Joint Pain

Knee pain

- knee, ankle, sprain, falls, cold days, standing too long, sitting too long
- humans age and as we age, our bones become fragile as a result of wear and bone thinning (osteoporosis)
- falls will result in broken bones (fractures)
- joint pain, bone pain (osteomalacia), osteoporosis, arthritis cause excruciating pain in the elderly


Flanil Analgesic Cream
RM9.12 Farmasi Makmur Jaya
For relief of simple muscular discomforts and painful muscles following unaccustomed exercise or exertion.


Fastum Gel
Nonsteroidal anti-inflammatory agent
Ketoprofen 2.5%
Tube of 30 g
For external use only

Voren Plus Gel 
RM10 Medica Pharmacy
Each gram contains 10 mg Sodium diclofenac.
Menthol added.
Anti-inflammatory and analgesic agent
For external use only
20g

Atroxene Flex
Emulgel 100 ml
Ozonized olive oil
Bought at Subang Airport
- good for painful knee
- no more knee pain after a few applications

MMG Massage Gel

Hot and rapid-acting gel

Contains water, Eucalyptus globulus leaf oil, menthol, acrylates/C10-30 Alkyl acrylate crosspolymer, Aloe barbadensis, apple fragrance. 120 g

For external use only. For all ages

Apply a little bit of MMG Massage Gel and massage anticlockwise.

A Bumiputra product. Made in Malaysia

By Turath Sarwa Jannah Resources

Distributed by Mirath SW Sdn Bhd, No 42-1 Jalan Prima SG 2, Prima Sri Gombak, 68100 Batu Caves, Selangor.

Mobile: 011-10785769

West Malaysia (Semenanjung Malaysia): RM49

East Malaysia (Sabah & Sarawak): RM55

Gellert Joint Care

Transdermal Glucosamine Cream

www.widgetwizards.com.sg (website has ceased to exist)

This small tub of Gellert Joint Care cream was purchased from a beach hotel shop in Penang in 2016. It was often used by elderly tourists who had knee pain and could not stroll on the beach. This is an effective cream. However, not all beach hotel shops carry it. Its production status today is unknown - whether it is still being produced or production has stopped. No supplier is known. Try and check out Medilynk below.

Kordel's Joint care assessment and solutions

https://joint-assessment.kordels.co/

Kordel's Hyaluronic acid with collagen

https://joint-assessment.kordels.co/hyaluronic-acid-with-collagen/

Medilynk

Transdermal glucosamine cream

75 g

S$45

Contains: (from most amount to least amount)

(most amount) Water, Glucosamine sulphate salt (10% w/w), Fatty acids, Polyethylene glycol & stearic acid (PEG-40 Stearate), Cetyl alcohol, Cetearyl alcohol, Ceteareth-14, Agar, Butylated hydroxytoluene (BHT), Methylparaben, Curcuma longa extract, Methylisothiazolinone (MIT) (least amount).

Glucosamine sulphate salt is derived from seafood.

Directions (1) for initial use:

Spread approximately 1-2 cm onto the joint area, and massage gently into the skin until absorbed. Use twice daily initially for 2-4 weeks. 

Directions (2) after improvement and maintenance:

When improvement is observed, use once daily for maintenance of healthy joints.

Cautions:

For external use only. 

Avoid contact with eyes, sensitive areas or broken skin. 

Keep out of reach of children. 

If pregnant or nursing, please seek medical advice.

Order online from NHG Pharmacy, National Healthcare Group (NHG), Singapore

https://www.pharmacy.nhg.com.sg/

Readers' comments 1

Check out links obtained from readers' comments.

Health

Effects of high cholesterol on the body
https://www.healthline.com/health/cholesterol/effects-on-body

Gallbladder
https://www.healthline.com/human-body-maps/gallbladder#1

Clinical imaging

http://radiantsage.com/

Kokilaben Hospital, Mumbai, India

https://www.kokilabenhospital.com/

Regenerative Medicine - Stem cell

https://r3stemcell.com/

Health benefits of apple

https://healtheals.com/apple-nutrition/

Health Check Up Packages, Mumbai, India

https://diagnosticsaci.blogspot.com/

MediArt, New Delhi, India - Renal Nutrition

https://www.mediartlifesciences.com/renal-nutrition/

Health - Type 2 diabetes (French)

https://www.lemeilleurschoix.com/destructeur-diabete/

Online medicinal herbs and drugs

Greenhouse Herbal Center
https://www.greenhouseonhollywood.com/

Dr Itua Herbal Clinic

https://m.facebook.com/drituaherbalclinic/

Global Online Pills - Tramadol HCl 50mg

https://globalonlinepills.com/product/tramadol-50-mg/

Drugs from Cali Plug 420

https://caliplug420.com/product/cherry-spice/

(Warning! Weed is not allowed in Malaysia.)

