S.L.E

one is diagnosed to have SLE in an appropriate clinical setting if 4 or more out of 11 criteria are present

A - arthritis involving 2 or more joints (swelling, tender or effusion)

R - renal disorder (1) proteinuria >3g/d, patient may develop generalized oedema or passing out bubbled urine (2) cellular cast, red cell, granular or mixed. both (1) & (2) detected by urinalysis

A - ANA antibodies detected from blood test

S - serositis (1) pleuritis (2) pericarditis

H - heamatological disorder (1) hemolytic anemia (2) thrombocytopenia (3) leukopenia (4) lymphopenia

P - photosensitivity

O - oral ulcer

I - immunological disorder (1) antiDSDNA (2) antiSM (3) anti phospholipid syndrome <coagulopathy - bleeding tendency, livedo reticularis, obstetric - miscarriage, thrombocytopenia - bleeding tendency>

N - neurological disorder (1) seizures (2) psychosis

M - malar rash (fixed reddish, flat or raised rash over malar eminence, nasolabial fold spared)

D - discoid rash (reddish raised patches with adherent keratotic scales & follicular pludging with or without atrophic scarring)

multiple MYELOMA

it's a malignant blood disorder involving the plasma cell derived from B cells that produce immunoglobulin (G,A,E,D,M)..usually many different plasma cells will produce different Ig, but in myeloma, single clone of plasma cell is producing identical Ig seen as monoclonal band or paraprotein, on serum or urine..but most of the Ig will deposit at bone marrow and stimulate cytokines release to induce osteoclast activity (bone turnover), therefore patient can complaint of bone pain or easily fracture as well as symptoms of hypercalcemia..

the bone marrow may be suppressed by the deposits and patient may presented with anemia or pancytopenia (reduction in all types of blood cell, RBCs, white cells as well as platelets)..other than that deposition of the paraprotein at kidney may lead to kindey impairment..

plus the defect immunoglobulin may not able to protect our body as the normal one from infection and patient may develop recurrent bacterial infection.

so to diagnose, 2 out of these 3 criterias must be fulfilled

1- increase malignant plasma cell in bone marrow (detection through bone marrow aspiration)

2- serum and/or urine paraprotein (detection through serm & urine electrophoresis)

3- skeletal lesion (detection through X-rays)

and other investigation will be ordered base on presentation..the usual treatment is chemotherapy..but the supportive therapy is aimed for acute management in order to prevent further kidney damage, further deterioration of the bones as well as pain management..

usually the patient die due to renal impairment or infection

median survival rate : 3-4 years as stated in the book..but honestly only God knows..doctors are human, we never know how successful or failure the treatment is..but our job is to do the best for the patient and to suggest them the most beneficial treatment based on study (evidence based medicine)

FLUSHING of the FACE

I met a teacher today..she's pretty warmth and welcoming..she looks healthy and happy..she was admitted due to generalized oedema for the past 3 weeks time, worsening during morning where she noticed puffiness over the face especially on left side and over the evening where she need to drag her feet in order to walk..she also complaint of passing out frothy urine for the past 2 weeks which made her more worried as whenever she pass out it bubbling out..it's not usual right..she told me that she need to ask permission from the headmaster to wear slipper as the swollen feet could not fit the shoes..she became easily dyspnoiec especially during exertion, plus she need to rest a bit before the lecture

when i asked her more, she claimed that she has been experiencing red flush over the cheeks, multiple joint pain, sensitivity to light for the past one year..have you got any idea of what she might be having?? i'm thinking of SLE and currently complicated with nephrotic syndrome

in the ward, doctor ordered her to collect the 24H urine for 24H urine protein and she was on strict nephrotic chart. she told me that since admission, she felt better as she frequently urinate as she took diuretic (frusemide), alhamdulillah the oedema slowly subsided..doctor planned for renal biopsy..and serial blood investigations has been sent (dsDNA, ANA, C3 C4) in order to confirm the diagnosis..

one thing i learn today is the importance of taking a good care of our own body..cause we might seem healthy but we may not know what's happening within..i know that some diseases is idiopathic..but to have thought that how bad my life is worried me most @..@, i stop to jog for almost 1 and half years, hailooo!! how am i going to look like when i'm 4os or 50s and even 60s..if possible i don't wanna lie on the hospital bed being cachexic hoping for others to look over me..i wanna be healthy for the rest of my life insyaAllah..o Allah please give me strength to live healthier..amin...

may ALLAH BLESS the GRANNY

homework is coming through and through..there's so much things to be covered and recalled within this 5 weeks..the first week will come to its end after tomorrow, so there's 4 weeks remaining..

medical posting..i love this posting..cause there's so many things about the posting..plus i hope that i can pursue my career in this field..

i clerked a granny this morning, she came due to shortness of breath associated with fever and productive greenish cough..i'd no intention to talk to her actually, but incidentally, i just go near to this granny with known history of obstructive lung disease on duo MDI and start talking to her..she's very warmth, friendly and cute +_+ she looked tachypnoiec and tired..she came to the hospital as she could not sleep due to worsening SOB..she was diagnosed to have AECOPD secondary to CAP base on history, physical examination, investigation as well as chest x-ray findings..

she was blessed alhamdulillah as she able to raised children whom in return grab the chance to show their gratitude by taking care of the parents..they did care of both the parents in the in need..may Allah bless them all insyaALlah..i was not worried for the psychosocial part about this granny as she did has good family support..

the thing that worry me most is her habit to smoke..i know it's not her fault as she grew in a time where they chew a lot of sireh and smoke their own planted tobacco..but it's my responsibility to educate her the about her illness and support her to stop her habit..

COPD is a chronic illness and as a keep on smoking, one may develop many other complications like cor-pulmonale, polycythemia, respiratory failure as well as lung cancer..plus tobacco alone has been a risk factor to many chronic diseases like hypertension, diabetes, ischemic heart disease and in the end developed organ failures..

and one important thing that might determine the frequency of attack and good quality of life is the compliance..the compliance on the dose of the MDI as well as good MDI technique..

o Allah give her the strength to keep on living until the day when she'll be called home..amen..