講CUHK單嘢都講到口臭,今日想講下現代醫學急速發展,科學醫學基因學一日千里後對醫學院學生同初級醫生嘅影響
拿,頭盔,我唔係故意要同senior們作對,而係有d好重要嘅概念我覺得一路都無人address過。而醫學界仍然有股好重嘅「當年都係咁捱咁讀,點解你咁多意見」嘅風氣
的確,當年前輩們嘅非人on call生活、要去library睇文獻睇書而唔係方便地用Microsoft surface神速打筆記、開uptodate、開pubmed/medline等等。
無可否認,上個年前代嘅醫生們要增進知識要靠嘅自動波去睇論文去溫書,甚至要自己去R導師做臨床教學等等。無人否認當年環境無咁豐富,上堂無精美PowerPoint、臨床教學今時今日已經好structured,分哂history session, examination session, skills session,有像真度極高嘅假人俾你練習,呢d係上代無嘅luxuries
No one is denying this fact
但上一代都一樣無嘅係咩,大家有無諗過?
就係千千萬萬種過去20年發展出來嘅科學醫學理論同治療方法。
O&G 幾十年前都未知道preeclampsia嘅實際原因係乜,原來可以early pregnancy low dose aspirin prevent or delay onset of preeclampsia。廿年前都無HPV疫苗, 都無話原來screen HPV virology比Pap smears更有效發現子宮頸病變,廿年前無人需要知道呢d
Rheumatology幾十年都無一堆biologics, TNFa, IL inhibitor 。原來autoimmune inflammatory arthritis failed NSAID/MTX可以轉infliximab, adalimumab。psoriatic可以用secukinumab但如果有IBD/enteropathic features要小心IL-17 inhibitor,廿前年無人需要知道呢d
Immunology/ID,幾十年前HIV邊有咁多種antiretroviral?今時今日ART多到就算你de novo resistance都可以換藥換到U=U,廿年前都係得舊式治療,無人需要知種種嘅新式療法。immunology仲多咗幾十種唔同嘅complement, complement inhibitor etc etc嘅investigation
Respiratory醫ILD或pulmonary HTN幾十年前個療法來來去去都係得幾種。今時今日IPF有nintedanib,Pul HTN有成堆endothelin antagonist、PDE5 inhibitor同prostacyclin類嘅藥要知。asthma當年來來去去都係ventolin+inhaled/oral steroid,今時今日分埋IgE asthma, eosinophilic asthma,有成堆唔同嘅SABA-LABA, SAMA-LAMA, IgE monoclonal antibodies, IL-5, IL-4 and IL-13,到底eosinophil要幾多先會大機會有response,用緊steroid嘅eosinophil個cutoff係幾多。
Hematology/oncology幾十年前都未有monoclonal antibodies,無rituximab、nivolumab、targeted therapy等等,幾十年來個發現多咗好多唔同gene mutation同targeted site,EGFR, VEGFR, CTLA-4, PD-1,PD-L1、BRAF,HER-2, you name it you got it。以前癌症病人你大多只要beware of neutropenic fever/infection,今時今日你要screen埋immune checkpoint inhibitor autoimmune hepatitis, pneumonitis, thyroditis, colitis,你要知埋有個病人用緊nivolumab時突然變黃,你要screen咩autoimmune,落咩藥,high dose steroid定點,之後仲可唔可以rechallenge。乳癌病人HER-2依加唔止用herceptin,仲有埋pertuzumab,你仲要screen埋cardiomyopathy,echo drop幾多可以接受,係唔係reversible,可唔可以rechallenge
Endocrine幾十年前糖尿病來來去去都係metformin, gliclazide, insulin今時今日T2DM有GLP-1, SGLT-2, gliptin等等,有埋continuous glucose monitoring device又有bump又有唔同林林總總嘅治療。唔止T1/T2DM,今時今日仲有埋LADA,你要知埋個autoimmune panel screen咩。骨質疏鬆當年玩來玩去都係bisphosphonate,今時今日有denusumab有teriparatide,仲有更多新藥。
Gastroenterology幾十年前IBD來來去去都係steroid/steroid sparing agent 5-ASA/aza,今時今日有TNFa blocker有a4b7 inhibitor vedolizumab。當年hepC得幾種antiviral今時今日有sofosbuvir, velpatasvir, glecaprevir等等,仲變成curative。
Neurology MS幾十年前邊有natalizumab,今時今日如果MS on natalizumab with rapid neurological decline,你要諗埋會唔會可能係JC virus reactivation。GBM以前都係只靠surgical resection,今時今日可以用avastin, temozolomide仲要screen埋MGMT hypermethylation去決定有無得用chemo
呢啲改變同發展只係佔各system嘅一小部分,只係我細小嘅腦袋突然諗到嘅小部分內容。世界不斷發展,學海無涯,我們有愈來愈多嘅知識要學,呢一點無人懷疑過。
醫生擁有比一般人更多嘅權力同地位,就自然需要更大嘅責任。
但係,值得大家反思嘅係,當個knowledge base不斷擴大嘅時候,考試仍然要期望你記埋某張slide嘅角落嘅minute details時,呢個係唔係一個合理嘅期望?
