ACUTE MYELOID LEUKAEMIA

ACUTE MYELOID LEUKAEMIA

Acute myeloid leukemia (AML), also known as acute myelogenous leukemia or acute nonlymphocytic leukemia (ANLL)is a cancer of the myeloid line of blood cells, characterized by the rapid growth of abnormal white blood cells that accumulate in the bone marrow and interfere with the production of normal blood cells.Acute means that the leukemia can grow quickly, and if not treated, could be fatal in a few months. AML is a cancer that starts in the cells that are supposed to mature into different types of blood cells.

Signs and symptoms of acute myelogenous leukemia include:

• Fever.
• Bone pain.
• Lethargy and fatigue.
• Shortness of breath.
• Pale skin.
• Frequent infections.
• Easy bruising.
• Unusual bleeding, such as frequent nosebleeds and bleeding from the gums.

Once the diagnosis of acute myeloid leukemia (AML) is established, induction chemotherapy is given with the goal of rapidly restoring normal bone marrow function.The main treatment for AML is chemotherapy. Other treatments for AML include growth factors, radiotherapy, and bone marrow transplants or stem cell transplants. The treatment for acute myeloid leukaemia varies depending on your type of AML, your general health, and your age and level of fitness. 

Remission means that no leukaemic cells can be found in the blood or bone marrow and the bone marrow is working normally again. In people treated for acute leukaemia remission may last many years, and then they are considered cured 

ACUTE LYMPHOCYTIC LEUKAEMIA

ACUTE  LYMPHOCYTIC  LEUKAEMIA

Acute lymphoblastic leukemia, also known as acute lymphocytic leukemia or acute lymphoid leukemia (ALL), is an acute form of leukemia caused by a DNA mutation in the stem cells causing too many white blood cells to be produced. ALL is the most common cancer in childhood,although it can also occur in adults.

Acute lymphoblastic leukemia (ALL) is a fast-growing cancer of a type of white blood cells called lymphocytes that crowds out bone marrow, preventing it from making the normal red blood cells, white blood cells, and platelets that your body needs.

Lymphocytic means it develops from early (immature) forms of lymphocytes, a type of white blood cell. This is different from acute myeloid leukemia (AML), which develops in other blood cell types found in the bone marrow.

For Diagnosing Acute Lymphoblastic Leukemia Usually, doctors begin with a blood test (called a CBC, or complete blood count). Although the blood test may show leukemia cells, doctors need to examine a sample of bone marrow before confirming the exact diagnosis.

The main treatment for acute lymphocytic leukemia (ALL) in adults involves the long-term use of chemotherapy (chemo). In the past several years, doctors have begun to use more intensive chemo regimens, which has led to more responses to treatment.

Relapsed childhood ALL is cancer that has come back after it has been treated. The leukemia may come back in the blood and bone marrow, brain, spinal cord, testicles, or other parts of the body.  

LIPOSUCTION

LIPOSUCTION

Liposuction is a type of cosmetic surgery. It removes unwanted excess fat to improve body appearance and to smooth irregular body shapes.also known as lipoplasty, liposculpture suction lipectomy or simply lipo,

Liposuction presents the same negative side effects generally associated with any surgical procedure.Common side effects of liposuction include: 
Temporary swelling,
bruising
irregular contour to the skin.

Every patient is a bit different in their recovery time.It usually takes about two weeks to fully recover from liposuction, but you should be able to return to work within a few days if a small area was treated. If a large area was treated, you may need up to 10 days off work to recover.

