»COMMON EYE DISEASES
DISCUSSANT: JOCELYN SY, M.D.
Common eye diseases affect daily, normal functions. There are a number of conditions and a number of treatment options are available. Some of these include:
Stye, which is an infl ammation of the eyelid glands caused by bacteria. Styes are usually treated with warm compress, oral antibiotics, or minor surgery.
Pterygnium, is characterized by a reddish fleshy tissue covering the cornea and include symptoms of tearing, redness, irritation, astigmatism, and is addressed by lubricants, scrapping, conjunctival grafting over the affected area.
Conjunctivitis or sore eyes, is highly contagious through tear transfer or hand-eye contact. Caused by viruses or bacteria, sore eyes are usually treated with topical antibiotics.
Cataract is a condition in which the clear lens of the eye gradually becomes cloudy and removal is advised if poor vision already interferes with daily activities. Symptoms range from blurring of vision that cannot be corrected with prescription glasses, seeing multiple images, among others.
Glaucoma occurs in conditions when pressure inside the eye causes damage to the nerve of sight and symptoms range from redness to eye pain and heaviness. Acute angle closure glaucoma may be treated with laser, open angle glaucoma with topical eye drops, but surgery is the option for advanced cases.
Error of Refraction includes conditions such as near sightedness, far sightedness, astigmatism, and presbyopia. Treatment options include prescription glasses, contact lenses, and refractive surgery.
Age Related Macular Degeneration as named comes with advancing years and affects the macula, which is the area of clear central vision. Treatment alternatives include vitamin supplements, laser, PDT, and anti-vegf injection inside the eye.
Diabetic Retinopathy results from uncontrolled diabetes that causes eye blood vessels to rupture and bleed, eventually leading to blindness. Treatment ranges from laser photocoagulation of the retina, regular follow-up retina examination, and surgery in advanced cases. Early detection of leaking blood vessels through dilated fundus examination and flurescien angiography are recommended.
MEDICAL FORUM NO.182
»RED FLAGS IN PEDIATRIC
DISCUSSANT: ROSITA YU, M.D.
The pediatric age group under a pediatrician’s care is the 0-19 years. Thorough knowledge and understanding of a child’s normal development is of critical importance so that abnormalities are detected right away.
Red flags are alert signs for parents and pediatricians to refer the child to a developmental pediatrician. These red flags generally refer to absence of certain skills at certain ages that are expected normal milestones.
Developmental milestones indicate the process of ripening and reaching maturity, an increase in function and skill, and the elaboration of structures and functions of the nervous system.
Four areas of development that should be checked by pediatricians are: gross motor, fine motor, language, personal and social skills. The most common manifestation of a developmental disability is the failure to achieve age-appropriate skills. Developmental disorders include autism, attention deficit hyperactivity disorder(ADHD), cerebral palsy, hearing impairment, learning disabilities, mental retardation, developmental language disorders, global developmental delay and visual impairment.
While child development varies among individuals, there should be a conscious effort to observe and monitor the red flags of development. The earlier problems are detected, the earlier rehabilitation can be instituted and therefore a better outcome may be expected.
MEDICAL FORUM NO. 183
DISCUSSANT: Arthur Lim, M.D.
Erectile Dysfunction is defined as the inability to maintain an erection firm enough to have sexual intercourse. This affects 1 out of 5 men, and 90% of the cases stem from physical rather than psychological problems. Occasional erection problem among healthy men usually resolves itself.
Physical causes of erectile dysfunction include diabetes, spinal injury, heart disease, hormone imbalance, surgery of the prostate, bladder, color, rectum), or intake of medications.
Treatment options range from oral medications (e.g. Viagra, Levitra, Cialis), injection therapy, urethral suppositories, penile implants, to vacuum erection devices.
Penile implant has been in the market for over 30 years, and has improved with technology in terms of design and reliability. More than 25,000 procedures are performed annually, with the procedure receiving very high patient and partner satisfaction scores. This procedure requires surgery and is non-reversible. Surgical complications include infection, and mechanical failures may require revision surgery.
On the other hand, vacuum erection devices are non-invasive. It uses a cylindrical device (made up of a vacuum chamber, a pump that produces negative pressure, and constriction rings which mechanically create penile blood engorgement) placed over the male organ. It can be used for the treatment of organic or psychogenic erectile dysfunction.
Lifestyle change is also part of the treatment process and focus of cessation of smoking, limiting alcohol intake, doing exercises, and learning to relax.
MEDICAL FORUM NO. 184
DISCUSSANT: STEPHEN WONG, M.D.
Cirrhosis is one of the most important and dreaded complications of prolonged and sustained liver injuries.
While the liver is capable of regenerating itself, it is also prone to a lot of damage from environmental and infectious diseases because of its important role in metabolizing toxic substances in the body.
Very much like the skin, liver response to injury is to form a scar. However, when the injury is repeated many times over a long period of time, scar tissues will not have time to be reabsorbed and majority of the liver tissue will be replaced by scar tissues. This is called cirrhosis. Liver cirrhosis is basically a change in the structure of the liver brought about by repeated liver injury either because of viral infection (Hepatitis B & C), metabolic (fatty liver, Hemochromatosis, Wilson’s Disease), and autoimmune (autoimmune hepatitis and primary biliary cirrhosis) and environmental (alcohol intake) causes.
The onset of cirrhosis significantly increases the risk to develop other complications of liver diseases such as gastrointestinal bleeding due to varices or peptic ulcer, swelling of the abdomen and feet due to accumulation of water, jaundice, and the development of liver cancer.
Liver cirrhosis can be prevented. Being aware of risk factors is a first step. People who have first or even second degree relatives diagnosed to have Hepatitis B, liver disease, or liver cancer should have themselves screened for Hepatitis B & C. Fatty liver is likewise an emerging cause of cirrhosis and is more common among the obese, diabetic, dyslipidemic, and hypertensive. Those who have these risk factors should undergo regular checks on their liver as well as lifestyle and dietary modifications.
Although liver cirrhosis and its complications should be feared, increased awareness of its risk factors by patients and primary care physicians should lead to a decrease in the incidence of these complications.
MEDICAL FORUM NO. 185
»NEW TRENDS IN DIABETES MANAGEMENT
DISCUSSANT: SUSAN YU GAN, M.D.
Diagnosis of diabetes is done through blood sugar testing. It is recommended that those at risk of developing diabetes should have an annual test. The risk profile includes those who are/have: 40 years old an above; Asians; obese; first degree relatives with diabetes; hypertension; high cholesterol levels; heart diseases; recurrent or unusual infections like tuberculosis or fungal infections; women have poor obstetrical histories or delivered babies weighing more than 8 lbs.
Causes of Type 2 Diabetes range from insulin resistance, insulin deficiency, and alpha cell dysfunction. Insulin resistance may be due to hormones produced by abdominal fat, insensitivity of peripheral muscles to insulin so that glucose is not taken up for use in energy production, and glucose remaining in the circulation causing blood glucose levels to increase and stimulates beta cells to produce more insulin.
Treatment options for Type 2 Diabetes cover diet, exercise, and medications. Diet should contain 45-65% carbohydrates, 10-20% protein, and 25-35% fats. Carbohydrates should mainly be in the form of complex carbohydrates and fats should be unsaturated fats, preferably mono saturated fats. Medications range from Metformin, Sulfonylureas, Alpha Glucosidase inhibitors, Thiazolidinediones, Miglitinides, DPP 4 inhibitors, insulin, and Incretin mimetics.