Rx Note

Introduction Hypertensive disorders during pregnancy affect approximately 8-10% of all pregnant women and the complications can be associated with significant morbidity and mortality to the mother and baby. Major Hypertensive Disorders Major hypertensive disorders that can occur in pregnant women are: Chronic hypertension Hypertension (BP >140/90) that exist before pregnancy or diagnosed in the first 20 weeks of gestation. Gestational hypertension New-onset of hypertension after 20 weeks gestation Preeclampsia Hypertension occur after 20 weeks gestation with features of multi-organ involvement Symptoms of pre-eclampsia include severe headache, problems with vision, severe pain below ribs, vomiting and sudden swelling of hands, feet or face accompanied with significant proteinuria and blood pressure greater than 140/90 mg Hg. In 2013, the American College of Obstetricians and Gynaecologists removed proteinuria as an essential criterion for diagnosis of preeclampsia. Eclampsia Ne...

Introduction Over the years, mercury containing thermometers or sphygmomanometers have been slowly replaced with electronic devices due to the potential hazard risks. However, if your facility still has these devices, you may have to know very well on this topic. When mercury is spilt from a broken sphygmomanometer or thermometer, it can break into multiple small droplets. An increase of total surface area and/or room temperature causes the mercury to volatilize at a faster rate. The spilt mercury may also get adhered to clothes and shoes; and get transported to another location. Proper/adequate ventilation in a room can dilute the mercury concentration in the air to a safe level. Mercury Spill Management If a mercury spill occurs, immediately: Inform clinic/ward supervisor and call for assistance. Isolate the area with red/white tags and signages . Turn off the fan and air conditioner (where applicable) and open the windows and doors for 24 hours (where applicable). Avoid walking on...

Introduction Extravasattion refers to unintentional or inadvertent leakage (or instillation) of fluid out of a blood vessel into surrounding tissue. A variety of symptoms, including erythema, ulceration, pain, tissue sloughing, and necrosis, are possible. A variety of drugs have been reported to cause tissue damage if extravasated. Irritant - An agent that causes aching, tightness, and phlebitis with or without inflammation, but does not typically cause tissue necrosis. Irritants can cause necrosis if the extravasation is severe or left untreated. Vesicant - An agent that has the potential to cause blistering, severe tissue injury, or tissue necrosis when extravasated. Can be further classified into DNA binding and non-DNA binding. Initial Management Stop the infusion: At the first suspicion of extravasation, the drug infusion and IV fluids should be stopped. Do NOT remove the catheter/needle: The IV tubing should be disconnected, but the catheter/needle should be left in place...

Introduction Although chemotherapy is used to treat cancer, it also damages normal healthy cells, hence causing a series of side effects . Even so, in clinical decision, it is all about benefits vs risks. Different from a cancer patient, exposure to chemotherapy medicines not only provides no potential benefits, but it harms those care giver or health care professionals if coming in contact. Body Fluids In an overview, most chemotherapy medicines remain in body fluids for about 48-72 hours after each treatment (up to 7 days for certain chemotherapy medicines). Hence, it is important to take precautions in handling body fluids during this period. Body fluids include blood, urine (wee), faeces (poo) and vomit. As the rule of thumb, caregivers should wear throw-away gloves (ideally, 2 pairs) if they need to touch any of your body fluids. They should always wash their hands with warm water and soap afterward - even if they had gloves on. NOTE: Children and women who are pregnant or b...

Introduction Bell palsy is a subacute weakness of the facial nerve. It may be due to idiopathic or secondary to herpes infections (likely cause in most cases). Evaluation Diagnosis is made clinically. Patients typically present with an acute onset of unilateral facial weakness , which may result in an asymmetric smile or trouble fully closing the eyelids. Onset is acute, over a day or two; the course is progressive, reaching maximal clinical weakness/paralysis within 3 weeks or less from the first day of visible weakness; and recovery or some degree of function is present within 6 months. Secondary causes of peripheral facial weakness should be distinguished (e.g. Lyme disease, parotid gland tumours, Guillain-Barre syndrome, stroke) Management Recommend eye protection if the patient cannot fully close the eye. May include lubrication (eye drop or ointment) and eyelid taping. Offer corticosteroid to patients with new-onset (usually ≤72 hours) to increase the likelihood of a full recov...