GYNECOLOGY AND OBSTETRICS

IUD intrauterine device

 IUDs are small, "T-shaped" devices made of flexible plastic. A health care provider inserts an IUD into a woman's uterus to prevent pregnancy. There are two types of IUD available — copper  and hormonal.
They are one form of long-acting reversible contraception which are the most effective types of reversible birth control. Side effects of IUDs include cramps, infection, spotting, heavy periods, infertility
 
INFERTILITY

 infertility is 'a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse'.
While it's true that many woman conceive without difficulty, more than five million people of childbearing age or one in every 10 couples have problems with infertility.
Causes of male infertility may include: Abnormal sperm production or function due to various problems, such as undescended testicles, genetic defects, health problems including diabetes, prior infections such as mumps, trauma or prior surgeries on the testicles or inguinal region.PCOS is the most common cause of female infertility 

IN VITRO FERTILIZATION

In Vitro Fertilization is a one assisted reproductive technology (ART) commonly referred to as IVF. IVF is the process of fertilization by manually combining an egg and sperm in a laboratory dish, and then transferring the embryo to the uterus.For IVF to be successful it typically requires healthy ova, sperm that can fertilise, and a uterus that can maintain a pregnancy. The success rate for IVF depends on the woman's age.

IMPOTENCY

 Impotence is a common problem among men and is characterized by the consistent inability to sustain an erection sufficient for sexual intercourse or the inability to achieve ejaculation, or both. It’s a form of erectile dysfunction (ED)but
Erectile dysfunction can vary.A penile erection is the hydraulic effect of blood entering and being retained in sponge-like bodies within the penis.Using alcohol can dampen mood, decrease sexual desire, and make it difficult for a man to achieve erections or reach an orgasm while under the influence.Men facing increased stress or anxiety may also have increased blood pressure and cholesterol. Both of these conditions increase a man's risk for ED.




HYSTERECTOMY

Hysterectomy is a surgery to remove a woman's uterus.The uterus is a hollow muscular organ that nourishes the developing baby during pregnancy. However other organs such as ovaries, fallopian tubes and the cervix are very frequently removed as part of the surgery. You'll no longer be able to get pregnant after the operation.The most common reason hysterectomy is performed is for uterine fibroids. Other common reasons are:cervical dysplasia , abnormal uterine bleeding , endometriosis, and uterine prolapse.

GESTATIONAL DIABETES (GDM)

Diabetes of pregnancy Gestational diabetes occurs when a pregnant woman has high levels of glucose in her blood. High blood glucose is caused because the mother can't produce enough insulin (a pregnant woman's insulin needs are two to three times that of normal).Usually around the 24th week of gestation.Risk factors include being overweight or obese, history of gestational diabetes in a previous pregnancy, and PCOS.Gestational diabetes may be a marker for diabetes development later in life.Whether insulin or only diet modification is used for treatment and whether or not the condition persists after pregnancy.



FETAL DEVELOPMENT

Fetal development begins before you even know you're pregnant.Within about three days after conception, the fertilized egg is dividing very fast into many cells. It passes through the Fallopian tube into the uterus, where it attaches to the uterine wall. The placenta, which will nourish the baby, also starts to form.Your baby is an embryo consisting of two layers of cells from which all her organs and body parts will develop.BY 3rd month looks like a baby and internal organs developing like brain.By 4-6 months heart beating starts , bones develop and able to give movements.By 7-9 months lung develops and fetus double it length

EPISIOTOMY

An episiotomy is a surgical cut in the muscular area between the vagina and the anus (the area called the perineum) made just before delivery during second stage of labor to enlarge your vaginal opening so that the baby's birth easier and prevent severe tears that can be difficult to repair.The average length of a hospital stay for a normal vaginal delivery is 36--48 hours or with an episiotomy is 48--60 hours, whereas a C-section is 72--108 hours.

ENDOMETRIOSIS

Endometriosis is a disease in which tissue that normally grows inside the uterus grows outside it. which most often occurs in women between the ages of 25 and 40.Pelvic pain during menstruation or ovulation can be a symptom of endometriosis, but may also occur in normal women.
Medical treatment  
Pain killers 
Oral contraceptives 
Progestins/progesterone 
GnRH-analogues

Early surgical menopause (hysterectomy) as a “treatment” for endometriosis may contribute to increased risk of heart disease in younger women.

