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"title": "Infectious Disease",
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"summary": "Infection and its consequences are in perpetual balance between the surrounding potential organisms that can affect us, and the ability of our immune systems to develop the means to handle and control them. This is why people with a weak immune system are more at risk, whether they are babies or elderly persons, or those with a background condition that affects the immune system—which includes poor nutrition.",
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"value": "<p>Some doctors would tell you that everything is infectious—in some ways, even certain psychiatric diseases are contagious! In medical terms, however, infectious diseases are those illnesses caused by external organisms—including viruses, bacteria, parasites, and some less-common vectors such as fungi and sporozoites. Some of these are easily transmitted between humans, while others are contracted from animals. They are external infections, external invaders that can cause damage.</p><p>Most people who contract such a disease won’t need to see an infectious disease (ID) specialist. Specialists usually deal with special or unusual infections, or cases where standard treatments aren’t working. An example might be when a patient’s condition is not responding to normal antibiotic treatment—an ID specialist will assess the resistance of the bacterial infection to antibiotics, and choose a more appropriate antibiotic or drug regime in complicated patients.</p><p>ID specialists work in a fascinating medical field—the domain of discovering diseases, diagnosing them, finding a treatment, and most importantly discovering how to prevent infection and arrest the spread of a disease.</p><p>When assessing means of treatment and control, it’s very important for an ID specialist to take into account three things: the potential transmissibility (how fast and easily a disease spreads), morbidity (how many people potentially become ill rather than just carry the infectious agent, and what the severity of the illness is) and mortality (how many people who become ill may die) of any given disease. The most alarming infectious diseases—which could be described as plagues—would be highly transmissible, cause many people to become sick, and have a high death toll.</p><p>Most diseases circulating in the world today are not combinations of those three dreaded factors—they are not highly transmissible while at the same time having a high rate of infectivity and causing death in high proportions. Influenza spreads extremely rapidly, although most people who contract the virus suffer only cold-like symptoms for a period of one to three weeks. HIV is transmitted only seldom via intimate contact, but it almost inevitably causes severe morbidity and fatality without treatment.</p><p>Some infectious diseases can be diagnosed clinically. The doctor is presented with a cluster of symptoms or a distinct visible symptom that may be readily diagnosed; the aspect of a chickenpox rash, for example, is easy to recognize—so you don’t have to isolate the virus or take blood to check for antibodies. You just know it when you see it.</p><p>At other times, you may see a patient who has a chronic cough or some prolonged fever, and it’s not clear what the infection is. You may need to use tests—sometimes attempting direct isolation of the organism when you find it in a place where it shouldn’t be, such as observing mycobacteria in the sputum that tells you a patient is suffering from tuberculosis.</p><p>Then you have indirect identification, not by isolating the organism itself, but by finding antibodies produced by the immune system—telling you that the immune system saw a certain organism and reacted against it.</p><p>Simply finding antibodies does not necessarily give you the answer, however, because we all carry antibodies to various kinds of infections that we may have recovered from in the past. Our bodies maintain a stock of antibodies to protect against any future possible reinfections of illnesses we’ve fought against before.</p><p>Sometimes doctors mistakenly diagnose a disease simply by not understanding what the test means— finding antibodies to a disease doesn’t necessarily mean that disease is creating the problem right now, it may be something from the past.</p><p>However, if we identify early forms of antibodies, or a rapid increase in the concentration of antibodies within a short time period, then we can be fairly certain that the immune system is reacting to a live infection. In such cases, you can connect the presence of antibodies to the disease of the patient.</p><p>The part of the world where you live is also an important consideration when making a diagnosis. An ID specialist should know the local incidence of certain diseases. If you’re in New York and somebody comes to you with a prolonged fever, you will not jump on the possibility of tuberculosis as you might here in Vietnam, because there are different incidences in different parts of the world.</p><p>This is the importance of an ID specialist, who should choose the right diagnostic tool, know how to interpret tests, and decide which will be the right medication to use, given the local epidemiology.</p><p>Infection and its consequences are in perpetual balance between the surrounding potential organisms that can affect us, and the ability of our immune systems to develop the means to handle and control them. This is why people with a weak immune system are more at risk, whether they are babies or elderly persons, or those with a background condition that affects the immune system—which includes poor nutrition. By keeping the immune system healthy and staying up to date with vaccines (including the annual flu vaccine) we are far better equipped to fight off diseases.</p>"
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"title": "What is Pediatric Emergency?",
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"summary": "Sometimes it is not possible to get to a child in those critical moments. This is why it’s very important for people who take care of children—even those already capable of administering first aid to an adult—to familiarize themselves with life-saving techniques that can help sustain the life of a critically injured child.",
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"value": "<h2><b>Dr. Takaaki Mori discusses the emerging field of Pediatric Emergency in Japan and its potential for Vietnam.</b></h2><p>Pediatric emergency is all about saving the lives of children. It’s a very different approach to providing medical care to children than that of general pediatrics. A general pediatrician will examine a child presenting with certain symptoms—for example, jaundice—and first consider what the most likely cause might be. An emergency pediatrician’s first thought will be, “what life-threatening condition could be responsible for these symptoms?” Only after ruling out the most dangerous possibilities will the pediatrician then turn to more common explanations. So while the diagnostic process might be very similar, the order in which things are done is markedly different.</p><p>While this important field of medicine is in its infancy in Vietnam, pediatric emergency practice has been around in developed countries like the USA for 30 or 40 years now. In my native Japan, pediatric emergency medical science has a very short history. I was among the first Japanese doctors to specialise in the field when a pediatric emergency department was established in the Tokyo Metropolitan Children’s Medical Center by my mentor, Dr. Nobuaki Inoue. Dr. Nobuaki had worked in the field in the US, and was keen to build the first pediatric emergency department in Tokyo. I hope very much to participate in the growth of this specialty here in Vietnam.</p><p>When I started out, three or four children’s hospitals in Japan had just been combined into one big medical center—that was our general hospital. The Tokyo government were trying to push the establishment of pediatric emergency in Tokyo, which gave Dr. Nobuaki the opportunity to build our department.</p><p>Classically, general pediatricians deal with child patients suffering from medical issues such as cold, cough and fever through to mild trauma. For critically ill child patients—those who have been victims of traffic accidents and so on—physicians who would normally attend to adult emergencies would deal with the children. This was the situation in Japan when I entered the field, and it is still the case here.</p><p>After Dr. Nobuaki returned to Japan, the pediatricians in our hospital started to deal with children suffering from critical medical and surgical conditions, following the American model. I was a pediatrician with an interest in the surgical sphere at the time, so I decided to enter pediatric emergency in Japan.</p><p>Essentially, the field is very similar to standard emergency medicine, particularly in the way we treat many kinds of emergency and medical conditions. But pediatric emergency differs in that we have to think about the child’s growth and development—we have to adjust the treatment and approach depending on the child’s age (or perhaps other conditions). For example, when we apply stitches, we follow a different procedure with a one-year-old child than with a child of ten. For some pediatric emergencies, we perform sedation in cases where an adult would not need it—for reasons of safety and to lessen their anxiety, and for the comfort of the children as well as the parents.</p><p>There is also the issue of the size of a child’s body. For pediatric emergency medicine, we have to prepare different medical equipment depending on the child’s age and weight. We usually use different types of equipment of different sizes, from infant to adolescent. An endoscope used on an adult, for example, could not possibly be used on a child. Currently, children who require such procedures in Vietnam must leave the country to receive treatment.</p><p>One hot topic in pediatric emergency medicine is the use of X-rays. People are becoming increasingly concerned about radiation exposure in children. In Japan, I was personally involved in promoting the use of ultrasound techniques in children to replace the use of X-ray and CT scans for pediatric emergency conditions. I have successfully detected conditions such as appendicitis as well as critical injuries using ultrasound rather than X-rays, sparing the patients from unnecessary radiation exposure. This is an area that stands primed for development in Vietnam, as the difference is procedural with the required equipment already available here.</p><p>One advantage that emergency pediatricians have over regular emergency doctors is that we’re quite used to the ultrasound, because we have to study neonatology during our residency in pediatrics.</p><p>What attracts me to pediatric medicine? Personally, I prefer working in an acute care setting where a quick decision is needed to treat the traumatised patient. If I administer proper treatment, the patient’s condition can change dramatically</p><p>At the Tokyo children’s medical center, we had some private ambulances for pediatric patients, similar to the modern, fully-equipped vehicles used by our medical practice here. When call-outs occurred, we would ride out to the scene, pick up the child patients and start treatment immediately while bringing them to the hospital. Prior to that, the ambulance would have to bring the child to hospital first for observation, so it would take much longer before the treatment. Accompanying the ambulance to the scene of the accident when the patient’s condition was critical—such as in the case of a brain hemorrhage—could make all the difference.</p><p>I remember one infant who was just 3–4 months old who had difficulty breathing, and went cyanotic—turning blue with low oxygen saturation. I brought the child to the clinic for aeration before intensive care. Any longer, and the infant wouldn’t have had a chance to survive. Speed is important in such cases. Quick and accurate analysis and a decision to give appropriate treatment has saved lives. It is an immensely rewarding experience to save the life of a child.</p><p>Sometimes it is not possible to get to a child in those critical moments. This is why it’s very important for people who take care of children—even those already capable of administering first aid to an adult—to familiarize themselves with life-saving techniques that can help sustain the life of a critically injured child. I would advise teachers, parents and other people who work with children in Vietnam to seek out a first aid course that includes pediatric emergency protocols. As with all emergencies, time is everything.</p><p><b>Dr. Takaaki Mori, Pediatrician, Family Medical Practice Vietnam</b></p>"
