sogonaika.blogspot.com

Evidence is to be applied not overlooked

2011-08-17T03:19:00.001+01:00

Dear ReadersIt's been a while since I last wrote on the blog. Many of you probably thought I had forgotten about it. Quite the contrary, but I have been very busy with other things though. I will continue to write on here from time to time but with no guarantees when.....sorry :-)I wanted to talk about the use of evidence based medical practice in every day medicine. Many physicians talk about

Rounds around the computer are not rounds

2011-01-28T05:47:00.002Z

Dear BloggersIt's been a while since I last wrote on this blog. I'm afraid I've been very busy but I nevertheless have not forgotten about the blog.From my experiences in Japan, patients are often discussed around computer terminals with much emphasis given to laboratory data and radiology rather than the history and examination. This is nothing new to this blog but the fact that the patients are

Japanese Medicine Should Use the iPad at the Bedside

2010-08-17T01:34:00.003+01:00

Dear BloggersYes, it's been 6 months since I last put finger tips to keys to write on this blog. I have been busy with many things :-)Since I last wrote, the iPad and the iPhone 4 have come on to the market.The iPad is a really neat device albeit somewhat heavy. The screen is a nice size but grainy unlike the new iPhone 4 retina display. But, it makes a great eBook reader, word processor,

A Friday Rant On Infection

2010-02-19T00:52:00.004Z

Dear BloggersWhen we do invasive procedures, we should consider whether we are doing the procedure for the right reason, that the right equipment is used, and in an aseptic manner and maintained correctly.Should we regard urinary catheterisation as a procedure less important than let's say, central line insertion? Should we be any less careful?Well, the UK Department of Health figures from 2001

A Flurry of Endocarditis

2010-02-09T01:45:00.002Z

Dear BloggersThere have been two recent cases of infective endocarditis in young adults -- both aged below 30 years with 3rd degree mitral valve prolpase, both growing streptococcal spp from blood cultures and both with previous valvular abnormalities. One had a 'floppy' mitral valve and suspected endocarditis several years before and the most recent patient had confirmed endocarditis in the

A Classic Bedside Physical Sign - Asterixis

2010-01-20T03:20:00.008Z

Dear BloggersAbove is the classic sign of Flapping Tremor, also termed Asterixis, commonly seen in hepatic encephalopathy and CO2 retention. It is also seen in uraemia. The clues for the cause in this patient were the obvious jaundice and palmar erythema. Smelling the breath also revealed the classic Fetor Hepaticus -- sadly there is no current technological means to purvay this smell

Blue Sclera Sign

2010-01-19T01:02:00.005Z

Dear BloggersAs part of inspection of the patient, one is occasionally faced with the Blue Sclera Sign as seen below:Often, the patient is unaware that the 'whites' of their eyes are in fact, blue.I was first introduced to this sign as a junior doctor by a neurologist, and the patient turned out to have osteogensis imperfecta !However, there are several causes of this unusual physical sign that

Simulated Training of Practical Procedures

2010-01-11T22:54:00.003Z

Dear BloggersSome training institutions are instructing medical students and residents in performing medical procedures using 'simulated training' on special manikins. The aim of this kind of training is to teach the 'global standard' for such procedures with the expected outcome to make us 'better doctors' and to reduce mistakes made on the patients.When techniques are taught on a 'see one, do

Look at the patient

2010-01-04T02:52:00.006Z

Dear BloggersAlthough technology has taken medicine into a new age, we should not leave the fundamental skills of doctoring behind.The following case is a vignette and has been anonymised to safe-guard patient confidentiality.An elderly lady of 86 years of age had been admitted to a hospital with severe dehydration, vomiting and abdominal distension and she was tentatively diagnosed with

End of Year Greeting

2009-12-29T04:23:00.002Z

Dear BloggersIt has been six weeks since I last updated this blog for which I am eternally sorry :-)I hope that you have all been enjoying the end of year celebrations though.For me, life has been rather hectic but I can assure you that I will be updating the blog with new cases and interesting matters on a more regular basis --- at least, as much as I can do in 2010.I would like to thank you all