ASSISTED DELIVERY

An assisted delivery is when your baby needs help to be born with instruments that attach to her head. It's also called an instrumental, or operative vaginal birth.
About one in eight women has an assisted delivery.
 Forceps are a surgical instrument that resembles a pair of tongs and can be used in surgery for grabbing, maneuvering, or removing various things within or from the body. They can be used to assist the delivery of a baby as an alternative to the ventouse (vacuum extraction) method.
A vacuum extraction is a procedure sometimes done during the course of vaginal childbirth. During vacuum extraction, a health care provider applies the vacuum — a soft or rigid cup with a handle and a vacuum pump — to the baby's head to help guide the baby out of the birth canal.

AMNIOCENTESIS

Amniocentesis ( amniotic fluid test or AFT) is a medical procedure used in prenatal diagnosis of chromosomal abnormalities such as Down syndrome, cystic fibrosis or spina bifida and fetal infections, determine lung maturity , and also used for sex determination. 
Amniotic fluid is the fluid that surrounds and protects a baby during pregnancy.
It is most often done in a doctor's office or medical center. 

OPHTHALMOLOGY

LOW VISION

Low vision is vision loss that's so severe, it can't be corrected with regular eyeglasses, contact lenses or surgery.

Besides age-related retinal conditions, there are many other possible causes of low vision, including conditions such as glaucoma and diabetes. Low vision may also result from cancer of the eye, albinism, stroke, eye trauma or a brain injury.

A person with low vision may find it difficult or impossible to accomplish activities such as reading, writing, shopping, watching television, driving a car or recognizing faces. 

Laser-assisted in situ keratomileusis (LASIK)

LASIK is a surgical procedure that uses a laser to correct nearsightedness, farsightedness, and/or astigmatism. In LASIK, a thin flap in the cornea is created using either a microkeratome blade or a femtosecond laser. The surgeon then folds back the hinged flap to access the underlying cornea (called the stroma) and removes some corneal tissue using an excimer laser.
LASIK solves myopia by correcting the corneal irregularities that cause it. Hyperopia (Farsightedness) Farsighted individuals have trouble reading up close or seeing objects near at hand. The farsighted eye is slightly shorter than a normal eye and has a flatter cornea, so distant objects focus behind the retina

GLAUCOMA

Glaucoma is a condition that causes damage to your eye's optic nerve and gets worse over time. It's often associated with a buildup of pressure inside the eye. Glaucoma tends to be inherited and may not show up until later in life.
The most common type of glaucoma, primary open-angle glaucoma, is hereditary. If members of your immediate family have glaucoma, you are at a much higher risk than the rest of the population. Family history increases risk of glaucoma four to nine times.
The eye disease glaucoma can cause severe headaches in some cases. 
Acute angle-closure glaucoma is a medical emergency. When you're diagnosed with this condition, you'll need urgent treatment to reduce the pressure in your eye. This generally will require both medication and procedures. You may have a procedure called a laser peripheral iridotomy.  

SPINAL PROBLEMS

LUMBAR FUSION

A spinal fusion surgery is designed to stop the motion at a painful vertebral segment, which in turn should decrease pain generated from the joint.

Spinal fusion is surgery to permanently join together two or more bones in the spine so there is no movement between them

 LOW BACK PAIN

Low back pain (LBP) is a common disorder involving the muscles, nerves, and bones of the back
Lower back pain is extremely common, the symptoms and severity of lower back pain vary greatly.
A sudden and involuntary contraction, or uncontrollable tightening, of a muscle in response to strain, overuse, weakness, or muscle pain related to injury or a disorder. Back spasms often occur near the spinal cord or near the nerve roots that lead in and out of the spinal cord.  

 BACK AND NECK BRACES

Braces can be worn on any section of the spine (cervical, thoracic, lumbar, sacral) and are named for the area of the spine to which they are applied.
a neck or back brace to wear after a spinal injury or surgery.