Introduction Kawasaki disease is a systemic febrile condition that predominantly affecting children <5 years old . The aetiology remains unknown, possible bacterial toxins or viral agents with genetic predisposition. Diagnostic Criteria Fever lasting at least 5 days PLUS at least 4 out of 5 of the following Bilateral non-purulent conjunctivitis Mucosal changes of the oropharynx (injected pharynx, red lips, dry fissured lips, strawberry tongue). Changes in extremities (oedema and/or erythema of the hands or feet, desquamation, beginning periungually). Rash (usually truncal), polymorphous but non vesicular Cervical lymphadenopathy Diseases with similar presentation should be excluded. NOTE: Clinical vigilance is needed to recognise patients with "incomplete" or "atypical" Kawasaki Disease. Management Early recognition and treatment are essential to reduce the risk of life-threatening complications. Up to 30% of untreated children develop coronary artery dilation...

Introduction Platelets maintain the integrity of the circulation. When platelets are activated, they undergo a series of reactions that are essential for haemostasis, important for healing of damaged blood vessels. Aspirin Low-dose aspirin in chronic use profoundly (>95%) inhibits platelet TXA 2 synthesis by irreversible acetylation of a serine residue in the active site of cyclo-oxygenase I (COX-1). Owing to association with Reye's syndrome , manufacturer advises aspirin-containing preparations should not be given to children under 16 years, unless specifically indicated , e.g. for Kawasaki disease . Contraindications to aspirin include a hypersensitivity to aspirin and major GI intolerance. Dipyridamole Dipyridamole inhibits platelet aggregation by several mechanisms, including Inhibition of phosphodiesterase, Block of adenosine uptake into red cells and Inhibition of TXA2 synthesis It is used in addition aspirin in some patients with stroke or transient ischaemic attack. T...

Introduction While scrolling through Facebook , I stumbled upon a fascinating and educational YouTube channel, called The Breakfasteur . This channel is hosted by a doctor mom who uses dough to educate her kid about various medical procedures. I was amazed by her dedication and creative abilities. Caesarean Delivery Coronary Artery Bypass Grafting Surgery (CABG) Hartmann's Procedure: Colectomy (Colon Removal) and Colostomy Creation

Introduction Infestation by head lice ( Pediculus humanus capitis ) can occur at any time of the year and is mostly transmitted by head-to-head contact . It is most prevalent in children aged 4 to 11 years, especially girls. Clinical Features Many cases of head lice infestation are asymptomatic . Pruritus (intense itchiness) resulting from sensitisation to louse salivary or faecal antigens is the most common symptom (seen in approximately one third of patients). Persistent scratching can cause lesions, and this can give rise to secondary infections or swollen lymph glands or both. Observation of live lice is diagnostic. Head lice are 1-4 mm long, and their colour ranges from nearly colourless (when they hatch) to reddish brown (after feeding). NOTE: It should be remembered that an itching scalp in children is not always due to head lice. Inspection of the scalp should be made to check for signs of dandruff , psoriasis or seborrheic dermatitis . Checking For Infection Wet combing of...

Drug Safety Update In 2014, the European Medicines Agency (EMA) reviewed the safety of domperidone-containing products due to its association with the risk of serious and potentially life-threatening cardiovascular adverse effects such as ventricular arrhythmias and sudden cardiac death. In 2019, a randomised controlled study showed that the use of domperidone in children below 12 years of age with acute gastroenteritis (in combination with oral rehydration therapy) showed no difference in efficacy when compared to placebo. As a result, domperidone is no longer indicated for the relief of nausea and vomiting in children aged under 12 years. Recommendations Healthcare professionals are advised to adhere to the licensed dose and to use the lowest effective dose for the shortest possible duration (maximum treatment duration should not usually exceed 1 week). Moreover, domperidone is contraindicated in Patients with known existing prolongation of cardiac conduction intervals; Patients ...

Drug Safety Update The International Council for Harmonization (ICH) has established a guideline "ICHQ3D" on the levels of certain elements in medicines. The guideline aims to limit exposure to these elements, as the general population is exposed to these elements from various sources over their lifetime. Since elements such as lead occur naturally in soil, naturally occurring diosmectite - the clay from which Smecta is produced - contains trace amounts of lead too. In 2019, as a precautionary measure, the company decided to remove the use of Smecta for acute diarrhoea in infants and children under 2 years, in line with the recommendations to use oral rehydration solutions (ORS) as the preferred treatment for this age category. For the same reason, the use of Smecta in pregnant and breastfeeding women is also restricted. NOTE: To date, there have been no report of lead poisoning following the use of Smecta reported to the NPRA. Antidiarrheal Agents in Paediatric Populati...