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MT Newsletter |  |
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SMT Faculty
Jessie Jacob Manu Prakash Rema Valsala |
Thought for the month: | Fame is a vapor, popularity an accident, riches take wing, and only character endures ...Horace Greely |
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MT Newsletter | |
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SMT Faculty
Jessie Jacob Manu Prakash Rema Valsala |
Thought for the month: | Fame is a vapor, popularity an accident, riches take wing, and only character endures ...Horace Greely |
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FAQs
Standards Questionnaire |
The patient complains of recurrent abdominal pain.
He is a bright boy. Here 'bright' is used as a metaphor. A bruise or a black and blue mark is also known as ecchymosis. Galactorrhea: Inappropriate secretion of milk. |
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Q. What is strangury?
A painful discharge of urine, drop by drop, produced by spasmodic muscular contraction. Patients usually complain of difficulty in micturition with straining to void the urine. Urine may be passed intermittently with pain and tenesmus. Tenesmus: A painful spasm of the urogenital diaphragm with an urgent desire to evacuate the bowel or bladder, involuntary straining, and the passage of little fecal matter or urine. Q. What is diabetes mellitus? - continued... Treatment of diabetes mellitus The major goal in treating diabetes mellitus is controlling elevated blood sugars (glucose) without causing abnormally low levels of blood sugar. Type 1 diabetes mellitus is treated with insulin, exercise, and a diabetic diet. Oral antidiabetic medicines do not help diabetic patients who have type 1 diabetes because these patients cannot produce or release insulin from their pancreas. Their blood sugar is best controlled by insulin injections. Type 2 diabetes mellitus is first treated with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugars, oral medications are used. If oral medications are still insufficient, insulin medications are considered. Weight reduction and exercise are important treatments of diabetes. Weight reduction and exercise increase the body's sensitivity to insulin, thus helping to control blood sugar elevations. Oral antidiabetic agents Sulfonylureas - medications that increase the insulin output by the pancreas. · chlorpropamide (Diabinese) · tolbutamide (Tol-Tab) · glyburide (DiaBeta/ Micronase) · glipizide (Glucotrol – regular and XL[extended release]) · glimepiride (Amaryl) Biguanides - medications that decrease the amount of glucose produced by the liver. · metformin (Glucophage) Metformin may be used alone or in conjunction with other oral agents, or insulin. Thiazolidinediones - medications that increase the sensitivity of cells to insulin · pioglitazone (Actos) · rosiglitazone (Avandia) Alpha glucosidase - medications that decrease the absorption of carbohydrates from the intestine · acarbose (Precose) Combination Medications Glucovance, Avandamet, and Metaglip are 3 relatively new combination pills that are on the market to treat diabetes. Glucovance combines glyburide with metformin in varying doses. Avandamet is a combination of varying doses of Avandia and metformin. Metaglip is a combination pill containing glipizide and metformin in varying strengths. The benefit to these agents is fewer pills to take, hopefully leading to better compliance.Treatment of diabetes with insulin Insulin is the mainstay of treatment for patients with type 1 diabetes mellitus. Insulin is also important in type 2 diabetes when blood glucose levels cannot be controlled by diet, weight loss, exercise, and oral medications. Adequate blood glucose control can be achieved with careful attention to diet, regular exercise, home blood glucose monitoring, and multiple insulin injections throughout the day. In the past, the insulin used was being derived from animal sources, particularly cows and pigs. Animal insulin caused immune reactions in people. With the acceleration of scientific research in the latter half of this century, beef and pork insulin were replaced by human insulin. In 1977, the gene for human insulin was cloned, and through modern technology, manufactured human insulin was made available. Human insulin is now widely used. Insulin now comes in a variety of preparations that differ in time of onset and length of action. Because of these differences, combinations of insulin are often used to allow for a more tailored regimen of blood sugar control. Name of Insulin Onset of Action Peak Effect After Injection Humalog and NovoLog (Very Short Acting) 5-15 minutes 30-60 minutes Regular(Short Acting) 30 minutes 2-5 hours NPH(Intermediate Acting) 1-2.5 hours 8-14 hours Lente(Intermediate Acting) 1-2.5 hours 8-12 hours Ultra Lente(Long Acting) 4-6 hours 10-18 hours Lantus 2-3 hours Stable from 2-3 hours to at 20 hours Combinations: 75/25, 70/30, 50/50 30 minutes 7-12 hours For example, a patient may take an injection of Lente in the morning and evening to provide a baseline of insulin throughout a 24-hour period. In addition, the same patient may take an injection of Humalog just before meals to cover the increase in carbohydrate load after eating. Insulin Delivery Devices Not only is the variety of insulin preparations available growing, so are the methods for administering insulin. All insulin delivery devices inject insulin through the skin and into the fatty tissue below. Most people inject the insulin with a syringe that delivers insulin just under the skin. Others use insulin pens, jet injectors, or insulin pumps. Several new approaches for taking insulin are under development. Many pharmaceutical companies are now offering discreet and convenient methods of insulin delivery. Syringes Syringes are hypodermic needles attached to hollow barrels that people with diabetes use to inject insulin. Insulin syringes are small with very sharp points. Most have a special coating to help the needles enter the skin as painlessly as possible. Insulin syringes come in several different sizes to match insulin strength and dosage. Pre-filled insulin pens This system is similar to an ink cartridge in a fountain pen. A small pen-sized device holds an