 ANKYLOSING SPONDYLITIS

A form of spinal arthritis, chiefly affecting young males, that eventually causes ankylosis of vertebral and sacroiliac joints.Ankylosing spondylitis is an inflammatory disease that can cause some of the vertebrae in your spine to fuse together.
The hallmark feature of ankylosing spondylitis is the involvement of the sacroiliac (SI) joints during the progression of the disease

 EPIDURAL

a medical route of administration in which a drug or contrast agent is injected into the epidural space of the spinal cord. Techniques such as epidural analgesia and epidural anaesthesia employ this route of administration.

UROLOGY AND NEPHROLOGY

UTI urinary tract infection 

  UTI is an infection involving the kidneys, ureters, bladder, or urethra. These are the structures that urine passes through before being eliminated from the body.

 Infection in the upper urinary tract generally affects the kidneys (pyelonephritis), which can cause fever, chills, nausea, vomiting, and other severe symptoms.
The lower urinary tract consists of the bladder and the urethra. Infection in the lower urinary tract can affect the urethra (urethritis) or the bladder (cystitis).

URINARY INCONTINENCE 

is the involuntary leakage of urine; in simple terms, to wee when you don't intend to. It is the inability to hold urine in the bladder because voluntary control over the urinary sphincter is either lost or weakened.
Painful or frequent urination is a common problem, especially in older men. Urinary tract infections, kidney stones and prostate problems can all produce these symptoms. Frequent urination without pain also can be a side effect of certain medications, or a symptom of diabetes.

 KIDNEY DIALYSIS

Dialysis is a treatment that does some of the things done by healthy kidneys. It is needed when your own kidneys can no longer take care of your body's needs

Kidney dialysis is a life-support treatment that uses a special machine to filter harmful wastes, salt, and excess fluid from your blood. This restores the blood to a normal, healthy balance.

 KIDNEY TRANSPLANT

Kidney transplantationis the organ transplant of a kidney into a patient with end-stage renal disease. Kidney transplantation is typically classifiedor living-donor transplantation depending on the source of the donor organ.

BENIGN PROSTATIC HYPERPLASIA (BPH)

Involves enlargement of the prostate gland. The prostate enlargement in BPH is not malignant. Symptoms include frequent urge to urinate, getting up at night to urinate, difficulty urinating and dribbling of urine.

A normal prostate gland is approximately 20 g in volume, 3 cm in length, 4 cm wide, and 2 cm in depth. As men get older, the prostate gland is variable in size secondary to benign prostatic hyperplasia. 

HEAD TO TOE PHYSICAL ASSESEMENT

This section describes the basics of a head-to-toe assessment which is a vital aspect of a doctor while doing physical examination. It should be done each time you encounter a patient for the first time each shift.But in general so many doctor are not doing all this head to toe examination.

Here I uploaded the videos which I found in youtube, and after seeing it I learn something,hope you can also like the video after watching it.

 Head to Toe Assessment part 1

Wash your hands. 
Greet and identify the patient. Explain what you are going to do. 
Provide for privacy. 
Begin with the 5 Vital Signs: Temperature, Pulse, Blood Pressure, Respiration and Pain.

 

Head to Toe Assessment part 2

Head: Shape and symmetry; condition of hair and scalp
Eyes: Conjunctiva and sclera, pupils; reactivity to light and ability to follow your finger or a light
Ears: Hearing aids, pain? Speak in a whisper: can he hear you and comprehend?

Head to Toe Assessment part 3

Nose: Drainage, congestion, difficulty breathing, sense of smell 

Throat and Mouth: Mucous membranes, any lesions, teeth or dentures, odor, swallowing, trachea, lymph nodes, tongue.

Skin:Assess the turgor, color, temperature and moisture of the skin, scars, lesions,wounds.

Head to Toe Assessment part 4

Level of Consciousness and Orientation:Is he awake and alert? Is he oriented to Person (knows his name),Place(he can tell you where he is) and Time(knows the day and date).A fourth level of orientation is Purpose(he knows why you are examining him).