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"value": "<p></p><p>BREAST CANCER is a serious illness affecting 1 in 8 women, and it’s vitally important to be aware of the factors that put women at risk. Earlier today, our physician Dr. Jane Shadwell-Li conducted a health talk at REPSOL's corporate office speaking on the risks, symptoms and screening methods. Attendees, women and men, were advised on the importance of early detection, which is proven to save lives—the breast cancer survival rate is as high as 98% in cases that are caught early.</p><p></p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Breast_Cancer_Awareness-Oct_19_2018_3.jpg\" class=\"format-left\" /><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Breast_Cancer_Awareness_-_Oct_19_2018_1.jpg\" class=\"format-left\" /><p></p>"
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"title": "Breaking the Mold",
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"summary": "All children have the power to grow up. We parents or families should also trust our children, and we need to see them as individuals, and not raise them as if by an instruction book, which will only serve to create undue stress and pressure for these children.",
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"value": "<p><b>As you watch your child grow, remember that each child develops at his or her own pace and the range of normal is quite wide</b></p><p>One of the most topical issues we deal with as pediatricians in Japan is the problem of childhood developmental disorders. Just as in many other developed countries, societal stressors can cause difficulties for both children and adults, but they can be especially problematic for those children suffering from these conditions.</p><p>There has recently been considerable attention given to this phenomenon in my home country, with cases of autism spectrum disorder and other developmental disorders receiving much attention in Japanese society. It’s interesting that in countries like Vietnam, especially in developing areas, such conditions seem to be less common. It could be that there are fewer trained pediatricians capable of diagnosing them, but it could also be that in a less stressful cultural environment, such disorders are far less likely to have obvious manifestations.</p><p>The problem is that more often than not, these children cannot speak clearly about what they are feeling and experiencing, because of their stage of development or their family environment—or sometimes because of the communicative limitations caused by a developmental disorder. Younger children especially don’t have the skills to speak out; they don’t have the words to describe how they feel, and they don’t know how to approach parents or adults. These are the things that a pediatrician needs to think about when seeing a patient. We need to examine them physically, but we also need to think about all the other factors related to their symptoms.</p><p><b>What is Normal?</b></p><p>Parents often really worry about whether or not their child is normal or abnormal, but the most important thing is how they live their lives. The central issue is that those children with developmental disorders often suffer from their daily living, though they look healthy.</p><p>Japanese people, as with most Asian people, prefer to behave as a collective. I can see in Vietnam that people like to “match” each other, which is very similar to my country. However, certain kinds of people don’t fit the mold.</p><p>In Japan, we are taught to behave nicely before others and act as one. This is a skill we have to learn, and it really does require skill to see how other people are feeling and behaving, but these children with developmental disorders, although they are generally clever, cannot understand and accept what is going on, which can cause significant stress.</p><p><b>Seek to Understand</b></p><p>To help somebody in this situation, we first need to understand their character. For example, a child suffering from autism spectrum disorder, when we give them a small toy like a car or train, may just look at certain parts, unlike most babies who tend to look at the whole. They will fixate on features like the car’s little light, and they will have a special interest in that. The things they are interested in are different from others. This shouldn’t mean that they are abnormal; this should be considered a kind of skill, a character.</p><p>Sometimes in old Japanese TV shows, we would see small children who had a certain skill, who at three or four years old could identify the brand name of many different cars, or the special names of certain trains. What is important to note here is how they can use their skills for themselves and for society. We need to accept and understand what skills they have. These disorders cannot be cured, so we need to understand the character of those whom we deal with, and understand how they suffer because of their character.</p><p>Some children who have this kind of disorder might be able to perform sixth grade math at first grade level. Their skills are very amazing, but sometimes their learning disorder prevents them from writing things down or taking notes—so they cannot do well at school, especially in Japanese schools that are very strict about writing.</p><p>My job is to think about what the children are like, and explain to parents how to raise a child with such disorders, how to develop their good characteristics. If they teach their child to use a computer instead of writing down notes, maybe they can exhibit their good characteristics more, and we don’t even need to think about their difficulties. It’s the same as if someone loses their legs in an accident—if they fit prosthetic limbs, they can run again, sometimes even faster than a healthy person!</p><p>There are many children who suffer from some sort of developmental disorder who go on to lead meaningful lives. There are many professional people who have some communication disorders who simply focus on their areas of interest; they just dig and dig, and intellectually they are very competent. They have difficulties in communicating with others and in understanding their surroundings. But as long as their characters can be fully expressed, they can lead happy lives for themselves and for others.</p><p>All children have the power to grow up. We parents or families should also trust our children, and we need to see them as individuals, and not raise them as if by an instruction book, which will only serve to create undue stress and pressure for these children.</p><p></p><p><b>Dr. Shoji Yoshimatsu, Pediatrician, Family Medical Practice Ho Chi Minh City</b></p>"
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"value": "<p>Thank you for attending the First Aid & CPR training course at Family Medical Practice Danang. We hope that you found the training informative and worthwhile. Your enthusiasm and positive spirit helped make our class together both productive and fun. Our primary goal was to improve the survival from cardiac arrest which begins with making sure everyone knows how to call Emergency Response and do First Aid & CPR. At the end of the training, our participants can be able to demonstrate the resuscitation of an adult in cardiac arrest using a simulated incident and a resuscitation training mannequins. </p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/First_aid_Training_Danang_3.jpg\" class=\"format-fullwidth\" /><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/First_aid_Training_Danang_1_SFJBNTe.jpg\" class=\"format-fullwidth\" /><p></p><p>Thanks for all of the comments and suggestions on the evaluations, we assure you that each will be given consideration so that future class will be even more of a success.</p>"
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"title": "Hand Foot & Mouth Disease",
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"value": "<p><i>MEDICAL ALERT: OCTOBER 2018</i></p><p></p><h3><b>Hand Foot & Mouth Disease</b></h3><p></p><p>Family Medical Practice’s pediatricians have seen multiple cases of Hand Foot & Mouth Disease (HFMD) being reported at our medical centers and confirmed an outbreak in our community.</p><p>HFMD usually spreads among children under the age of five, so school faculty staff and parents should be aware of how to detect this disease and prevent it from spreading.</p><p>HFMD is a viral infection with a typical rash and mouth lesions. It is caused by an enterovirus infection. The most susceptible are infants and toddlers. Adults usually are only carriers. In the past several years there have been ongoing epidemics of HFMD all over Southeast Asia.</p><p></p><p>After an incubation period of about 4–6 days, the child may develop fever, complain of a sore mouth, and refuse to eat or drink. The lesions in the mouth start as small vesicles (blisters) that turn into yellowish ulcers. They involve mainly the palate but can appear anywhere in the mouth. Soon after, several red spots may appear on the hands, feet and sometimes the buttocks. They may gradually change into grey-yellow small blisters.</p><p></p><p>The disease lasts for a few days up to a week. Since there are many different subtypes of enteroviruses, developing antibodies against one doesn't give immunity to the others. Reinfection with same type is uncommon, but getting HFMD/herpangina (a similar infection which involves only the mouth) again is common.</p><p></p><p>The main method of care for a sick child with HFMD is to make sure he drinks enough fluids during the day to ensure he remains hydrated and administer analgesia to manage the pain and fever. Mouthwashes with salty water can alleviate the pain. Soft and cold food are preferred (even ice cream). The most commonly used medications are paracetamol (e.g. Panadol, Tylenol, Efferalgan) and ibuprofen (e.g. Advil, Nurofen). Both are very effective and very safe. While using ibuprofen, it is important to make sure the child drinks properly.</p><p></p><p>The enterovirus spreads through saliva and feces. In order to minimize the spreading of the virus, good hygiene should be maintained and children should avoid sharing the same utensils or having mouth to mouth contact. It is essential to wash hands thoroughly with soap and water after using the bathroom, especially in kindergartens and daycare centers.</p><p></p><p>The disease usually is mild with no long term complications. Neurological (e.g. encephalitis—infection of the brain) and cardiac complications are extremely rare, but may lead to severe disability or death. These complications usually appear after 3–5 days of illness, especially in children younger than two.</p><p></p><p>You should seek medical help immediately if your child develops the following symptoms:</p><ul><li>Lethargy</li><li>Severe headaches</li><li>Recurrent vomiting</li><li>Significant reduction in urine output</li><li>Chest pain</li><li>Difficulty breathing</li><li>Unusual muscle movements</li></ul><p>(jerks, twitching)</p>"
