27 November 2011 (Sunday) - Diabetes

It is commonly felt that patients with type II diabetes treated with oral therapy alone rarely achieve the recommended 7% HbA1c goal for glycemic control. As control worsens over time, the risks of the complications which are common to the diabetic patient increase.
Traditionally doctors can be loathe to use insulin therapy in the type II diabetic patient (for a variety of reasons), and when insulin is prescribed, it is often not prescribed in a sufficiently aggressive dosage.
A recent survey has shown that supplementing oral therapy with a single injection of insulin given at bed time can routinely lower fasting glucose measurements, and achieves and surpasses the recommended target of 7% for HbA1c levels.

Furthermore the use of glargine (a new long-acting insulin analog) rather than more traditional insulin analogues can achieve this reduction in fasting glucose measurements and HbA1c levels whilst significantly reducing the incidence of nocturnal hypoglycaemia; with about a third of all patients having no incidents of nocturnal hypoglycaemia at all. With patient adherence to the treatment protocol exceeding 90%, this regimen is easy to follow.

19 November 2011 (Saturday) - An on-line survey

The Saturday Survey – what’s the cell? There’s a nucleated red cell which are very common in babies. But I don’t think this is from a baby because of the Howell-Jolly bodies and acanthocytes



5 November 2011 (Saturday) - Trypanosomiasis

Trypanosomiasis is the generic name of several diseases in vertebrates (not just humans) caused by parasitic protozoan trypanosomes of the genus Trypanosoma.

Approximately 500,000 men, women and children in 36 countries of sub-Saharan Africa suffer from human African trypanosomiasis which is caused by either Trypanosoma brucei gambiense or Trypanosoma brucei rhodesiense, transmitted by the tsetse fly infected with Trypanosoma brucei, (sleeping sickness)

The other human form of trypanosomiasis, (Chagas disease) causes 21,000 deaths per year  mainly in Latin America, transmitted by the assassin bug infected with Trypanosoma cruzi,

Diagnosis depends on seeing the parasites in blood or other bodily fluids. Presumably in the fullness of time antigen-type trsts might become available (as is the case for malaria)…

3 November 2011 (Thursday) - Rbc Morphology

ScienceDaily (Oct. 31, 2011) — Misshapen red blood cells are a sign of serious illnesses, such as malaria and sickle cell anemia. Until recently, the only way to assess whether a person's RBCs were the correct shape was to look at them individually under a microscope -- a time-consuming process for pathologists. Now researchers from the University of Illinois at Urbana-Champaign have pioneered a technique that will allow doctors to ascertain the healthy shape of red blood cells in just a few seconds, by analysing the light scattered off hundreds of cells at a time.

2 November 2011 (Wednesday) - Perthes Disease

This disease attacks the femoral head (the ball part of the ball-and-socket hip joint). Starting in children aged 4 to 8, it occurs in boys four times as often as girls. Those who are small for their age are also at risk.

LCP typically affects only one hip in which the femoral head gradually weakens and dies from a lack of blood supply. It becomes brittle and may collapse, leading to deformity and arthritis. The problem develops gradually. The child will begin to feel pain in the hip joint or knee, and then start to limp. The limp may get worse with activity. The affected leg may be shorter than the other.

The causes are still rather uncertain, heredity, trauma, endocrine, inflammatory, nutritional, and altered circulatory haemodynamics have all been cited.

X-rays and MRI may be helpful in confirming the diagnosis. The goal of treatment is to avoid severe degenerative arthritis. Perthes disease is self limiting, but if the head of femur is left deformed there can be a long-term problem. Treatment is aimed at minimizing damage while the disease runs its course, not at 'curing' the disease. However the child may need traction followed by bracing, or may require an osteotomy to shift weight away from the collapsing bone.