Head to Toe Assessment part 5

Thoracic region:

Assess lung and cardiac sounds from the front and back. Assess them for character and quality as well as for the presence or absence of appropriate sounds. Palpate the chest wall and breasts for any tenderness or lumps

Head to Toe Assessment part 6

 Abdomen: 
Listen to bowel sounds throughout the 4 quadrants. Palpate for tenderness or lumps. Palpate the bladder. Ask about intake and output of bowels and bladder. Ask about appetite. Asses genitalia for tenderness, lumps or lesions.

Extremities:Assess for temperature, capillary fill and ROM. Palpate for pulses. Note any edema, lesions, lumps or pain.

General Questions:Ask the patient how he feels. Has anything changed recently? Any pain, burning, SOB, chest pains, change in bowel or bladder habits/function, change in sleep habits, cough, discharge from any orifice, depression, sadness, or change in appetite?

Wash your hands and Document your findings and then evaluate your assessment

How To Read Ecg's (Video Training)

Electrocardiography (ECG or EKG) is the process of recording the electrical activity of the heart over a period of time using electrodes placed on the skin. These electrodes detect the tiny electrical changes on the skin that arise from the heart muscle depolarizing during each heartbeat. It is a very commonly performed cardiology test. 

***Not to be confused with other types of electrography or with echocardiography.***

 How To Read Ecg's part 1

indications for performing electrocardiography
1)Suspected myocardial infarction (heart attack)
2)cardiac dysrhythmias
3)Suspected pulmonary embolism
4)Hypertrophic cardiomyopathy
5)Cardiac stress testing
6)Fainting or collapse 

 How To Read Ecg's part 2

On a standard 12-lead EKG there are only 10 electrodes 

Leads are broken down into three sets: three limb leads, three augmented limb leads, and six precordial leads.

 

 How To Read Ecg's part 3

HOW TO ASSESS DIARRHOEA IN CHILD

Assess all children with diarrhea for the following signs of dehydration:  

1)General condition When a child becomes dehydrated, he or she is at first restless and irritable. If dehydration continues, the child becomes lethargic or unconscious (this is also a general danger sign)

2)Sunken eyes

3)Thirst

4)Reaction to skin pinch

1)HOW TO ASSESS SUNKEN EYES IN CHILD

As the child's body loses fluids, the eyes may look sunken.

    Decide if you think the eyes are sunken.
    Then ask the mother if she thinks her child's eyes look unusual. Her opinion helps you confirm that the child's eyes are sunken.

2)HOW TO CHECK THIRST OF CHILD HAVING DIARRHOEA

OFFER the child fluid
    Is the child not able to drink?
    Is the child drinking poorly?
    Is the child drinking eagerly, thirsty?

A child is not able to drink if he or she is not able to take fluid in his or her mouth and swallow it. For example, a child may not be able to drink because he or she is lethargic or unconscious

 A child is drinking poorly if he or she is weak and cannot drink without help. The child may be able to swallow only if fluid is put in his or her mouth.
 A child has the sign drinking eagerly, thirsty if it is clear that the child wants to drink. Notice if the child reaches out for the cup or spoon when you offer him or her water. When the water is taken away, see if the child is unhappy because he or she wants to drink more. If the child takes a drink only with encouragement and does not want to drink more, he or she does not have the sign "drinking eagerly, thirsty."


                                                                              

3)HOW TO CHECK SKIN PINCH IN CHILD HAVING DIARRHOEA

Ask the mother to place the child on the examining table so that the child is flat on his or her back with arms at sides (not over head) and legs straight. Or ask the mother to hold the child so he or she is lying flat in her lap.Locate the area on the child's abdomen halfway between the umbilicus and the side of the abdomen.To do the skin pinch, use your thumb and first finger. Do not use your fingertips because this will cause pain.

