Free Online Medical Resources

Just wana packed up all the reliable online resources that is freely available for public or medical views.

Medical :

1) http://emedicine.medscape.com/
This website provide a wide range of medical information including detailed management of specific disease therefore is very useful for medical personals.

2) http://www.webmd.com/

3) http://medlineplus.gov/

4) http://www.imaios.com/en/

5) Internet Scientific Publications
http://www.ispub.com/
- covers a wide range of medical and surgical specialties

6) British Medical Journal - Student Site
http://student.bmj.com/student/archive.html
pretty much a revision website for medical students.

7) National Comprehensive Cancer Network
http://www.nccn.org/professionals/physician_gls/f_guidelines.asp
- providing information from the range of basic oncology/ tumour to specific tumours and its management.

8) Family Practice Notebook
http://www.fpnotebook.com/
- useful wide range of common medical illnesses and the treatment.

9) Oxford Journals
http://www.oxfordjournals.org/subject/medicine//

10) British Society of Rheumatology
http://www.rheumatology.org.uk/Resources/
- provide information on joints diseases.

11) Endotext
http://www.endotext.org/
- resources for endocrinology.

Surgery :

1)Bailey and Love. com
http://www.baileyandlove.com/links.htm
- multiple essential links in multiple surgical specialties including general surgery, vascular surgery, cardiothoracic surgery and etc for information of surgically-treatable diseases.


Orthopedic :

1) http://www.orthopaedicweblinks.com
2) http://www.wheelessonline.com/





Obstetric and Gynaecology

1) Royal college of Obstetricians and Gynaecologists
http://www.rcog.org.uk/
- privide useful O & G guidelines for medical and lay persons.


Anaesthesia

1) Anaesthesia UK
http://www.frca.co.uk/
- importatn organization in UK with plenty of Anaesthesia guidelines


Opthalmology

1) http://www.opt.indiana.edu/riley/HomePage/1lecturenotes.html



Dermatology / Skin Diseases

1) Derm Net NZ
http://www.dermnetnz.org/
- provide brief and simple information for reference. easy to read and understand.

2) European Academy of Dermatology and Venereology
http://www.eadv.org/
- give of vital info regarding skin diseases and venereal / sexually transmitted skin diseases.

Acute Immune Thrombocytopenic Purpura (ITP)

1) ITP :

Immune Thrombocytopenic Purpura (ITP) is believed to be a immunological reaction which follows an acute viral infection causing antibody binding to platelet membrane thereby allowing destruction of the antibody-coated platelets to be destroyed in reticuloendothelial system. It’s usually a clinical diagnosis with exclusion. However, those presenting with atypical features such as knee pain, inguinal mass and back pain should be investigated with bone marrow aspiration to rule out leukemia1. Platelet – associated IgG can also be tested in him and 90% of those with ITP will be tested positive1.

2) Approach in treating acute ITP :

As most of the patients of ITP achieve spontaneous remission within 8-12 weeks, it’s recommended that only those patients having platelet count of less than 20,000/mcL and significant mucous membrane bleeding or platelet count < 10,000/mcL and minor purpura be treated. He therefore fulfilled the criteria. First line of treatment would be using Prenisolone 1-2mg/kg/day until platelet count becomes normal and taper off. Prednisolone alone would be able to achieve 70% remission rate. Otherwise, intravenous gamma globulin is also effective in children usually given over 5 days or 1g/kg/day for 2 days. It’s proved to enable platelet count raise more rapidly and cost-effective than corticosteroid in acute ITP3. Platelet transfusion however is to be reserved for life threatening condition only whereas splenectomy is not indicated in the case of ITP unless severe uncontrollable haemorrhage developed. Research shows that about 22-27% of those with acute ITP will develop chronic ITP that persisted more than 6 months 4. It’s shown that active treatment do accelerate platelet count recovery however do not avert the development of chronic ITP or reduce morbidity during follow up 4. However, treatment with immunoglobulin G , intravenous Anti-D or high-dose pulse steroids have been showing promising results in delaying the need of splenectomy in chronic ITP.