Personal Care 

Skincare

http://myaffordablebeauty.blogspot.com/

Equipment

Stark toxin scanner - Tony Stark

https://marvelcinematicuniverse.fandom.com/Stark_Medical_Scanner

TOSHIBA PVM-375AT Convex Probe for Toshiba Nemio

Unison Biomed, Dhaka, Bangladesh

http://www.unisonbiomed.com/

e Commerce

Khojdeel, Mumbai, India - Medlife coupons code Nov 2021

https://www.khojdeal.com/medlife-coupons/

Technology

Photostick Omni - for photos and video transfer

https://www.thephotostick.com/photostick-omni-for-computers-and-mobile-devices

Infiniti Kloud Wireless - Review 2021

https://theviraltech.com/infinitikloud-wireless-review

MemorySafeX - Review - photos and video 60K backup in a click

https://www.reviewpadho.com/memorysafex-review/

Construction

PT Bondor Indonesia, Sentul, Jawa Barat, Indonesia

Insulated Panel Systems, Insulated Sandwich Panel

for clean room, cold storage, food processing plant, mineral wood panel, etc.

https://bondor.co.id/

Education

Rattanachai Suksa School, Thailand (Thai primary school)

(school website with an IT Department)

https://rcs.ac.th/frontend/page

Sports and Recreation

Fishing in Southwest Florida

https://auuooh.com/

Cricket World Cup 2019 Live

https://www.cricketworldcup2019schedule.com/crichd-live-cwc/

Omoide & Dreams, Mexico (Spanish)

http://omoidendreams.blogspot.com/

Pets

Heated cat houses - Reviews

http://heatedcathousereviews.blogspot.com/

Hits 668,443 in mid-Nov 2021

This blog had 668,443 hits on 16 November 2021.

We are still enduring the COVID-19 pandemic.

There were 250 comments by 16 November 2021.

I have checked all comments and links provided there-in. I have had to remove more than 40 comments with broken or inappropriate links.

I would like to remind readers to comment appropriately and to link to useful sites only. Please check that your links are not broken. 

I will keep checking all comments from time to time.

TQ for your cooperation and understanding.

Prof Faridah
Medicine Newbie
Blog Admin

Longevity

 Longevity is subjective and means different things in different communities. Short life span will mean rushing everything into the short time span. Long life means there is no need to rush things as there is time to do everything at leisure.

What to study in people who live long (long livers)?

• Food: food composition, diet and nutrition, natural food products
• Food KAP: Knowledge, activities, and practices
• Level of eating food: good amount, extra amounts, moderate amounts
• Activities: daily, weekly, monthly
• Social status: alone (solo), together (family, small group, large groups)
• Stress relivers: how do people relief stress?
• Brain and senility: how active is the brain?, cognitive function (count, group, class etc)
• Attitude: calmness, level of stress
• Ecology: level of air pollution 
• Celebrations: what do they celebrate?
• Rest: how much rest is needed?

Age of participants:

• young livers
• middle-age livers
• elderly livers
• long livers

Study questions:

1. How old are you?
2. How old is the youngest in your family?
3. How old is the eldest in your family?
4. How long do you sleep?
5. How do you start your daily activities?
6. What do you do daily?

Health check

1. Heart
2. Muscle
3. Brain

How to study communities?

1. Group A: Communities which lived to between 40 and 50. Some lucky ones lived beyond 50.
2. Group B: Communities which lived to between 50 and 60. Some lucky ones lived beyond 60.
3. Group C: Communities which lived to between 60 and 70. Some lucky ones lived beyond 70.
4. Group D: Communities which lived to between 60 and 70. Some lucky ones lived beyond 80.
5. Group E: Communities which lived to between 80 and 90. Some lucky ones lived beyond 90.
6. Group F: Communities which lived to between 90 and 100. Some lucky ones lived beyond 100.
7. Group G: Communities which lived to between 100 and 110. Some lucky ones lived beyond 110.

