryoglobulinemia, Cryoglobulins, Immune complexes, Hepatitis C

Refractory Asthma

Refractory asthma refers to poorly controlled asthma. It is also called as severe asthma, steroid-dependent or resistant asthma, difficult to control asthma, brittle asthma and irreversible asthma. The following steps can be taken for the patients with refractory asthma:

• Check the patient compliance with the medication prescribed.
• Correct the use of inhalers.
• Add low dose low release theophylline.
• Consider long term oral steroids.
• Infusion of beta-2 agonists may benefit some of the patients.

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Keywords: Refractory asthma, Treatment, Severe asthma, Steroid-dependent or resistant asthma, Difficult to control asthma, Brittle asthma, Irreversible asthma

Butterfly Fracture

What is butterfly fracture?

Butterfly fracture is a type of comminuted fracture. So, it refers to a comminuted fracture with a wedge-shaped or triangular-shaped piece of bone involving one cortex of the bone, between the proximal and distal portions of the fractured bone. It is also called as comminuted fracture with butterfly fragment or wedge fracture.

A butterfly fracture of right tibia

What is the cause of butterfly fracture?

Butterfly fractures are caused by angulation or bending movements and butterfly fragment is produced due to compression.

What is the treatment of butterfly fracture?

Butterfly fractures are managed with inter-fragmentary compression screw fixation at each fracture interface of the fractured bone.

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Keywords: Butterfly fracture, Comminuted fracture, Butterfly fragment, Types of fracture, Wedge fracture

Spot Diagnosis # 5

A 70 years old male presented with earache deep inside the left ear radiating to pinna. On examination, his left external canal and pinna showed vesicular rashes with drooping left side of the mouth.  What is your spot diagnosis?

Answer:
The diagnosis is Ramsay Hunt Syndrome (RHS). It is a reactivation syndrome of herpes zoster virus in an L-shaped ganglion of facial nerve named  as geniculate ganglion, present in facial canal. RHS occurs when herpes zoster virus infects facial nerve and presents with painful shingle rash with fluid filled vesicles seen on, in or around the single ear. It may present with ear pain, hearing loss, ringing of ear, difficulty in closing the eye on the affected side as well as vertigo, change in taste and facial paralysis. All the signs and symptom described in the scenario above support the diagnosis of Ramsay Hunt Syndrome or herpes zoster oticus.

Spot Diagnosis # 4

Keywords: Earache, Vesicular rash, Drooping mouth, Ramsay Hunt Syndrome or herpes zoster oticus

Spot Diagnosis # 4

A 25 years old boy, a treated case of tuberculosis presents with shortness of breath and painful tense, distended abdomen (image of the abdomen is shown below). Echocardiography shows a thin pericadial effusion around the heart. Ultrasound shows splenomegaly. What is your spot diagnosis?

Tense distended abdomen

Please write your spot diagnosis below in the "comments section". The answer will be given after a week!

Spot Diagnosis # 3

Keywords: Tuberculosis, Thin pericardial effucion, Distended abdomen

Spot Diagnosis # 3

A 90 years old emaciated female with the given image of reddened palmar aspect of her hands. She is known case of metastatic hepatic cancer. She has not applied and colour or mehndi. What is your spot diagnosis?

Palmar redness

Answer:

Diagnosis: Palmar Erythema (PE) due to hepatic CA

What is palmar erythema?

Palmar erythema is a non-specific condition where palms of the hands become red, especially at thenar (at the base of thumb) and hypothenar (at the base of little finger) eminences. Palmar erythema may be normal, may be physiological or may be pathological. It may be primary palmar erythema (e.g. pregnancy, heredity and idiopathic) or secondary palmar erythema (various conditions/diseases).

What causes palmar erythema?

The exact cause of palmar erythema is yet not known. However, some experts are in view that high levels of estrogen in the blood cause palmar erythema as this hormone has been seen raised in cirrhosis of liver and during the pregnancy. It is thought that estrogen increases vascularity, leading to redness of palms. Redness of palms in palmar erythema varies person to person and may extend to the fingers and nail beds.

Which conditions have palmar erythema?

A lot of conditions have palmar erythema as a sign. The following conditions/diseases show PE:

1. Pregnancy- PE in pregnancy is a type of primary PE and is shown by about 30% of the pregnant women.
2. Chronic liver disease- About 23% patients with CLD show secondary PE.
3. Portal hypertension
4. Polycythemia
5. Rheumatoid arthritis- More than 60% patients with RA show secondary PE.
6. Thyrotoxicosis- About 18% patients with thyrotoxicosis show secondary PE.
7. Eczema or psoriasis
8. Drug-induced- Drugs such as amiodarone, gemfibrozil, cholestyramine, topiramate and albuterol also cause secondary PE as a side effect. 
9. Metastatic and primary brain neoplasms- Increased angiogenic factors and estrogens levels in the patients with metastatic and primary brain neoplasms show secondary PE.
10. Smoking- An environmental cause of PE
11. Chronic mercury poisoning- An environmental cause of PE

What is the treatment of palmar erythema?

There is no treatment of palmar erythema except treating the cause. Drug-induced PE can be abolished by discontinuing the same drug.

Spot Diagnosis # 2

Keywords: Palmar erythema, PE, Pregnancy, CLD, RA, Rheumatoid arthritis, Hepatic cancer, Metasatic liver cancer, CA liver, Red hands, Palmar redness