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«۩۞۩-منتدى الأسرة والصحة-۩۞۩» كل ما يخص الامور الطبية والصحية |
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12-23-2013, 07:21 AM | #35 |
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مشكور دكتور منصور على المجهود المقدر
سعدت جدا بهذا البوست المفيد والمهم اسأل الله ان ينفع به الجميع |
جاييك يا آخر المواني من ظلمة البحر الممدده في الفراغ ... جاييك من غربة الجزر المسورة بالهواجس والضياع جاييك معاي ملح التجارب ذي محارب مجروح و خايض في الغبار لكني ثابت في المدى واقف أنا ودايس على الإبر المسممة بالكلام علمني غدر الناس أشوف واتحدى نار كل المصائب ..والظلام..
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الحصاحيصا تحتل الفضائيات السودانيه
• مبدعون ومشاهير من ابناء مدينتى الحصاحيصا • ذكرياتى واجمل الايام فى مدينة الحصاحيصا |
01-31-2014, 02:52 PM | #36 |
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A 31 years old Thai woman presented with bilateral breast pain without fever. She had injection of liquid foreign material for breast augmentation and body sculpturing 3 years ago by non certified medical personnel. On physical examination, there were multiple painful breast lumps varying in size spread throughout both of her breasts. The overlying skin and subcutaneous layer was found indurated and stiffness with redness on the adjacent skin and nipple areola complexes. There was asymmetry of nipple areola complex level and symmastia with indurated tissue at lower sternal area. Two centimeters left axillary lymphadenopathy was also detected.
She was scheduled for bilateral mastectomy with removal of damaged subcutaneous layer and skin. Despite trying to preserve the healthy skin and nipple areola complex, however, we failed to preserve them because they were infiltrated by liquid silicone and severe fibrosis. The lymph nodes at left axilla were also removed. Tissue expanders (700 cc) were inserted in subpectoral plane with intraoperative filled 70 cc (10% volume) in both breastss. There was no immediate complication. We started to inflate tissue expander on post operative day 7th then continued weekly inflation until reaching target volume 700 cc at 12th week). We waited three months to allow the optimal tissue expansion effect before definitive prosthesis substitutionn. |
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02-21-2014, 08:32 PM | #37 |
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\L.N. is a 49-year-old white woman with a history of type 2 diabetes, obesity, hypertension, and migraine headaches. The patient was diagnosed with type 2 diabetes 9 years ago when she presented with mild polyuria and polydipsia. L.N. is and has always been on the large side, with her weight fluctuating between 165 and 185 lbInitial treatment for her diabetes consisted of an oral sulfonylurea with the rapid addition of metformin. Her diabetes has been under fair control with a most recent hemoglobin A1c of 7.4%Hypertension was diagnosed 5 years ago when blood pressure (BP) measured in the office was noted to be consistently elevated in the range of 160/90 mmHg on three occasions. L.N. was initially treated with lisinopril, starting at 10 mg daily and increasing to 20 mg daily, yet her BP control has fluctuate One year ago, microalbuminuria was detected on an annual urine screen, with 1,943 mg/dl of microalbumin identified on a spot urine sample. L.N. comes into the office today for her usual follow-up visit for diabetes. Physical examination reveals an obese woman with a BP of 154/86 mmHg and a pulse of 78 bpm)
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02-21-2014, 08:43 PM | #38 |
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[؟؟؟]What are the effects of controlling BP in people with diabetes
؟؟؟؟What is the target BP for patients with diabetes and hypertension ؟؟؟Which antihypertensive agents are recommended for patients with diabetes[/SIZE] |
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02-21-2014, 08:48 PM | #39 |
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L.N. is a typical patient with obesity, diabetes, and hypertension. Her BP control can be improved. To achieve the target BP goal of < 130/80 mmHg, it may be necessary to maximize the dose of the ACE inhibitor and to add a second and perhaps even a third agent.Diuretics have been shown to have synergistic effects with ACE inhibitors, and one could be added. Because L.N. has migraine headaches as well as diabetic nephropathy, it may be necessary to individualize her treatment. Adding B-blocker to the ACE inhibitor will certainly help lower her BP and is associated with good evidence to reduce cardiovascular morbidity. TheB -blocker may also help to reduce the burden caused by her migraine headaches. Because of the presence of microalbuminuria, the combination of ARBs and ACE inhibitors could also be considered to help reduce BP as well as retard the progression of diabetic nephropathy. Overall, more aggressive treatment to control L.N.'s hypertension will be necessary. Information obtained from recent trials and emerging new pharmacological agents now make it easier to achieve BP control targets