External links:

1. Greece. The Oldest People in the World 
2. Icaria 
3. Diane Kochilas - Flavors of Ikarian Longevity I
4. Diane Kochilas - Flavors of Ikarian Longevity II

Penicillin

The Penicillium mold (fungus) was accidentally discovered by Alexander Fleming in his laboratory in 1928. The fungus produced pencillin which blocked the growth of Staphylococcus (a bacteria). Penicillium is important for the production of penicillin, an antibiotic.

Penicillin took a long time to come on the market. It was made available by the end of the Second World War (1945), and helped to save soldiers on the battle field from influenza (flu), who would otherwise die. Thus, penicillin was hailed as a saviour of the soldiers involved in the great war. More soldiers were returning after the war due to penicillin. Even postal boxes had penicillin posters draped them, with the words, 'Penicillin cures gonorrhea in 4 hours'.

While the initial green fungus (Penicillium notatum) was grown in petri dishes, the fungus grows well on orange skin. It also grows well on orange skin kept in the fridge and on stale bread. However, higher yields of penicillin comes from Penicillium chrysogenum grown on the flesh of cantaloupe (a fruit like a melon, with orange flesh).

Penicillin allergy is uncommon but people who have severe allergy to penicillin have severe itch after trying oral penicillin or died after being injected with penicillin. Doctors will always ask parents or patients before prescribing or administering penicillin. You should know whether you are allergic to penicillin or otherwise.

Commercial penicillin is produced by fermentation, which is done in batches using cultured media from microbial sources (not animal sources). Corn steep liquor is mixed with glucose (as carbon source) and first sterilised in tanks. The fungus is added to the fermentation tanks and produces penicillin as a natural secondary product (metabolite). The fungus is then separated from the penicillin (in the fermentation broth). The penicillin is then purified for use as medicine. The fungus is recycled to produce another batch of penicillin.

There was one poster which said, 'Try Penicillin. Made from mold, you can get this drug from your doctor or prepare it yourself'. It is alright to try and see Penicillium growth on orange skin and/or bread at home. However, care has to be taken not to contaminate other food kept at home or stored in the fridge. Care has also got to be taken not to breathe in the spores released from the fungus. If you can smell the fungus, the spores are already inside you! Keep your distance or use a face mask. Take pictures and destroy the fungus by burning it outside your home. Take precaution when you use fire.

External links:
https://botit.botany.wisc.edu/toms_fungi/nov2003.html
https://labmonk.com/fermentation-process-of-antibiotics
https://www.nlm.nih.gov/exhibition/fromdnatobeer/exhibition-interactive/illustrations/penicillin-alternative.html
https://www.slideshare.net/seetaram443/penicillins-53561419
https://www.slideshare.net/banuman35/penicillins-by-dr-panchumarthy-ravisankar-mpharm-phd

CKD Stage 3 and Ketosteril

Chronic Kidney Disease (CKD) Stage 3 is a renal condition with symptoms or asymptomatic, depending on severity.

1. reduced clearance of urea and creatinine from blood into urine. 
2. Blood urea and creatinine exceed normal levels. 
3. Urine output can be none, little (oliguria) or normal. 
4. The patient has uremia with nausea. 
5. The patient may feel lousy at times, 
6. tired at times, 
7. loss of appetite at times, and 
8. fatigued at times. 
9. Depression may begin to seep in as the patient learns of his/her worsening condition, while doctors try to figure out the best treatment regime for the patient's failing kidney(s) or renal function/system.

Protein intake becomes important in CKD. Controlling protein intake in the diet is not so easy to do. It is easier said than done in the home setting. A protein restricted diet (40 g protein/day) contains protein the size of a match-box. That is not much for a 70 kg patient. The patient will start feeling hungry very easily.

There are options which researchers have worked on.

1. Low protein intake
2. Restricted animal protein
3. Vegetarian protein
4. Vegetarianism

To reduce dietary protein intake and yet maintain amino acid metabolism, a ketoanalogue can be used.

1. Ketosteril is a ketoanalogue of creatinine. 
2. Ketosteril will reduce blood creatinine levels and save the kidney(s), giving the kidney(s) time to recover. However, CKD can still progress, but slower.
3. Ketosteril is prescribed for pre-dialysis stable CKD patients. 
4. It is prescribed for CKD Stage 5. 
5. However, it can be prescribed for stable CKD Stage 2 and Stage 3.