Answers to the November 'Spot Case'

2009-11-17T00:26:00.005Z

Dear BloggersThank you for waiting for the answers to the November short case which involved no history, but the sole use of observational skills.Without further ado, here are the answers to the following questions:Question 1: Please carefully examine the patient's arm (first photo). What physical signs can be seen here?When we look at the picture we are immediately drawn to the skin abnormality

A Short 'Spot' Case for November

2009-11-05T02:59:00.000Z

Dear Bloggers Welcome back! I hope that you have been enjoying the recent cases. Below is an anonymised short 'spot' case whereby the physical signs provide the diagnosis.Question 1: Please carefully examine the patient's arm (first photo). What physical signs can be seen here? Question 2: Please carefully examine the second photo. What physical signs can be seen here? Question 3: Which ONE

An interesting rash

2009-10-27T05:23:00.004Z

Dear BloggersThis 40 year old man was mending his wall when he fell and hit his chest. He was admitted to a hospital with a pneumothorax for which a chest drain was inserted. A fever developed after several days and pus started to drain from the chest tube. MRSA was cultured from the fluid and intravenous vancomycin was commenced after discontinuing initial therapy with ceftriaxone and

The Answers to October's Case 2009

2009-10-21T05:06:00.003+01:00

Dear Bloggers I hope that you have had a go at trying to work out this case. This month, Prof Matsumura (Japan) and Prof Dhaliwal (USA) have kindly contributed their expert opinions to this case. A contribution was also gratefully received from a first year Japanese resident (shown below). As a reminder, here are the original questions to the case:Question 1: From the history, physical exam,

Min-oooohhhh-cycline

2009-10-11T08:32:00.004+01:00

Dear BloggersThis patient with inoperable gastric carcinoma was commenced on palliative chemotherapy several months before the current admission. However, there was development of intermittent fever several days after the insertion of a tunneled Hickman line. The patient was not found to be neutropaenic.Blood cultures were taken from the peripheral veins and from the line - both grew coagulase

A Case for October 2009

2009-10-05T01:29:00.005+01:00

Dear BloggersA 65 year old retired lady school teacher was admitted to a hospital with a one-week history history of fever and back pain.The back pain had started gradually over a few days and was worse on movement. Initial pain scale was 3/10 but over several days it worsened. The pain was described as sharp and there was no radiation to the lower extremities. The fever was continuous and she

History O'History - The Wonderful World of Dermatology

2009-09-17T04:50:00.014+01:00

Dear Bloggers I am back with a nice dermatological short case. As usual this patient's details have been anonymised to maintain confidentiality.This 40 year old officer worker was admitted with an uncomplicated community acquired pneumonia. Nothing unusual about that you might think. However, the admitting doctor noticed the unusual skin rash on the patient's legs (only one shown here!). The

A vision of the not so distant future

2009-08-25T02:44:00.006+01:00

Dear BloggersI wanted to share my thoughts with you about how I envision the world of medical information technology will become in the next 10 to 20 years.At present, we either write or type our medical notes. How quaint indeed. Humans have been using some form of paper for thousands of years. Papyrus was one of the earliest forms of writing material and before that, the Greeks wrote on tablets.

Answer to August 2009 Case

2009-08-19T05:17:00.001+01:00

Dear Bloggers Thanks for waiting for the answers to this exciting case. I would like to apologise for the typing error with the PNS exam which should have been like this RUL LUL RLL LLLSupin +/- ++ n/a n/aBicep +/- ++ n/a

History Revisited With Examination ! It CAN be better than a CT scan!

2009-08-07T01:12:00.007+01:00

Dear BloggersA 70 year old patient was recently admitted with fever of 'unknown' origin to a rural hospital.The patient had developed the fever suddenly with associated shivering sensation and had presented to the same hospital. Other symptoms included some rhinorrhoea and a mild cough. The on-call physician took blood cultures and prescribed an antibiotic for an URT infection and the patient

August 2009 Case

2009-08-03T03:44:00.004+01:00