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02-21-2014, 08:54 PM | #40 |
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ACE inhibitors, ARBs, diuretics, and B-blockers have all been documented to be effective pharmacological treatment
Combinations of drugs are often necessary to achieve target levels of BP control ACE inhibitors and ARBs are agents best suited to retard progression of nephropathy |
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03-29-2014, 10:27 PM | #41 |
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Emma Bovary was a healthy 15-year-old when she suddenly developed a very sore throat accompanied by fever and malaise. Her throat was so swollen she had difficulty swallowing. Over the next few days the fever waxed and waned, her sore throat became worse, and she became progressively more tired and anorectic (lost her appetite). On the third day of illness her pediatrician noted severe pharyngitis and took a throat culture for -hemolytic streptococci; the culture proved negative
Emma’s symptoms persisted, and she was unable to eat because she could hardly swallow. She said she had no difficulty breathing but that her left upper abdomen felt slightly uncomfortable. Emma’s 1-year-old brother became ill at the same time, but did not have such severe symptoms. He was merely listless and felt warm. He had no particular physical symptoms, and seemed to recover completely after a few days On physical examination on the tenth day of illness, Emma appeared very ill. She had a high temperature (38.2°C), a pulse rate of 84 min, a respiratory rate of 18 min, and a blood pressure of 85/55 mmHg. Her mouth was dry and her tonsils were red and enlarged. They met in the midline, leaving a passage of only about 2 cm × 2 cm. Palatal petechiae (very small hemorrhages under the mucosa) could be seen. Her anterior and posterior cervical lymph nodes were swollen and tender (lymphadenopathy); the largest nodes were 2 cm × 2 cm. Her abdomen felt soft and the liver was enlarged, the edge being palpable 2 cm below the right costal margin. The spleen was also enlarged; the tip was easily palpable under the left costal margin. A blood test gave a white blood cell count of 18,590, with 39% neutrophils, 27% lymphocytes, 22% atypical lymphocytes (very high), and 11% monocytes (high); her hematocrit was 45% and the platelet count 397,000 . Serum electrolytes were normal. Another throat culture was obtained, and blood tests for Epstein–Barr virus (EBV) were ordered In the meantime a presumptive diagnosis of acute infectious mononucleosis was made with complications including partial pharyngeal obstruction and mild dehydration. Emma was admitted to the hospital and received 1 liter of normal saline intravenously followed by 20 mg of methylprednisolone (a corticosteroid) intravenously every 12 hours Her throat culture again proved negative for streptococcus but her blood serum was positive for IgM and IgG antibodies against EBV capsid antigen. Emma improved quickly with the symptomatic treatment and was discharged on the second day after admission to complete her recovery at homee |
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03-29-2014, 10:36 PM | #42 |
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In most patients, IM is a self-limited disease for which supportive therapy suffices. Nucleoside analogs such as acyclovir or ganciclovir, or the DNA polymerase inhibitor foscarnet, have limited ability to inhibit the replication of EBV in vitro. The clinical usefulness of these drugs is so far unproven. Corticosteroids are often prescribed as a palliative measure, especially when airway obstruction is a potential concern. In the most extreme cases, when respiratory distress is present, tonsillectomy can be required. Corticosteroids reduce virus shedding and provide some symptomatic relief as a result of their anti-inflammatory effects. They do not significantly alter the course of the disease. Immunocompromised individuals are at high risk of severe lymphoproliferative disease and B-cell lymphoma after infection with EBV or reactivation of this infection. In these circumstances, monitoring of the infection is best performed by evaluating the number of viral copies in peripheral blood. If a significant viremia is detected, treatment is most often based on injection of the B-cell-depleting anti-CD20 monoclonal antibody rituximab, which destroys both infected and uninfected B lymphocytes. This treatment causes a profound B-cell lymphopenia and hypogammaglobulinemia, which requires immunoglobulin replacement therapy until circulating B lymphocytes reappear in normal numbers
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