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"summary": "It’s very important to treat actinic keratosis, as the mutations in the cells can lead to the development of squamous cell carcinomas and cancer. The fact is that actinic keratosis has a 10–30 percent chance of becoming, over a period of around ten years, a squamous cell carcinoma.",
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"value": "<p>Actinic keratosis is a precancerous lesion that can develop into a carcinoma. It normally appears in sun-exposed areas—as opposed to melanomas, which can appear anywhere on the skin.</p><p>It’s typically a patch of raw skin that looks a little like eczema, but instead of appearing in areas of flexure (such as behind the knees or elbows) it appears on the “roof ” of the body; the ears, nose, scalp (especially in people with fair skin and not much hair), the back of the arms, the back of the hands. Sometimes it’s not so visible—it might look normal, but feel somehow wrong—or it could be raised, scaly, non-healing, sometimes itchy or burning. When we see a skin lesion with these features, diagnosis can be relatively straightforward.</p><p>They’re very common in people who are frequently exposed to the sun— sailors, surfers, beach-lovers, pool-lovers. It’s typical in older men, but can occur early depending on the type of skin; especially with people who have many freckles or who were sunburned when they were a young child when the skin is comparatively weak. They don’t occur as broad rashes, but more like mushrooms— you might have two or three, four maximum, not very close together. On the scalp, however, there can be many. The interesting thing is that they can be mostly invisible, so the skin changes happen much earlier than when the effects can be seen visually.</p><p>It’s very important to treat this condition, as the mutations in the cells can lead to the development of squamous cell carcinomas and cancer. The fact is that actinic keratosis has a 10–30 percent chance of becoming, over a period of around ten years, a squamous cell carcinoma. So if we find it, we don’t give it a chance.</p><p>There are different strategies of treatment. One of the strategies is “kill on the spot.” You see the lesion and you freeze it or treat it with something that is destructive. Normally on this kind of lesion, it’s not necessary to do a biopsy, you don’t need to make a cut. But most skin clinics choose “destroy on sight.” It’s done repeatedly—once you have some, you have to go back after a few months to check for more.</p><p>There are also certain “field treatment” strategies using an immune stimulator called imiquimod. An alternative product is ingenol mebutate, which is derived from the plant Euphorbia peplus. These medicines burn the cancer cells via a direct chemical reaction. Imiquimod increases the skin’s immune awareness toward anything that is strange (and especially viral), which is why we use it to treat warts and cancer. When you put imiquimod on your body, if you have a healthy immune system, it triggers a very strong inflammatory reaction—not only in the lesions that you are treating, but also in the neighboring skin. The visual effect is very ugly, but it disappears after about a week or two and takes with it the existing lesions and any potential ones that are developing unseen. Finally, the skin is rejuvenated, and usually looks fresher and healthier than it did before, free of spots.</p><p>It’s good to examine your skin for anything that doesn’t heal, is pinky, scaly or scar-like. Actinic keratosis typically has volume or an atrophy; they can get discolored or have a whitish, spidery aspect. Any lesions like this that are raw and don’t heal should warrant a dermatological check-up. At the clinic, we can examine the skin and do a dermoscopic check to see if treatment is necessary.</p>"
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"title": "Dengue Fever in Vietnam",
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"value": "<p><i>MEDICAL ALERT: OCTOBER 2018</i></p><h3><b>Dengue Fever In Vietnam</b></h3><p>Dengue fever is a disease ranging from mild to severe caused by four related viruses spread by the Aedes mosquito. "Milder"dengue fever causes high fever, rash, severe headache, muscle and joint pain. More severe but much rarer forms of the disease—dengue hemorrhagic fever and dengue shock syndrome—can additionally cause severe bleeding, a sudden drop in blood pressure (shock) and even death (very rare).</p><p><br/></p><p><b>TREATMENT</b></p><p>If you have any signs or symptoms of dengue fever, please visit a Family Medical Practice medical center. We have the expertise to diagnose and manage this disease. We can perform specific blood tests to diagnose dengue fever and rule out other diseases that present in a similar fashion—such as malaria, influenza, leptospirosis and typhoid fever.</p><p>No specific treatment for dengue fever exists, and most people do recover—but supportive care is essential, so drink plenty of fluids to avoid dehydration from vomiting and high fever. Also take acetaminophen (Tylenol) or paracetamol to alleviate pain and reduce fever. Don't take aspirin or other non-steroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin) as these can increase the risk of bleeding complications.</p><p>If you do develop a severe form of the disease, you will need hospital care. Hospital treatment will involve supportive care as an in-patient with analgesics, intravenous (IV) fluid and electrolyte replacement, blood pressure monitoring and sometimes transfusion to replace blood loss (very rare).</p><p><b>PREVENTION</b></p><ul><li>The best way to avoid dengue fever is to avoid being bitten by mosquitoes that carry the disease. No vaccine is available yet to prevent dengue. To reduce your risk of mosquito bites, minimize your exposure to mosquitoes:</li><li>Schedule outdoor activities for times when this kind of mosquito is less prevalent. Avoid being outdoors at dawn, dusk and early evening, when more mosquitoes are about.</li><li>Wear long-sleeved shirts, long pants, socks and shoes.</li><li>Stay in air-conditioned or well-screened housing.</li><li>Check for sources of stagnant water near your house and garden—these are places where the mosquito that transmits dengue/zika/chikungunya fever breed and where the larvae live.</li><li>Use repellent with a 10–30% concentration of DEET on your skin. Choose the concentration based on the hours of protection you need—a 10% concentration of DEET is effective for about two hours; higher concentrations last longer.</li><li>Chemical repellents can be toxic, so use only the amount needed. Don't use DEET on the hands of young children or on infants under 2 months of age. Instead, cover your infant's stroller or playpen with mosquito netting when outside.</li></ul><p></p><p></p><p></p><p></p><p></p><p></p><p></p><hr/><p></p><hr/><p></p>"
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"title": "Traveler's Guide: Bites and Stings",
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"summary": "Most bites or stings are quite minor, causing little more than redness, itching, stinging or mild swelling. However, some are more severe and can result in an allergic reaction, which will require medical intervention.",
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"value": "<p>Every year, millions of people around the world are bitten or stung by insects, which account for a great majority of the species of animals on the planet. Most bites or stings are quite minor, causing little more than redness, itching, stinging or mild swelling. However, some are more severe and can result in an allergic reaction, which will require medical intervention.</p><p><b>The Difference Between a Bite and a Sting</b></p><p>When an insect bites you, it uses its mouth parts, while an insect that stings you uses a stinger on the back of its body. Biting insects like mosquitoes and ticks can infect you with diseases, while stinging insects such as wasps, bees and fire ants do not carry disease but can inject you with venom that can cause skin inflammation and sometimes a severe form of allergic reaction.</p><p><b>Mosquito Bites</b></p><p>Bites from mosquitoes produce small red itchy lumps on your skin, and some may develop into blisters. They may spread infections (malaria, dengue fever, chingkugunya and other diseases) and cause symptoms such as fever, chills, headaches, generalized bodyaches and rashes.</p><p><b>Sandfly Bites</b></p><p>Sand fly bites are painful and may cause small red bumps and blisters which can be incredibly itchy. If you give in to the itch, these bumps and blisters can become infected or cause skin inflammation, or dermatitis. </p><p><b>Tick Bites</b></p><p>Bites are not usually painful, and you may not even realize that you have been bitten.</p><p><b>Bedbug Bites</b></p><p>These develop into itchy red bumps that may be found in straight lines across the skin (neck, arms and legs).</p><p><b>Mite Bites</b></p><p>These cause very itchy red lumps on the skin and may cause scabies.</p><p><b>Spider Bites</b></p><p>Spider bites leave painful small puncture marks on the skin, causing redness and swelling. Some are venomous and may produce the following symptoms: nausea, vomiting and dizziness—and some may develop a severe form of allergic reaction.</p><p><b>Bee and Wasp Stings</b></p><p>Bee stings feel the same as a wasp sting. They are painful with redness and swelling. For bee stings, the sting is often left in the wound.</p><p><b>If You Get Stung/Bitten?</b></p><p>When stung, quickly remove the stinger if it’s still present in your skin. Don't pinch the sting with your fingers or tweezers, because you may spread the venom. Some may develop a severe form of allergic reaction and the following symptoms should be observed: difficulty breathing, swelling of face, eyelids, lips and ears, feeling dizzy, vomiting and diarrhea. You need to seek medical attention if these symptoms develop.</p><p>If being bitten by a tick that is still attached to your skin, remove it as soon as possible to reduce the risk of catching a disease. Wash your skin with water and soap afterwards, then apply an antiseptic cream to the skin around the bite. Ticks can cause Lyme disease, and some may develop the typical bull’s eye rash and symptoms such as fever with headaches. You need to seek medical attention if the following symptoms develop: persistent rashes that don’t improve with antihistamines or antiseptic creams, multiple red raised spots on your skin with swelling of the face, difficulty breathing, dizziness, vomiting or diarrhea, systemic symptoms like fever, generalised body aches, chills and bulls eye/target lesion on the skin.</p><p><b>Prevention</b></p><p>Take the following measures to help prevent bites and stings:</p><ul><li>Wear long-sleeved shirts, shoes and pants when going outside in the early morning, late afternoon and evenings. This includes long sleeve pants, long sleeve shirts with a collar and closed in shoes.</li><li>Keep foods and drinks covered when you are outside.</li><li>Apply insect repellant spray and use it according to directions, particularly when applying repellent to children. Focus on areas such as your ankles, neck and scalp.</li><li>Avoid stepping on ant mounds.</li><li>Avoid localities, especially at dawn and dusk. These are known to be frequented with biting midges. </li><li>When indoors, use ceiling and pedestal fans as a deterrent. Midges don’t like air currents and will potentially stay away. Mosquito coils also work reasonably well.</li></ul><p><b>Management</b></p><p>Insects bites produce an inflammatory reaction at the site of the bite, which presents for a few minutes. They cause itchiness with redness and sometimes swelling. The local reaction may subside in a few hours, while others persist and can become a nuisance or may lead to severe allergic reactions.</p><p>Management of local reactions includes the use of oral anti-histamines and some mild potency corticosteroid creams. For those who develop some systemic symptoms (fever, bodyaches, headaches, fatigue) and severe form of allergic reactions, immediate doctor’s consultation is recommended.</p><p>You are advised to maintain vigilance at all times. Bites or stings may be small, but they can be very dangerous when it comes to disease.</p><p></p><p><b><i>Doctor Christopher M. Suazon, Director, Danang Family Medical Practice</i></b></p>"