insulin cartridge (usually containing 300 units). Cartridges are available in the most widely used insulin formulations, such as those listed in the table above. The amount of insulin to be injected is dialed in by turning the bottom of the pen until the required number of units is seen in the dose-viewing window. The tip of the pen consists of a needle that is replaced with each injection. A release mechanism allows the needle to penetrate just under the skin and deliver the required amount of insulin. The cartridges and needles are disposed of when finished and new ones are simply inserted. These insulin delivery devices are discreet and less cumbersome than traditional methods. Jet Injectors Insulin jet injectors may be an option for people who do not want to use needles. These devices use high pressure air to send a find spray of insulin through the skin. Jet injectors have no needles. Insulin pump The most recently available advance in insulin delivery is the insulin pump. An insulin pump is composed of a pump reservoir similar to that of an insulin cartridge, a battery-operated pump, and a computer chip that allows the user to control the exact amount of insulin being delivered. Currently, pumps on the market are about the size of a beeper. The pump is used for continuous insulin delivery, 24 hours a day. The amount of insulin is programmed and is administered at a constant rate (basal rate). Often, the amount of insulin needed over the course of 24 hours varies depending on factors like exercise, activity level, and sleep. The insulin pump allows for the user to program many different basal rates to allow for this variation in lifestyle. In addition, the user can program the pump to deliver a "bolus" during meals to cover the excess demands of carbohydrate ingestion. Over 50,000 people worldwide are using an insulin pump. This number is growing dramatically as these devices become smaller and more user-friendly. Insulin pumps allow for tight blood sugar control and lifestyle flexibility while minimizing the effects of low blood sugar (hypoglycemia). At present, the pump is the closest device on the market to an artificial pancreas. Insulin Delivery Devices Under Development Inhalation Another promising route of insulin administration is through inhalation. Inhaled insulin is currently being tested but has not been approved by the United States Food and Drug Administration (FDA). The safety of inhaled insulin still needs to be established before a product for consumer use can be made available. Trials are currently underway to establish the safety of inhaled insulin. Inhaled insulin delivery systems will give insulin as a dry power, inhaled through the mouth directly into the lungs where it passes into the bloodstream. This aerosol delivery system will likely be about the size of a flashlight and use rapid-acting insulin. Intranasal, Transdermal, and PILL Other routes for the delivery of insulin have also been tried. Intranasal insulin delivery was thought to be promising. However, this method was associated with poor absorption and nasal irritation. The insulin patch, when placed on the skin, will give a continuous, low dose of insulin. To adjust insulin doses before meals, users will pull off the tab on the patch to release insulin. Transdermal insulin (skin patch delivery) has also yielded disappointing results to date. Insulin in pill form is also not yet effective since the digestive enzymes in the gut break it down. Pancreas transplantation Ultimately, the goal in the management of type 1 diabetes is to provide insulin therapy in a manner that mimics the natural pancreas. Perhaps the closest therapy available at this time is a transplant of the pancreas. Several approaches to pancreatic transplantation are currently being studied, including the whole pancreas and isolated islet cells (these groups of cells contain beta cells that are responsible for insulin production). |
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Use of contractions:
Avoid contractions except in direct quotations. Dictated Transcribed as ------------- --------------------- can’t cannot I’d I would he’s he is it’s it is don’t do not won't will not Example: Dictated: The patient states that he's having pain in the left wrist for 2 days. He can't flex the wrist now. Transcribed: The patient states that he is having pain in the left wrist for 2 days. He cannot flex the wrist now. Dictated: When the patient was advised CT scan of her abdomen she stated within quotes I don't have insurance coverage. Transcribed: When the patient was advised CT scan of her abdomen she stated, "I don't have insurance coverage."Extend abbreviations that contain contractions. Dictated Transcribed as ------------- --------------------- OD'd overdosed DC'd discontinued Example: Dictated: I DC'd the lisinopril and advised her to continue the rest of the medications. Transcribed: I discontinued the lisinopril and advised her to continue the rest of the medications. Units of measure: Metric units: Use abbreviations whenever a numeric quantity precedes the metric unit of measure. Never use periods and never add s to plural form. Twenty milligrams is transcribed as 20 mg DO NOT transcribe as 20 milligrams or 20 mg. (with a period) or 20 mgs (with an s) Note the following: Dictated Transcribed as ------------- --------------------- Millimeter: mm Centimeter: cm Hertz: Hz Decibel: dB Liter: L (upper case) preferred to l (lower case) Use the decimal form with metric measurements even when dictated as a fraction. Transcribe as 4.5 mm and NOT 4 ½ mm |
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Q. The greater the demand, _________ the price.
a. higher b. high c. the higher d. the high Q. Select the meaning of the proverb -- The die is cast. a. Plans must not be altered at the wrong time. b. Once a decision has been made, it cannot be reversed. c. If one arrives early, one gets a better choice. d. Everything that is attractive on the outside may not be really valuable inside. Q. What letter comes in the blank in the sequence below? A, C, F, J, ____, U a. K b. S c. O d. N Q. Find the meaning of these homonyms: breech and breach quiet and quite elicit and illicit See the answers in the next month's issue.... |
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