Place your hand so that when you pinch the skin, the fold of skin will be in a line up and down the child's body and not across the child's body.Firmly pick up all of the layers of skin and the tissue under them.Pinch the skin for one second and then release it. When you release the skin, look to see if the skin pinch goes back:
    very slowly (longer than 2 seconds)
    slowly (skin stays up even for a brief instant)
    immediately

4)HOW TO ASSESS DEHYDRATION IN CHILD

 

Check for general danger signs

General danger signs are:

1.    the child is not able to drink or breastfeed
2.    the child vomits everything
3.    the child has had convulsions during the present illness or has convulsions now
4.    the child is lethargic or unconscious

 A child with a general danger sign has a serious problem need urgent referral to hospital.

General danger signs

Watch this video to see why it is important to check EVERY sick child for general danger signs

 A sick child may have signs that clearly point to a disease.General danger signs suggest that a child is severely ill and needs urgent attention.

 .

Is the child able to drink or breastfeed? 

A child who is not able to suck or swallow when offered a drink or breast milk because he or she is too weak or cannot swallow has the danger sign not able to drink or breastfeed.

 

 

 

 Does the child vomit everything?

 A child who is not able to hold anything down at all has the danger sign "vomits everything." What goes down comes back up.

A child who vomits several times but can hold down some fluids does not have this general danger sign. 

Has the child had convulsions during the present illness?

Convulsions considered a life threatening danger sign are:
1)Any convulsions in children aged less than 6 months.
2)More than one episode of convulsions during the present illness or convulsions lasting for more than 15 minutes in children aged 6 months or more.

One episode of generalized convulsions during the current febrile illness in a child aged 6 months or more lasting for less than 15 minutes are considered simple febrile convulsions, NOT a general danger sign.

Is the child is unconscious or lethargic?

An unconscious or lethargic child is likely to be seriously ill.A lethargic child is not awake and alert when he or she should be. The child is drowsy and does not take any notice of his or her surroundings or does not respond normally to sounds or movement and appear not to notice what is going on around him or her. An unconscious child cannot be wakened. The child does not respond when he or she is touched, shaken or spoken to.

 

ASSESS COUGH OR DIFFICULTY BREATHING

A child with a cough or difficulty breathing is assessed for:

1.  How long the child has had a cough or difficulty breathing
2.  Fast breathing
3.  Chest indrawing
4.  Stridor
5.  Wheezing 

 Why important assess for cough or difficult breathing

ASK: For how long has the child had a cough or difficulty breathing?
 

 A child who has had a cough or difficulty breathing for more than 2 weeks has a chronic cough. This may be a sign of tuberculosis, asthma, whooping cough or another problem.

 

 

 COUNT the breaths in one minute

 You must count the breaths the child takes in one minute to decide whether the child has fast breathing.

The child must be quiet and calm when you watch and listen to his or her breathing.

 

 2 months up to 12 months    50 or more breaths per minute

 12 months up to 5 years        40 or more breaths per minute

 A child who is exactly 12 months old has fast breathing if you count 40 or more breaths per minute.

LOOK for chest indrawing 

Lower chest wall indrawing is an indicator of pneumonia.Look for chest indrawing when the child breathes in.

In normal breathing, the whole chest wall (upper and lower) and the abdomen move out when the child breathes in. When chest indrawing is present, the lower chest wall goes in  when the child breathes in.

LOOK and LISTEN for stridor

Stridor is a harsh noise made when the child breathes in when there is a swelling of the larynx, trachea or epiglottis.This swelling interferes with air entering the lungs.

Put your ear near the child's mouth because stridor can be difficult to hear.

A child who has stridor when calm has a dangerous condition.

LOOK and LISTEN for wheezing

Wheezing is a soft musical noise made when the child is breathing out caused by a narrowing of the air passages in the lungs. Breathing out takes longer than normal and requires effort.

Hold your ear near the child's mouth because the wheezing noise can be difficult to hear.