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"title": "Are you Bipolar?",
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"summary": "I have witnessed painful moments during treatment when someone recovering from a manic phase realises the implications and consequences of their behaviour. That is part of what makes bipolar such a tragic condition that can destroy people’s lives.",
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"value": "<p>Mental illness is often experienced in loneliness and isolation, no matter where in the world the sufferer lives.</p><p>In Vietnamese society, mental illness is still considered a shameful affliction, and most only think of the stereotyped psychiatric disorders, with sufferers behaving erratically and potentially dangerously. The stigma of mental illness can lead to additional suffering and can be an obstacle to people accessing timely and appropriate treatment.</p><p>With education, attitudes are changing, and many people are interested in getting more information, in promoting good mental health and in understanding specific psychiatric conditions.</p><p>Bipolar affective disorder is a severe mental illness, present across cultures. With skillful diagnosis and treatment, the clinical outcomes, prognosis and associated risks are significantly improved.</p><p>Locals and expatriates from different cultural backgrounds with bipolar affective disorder share a crucial challenge in Vietnam: they need to establish an effective system to manage their condition and minimise the chance of a relapse with less support than would be available in other parts of the globe.</p><p>Understanding a little about bipolar affective disorder, and sharing this knowledge with friends and family is an essential part of a system to manage one’s mental health. To really understand what this illness is and how to recognise it, we need to take a closer look at what we mean when we talk about bipolar.</p><h4><b>The Condition</b></h4><p>Bipolar affective disorder, once known as manic depression, is considered a severe mental illness, at times requiring a high level of care or even hospital treatment. At present there is no known cure, but symptoms can be managed with appropriate and timely treatment.</p><p>What typifies the disorder are relatively prolonged episodes of depression, mania (or in a less severe degree, hypomania) and normality. It tends to affect people in the prime of their lives, and is a significant cause of disability, associated with higher rates of divorce, employment issues, hospitalisations, imprisonment and suicide. Given its potentially devastating impact, it is a condition that warrants treatment. With appropriate medication, psychological interventions and a good awareness of the early signs of relapse, it can be managed well. But it is a chronic condition, so it will not simply disappear.</p><p>There are different types of bipolar affective disorder, the most common known as bipolar disorder types I and II.</p><p>Mania is a term representing a significant change in mental state. Somebody suffering from a manic episode can have spectacularly unusual behavior, involving, for example, reckless driving, public nudity, extreme sexual impropriety, unbridled spending of money, or physical violence. They may have racing thoughts, incoherent speech, hyperactivity, over-talkativeness, extreme impulsivity, no need to sleep, too much energy, euphoria, and may not measure the consequences of their actions. Some people will have psychotic symptoms such as hallucinations or delusional beliefs. There is often a need for hospital treatment, sometimes in special units with greater security if the risk to the patient or to others so requires.</p><p>I have witnessed painful moments during treatment when someone recovering from a manic phase realises the implications and consequences of their behaviour. That is part of what makes bipolar such a tragic condition that can destroy people’s lives.</p><p>In bipolar type I, these manic episodes are so severe that people cannot function normally when experiencing them. If one can still maintain a reasonable degree of functioning, then we are likely dealing with a hypomanic episode. People who are not familiar with one’s habits may not notice the departure from normal behaviour.</p><p>Hypomania is more characteristic of bipolar type II, although <i>depression</i> usually represents the greatest burden of the illness, with long depressive episodes and often delays in diagnosis, primarily due to non-recognition of hypomanic episodes, which can delay the correct treatment. The depressive phase is extremely debilitating, and it can drag on for month after nightmarish month.</p><h4><b>Treatment</b></h4><p>There are mainly three categories of pharmacological treatments available to sufferers of bipolar disorder: mood stabilisers, and on some occasions, antidepressants. There are also two periods of treatment: the acute treatment of an active episode; and the longer-term maintenance treatment primarily with mood stabilisers to prevent further episodes.</p><p>There are several treatment guidelines and protocols available, but an effective treatment plan needs to be individualised, taking into account the severity of the illness, the frequency and distribution of the episodes, the risks that those episodes carry and the support systems available to the person. In addition, psychological therapies of different modalities can be very important, especially in the depressive phases.</p><p>Although we still can’t talk of a cure for bipolar affective disorder, treatment is often effective and recovery is possible. I have seen several patients over the years who got their condition under control and went on to live fulfilling lives.</p><h4><b>Relapse Prevention</b></h4><p>In a chronic condition like bipolar affective disorder, it is important to recognise the early warning signs of a relapse, be it a depressive or manic one. I usually work with people with bipolar disorder and their families to create “wellbeing plans” that can help them take control of the disorder and manage the symptoms early, before they become a full-blown episode.</p><p>The idea is to empower the person to manage their condition by gaining awareness of how the condition manifests in their particular case, identifying subtle changes that may indicate their mental health is again at risk and designing an action plan that allows the person to remain in charge of their own mental health. For example, when someone starts to notice increased stress, irritability, or that it takes them longer to get to sleep, the plan reminds them of what remedial action to take, when to ask for help, who to contact, or when to get to a medical centre.</p><p>In a case of relapse, it is important that action is taken promptly. A wellbeing plan is a reminder, a tool to make sure that the patient is actively managing both their general mental health and the particular mental illness. By being informed and proactive, managing bipolar affective disorder can be a lot less daunting.</p><p></p><p><b>Dr. Miguel de Seixas, Psychiatrist, Family Medical Practice Ho Chi Minh City</b></p>"
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"summary": "It can be hard for a parent to know just when to start talking to their daughters about periods. The time when the period starts can be frightening for a girl, especially if it happens outside the home. In general, it’s a good idea to bring up the subject (in terms that hey would understand) at about the age of 9 to make sure they’re prepared for the big day.",
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"value": "<p><b>Start talking about menstruation to your daughter early and often</b></p><p>It can be hard for a parent to know just when to start talking to their daughters about periods. The time when the period starts can be frightening for a girl, especially if it happens outside the home. In general, it’s a good idea to bring up the subject (in terms that hey would understand) at about the age of 9 to make sure they’re prepared for the big day. If they have a friend who has started, that’s a very good opportunity to open a discussion; to say, “Hey, what do you think about that? What do you think is going to happen to you? Do you want to talk about it?” Using TV ads for sanitary pads or tampons can also be a good way to start a conversation. Or simply ask your daughter what she already knows.</p><p>Starting to have periods is a part of growing up for girls. Periods usually start to occur around the same time as other changes happen to the body, such as starting to develop breasts or to grow pubic or underarm hair. Most girls get their period between 12 and 13 years of age—however, it can be anywhere between 9 and 15, and in a small number of girls it can even start a bit earlier or a bit later. If a girl hasn’t started her period by the age of 16, then she should visit a doctor for a checkup. It doesn’t mean that anything is seriously wrong, it just means that we have to find out why. Some common reasons are stress, overexercising, under-eating, loss of weight, obesity, or a hormonal imbalance.</p><p><b>The Basics</b><br/>So what happens during a period? It’s the time of each month, for several days, where some blood will be discharged through the vagina from the lining of the womb following hormonal changes. The amount of blood that is lost varies between girls, although the heaviest blood flow is within the first few days.Bleeding can last from one to eight days, but on average five days is normal.</p><p>Prior to and during the period, some pain in the abdomen—period pain— is normal and common. Hormonal changes can also cause water retention in various parts of the body causing breast tenderness and slight enlargement, and the tummy may swell a little before a period. Headache, fatigue and mild mood changes can also be common—to have such symptoms before a period is normal. Sometimes the symptoms prior to periods can be more severe. This is then called “premenstrual syndrome” or “premenstrual tension.”</p><p>When such symptoms do happen and they start to interfere with a girl’s life—for example, she doesn’t want to go to school, she’s prevented from doing any exercise, or it’s affecting her general wellbeing or mental health—then it is certainly recommended to see a doctor, especially if her symptoms are really bad from the first-ever period or if each cycle is getting worse and worse .