當一個basic trainee去考PACES/long case嘅時候,到底係唔係同以前一樣要知得咁深入?當深度一樣,而個base不斷widen broaden時,新世代嘅醫生應該如何應對?
而考試嘅範圍似乎未有被address過,呢點好值得我地一齊諗諗
rapid insulin 在 Hero Athletes Facebook 的最讚貼文
โว้ยยยยย
เพาะกายหรือกีฬาอะไรก็ตามใช้insulinเพราะหวังผล
-anti-catabolic
-synergist กับ anabolic อื่นๆ
-hypoglycemic จะหิวๆได้กินได้เยอะๆ +ถ้าน้ำตาลต่ำ ก็จะง่วงทำให้หลับได้ดี เพิ่ม recovery (นอนหลังซ้อม)
-nutrient transport บังคับให้อาหารเข้าไปเลย load carb
ส่วนใหญ่เริ่มจาก Rapid insulin post training(aspart, lispro) ใช้ในเวลาที่กล้ามเนื้อมี insulin sensitivity มากที่สุด โดสไม่บอกแล้วกัน
พวกนี้ต้องมีเครื่องเจาะน้ำตาลส่วนตัวเลย ลองกันตั้งแต่ very low dose ไต่ไปจนถึงtarget dose
คำนวนเวลาออกฤทธิ์ของยา กินอาหารให้ตรงกับ peak level
ต่อไปก็เพิ่มอีกมื้อ
เพิ่มอีกก็ใช้ basal insulin อยู่ไปทั้งวัน
พวกนี้เค้าไม่สนใจหรอกว่าร่างกายเป็นไงเพราะถ้าตับอ่อนมันเสียเค้าก็ใช้ยา insulin ไปตลอดอยู่ดี
มันคืออาชีพ ไม่ทำก็ไม่มีตังกินข้าว
มันอยู่ที่ risk/benefit ว่าเรายอมรับมันได้ไหม
ใครใช้ก็รับความเสี่ยงเอง
ใครใช้เป็นก็ได้benefit มากกว่า risk น้อยกว่า
โว้ยยยยยหยุดเถียง
Credit : หมอมิค เซียน Anabolic
STEROID DOCTOR OF HERO ATHLETES TEAM
rapid insulin 在 Thai Top Fitness Facebook 的最讚貼文
146 Reasons Why Sugar Is Ruining Your Health
146 เหตุผลที่เราไม่ควรกินน้ำตาล
By Nancy Appleton, Ph.D.
(สำหรับคนที่ยังคิดว่ามันมีข้อดีบ้างครับ อาหารทุกชนิดมีข้อดีบ้าง เพียงแต่ว่าเราต้องชั่งข้อดีกับข้อเสียกันครับ)
1. Sugar can suppress the immune system.
2. Sugar upsets the mineral relationships in the body.
3. Sugar can cause hyperactivity, anxiety, difficulty concentrating, and crankiness in children.
4. Sugar can produce a significant rise in triglycerides.
5. Sugar contributes to the reduction in defense against bacterial infection (infectious diseases).
6. Sugar causes a loss of tissue elasticity and function, the more sugar you eat the more elasticity and function you loose.