Use of Ketosteril comes with its dangers. There are safety guidelines for using Ketosteril. Some doctors will prescribe 2 tablets 3x a day. Without a doctor's prescription, patients may take more tablets per day. Refer to pharmacy.

Government hospitals and university hospitals do not supply Ketosteril FOC. Patients have to purchase Ketosteril on their own, from pharmacies. The cost varies widely, from RM250 to RM280 per 100 tablets.

External links

"Ketosteril® - Fresenius Kabi India." Fresenius-kabi.com. N. p., 2019. Web. 4 Mar. 2019.

Tzekov VD, et al. (2000). Low protein diet and ketosteril in predialysis patients with renal failure. Folia Med (Plovdiv). 2000;42(2):34-7. PubMed - NCBI . Ncbi.nlm.nih.gov. Retrieved 4 March 2019, from https://www.ncbi.nlm.nih.gov/pubmed/11217281

J, B. (1984). Discovery and rediscovery of low protein diet. Clin Nephrol. 1984 Jan;21(1):29-35. PubMed - NCBI . Ncbi.nlm.nih.gov. Retrieved 4 March 2019, from https://www.ncbi.nlm.nih.gov/pubmed/636806

Gluba-Brzózka, Anna, Beata Franczyk, and Jacek Rysz. "Vegetarian Diet In Chronic Kidney Disease—A Friend Or Foe." Nutrients 9.4 (2017): 374. Web. 4 Mar. 2019.

CT Urography

Each normal ureter is 25 cm long.

In hydronephrosis of the kidneys and ureters, there is inflammation of both kidneys and ureters. Inflammation of the kidneys may appear similar. However, the ureters maybe asymmetrically affected.

Two separate soft tissue masses can surround the ureters at two different locations along each ureter. The right soft tissue mass can surround the distal part of the ureter (about 4 cm). The left soft tissue mass can surround the proximal part of the ureter (about 4 cm).

The soft tissue mass may continue to grow and compress on the ureters and stop urine flow into the urinary bladder, leading to little or no urine. The patient may not suffer any pain (asymptomatic) in the beginning . However, later on, the patient may suffer great pain as renal conditions worsen.

There are 2 investigations to be done: CT Urography, and biopsy.

CT Urography is for evaluation of the ureters. The radiologist and urologist will investigate to find out the underlying cause(s):

1. Congenital abnormalities
2. Filling defects
3. Dilatation
4. Narrowing
5. Deviations in the course of urine flow and output

Biopsy is to investigate what the soft tissue mass is. Biopsy may show malignant (cancerous) growth. It maybe limited or have spread. The cytologist in Pathology will inform. Fine Needle Aspiration Biopsy (FNAB) involves aspirating a small volume of biopsy sample via a small keyhole made in the abdomen. Any biopsy is painful and will need anaesthesia.

Treatment is by surgical removal of the soft tissue masses surrounding the ureters.

The entire uterus may have to be removed too.

Radiotherapy, chemotherapy etc may be needed.


External links:

CT Urography for evaluation of the ureter
https://pubs.rsna.org/doi/full/10.1148/rg.2015140209

Retroperitoneal sarcoma of the ureters
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4049017/pdf/cro-0007-0301.pdf

Soft tissue sarcomas of the kidneys
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4387353/pdf/rt-2015-1-5635.pdf

Fibrosarcoma
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5732833/pdf/oncotarget-08-104638.pdf

Malignant soft tissue tumors
https://www.cedars-sinai.edu/Patients/Health-Conditions/Soft-Tissue-Tumors---Malignant.aspx

Urothelial Tumors of the Renal Pelvis and Ureters: Problem, Epidemiology, Etiology
https://emedicine.medscape.com/article/452449-overview#a5
https://emedicine.medscape.com/article/452449-overview#a7

Ureteral neoplasms
https://pubs.rsna.org/doi/pdf/10.1148/radiographics.10.2.2183298

Leiomyosarcoma of the distal ureter
https://www.um.edu.mt/umms/mmj/PDF/547.pdf

Kidney tumor > Renal pelvic tumors > Urothelial carcinoma of renal pelvis
http://www.pathologyoutlines.com/topic/kidneytumormalignanturothelialcarcinoma.html

Transitional cell carcinoma (TCC)
https://radiopaedia.org/articles/transitional-cell-carcinoma-ureter?lang=us