</p><p><b>Hormones</b><br/>Females have small organs called ovaries in the lower part of their tummy. The ovaries lie on either side of the uterus (womb). The ovaries start to produce female hormones in girls around puberty, which causes changes to the lining of the womb. This is what causes periods.</p><p>The menstrual cycle is the time between the start of one period and the start of the next one. The average length of a menstrual cycle is 28 days—however, anything between 24 and 35 days is common.</p><p>During the cycle, various changes occur in the body. The changes are controlled by chemical substances called hormones, which act like messengers.</p><p>There are two main female hormones that trigger periods—estrogen and progesterone, which change in amount during the cycle. In the first half of the cycle, estrogen increases and causes a thickening of the lining of the womb; it gets very thick and very red and boggy. Ovulation occurs about halfway through the cycle (about 14 days after the start of the period). Ovulation is a release of an egg into the fallopian tubes (the tubes connecting the ovaries to the womb). During the second half of the cycle, after ovulation, progesterone increases. Progesterone then causes a swelling of the wall of the womb so that it is ready to receive a fertilized egg. If the egg is not fertilized, the levels of progesterone and estrogen fall, and a sloughing/shedding of the wall of the womb occurs, and a new cycle begins.</p><p><b>Symptoms Relating to Periods</b><br/>In general, if a girl experiences a change from the usual pattern that lasts for several periods, it may be abnormal and she should see a doctor. Some common complications that can occur are painful periods, heavy periods, and irregular periods.</p><p><i>Irregular periods</i><br/>Irregular periods are common during the first 1–2 years of starting periods. Teenagers don’t usually produce an egg with each cycle (an “anovulatory cycle”) due to an imbalance of hormones.Because of that imbalance, eggs are not released, and the uterus breaks down outside the perfect 28-day cycle. Eventually, it all balances out, and you get the whole nice cycle of eggs being released at 14 days, just when the uterus is ready, and then if pregnancy does not occur, you shed everything at about 28 days.</p><p>If periods are still irregular after the first two years of starting, or if the girl has bleeding in between her periods, she should see a doctor.</p><p><i>Periods That Stop (Amenorrhea)</i><br/>Pregnancy is the most common reason for periods to stop. However, it is not uncommon to miss the odd period for no apparent reason. Apart from pregnancy, other causes of periods stopping include stress, losing weight, exercising too much and hormonal problems such as Polycystic Ovarian Syndrome (POS), or thyroid disease</p><p><i>Heavy Periods (Menorrhagia)</i><br/>This is common. Periods are considered heavy if they are affecting your life and causing problems. For practical purposes, a period is probably heavy if it causes flooding through to clothes or bedding, frequent changes of sanitary towels or tampons, the need to wear double pads, passing large blood clots, or restrictions to normal life activities because of the heavy bleeding.</p><p>Some causes of heavy periods are fibroids, infections, hormonal changes, blood clotting disorders (this should be especially considered in girls who have had heavy periods since menarche) and in many cases the cause is unknown.</p><p><i>Painful periods (Dysmenorrhoea) </i><br/>It’s common for girls to experience an ache in the lower abdomen, back and the tops of the legs, especially in the first few days of a period. Some girls have more pain than others. In most cases, the cause of the pain during periods is not clear. When the pain is severe enough to affect her day-to-day activities, she should see a doctor. While sometimes a cause is not found, some causes are infection, fibroids and endometriosis. The doctor will normally ask about any other associated symptoms such as fever or vaginal discharge.</p><p>One cause of painful periods is something called endometriosis, which is when some of the cells or tissue of the lining of the womb are found outside of the womb, such as in the fallopian tube, the ovaries; and sometimes they’re present in the peritoneal cavity, which is the mass of ligaments and tissues surrounding the womb and the ovaries. They can be tiny, little balls of cells and tissues, and they respond the same way as the lining of the uterus does to hormones. So if these little bunches of cells end up anywhere else, they can cause period-type pain. Sometimes endometriosis can cause heavy bleeding. After diagnosis of endometriosis a doctor will discuss several options for treatment.</p><p><b>TEEN MENSTRUATION FAQS</b></p><p><i>Is the menstruation the first manifestation of puberty?</i></p><p>Not necessarily. It could be pubic hair, underarm hair, body odor, or breast development—it’s different for different girls.</p><p><i>What is the proper age to wear a tampon?</i></p><p>You can start whenever you want, but many teenage girls are uncomfortable with them and they can take some getting you used to. It may be advisable to start out with sanitary pads, just to get used to the period first, and then moving onto tampons. Tampons come in different sizes and styles, so starting with the smallest one would be the most appropriate to get used to it Larger sizes can be used if your period is heavier or during the night. Sometimes you may like to mix and match- using tampons for swimming but pads at other times.</p><p><i>Are tampons more convenient to use than pads?</i></p><p>From a certain point of view, they can be more convenient—for example, if you wanted to go swimming you could use tampons as opposed to sanitary pads. Often girls find that in their first few days of a period, they prefer pads more than tampons, because they’re changing quite regularly, but this is just a preference. Some people prefer using pads for the first few days, and then when it slows down they can use tampons, which they can leave in for a few more hours, and it becomes a little easier. It’s about what’s right for you; there’s no right or wrong way.</p><p><i>Is pregnancy possible from the first period?</i></p><p>Yes it is possible, although, as discussed above, most girls do not always release an egg with each cycle in the first 1-2 years.</p><p><i>Can you get pregnant during your period?<br/></i>Although unlikely, it is possible to get pregnant by having sex during your period. Sperm can stay alive inside you for up to five days, so if you ovulate early and have a short menstrual cycle, then it is possible to become pregnant</p><p><i>Is depression a normal symptom of menstruation?<br/></i>Depression is not a normal symptom. Irritability and fatigue can be expected, but depression could be a sign of more serious premenstrual syndrome. You should see a doctor.</p><p></p><p><b>Dr. Olivia Wyatt - Internist, Family Medical Practice Ho Chi Minh City</b></p>"
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"id": 663,
"title": "Frightening Facts About Trampolines",
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"summary": "The use of trampolines can end up in injuries such as sprains, fractures of limbs, teeth and facial bones and even in serious head and spine injuries… the study found that patients are more likely to be male and the most severe injuries occur in children on average age of 13. It’s not surprising as this age group often try more dangerous jumps and flips, and tend to be more aggressive when sharing a trampoline with friends.",
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"value": "<p>Children and injuries often come hand in hand. Every child is bound to fall over or hurt themselves as they grow up, it’s an instrumental part of learning and developing a sense of awareness to the world around you.</p><p>Trips, scuffs and bruises are an inevitable part of childhood, unless you’re planning on surrounding your child in bubble wrap. These kinds of minor injuries can be patched up with a plaster and cuddle from a parent, but there are some more serious injuries that can be avoided altogether with a bit of sensibility.</p><h4><b>Head Bangers</b></h4><p>Bouncing up and down on a trampoline whilst on holiday, Theo, son of Jonny Edbrooke Director of AsiaLIFE, and his older and bigger friend mistimed their jumps. As his friend came down, Theo was hurled into the air, and his head was launched into the other child’s teeth. Gallons of blood and a quick trip to the emergency department ensued. In the hospital waiting room, Theo and his parents noticed a video warning of the dangers of trampolines.</p><p>Perhaps if the video had been seen before Theo and his friend were on the trampoline, their collision could have been avoided. But life doesn’t always work as smoothly as that.</p><p>Dr Jonathan Halevy, the medical director for the pediatric division at Family Medical Practice Ho Chi Minh City, says trampolines can be more dangerous than we realise.</p><h4><b>Call for Ban</b></h4><p>Interestingly, the American Academy of Pediatrics warns against the use of trampolines, at home or in parks, since they can cause serious injuries, he says. The American Medical Association is also in agreement, and believes that children should not use backyard trampolines, and the sale of trampolines for private recreational use should be stopped.“The use of trampolines can end up in injuries such as sprains, fractures of limbs, teeth and facial bones and even in serious head and spine injuries,” Dr Halevy says.</p><p>“A study published in 2016 found that injuries from trampoline parks are on the rise, since they have become so much more popular.“The study found that patients are more likely to be male and the most severe injuries occur in children on average age of 13. It’s not surprising as this age group often try more dangerous jumps and flips, and tend to be more aggressive when sharing a trampoline with friends.”</p><h4><b>Safety Equipment</b></h4><p>Evidently Theo’s injury is not uncommon among children using trampolines. Dr Halevy said if a parent still decides to allow their child to use a trampoline, they need to make sure the child wears adequate protective gear, including a helmet.</p><p>Further injuries can be avoided by making sure that the trampoline is secure, with a safety net and pads and that the trampoline is level with the ground level in case jumps are more horizontal than vertical. However, a study published by the American Medical Association in 1998 found that prevention strategies such as warning labels, public education, and adult supervision were inadequate to prevent trampoline-based injuries, as most of them occur in backyards, with adult supervision.</p><p>The main cause of injury in Theo’s case was the two friends bouncing on the trampoline at the same time. To avoid collision-based injuries, it is best to keep the trampoline to one child at a time.</p><p>Playgrounds are often another place where injuries occur. While it would be ridiculous to never let your child play on the swings or monkey bars, there are things you can do as parents to ensure your children are as safe as possible in these situations.</p><h4><b>Danger Danger Everywhere</b></h4><p>The US Department of Health and Human Services states that the most common injuries occur on monkey bars and climbing equipment in public playgrounds. Among those that are injured, children aged five to nine have the highest rates of visits to the emergency department. As a parent, there are a few things you can do without stopping the fun altogether. For equipment, such as monkey bars, checking that there is a soft material underneath such as wood chips, sand, or mulch to cushion your child if they fall. After all, monkey bars are a challenge to hold onto.</p><p>Another step is to read the signs on playground equipment, as they often state which ages it is designed for. It is best to let your child enjoy themselves on activities designed for their age, height or weight rather than put them at risk of injury by climbing up something much more difficult than their abilities can handle.</p><p>The US Department of Health and Human Services states that well-maintained playgrounds pose fewer risks to children, as they won’t have rusty or broken equipment. Checking that there are guardrails in good condition, and not rusting away, can also help to prevent falls.</p><p>While a grazed knee isn’t the end of the world, looking out for tree stumps, rocks or uneven surfaces that could pose a trip hazard, and pointing them out to your child can help. This makes your child more aware of their surroundings, and can provide you with peace of mind as they run around the park.</p><h4><b>Hydration</b></h4><p>When playing outdoors in high temperature, as is often the case here in Ho Chi Minh City, heat-related injuries or illness can occur. To mitigate this make sure your child stays hydrated, and is effectively covered from the sun during peak-times. This will help ensure they are less likely to suffer the effects of heat exhaustion.</p><p></p><p><b>Dr. Jonathan Halevy, Head of Pediatrics, Family Medical Practice Ho Chi Minh City</b></p>"