7. Sugar reduces high density lipoproteins.
8. Sugar leads to chromium deficiency.
9 Sugar leads to cancer of the ovaries.
10. Sugar can increase fasting levels of glucose.
11. Sugar causes copper deficiency.
12. Sugar interferes with absorption of calcium and magnesium.
13. Sugar can weaken eyesight.
14. Sugar raises the level of a neurotransmitters: dopamine, serotonin, and norepinephrine.
15. Sugar can cause hypoglycemia.
16. Sugar can produce an acidic digestive tract.
17. Sugar can cause a rapid rise of adrenaline levels in children.
18. Sugar malabsorption is frequent in patients with functional bowel disease.
19. Sugar can cause premature aging.
20. Sugar can lead to alcoholism.
21. Sugar can cause tooth decay.
22. Sugar contributes to obesity
23. High intake of sugar increases the risk of Crohn's disease, and ulcerative colitis.
24. Sugar can cause changes frequently found in person with gastric or duodenal ulcers.
25. Sugar can cause arthritis.
26. Sugar can cause asthma.
27. Sugar greatly assists the uncontrolled growth of Candida Albicans (yeast infections).
28. Sugar can cause gallstones.
29. Sugar can cause heart disease.
30. Sugar can cause appendicitis.
31. Sugar can cause multiple sclerosis.
32. Sugar can cause hemorrhoids.
33. Sugar can cause varicose veins.
34. Sugar can elevate glucose and insulin responses in oral contraceptive users.
35. Sugar can lead to periodontal disease.
36. Sugar can contribute to osteoporosis.
37. Sugar contributes to saliva acidity.
38. Sugar can cause a decrease in insulin sensitivity.
39. Sugar can lower the amount of Vitamin E (alpha-Tocopherol in the blood.
40. Sugar can decrease growth hormone.
41. Sugar can increase cholesterol.
42. Sugar can increase the systolic blood pressure.
43. Sugar can cause drowsiness and decreased activity in children.
44. High sugar intake increases advanced glycation end products (AGEs)(Sugar bound non-enzymatically to protein)
45. Sugar can interfere with the absorption of protein.
46. Sugar causes food allergies.
47. Sugar can contribute to diabetes.
48. Sugar can cause toxemia during pregnancy.
49. Sugar can contribute to eczema in children.
50. Sugar can cause cardiovascular disease.
51. Sugar can impair the structure of DNA
52. Sugar can change the structure of protein.
53. Sugar can make our skin age by changing the structure of collagen.
54. Sugar can cause cataracts.
55. Sugar can cause emphysema.
56. Sugar can cause atherosclerosis.
57. Sugar can promote an elevation of low density lipoproteins (LDL).
58. High sugar intake can impair the physiological homeostasis of many systems in the body.
59. Sugar lowers the enzymes ability to function.
60. Sugar intake is higher in people with Parkinson’s disease.
61. Sugar can cause a permanent altering the way the proteins act in the body.
62. Sugar can increase the size of the liver by making the liver cells divide.
63. Sugar can increase the amount of liver fat.
64. Sugar can increase kidney size and produce pathological changes in the kidney.
65. Sugar can damage the pancreas.
66. Sugar can increase the body's fluid retention.
67. Sugar is enemy #1 of the bowel movement.
68. Sugar can cause myopia (nearsightedness).
69. Sugar can compromise the lining of the capillaries.
70. Sugar can make the tendons more brittle.
71. Sugar can cause headaches, including migraine.
72. Sugar plays a role in pancreatic cancer in women.
73. Sugar can adversely affect school children's grades and cause learning disorders..
74. Sugar can cause an increase in delta, alpha, and theta brain waves.
75. Sugar can cause depression.
76. Sugar increases the risk of gastric cancer.
77. Sugar and cause dyspepsia (indigestion).
78. Sugar can increase your risk of getting gout.
79. Sugar can increase the levels of glucose in an oral glucose tolerance test over the ingestion of complex carbohydrates.
80. Sugar can increase the insulin responses in humans consuming high-sugar diets compared to low sugar diets.
81 High refined sugar diet reduces learning capacity.
82. Sugar can cause less effective functioning of two blood proteins, albumin, and lipoproteins, which may reduce the body’s ability to handle fat and cholesterol.