Reference :
1) Jeffrey T. Kirchner Idiopathic Thrombocytopenic Purpura Diagnosis in Children
http://www.aafp.org/afp/981015ap/tips.html#12
2) Nelson Essential of Paediatrics Fifth Edition 2006 pg 714-719
3) Beck et al . Corticosteroids versus intravenous immune globulin for the treatment of acute immune thrombocytopenic purpura in children: a systematic review and meta-analysis of randomized controlled trials. 2005 Oct;147(4):521-7.
http://www.ncbi.nlm.nih.gov/pubmed/16227040?dopt=Abstract
4) Treutiger I et al Does treatment of newly diagnosed idiopathic thrombocytopenic purpura reduce morbidity? Arch Dis Child. 2007 Aug;92(8):704-7. Epub 2007 Apr 25.
http://www.ncbi.nlm.nih.gov/pubmed/17460024?dopt=Abstract

Iron Overload in Thalassaemic Patients

It it a need for patients with thalassaemia to be transfused with blood at least once a month especially when they are of thalassaemia major which is the severe form that need blood tranfusion.

And, sadly to say; there is no medication in this world that can be given without any side effect. Though blood tranfusion helped them to prolonged their life as campared to those in the ancient time, it brought up another problem for them - Iron overload.

Those excess iron as a result of repeated tranfusion couldn't possibly be excreted by our body, hence starting to accumulate in our body in the form of ferritin. When in excess, this will lead to a condition called as Haemosiderosis and Haemochromatosis.

Moreover, this excess iron tend to accumulate in the vital organs such as the heart (heart failure/cardiomyopathy), liver (hepatic cirrhosis), pancreas (diabetes mellitus) and endocrine organs (hypopituitarism and hypogonadism).

Therefore, iron chelation therapy is the choice of options in order for them not to get the side effects from repeated blood transfusion. Usually, iron chelation therapy is only needed after 20 transfusion have been done as each unit of blood tranfusion will give them an excess of 200-250mg of iron.

There are 3 form of iron chelating therapy available :

Desferrioxamine

- subcutaneous injection via an infusion pump (5-7x per week) for 8-12 hours
- indicated for those > 3 years old, ferritin > 1000 ug/l after 10-20 tranfusion
- promote urine excretion
- s.e = skin rashes, yersinia infection (fever, abdominal pain & diarrhea)
- cost - RM 500-1000

Deferiprone

- oral tablet form trice daily (tds)
- usually use in combination with desferrioxamine
- chelate iron from heart also
- s.e = agranulocytosis, joint pain,nausea, diarrhea & elevated liver enzymes

Desferasirox (Exjade)

- once daily dose tablet (OD)
- excrete iron via defaecation
- s.e = nausea/vomiting/abdominal pain, rashes,increased creatinine and liver enzymes


Other options available would include Splenectomy and Bone Marrow transplant

Spleenectomy

- when there is hypersplenism, large spleen or excess haemolysis
- indicated for those > 5 years old, transfusion of more than 200-220mls/kg/year.
- pancytopenia
- s.e = increased susceptibility to bacterial infection (meningococcus/ penumococcus/haemophilus influenza b) - need vaccination 4-6 weeks before surgery
thrombocytosis (use aspirin)

Bone Marrow Transplantation

- ideal choice of treatment (cure rate > 80%)
- allograph transplant from HLA-matched siblings
- s.e = infection, graft rejection and graft versus host disease
- greater chance of success rate if compliant to iron therapy, < 2cm of hepatomegaly and no portal fibrosis

Lethargy and Anemia

******Please make sure that you are not as pale as the panda, because they look cute when they are pale but not any of us!!!

Causes of Anemia :

1) Nutritional

Iron Deficiency Anemia - diet hx,
Pernicious Anemia - peripheral neuropathy, alcoholism, chronic liver disease

2) Chronic Blood Lost

Peptic Ulcer Disease - gastric pain in relation to meal, NSAIDS
GIT Bleed - haematemesis and malaena
Mentrual Hx- menorrhagia


3) Increased Destruction

Haemolytic Anemia - hx of jaundice

4) Under Production

Malignancy - fever, night sweats , LOA, LOW
Drugs