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"id": 591,
"title": "Baby’s First Test",
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"summary": "Newborn screening is important because affected babies do not show any problems at birth and look “normal.” By the time any symptoms appear, the baby’s development may already have been impaired.",
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"value": "<p>It’s sometimes said that “an ounce of prevention is worth a whole pound of cure.” Early identification of an illness or condition will almost certainly lead to better medical outcomes for a developing child. This is the essence of why newborn screening is so important—it is an opportunity to catch a problem in its earlier stages and identify it before it potentially gets worse or causes further complications.</p><p>Newborn screening has been around since the 1960s in Western countries. Due to technological advances throughout the years, the scope of this screening has expanded. In Vietnam, it has already been going on for a number of years, although the newborn screening center was only formally established in 2014.</p><p>Newborn screening is important because affected babies do not show any problems at birth and look “normal.” By the time any symptoms appear, the baby’s development may already have been impaired. Thus, newborn screening allows the conditions to be identified early. With early detection, the conditions can be treated or managed in most cases.</p><p>A standard screening involves a series of tests that are administered to newborn babies to identify illnesses that may cause a serious medical condition and could affect the child’s growth and development if left untreated. Because the test is performed before an individual has any observable symptoms, it allows for a condition to be identified and managed before any problem occurs.</p><p>It’s important for parents to understand that newborn screening DOES NOT diagnose an illness in itself—it is rather used to identify children who need further confirmatory tests. Children who test positive are referred to a pediatrician who will conduct an examination and make a diagnosis.</p><p>The usual procedure is to take a very small amount of blood from the heel of a newborn 24–48 hours after birth. The timing of the test is very important—doing it too early may decrease the sensitivity of the tests, and doing the test later after the newborn period may not be as accurate.</p><p>There is no universal format—different countries have different illnesses tested for under newborn screening programs. In Vietnam, public reports suggest that it is usually done as a matter of routine. There are a number of tests available (depending on the facility), but most of them come with a fee—whereas the government provides two free newborn screening tests to detect for Glucose-6-phosphate dehydrogenase (G6PD) deficiency and for congenital hypothyroidism in newborns. There are sometimes issues with parents being reluctant to have the test done, usually as a result of lack of knowledge or misinformation.</p><p>When a baby is lacking in the G6PD enzyme, they may develop bleeding and anemia if exposed to certain food or drugs. It’s very important to know if this is the case so a parent can avoid foods that will cause these symptoms. Congenital hypothyroidism is a condition resulting from a lack of thyroid hormones—if left untreated, it may lead to growth failure and intellectual impairment.</p><p>Some international hospitals in Vietnam offer a broader range of tests to check for more metabolic diseases. Likewise, a hearing screening is done prior to discharge—early identification and intervention of hearing loss can prevent severe psychosocial, educational, and speech delay. There is also a critical congenital heart disease screening that is usually performed during the first 24 hours of life. It’s a simple procedure and check of the baby’s O2 saturation (level of oxygen in the blood) with a probe. This test determines if there is any suspicion of a congenital heart disease, so that an early diagnosis can be made.</p><p>Common screening tests can include:</p><ul><li>Tandem Mass Spectrometry<ul><li>Fatty Acid Oxidation Disorders</li><li>Organic Acid Disorders</li><li>Amino Acid Disorders</li><li>Hyperalimentation</li><li>Medium Chain Triglyceride Oil Administration</li><li>Treatment with Benzoate, Pivalic Acid, or Valproic Acid</li><li>Liver Disease</li><li>Presence of EDTA Anticoagulants in blood specimen</li><li>Carnitine Uptake Deficiency</li></ul></li><li>Congenital Hypothyroidism (CH)</li><li>Galactosemia (GAL)</li><li>Congenital Adrenal Hyperplasia (CAH)</li><li>Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD)</li><li>Biotinidase Deficiency (BIOT)</li><li>Cystic Fibrosis (CF)</li><li>Sickle Cell Anemia (Hb S/S)</li><li>Sickle-C Disease (Hb S/C)</li><li>S-beta Thalassemia (Hb S/bTh)</li><li>Hb Variants (Var Hb)</li></ul><p>At Family Medical Practice, we have a comprehensive newborn screening package available in Hanoi, but this procedure is not usually requested in Ho Chi Minh City, although it can be arranged on request. Parents must remember that timing is critical, as the tests must be performed within 48 hours.</p><p></p><p><b><i>Dr. Agnes R. Viay</i></b> <b><i>- Pediatrician, Family Medical Practice Ho Chi Minh City</i></b></p>"
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"id": 696,
"title": "Ankle Sprains",
"slug": "ankle-sprains",
"slug_en": "ankle-sprains",
"slug_vi": "ankle-sprains",
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"post_date": "2018-07-23",
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"summary": "After twisting our ankle, the first thing we should do to relieve the pain and prevent more damage is to rest, keeping our foot elevated and applying ice for at least 10 minutes after covering the skin to avoid cold burns. We must visit a doctor as soon as possible to check if a fracture or any other major ligament injury is present.",
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"value": "<p>Twisting our ankles is a very common situation, especially when we are doing sports, using high heels, walking on the road or crossing the street. After a twist, our ankle will become painful and swollen and a purple mark or bruise might appear at the same side of the injured ligaments. This situation is medically known as an Ankle Sprain.</p><p>Ankle bones are supported by ligaments – resistant and flexible strings that protect our joints from unexpected or unnatural movements, keeping our bones in the right position. However, they can get lengthened, torn or broken if we overstretch them. Our ligaments have some special nerves inside acting like motion sensors to help our brain to control our balance and body posture.</p><p>After twisting our ankle, the first thing we should do to relieve the pain and prevent more damage is to rest, keeping our foot elevated and applying ice for at least 10 minutes after covering the skin to avoid cold burns. If someone nearby knows how to correctly apply a bandage, it might be helpful. However, we must visit a doctor as soon as possible to check if a fracture or any other major ligament injury is present.</p><p>If ligaments are seriously injured after a sprain this may lead to severe complications like subluxations, dislocations, consecutive sprains and fractures. Therefore, ankle sprains should not be underestimated. After the acute period, people could feel discomfort or instability while walking for long time or long distances, using the stairs, wearing high heels or practicing sports. This is the most common complication after a poorly treated Ankle Sprain and it is called Ankle Instability.</p><p>The appropriate orthopedic care for an ankle sprain includes an evaluation from a specialist, ankle X-rays to confirm the presence of fractures or serious ligament injuries, a soft or rigid immobilisation according to each case and a personalised therapy to reduce the swelling and to relieve the pain. Patients must be instructed to avoid stepping with the injured foot using a pair of crutches and to keep the foot elevated as much as possible. After one week, the ankle will be less swollen and painful and a second medical evaluation is necessary. Physical therapy is often required to improve our ligaments condition and to prevent ankle instability. </p><p>If an Ankle Instability is confirmed, then you will need additional image studies to evaluate your ligaments, such as ultrasound or Magnetic Resonance Image together with a dedicated and very specific Physical Therapy programme.</p><p>Sometimes, the injured ligaments may continue to hurt even after they have healed. In those cases, the application of a steroid injection therapy is recommended, a very simple procedure that can be carried out by the specialist in his own office.</p><p>In order to prevent ankle sprains while working out, remember to warm up well before training and to stretch enough at the end of every session. Be very careful on the roadsides and stairs when using high heels and try to prevent falls using closed shoes instead of sandals or flip flops. — <b>Family Medical Practice Vietnam</b></p><p></p><p><b><i>Dr. Andres Sosa - Orthopedic Surgeon, Family Medical Practice Hanoi</i></b></p>"
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"id": 700,
"title": "Helicobacter Pylori",
"slug": "helicobacter-pylori",
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"post_date": "2018-07-09",
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"summary": "Helicobacter pylori (H. pylori) is a bacteria that can infect and live in the stomach. It’s presence in the stomach has been linked with gastritis, stomach ulcer and stomach cancer. However, most of the people infected are not symptomatic and the bacteria does not cause any problems.",