83. Sugar can contribute to Alzheimer’s disease.
84. Sugar can cause platelet adhesiveness.
85. Sugar can cause hormonal imbalance; some hormones become underactive and others become overactive.
86. Sugar can lead to the formation of kidney stones.
87. Sugar can lead to the hypothalamus to become highly sensitive to a large variety of stimuli.
88. Sugar can lead to dizziness.
89. Diets high in sugar can cause free radicals and oxidative stress.
90. High sucrose diets of subjects with peripheral vascular disease significantly increases platelet adhesion.
91. High sugar diet can lead to biliary tract cancer.
92. Sugar feeds cancer.
93. High sugar consumption of pregnant adolescents is associated with a twofold increased risk for delivering a small-for-gestational-age (SGA) infant.
94. High sugar consumption can lead to substantial decrease in gestation duration among adolescents.
95. Sugar slows food's travel time through the gastrointestinal tract.
96. Sugar increases the concentration of bile acids in stools and bacterial enzymes in the colon. This can modify bile to produce cancer-causing compounds and colon cancer.
97. Sugar increases estradiol (the most potent form of naturally occurring estrogen) in men.
98. Sugar combines and destroys phosphatase, an enzyme, which makes the process of digestion more difficult.
99. Sugar can be a risk factor of gallbladder cancer.
100. Sugar is an addictive substance.
101. Sugar can be intoxicating, similar to alcohol.
102. Sugar can exacerbate PMS.
103. Sugar given to premature babies can affect the amount of carbon dioxide they produce.
104. Decrease in sugar intake can increase emotional stability.
105. The body changes sugar into 2 to 5 times more fat in the bloodstream than it does starch.
106. The rapid absorption of sugar promotes excessive food intake in obese subjects.
107. Sugar can worsen the symptoms of children with attention deficit hyperactivity disorder (ADHD).
108. Sugar adversely affects urinary electrolyte composition.
109. Sugar can slow down the ability of the adrenal glands to function.
110. Sugar has the potential of inducing abnormal metabolic processes in a normal healthy individual and to promote chronic degenerative diseases.
111.. I.Vs (intravenous feedings) of sugar water can cut off oxygen to the brain.
112. High sucrose intake could be an important risk factor in lung cancer.
113. Sugar increases the risk of polio.
114. High sugar intake can cause epileptic seizures.
115. Sugar causes high blood pressure in obese people.
116. In Intensive Care Units, limiting sugar saves lives.
117. Sugar may induce cell death.
118. Sugar can increase the amount of food that you eat.
119. In juvenile rehabilitation camps, when children were put on a low sugar diet, there was a 44% drop in antisocial behavior.
120. Sugar can lead to prostrate cancer.
121. Sugar dehydrates newborns.
122. Sugar increases the estradiol in young men.
123. Sugar can cause low birth weight babies.
124. Greater consumption of refined sugar is associated with a worse outcome of schizophrenia
125. Sugar can raise homocysteine levels in the blood stream.
126. Sweet food items increase the risk of breast cancer.
127. Sugar is a risk factor in cancer of the small intestine.
128. Sugar may cause laryngeal cancer.
129. Sugar induces salt and water retention.
130. Sugar may contribute to mild memory loss.
131. As sugar increases in the diet of 10 years olds, there is a linear decrease in the intake of many essential nutrients.
132. Sugar can increase the total amount of food consumed.
133. Exposing a newborn to sugar results in a heightened preference for sucrose relative to water at 6 months and 2 years of age.
134. Sugar causes constipation.
135. Sugar causes varicous veins.
136. Sugar can cause brain decay in prediabetic and diabetic women.
137. Sugar can increase the risk of stomach cancer.
138. Sugar can cause metabolic syndrome.
139. Sugar ingestion by pregnant women increases neural tube defects in embryos.
140. Sugar can be a factor in asthma.
141. The higher the sugar consumption the more chances of getting irritable bowel syndrome.
142. Sugar could affect central reward systems.
143. Sugar can cause cancer of the rectum.
144. Sugar can cause endometrial cancer.
145. Sugar can cause renal (kidney) cell carcinoma.
146. Sugar can cause liver tumors.
rapid insulin 在 Insulin Preparations (Rapid, Short, and Long Acting) - YouTube 的推薦與評價
Lispro, Aspart, NPH, and Glargine - Insulin Preparations ( Rapid, Short, and Long Acting). 12,782 views12K views. Nov 9, 2020. ... <看更多>