Nov 182012
 

Diabetes mellitus is a common disease affecting a large number of population. It is characterized by increased blood sugars and abnormalities of carbohydrate and lipid metabolism.Diabetes can be managed by family physicians as effectively as in hospital clinics.

Aims Of Diabetic Care

  • Alleviation of symptoms.
  • Minimization of complications.
  • Reduction of early mortality.
  • Quality of life enhancement.
  • Education of the patient and family.
  • Features of well organized care
  • Use of a register and well maintained records.
  • Regular review , following a proper protocol and provision of adequate time  and open access for patients to review advice.
  • Multidisciplinary team covering all aspects of diabetes care- GPs, diabetes nurses/assistants and educators.
  • Continuing education for professional staff.

Routine diabetic review

Each diabetic patient requires 6 monthly review or more frequently as necessary. This should include a through annual review of all aspects of disease and care.

Review include

  • The indices of blood sugar control e.g HbA1c
  • Dietary behaviors, physical activity and injection techniques.
  • Foot care.
  • Immunizations – infuenza and pneumococcal vaccination.
  • Depression screening.
  • Any complications like cardiovascular disease, nephropathy, neuropathy, eye disease, errectile dysfunction etc. Continue reading »
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Oct 302012
 

Patients with rheumatoid arthritis need proper management and control of their symptoms to improve the quality of life. Although taking analgesic medicines for a long duration of time leads to gastric problems but it is important to give patient some relief from disturbing pain and inflammation.

Non Pharmacological Management

  • Encourage regular exercise, physio and occupational therapy.
  • Provide household aids and personal aids e.g wrist splints.
  • Good mental and social support to improve life style and cope up with the disease.

Pharmacological Management

NSAIDs

If there is no contraindication e.g an active peptic ulcer start with an NSAID, such as ibuprofen. There is no single NSAID that is superior to other agents, and newer agents have not been shown to have a decreased incidence in toxicity. If patient cannot tolerate NSAIDs then consider COX2 inhibitors that prevents gastrointestinal side effects.

Steroids

Steroids may decrease joint damage and control difficult symptoms but using them for prolonged period of time leads to decreased bone density and predisposition to osteoporosis as well as other side effects related to prolonged steroid use.

Disease Modifying Drugs

Start DMARDs if there is persisting synovitis for more than 6 weeks. Sulfasalazine and methotrexate are typical 1st choices and are often used together. The drugs included in this group include: Continue reading »

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Oct 132012
 

The skin functions as a barrier against potentially harmful physical and chemical agents as well as against different microorganisms. Sometimes different features may be seen that help to differentiate different systemic diseases. A brief list of the skin manifestations of non malignant systemic diseases is given here:

1. Erythema

  • Collagen disease
  • Carcinoid
  • Mitral valve disease
  • Polycythemia
  • Superior vena caval obstruction
  • Liver disease
  • Hyperviscosity syndrome

2. Erythema Multiforme

  • Fever
  • Inflammatory bowel disease
  • Rheumatoid arthritis
  • Thyrotoxicosis
  • Viral Infections

3. Urtricaria

  • Collagen disorders
  • Xanthomatoses
  • Hereditary angioneurotic edema
  • Urtricaria pigmentosa
  • Henoch-Schonlein purpura
  • Cold aglutinins

4. Scaling

  • Vitamin deficiencies
  • Hypothyroidism
  • Acromegaly
  • Malabsorption
  • Refsum’s and Reiter’s diseases

5. Papules and Nodules Continue reading »

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