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"value": "<p>Helicobacter pylori (<i>H. pylori</i>) is a bacteria that can infect and live in the stomach. It was identified for the first time in 1982. It’s presence in the stomach has been linked with gastritis, stomach ulcer and stomach cancer. However, most of the people infected with <i>H. Pylori</i> are not symptomatic and the bacteria does not cause any problems. The infection is more common in developing countries than in Western countries. This is usually a lifelong infection unless it is treated with medicines to eradicate the bacteria.</p><p><b>How do we catch H. pylori ?</b></p><p>The exact mechanism of transmission is not known with certainty. We probably catch it during childhood, from other child or family members. It is very rare to catch H. pylori as an adult, most of the people are infected during childhood. The bacteria stays in the stomach all the life if it is not treated. Possibilities of transmission include sharing food and utensils, contact with contaminated water, contact with vomit or stools from contaminated people.</p><p><b>How to prevent it?</b></p><p>Follow good hygiene practices. Wash hands with soap and water after going to the bathroom and before eating. Eat well washed and well cooked food. Drink water from a clean and safe source. Teach the children to do so.</p><p><b>What can</b> <b><i>H. pylori</i></b><b> do to our body?</b></p><p><i>H. pylori</i> bacteria can cause inflammation of the lining of the stomach. It can lead to chronic inflammation (gastritis), stomach ulcer and duodenum ulcer. An ulcer is a hole in the gut lining of the stomach or duodenum. <i>H. pylori</i> is the cause of the majority of the stomach and duodenum ulcers. Aspirin and non-steriodal anti-inflammatory drugs overuse can lead to ulcers. Indigestion (dyspepsia) can be caused by chronic inflammation and ulcers, secondary to <i>H. pylori</i> infection. Indigestion can have many other different origins, H. pylori is just one of them.</p><p>Some stomach cancers have been suspected to be caused by chronic inflammation and ulcers secondary to <i>H. pylori</i> infection.</p><p>Only 10 to 15 per cent of the people with <i>H. pylori</i> infection will develop symptoms or disease. Why some people will develop an ulcer or cancer and some others will not is not known yet.</p><p><b>How to be tested ?</b></p><p>Several tests are available for the diagnostic of <i>H. pylori</i> infection. One of them is a breath test. It analyses a sample of the breathing after drinking a liquid containing a substance called urea. To be accurate, the test must be performed after fasting and without having taken antibiotics and anti-acid/anti-ulcer drugs in the four previous weeks. It is simple and quick to perform.</p><p>Another possible test is a simple blood test, it will check for <i>H. pylori</i> antibodies and will say if there is an infection going on. <i>H. pylori</i> can also be detected in the stools, this test analyses a small portion of stool to look for proteins from the bacteria.</p><p>Finally, the presence of <i>H. pylori</i> can be checked during gastric endoscopy. The doctor will perform what is called a stomach biopsy, meaning taking a very small piece of the lining of the stomach for microscopic analysis.</p><p>To avoid false negative result, all those tests (except for the blood test) must be performed if the patient did not recently take anti-acid or antibiotics drugs, otherwise the test accuracy is not guaranteed.</p><p><b>Which treatment ?</b></p><p>Not everyone who is infected with <i>H. pylori</i> should be treated. Most of infected people do not have symptoms and their stomach is perfectly fine. Those people do not need treatment. For the ones with a gastritis, ulcer or a past history of ulcer, <i>H. pylori</i> should be eradicated. The reason is a successful treatment will promote the healing of the ulcer and will prevent recurrence.</p><p>The treatment include a combination of four drugs (three antibiotics and one anti-acid drug). The reason for drug combination is that it is reducing the risk of bacterial resistance to antibiotics and increase the chances for success. The duration of the treatment is usually 14 days. The possible side effects include nausea, bad taste in the mouth, diarrhea, rash and allergic reaction.</p><p>Others factors can play a role, for example smoking and drinking alcohol worsen ulcers and slow down healing. </p><p><b>After treatment</b></p><p>After a successful treatment, the risk of being reinfected is very low, the reason is most of infections occur during childhood. Children have a higher chance to get reinfected.</p><p>In a majority of people, <i>H. Pylori</i> infection does not cause any problem to the stomach. It could even contribute to the normal balance of the digestive system and have benefits for the body. That is why eradication with antibiotics is only indicated for symptomatic people.</p><p>It is usually not recommended to test all the family members if one of them is tested positive for <i>H. pylori</i> infection.— <b>Family Medical Practice</b></p><p><b><i>Dr. Mathieu Nalpas</i></b> <b><i>- Internist, Family Medical Practice Hanoi</i></b></p>"
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"id": 578,
"title": "What to do after an accident?",
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"post_date": "2018-07-07",
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"summary": "In a lot of cases, the driver who caused the accident won’t stop, especially if a foreigner is involved, because they fear they’ll be required to pay for expensive medical treatment. Public ambulances can also be quite slow, and the emergency team may not speak English. Many locals opt to take a taxi to a medical clinic rather than rely on the public ambulance.",
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"value": "<p><b>Barbara Adam</b> <b>and Yendy Tsang</b> <b>look into what to do after a traffic accident. Photo by</b> <b>Romain Garrigue.</b></p><p>Australian Sue Wise was riding home from work on a Thursday evening when she was clipped by a large box on the back of a motorbike that zoomed past her.</p><p>The next thing she knew, she was rolling along the road watching her motorbike slide ahead of her.</p><p>“Shocked and dazed, I sat on the road for a while,” Sue said. “Suddenly two guys were trying to get me up. The guy who hit me had stopped, looked at me, and left.”</p><p>Passersby helped Sue to the side of the road, where she realised she was bleeding from her mouth, she had a broken tooth and her hands and knees were badly grazed. Someone offered to give her a lift home, but Sue knew she needed medical attention.</p><p>She tried calling friends for help, but no one picked up. “I decided to go to Family Medical Practice, as it was relatively close,” she said. “The people around me hailed a taxi and started helping me get in. Then I remembered my motorbike.”</p><p>Someone told her that “a girl” would take her motorbike to the clinic but Sue only realised she didn’t have the girl’s details once the taxi had driven away.</p><p>“I arrived at Family Medical, walked inside and they put me into a wheelchair. Then a girl came in and handed me the keys to my bike and a parking card. I was taken to the examination room and I didn’t get her name.”</p><p>Sue admits she was very lucky in the aftermath of her accident, with people stopping and helping her. She never did get the name of the girl who helped or the driver who clipped her and drove off.</p><p>This story is one of the more positive accident stories you hear in Vietnam. No major injuries, and people offering to assist.</p><p>But what are you actually supposed to do when you’ve been involved in a traffic accident?</p><p>Vietnam’s National Traffic Safety Committee advises people to notify police about any accidents by calling 113. In the event of an injury, call 115. However, it’s not clear whether any emergency operators speak English.</p><h4><b>General Medical Number</b></h4><p>If you call 115, you should be prepared to tell the operator the number of victims, the type of injuries, your location and phone number. The operator will organise the nearest traffic police and medical facility to come and help.</p><p>The National Traffic Safety Committee recommends recording as much information as you can at the scene of the accident, including the name, phone number and address of everyone involved, and any witnesses. Take photos of the scene, and any damage to the vehicles.</p><p>It’s probably also worth taking a photo of the license plates of all vehicles involved, even though not every vehicle sale is registered with authorities, so you may only be able to track the original buyer.</p><p>If the police arrive, they should give you an accident information statement, which you can use to claim insurance.</p><p>So that’s the official advice, but the reality may be very different. In a lot of cases, the driver who caused the accident won’t stop, especially if a foreigner is involved, because they fear they’ll be required to pay for expensive medical treatment.</p><p>Public ambulances can also be quite slow, and the emergency team may not speak English. Many locals opt to take a taxi to a medical clinic rather than rely on the public ambulance. </p><h4><b>Private Ambulance Service</b></h4><p>Family Medical Practice also has an ambulance service, which can be summoned by calling *9999.</p><p>You can call the number for free advice on how to handle your medical emergency, or you can call for an ambulance.</p><p>A one-year subscription to the FMP ambulance service is VND575,000 per person a year. Non-subscribers can also get an ambulance service, but the fee ranges from $80 to $225. The ambulance will take you to the most reasonable hospital and clinic for your situation.</p>"
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"title": "HIV Testing and Treatment for an AIDS Free World",
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"summary": "There is strong evidence to show that if enough persons living with HIV know their status by being tested and if enough people get treated, the HIV epidemic could be stopped.",
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"value": "<p>The Human Immunodeficiency Virus (HIV) is spread through contaminated blood, unprotected sex, and from mother to child during pregnancy, delivery, or breastfeeding. Healthy skin and other bodily fluids like saliva and tears do not transmit HIV.</p><p>Six to 10 years after contamination and without treatment, HIV infection leads to AIDS and death by general failure of the immune system. Since antiretroviral therapy treatment became widely available in the late 90s, HIV has become a chronic infection. People on treatment do not die from AIDS anymore and are able to live with the virus for the rest of their lives. However, there is still no vaccine against the virus available today.</p><p>Since 1981, the HIV epidemic killed 36 million people around the world. In 2016, the total number of infected people stood at 36 million people, while 1.2 million died and 1.8 million were newly infected.</p><p>Despite these terrible numbers, there is hope for the near future. The end of HIV epidemic is possible to happen within the next few decades.</p><p>In 2011, Scientists from Switzerland showed that persons living with HIV who were taking effective antiretroviral therapy were not contagious for their sexual partner.</p><p>The so-called “treatment as prevention” concept became fundamental in the fight against HIV.</p><p>Therefore, a new consensus emerged – the more people living with HIV will take treatment, the less contagious they will become and the less new contaminations will occur. A maximum of people who are living with HIV and who ignore there status must be tested. If they know they are HIV positive they are more unlikely to continue risky behaviors such as unprotected sex and unsafe intravenous drug injection, and they can access treatment</p><p>There is strong evidence to show that if enough persons living with HIV know their status by being tested and if enough people get treated, the HIV epidemic could be stopped.