Tuesday, March 31, 2009

Multiple Sclerosis Diagnosing

Posted by:Dr.Iliana

The underlying autoimmune process in MS causes demyelination of white matter in brain and spinal cord, resulting in episodes of variable focal neurological symptoms.

Remember the essence of modified McDonald’s Criteria used for MS diagnosis – dissemination in space (two or more focal neurological symptoms) and time (two or more episodes of symptoms) without a better neurological explanation.

Most common presenting symptoms of MS;

Motor symptom

lower extremities paraparesis with spasm, indicating UMNL aka upper motor neuron lesion (exception in patient with concomitant cerebellar involvement, which cause muscular hypotonia).

Sensory symptom

Hypoesthesia-numbness and paresthesia-tingling sensation

Optic nerve involvement

Decreased visual acuity-blurred vision and diplopia-doubling of vision, or optic neuritis- unilateral eye pain which increases with eyeball movement, often accompanied by decreased visual acuity

Cerebellar sign

Loss of balance (the pathognomonic scanning speech is seldom meet)

Apart from above stated common symptoms, most of MS patient also experienced nonspecific generalized symptoms such as;

Increased fatigability, typically in mid afternoon


Heat insensitivity, which is provoked or worsened when exposed to heat, e.g. a hot shower

NB – Patient with MS tend to neglect or forget their symptom (especially the presenting ones), as most of the them are temporary. Therefore it’s crucial to ask thoroughly about other common neurological symptoms. A simple question like “Have you ever experienced blurring of vision or unexplained weakness and numbness in your leg/hand before? ” would remind the patient about their previous symptoms .

When should we suspect MS?

(NB – MS is relatively rare in Malaysia and other South East Asian countries)

Onset of symptoms in patient aged 20-50 years old;

onset earlier than 20 years is more typical for hereditary diseases e.g. spinocerebellar atrophy, while in patient older than 50 years such symptom are more frequently caused by TIA aka transient ischemic attack, or reversible ischemia.

Symptoms and signs indicating the involvement of central nervous system

(i.e. any part of the brain or spinal cord);

Optic-spinal form of MS aka OSMS is more often encountered in South East Asian region than prototypic/classical MS which is typical in western countries

Two or more episodes lasting at least 24 hours and occurring at least one month apart;

usually symptom develops progressively during few days, stabilized than regress spontaneously or due to corticosteroid administration – NB – regression maybe complete or partial according to course of the disease, note that in primary progressive type there might be no regression of the symptom at all

Further Management

Refer patient to neurologist – this is the best part being a family med specialist - we diagnose and let others manage (kidding =p)

Friday, March 20, 2009

Treating Common Problems

Firstly, I would like to apologize for being in hiatus.
I will try to make it up on the past few weeks I had left.
I hope everyone is in their best condition right now as there have been four cases reported on ( Rubella ).

Continuing on our topic on Prophet's Medicine, this post will guide you on among the common problem and diseases we need to maturely treat.

Treating Tonsillitis & Administration of Medication Orally.

Sahihah narrated that the Prophet (PBUH) said that;

Cupping and marine costus are among your best remedies; and do not torture your children by pressing their uvula to cure tonsillitis.

Bleeding of nose can caused due to ( tonsillitis ) or headache, at most people that isn't in the state of trauma.

Abu Ubaidah once said that this is a blood-related throat irritation. Roughly, it is an ulcer that appears between the ear and the throat that normally attacked young boys.

Aloes are widely known for their benefits. Among them is to cure tonsillitis, in this case.
Scrub aloes through the nose externally where composed of
bloods related phlegm accumulates in the body/nose. it will tighten up the uvula and pulls it up to the proper anatomical position. Doing this when the person is laying on his back and his shoulders are elevated so that the head lay back. In this position, medication would reach the head and disease is extracted by sneezing.

In those days way back before our great gr
andfather was born, children suffered from tonsillitis had to be treated by pressing the uvula and sometimes affixing an object to the uvula.
This practise is disallowed by Prophet (PBUH) strictly.

Treating Disease of Heart.

Dates (Kurma) especially from Madinah gives great qualities and very effective in treating heart ailments.

Using seven dates is known through relevation.

Prophet had once said that;

Whoever eat dates from the area of Al-Aliah when he gets up in the morning then no poison or magic would harm that day.

Dates; a type of fruit widely known for its nutritional and medicinal value. Physiologically, dates do not produce harmful waste or excretements like any other types of foods. It preserves the bodily waste from being spoiled and from rotting, especially for those who are used to eating dried dates. Now, that's a bonus!

As said before, dates has a spiritual and material significance.
Allah SWT has created seven heavens, seven earths, seven days in a week and made the creation of mankind pass through seven stages.
Plus, Tawaf is made seven circumambulations, and the Sa'i is also seven trips between Safa and Marwah. Besides that, the Jamrat are stoned with seven pebbles each and the Takbir during 'Eid prayer is made seven times.

In addition, Prophet (PBUH) reminded;

Command him to pray upon reaching the age of seven.

These statements coming from The Prophet are certainly true and divinely revealed, deserve to be believed, without any hesitation or denial.

Guidance on Food and Drink contaminated by Flies.

