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A young lady is presented with a severe chest pain. Her ECG and cardiac enzyme ruled out a cardiac origin (or partly). It was localised to 5th intercostal space next to left sternal edge. To tell the truth, the specialists, the MOs and HO have no clue. Her chest-xray shows no abnormalities.  So, the diagnosis is costochondritis. She was discharged with analgesic as the pain had partly resolved.

I just wonder if there anything that can be done for her. I order an outpatient echo and follow-up at clinic. I hope the additional investigation can safely rule out any cardiac origin and may hope the clinic can picked something.

In medicine, if the diagnosis is unclear, all the management may be futile and it’s harmful to patient. It’s causes treating a non-exist disease and delay treatment of a real disease.

Just the other day, a lady with high grade fever present with LIF pain. It’s should be a acute pyelonephritis. Surprisingly, urine test negative. At the same time, she having cough. So finally x-ray of chest was ordered. True enough, a haziness appear at the lower zone of left lung.  Anyway, she already given antibiotics and it’s seem working well, the pain went away.

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The coming election finally kicked off today with the nomination of candidates.

Election can be an interesting events.

One of the most hot news in the election is the MCA new comer Victor Gu.  With a modified photo feature Victor as King Kong.

There is also some discussion on his political ambitious and the fellow who posted did not like him and decided to call for vote against him.

I think general election is the best thing a country that can offered to their people. It’s a chance for us to choose our leaders, to support or to protest the previous government.

So, be sure to vote on 8 Mac 2008.

Just a reminder, MOH has a circular saying that doctors can take turns to go to voting.

I thought I heard from TV series House on the important of getting the correct diagnosis and thereafter, the management will be a fair affair.

How true!!!!

Having switch to medical posting in less that 2 weeks, I see the paramount task of pinning the diagnosis.

Sometime what resemble a harmless may prove fatal.

I’m was to be translator yesterday for a Chinese patient. The patient presented with history of suggestive a syncope attack. She was ok and by the afternoon, she’s just collapse with cardiac arrest. We had missed the opportunities of treating her.

That one more case today. Despite rigorous resuscitation, patient passed away due to DIVC which precipitated by a septic shock, which was presented with signs of hypotension for past 24 hrs.

Those events is terrfying me.  I just wondered it’s could happened to the patients that I take care off. What if I dismissed some symptoms that the patients are telling me? and in the process, we left the patients conditions deteriorated.

Now, practicing medicine really becoming a challenge task.

Happy Chinese New Year!!!!

Day 3 of New Year. Got one more days before resume working.

I have been working on this java program for past 2 months which should able to run on most of the handphone.

The reason for writing this software is because all the obstetrics chart had gone missing. So I think of writing a replacement tool for the same purpose. Sun provide a free development kit. I got the prototype from the demo program and modify the source.

Later I just added other functions to the program.

Overall the program will provide the following functions:

  1. Obstetrics Calender
  2. BMI
  3. Correct Calcium
  4. GFR estimation (Cockcroft-Gault formula)
  5. Peakflow Estimation
  6. Cardiac Risk Assessment (the number only)
  7. Corrected Sodium (in case of hyperglycaemia)

Screen capture:

medsoft1.jpg

It was developed using Sun Java Wireless Toolkit 2.5.2 for CLDC.

Here is the jar file: Fpdemo.jar which is zipped can be download from this link;

The project and source files of the all the small programs are located in the Src directory of this zip file. Click this link to download.

Warning & disclaimer:

The program had not been underwent rigorous testing. So it should be used with caution and It’s only tested on the toolkit and my sony eriksson handset

The formula used in each of the program:

1. Obstetric Calender.

EDD = LMP + 280;

2. BMI

  • Starvation less than 14.9
  • Underweight from 15 to 18.4
  • Normal from 18.5 to 22.9
  • Overweight from 23 to 27.5
  • Obese from 27.6 to 40
  • Morbidly Obese greater than 40

3. Corrected Calcium

Corrected Calcium = serum calcium + ((40 – albumin) x 0.02) ;

4. GFR

Female = ((140 – Age ) * Weight * 1.04) / Creatinine ;

Male = ((140 – Age ) * Weight * 1.23) / Creatinine ;

5. CHD Risk scoring

6. Peakflow estimation

PEFR = (((Height * 3.72) + 2.24) – (Age * 0.03)) * 60; // for Female
PEFR = (((Height * 5.48) + 1.58) – (Age * 0.041)) * 60; // for Male
PEFR = (Height – 100) * 5 + 100; // for children

7. Corrected Sodium ( in hyperglycaemia)

Corrected [Na+] mmol/l = [plasma Na+] mmol/l+ (1.6x{(plasma glucose–5.6)/5.6}