Sahihan narrated that Messenger of Allah SWT said;

If a housefly falls in the drink of anyone of you, he should dip it (in the drink), for one of its wings has a disease and the other has the cure for the disease.

This is to confirm your disbelieves to some of you in this matter.
In this case, Allah SWT reminded us to not waste the food or drinks that had been intruded by the flies. There is always a silver lining behind every cloud, isn't it?

This Hadith comes in two areas of interest, Fiqh and medicinal.
In Fiqh part, Hadith states that when a flyfalls in water or fluids, it does not make it impure. The Prophet ordered when the fly falls on hot food, dip it. thus killing the fly. Logically thinking, if the fly's death inside the food will lost it's purity, surely The Prophet would have ask us to throw the food away. On the contrarary, we are asked to salvage the food.

Bees, hornets, spiders and their familes are treated the same way as the houseflies of which they have no blood and do not cause impureness of the food.

A for medicinal value, purpose of dipping the fly is to extract the cure from its wing just as the poison was extracted from the other wing that fell on the food.

Houseflies do carry poisonous materials as evidenced by the effect of their bite, such as rashes and infections. This poison is the fly's weapon to defense itself. The Prophet (PBUH) ordered that we neutralize the poisonous substance produced by the fly with the cure Allah SWT has kept on its other wing.

If the head of houseflies is amputated, the body is used to scrub the tumor that appears in the eyelid, and it will cure it, Allah's willing.

Sunday, March 15, 2009

Dietetic table of № 10

Posted By Dr.Zharif From RMTCardiology

Dietetic table of № 10

Indication: diseases of cardiovascular system with Heart Failure NYHA I -II[a] degree.


1. improvement in the blood circulation,

2. functions of cardiovascular system, liver and kidneys,

3. the normalization of exchange of substances,

4. protection of cardiovascular system and organs of digestion.

General characteristic: -

1. small reduction in the caloricity due to the fats and partly carbohydrates.

2. limitation of a quantity of sodium of chloride,

3. the decrease of the consumption of liquids.

4. The content of the substances, which excite cardiovascular and nervous system, which irritate the liver and nights, is limited superfluously burdening gastrointestinal tract, that facilitate meteorism.

5. increased the content of potassium, magnesium, lipotropic substances, products, which render the alkalizing action (milk, vegetables, fruits). Culinary working is performed with that moderated by mechanical .

6. Meat and fish they boil.

7. Food is prepared without the salt.

8. The temperature of food is usual.

9. Feed mode: 5 times a day by relatively uniform portions.

Chemical composition and energy-value (daily ration):

· the proteins 90[g] (55- 60% animals)

· the fats 70[g] (25 30% plant)

· the carbohydrates 350-400 g

· Energy-value 2500-2600 kcal.

· the common salt 6-7[g]

· the liquid 1,2[l]



• bread is wheaten from the flour the 1st and 2nd types, yesterday's baking or slightly dried slightly; dietetic salt-free bread, pastry and sponge cake;

• any vegetarian soups with different groats, milk soups;

• the nonfatty types of beef, veal, meat and trimming pork, rabbit, hen, turkey. they boil meat after cleaning from the tendons and fascias, and then bake or brown, dishes from the chopped or lump boiled meat, flood from the boiled meat, limited - doctoral and dietetic sausages, the nonfatty forms of fish - boiled or with subsequent roasting, dish from boiled sea products;

• milk, sour-milk beverages and cottage cheese;

• egg – 1per day, soft-boiled, the steam and baked omelettes, protein omelettes, in the dishes • dish from different groats; boiled macaroni articles;

• vegetables in the boiled and baked form potatoes, cauliflower, carrot, beet, summer squashes, pumpkin, tomatoes, lettuce, cucumbers, the cabbage and green peas – limited green bow, dill, parsley - in the dishes;

• lettuces from the fresh vegetables (ground carrot, tomatoes, cucumbers), vinaigrettes with vegetable oil, vegetable roe, lettuces are fruit, with sea products, fish the boiled flood

• fresh bread, article made of the rich test and puff-pastry Guest, pancakes, fritter;

• soups from the bean, meat, fish and fungus bouillon;

• the fatty forms of the meat of goose, weft, the liver, kidney, the brains, smoked foods, sausage articles, meat canned foods, fish, bird;

• kidney, smoked foods, sausage;

• salt, the fatty forms of fish, roe, canned foods, salt and fatty cheeses;

• bean;

• the eggs hard-boiled, fried;

• the salt, and sour vegetables; fruits with rough cellulose tissue, spinach, sorrel, horseradish, radish, garlic, turnip-shaped bow, fungi;

• chocolate, strong tea, coffee and coco

Exemplary menu of diet N 10.

• the 1st breakfast: egg soft-boiled, porridge is oat milk, tea.

• the 2nd breakfast: apples are baked with the sugar.

• Dinner: soup is pearl-barley with the vegetables on vegetable oil (1/2 portions), meat boiled with the carrot puree, compote from the dried fruit.

• Dishes: the broth of sweetbrier.

• Supper: pudding is curd (1/2 portions), boiled fish with the potatoes boiled, tea.

• On the night: kefir

Ref: RmtCardiology