</p><p>It is based on this new hope that international HIV expert institutions have developed a new model of its goals called the 90-90-90 programme.</p><p>The 90-90-90 programme aims to ensure that 90 per cent of people living with HIV are aware of their infection, 90 per cent of people who know about their infection are given treatment, and 90 per cent of individuals receiving treatment do not have detectable virus in their blood.</p><p>If these goals are reached, the proportion of HIV-positive individuals who cannot infect others would increase immensely and the current epidemic would then be stopped, in the same way that the measles epidemic in young children was stopped through vaccination. A number of cases would still persist, but the scourge of AIDS would come to an end.</p><p>Access to generalised HIV testing and treatment are fundamental in reaching that goal.</p><p>In Việt Nam, where 260,000 persons live with HIV, the virus has become a public health threat. In addition to that figure, there were 11,000 new infections and 7,800 AIDS-related death in the country in 2016. According to the Ministry of Health, AIDS is one of the top 10 causes of death in Việt Nam.</p><p>The majority of Vietnamese living with HIV are residents of large cities and mountainous areas. Drug use through injections is the main mode of transmission in Vietnam and the epidemic remains concentrated in some key population groups, including female sex workers, men who have sex with men, and people who inject drugs.</p><p>These population groups face strong stigma and discrimination from their families and society in general, making access to screening and treatment a tough challenge for them.</p><p>According to social research, recurrent barriers to HIV testing and treatment access in these populations include the dual stigmatisation of homosexuality, prostitution, and drug use with HIV/AIDS, as well as failure to protect patient confidentiality, difficulty for health providers to discuss certain issues such as sexual identity, lack of clear referral pathways and peer support, and low access to services in remote areas. In this context, HIV testing and disclosure of HIV status is often not an option for these persons.</p><p>In 2014, Việt Nam was the first country in Asia to adopt and commit to the 90-90-90 target. The Vietnamese government has set a target where 90 per cent of people living with HIV must know their status, 90 per cent of people who know their HIV-positive status must be on treatment and 90 per cent of people on treatment must have undetectable virus in their blood. </p><p>If this goal can finally be reached in the near future, it will mean the end of the HIV/AIDS epidemic in Việt Nam. — <b>Family Medical Practice</b></p><p></p><p><b><i>Dr. Mathieu Nalpas - Internist, Family Medical Practice Hanoi</i></b></p>"
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"title": "Preventing Deep Vein Thrombosis When Traveling",
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"summary": "Immobility is known to be one factor that can contribute to the formation of blood clots in the deep veins—so-called \"deep vein thrombosis” or DVT. Research has shown that DVT can result from prolonged immobility; for instance, during long-distance travel by car, bus, train or air.",
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"value": "<p>Immobility is known to be one factor that can contribute to the formation of blood clots in the deep veins—so-called “deep vein thrombosis” or DVT. Research has shown that DVT can result from prolonged immobility; for instance, during long-distance travel by car, bus, train or air.</p><p>Most cases of DVT occur in the legs (calf area), but they can also occur in other parts of the body such as the thigh and arms. Blood normally flows quickly through these veins, helped along by the movement of the muscles, which squeeze the veins and protect against clotting. Prolonged immobility, especially when seated, can lead to the pooling of blood in the legs, which in turn may cause swelling, stiffness and discomfort.</p><h2><b>Diagnosis and Treatment</b></h2><p>The risk of developing DVT when traveling is increased in the presence of other risk factors, including:</p><ul><li>Older age—the risk is greater every year after 50 years old.</li><li>Cancers—sufferers of metastatic cancers, acute leukemias and myeloma carry a greatest risk.</li><li>Obesity—increased risk begins at greater than 35 kg/m BMI.</li><li>Hormone treatments—all forms of exogenous estrogen (e.g. oral contraceptive pills, transcutaneous, vaginal ring, depot progestin injections, hormone replacement), with worst risk in the first months of therapy.</li><li>Genetic predisposition, personal and/or family history of DVT—patients with inherited thrombophilias are often unaware of their condition until diagnosed with their first DVT.</li><li>Certain diseases and conditions—such as varicose veins, chronic atrial fibrillation, inflammatory bowel disease, lupus erytematosus, heart failure, heart attack, arterial disease.</li><li>Pregnancy—increasing risk with each trimester due to the increase in the concentration of clotting factors in the blood.</li><li>Surgical operation—surgical procedures lasting longer than 60 minutes, such as abdominal, hip or leg surgeries.</li><li>Any illness or injury that causes immobility—such as those with leg fracture(s), patients who are admitted at the ICU (bedridden for over three days).</li><li>Smoking—this is not an independent risk factor, but it increases the risk of cancers and other co-morbidities, working synergistically with other risk factors such as the contraindication for estrogen oral contraceptive pill use.</li></ul><p>The combination of long-distance travel with one or more of these risks may increase the likelihood of developing a blood clot. It is advisable for travelers with one or more of these risk factors to seek specific medical advice from your doctor well before embarking on a transportation mode of four or more hours to protect your health.</p><h2><b>Signs and Symptoms of DVT</b></h2><p>It’s helpful to know the signs and symptoms so you can recognize them if you develop DVT. The following are the ones that occur in the affected part of the body (usually in one leg, above or below the knee):</p><ul><li>Swelling—one calf or thigh may be larger than the other.</li><li>Edema—when the swollen area is pressed with a finger, a depression may remain.</li><li>Swelling—along the vein of the leg.</li><li>Warmth—A feeling of increased warmth in the leg area that is swollen or painful.</li><li>Leg pain—which may increase when standing or walking.</li><li>Tenderness of the leg—which may be confined to one area.</li><li>Color— bluish or red change in leg skin color.</li></ul><h2><b>Reducing Risk while Traveling</b></h2><p>You can reduce your risk of DVT by taking the following steps:</p><ul><li>Keep hydrated by drinking plenty of fluids. Dehydration causes blood vessels to narrow and the blood to thicken, increasing the risk for DVT; reduce alcohol and coffee consumption, which both contribute to dehydration.</li><li>Walk around for five minutes every one or two hours: keep moving your legs to help the blood flow, even when waiting in the airport terminal.</li><li>Avoid crossing your legs.</li><li>Wear comfortable, loose-fitting clothing—consider wearing compression stockings, which put gentle pressure on the leg muscles If you’re at higher risk of getting DVT.</li><li>Do leg exercises while seated—stretch and move your legs frequently; try clenching and releasing your calves and thighs or lifting and lowering your heels with your toes on the floor.</li></ul><h2><b>Diagnosis and Treatment</b></h2><p>Sudden onset of chest pain, shortness of breath—these are serious symptoms that require medical attention right away. This can be a sign that a clot has broken loose and traveled to your lungs. This is called a Pulmonary Embolism (PE) which is a life-threatening condition.</p><p>Before seeing a doctor, what can you do?</p><ul><li>For symptom relief, apply a warm compress or heating pad on the affected leg to promote circulation and reduce pain.</li><li>Bed rest with legs elevated to reduce swelling.</li><li>Wear elastic support stockings to help increase the flow of blood from your legs.</li><li>Avoid rubbing or massaging the affected area (a clot could break loose).</li></ul><p>Specific treatment will be determined by your physician based on your history, her physical examination findings in conjunction with imaging studies, and laboratory test results taking into consideration your opinions or preferences and expectations for the course of the disease.</p><p></p><p><b>Dr. Hazel Gallardo-Paez, Internist, Family Medical Practice Danang</b></p>"
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"summary": "Zika has been linked to developing the neurological disorder Guillain-Barré syndrome, the potential health impacts among the pregnant population. Contracting the virus while expecting a child has serious birth defect implications, specifically to the brain and head.",
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"value": "<p>On a recent flight back from the US, I was bombarded with signs about the mosquito-transmission of the virus. News reports seem fewer and farther between than previous months, but recently an expat Facebook group in Vietnam posted three links, back-to-back, on the subject. As such, I have now adopted the delightful musk of DEET, and even carry an extra spray bottle in my purse.</p><p><b>Transmission</b></p><p>The virus is primarily spread through mosquitoes, technically only through the females of the Aedes specie of the hematophagous buzzers. It can also be transferred sexually. Most infected people show little or no symptoms, and may not even feel the need to visit the doctor. Rarely fatal, the most common symptoms include red eyes, skin rash, fever and pain in the joints. Overall the virus passes with mild ailments over the course of several days to a week. Currently there is no vaccine, but it is believed that after being infected, one is unlikely to contract the virus again.</p><p>Sounds mild? Well, it can be, when contained within a male population. Even still, Zika has been linked to developing the neurological disorder Guillain-Barré syndrome. Of note. however, are the potential health impacts among the pregnant population. Contracting the virus while expecting a child has serious birth defect implications, specifically to the brain and head.</p><p><b>Taking it Seriously</b><br/>Central and South America are currently the most concentrated zones for Zika. Between October 2013 and March 2014, more than 30,000 cases were estimated in French Polynesia, according to Dr Stephen Berger, an expert on infectious diseases. <i>Reuters</i> also reported that between February and April 2016, Brazil registered 91,387 likely cases of the virus. With first-ever human cases reported in 1952, the virus has most recently skyrocketed to the forefront of the media, grabbing more than its fair share of attention from the Center for Disease Control and Prevention (CDC), and the Pasteur Institute, largely due to the linked birth defects, specifically microcephaly. Brazil is the hardest hit, with 4,908 cases as of late April 2016, reports <i>Reuters</i>. By comparison, in the same month, Deputy Health Minister Nguyen Thanh Long confirmed the first two cases of the virus in Vietnam.</p><p>Much of the western hemisphere is fighting it on the front lines. US President Obama has proposed to Congress a US$1.9 billion be found for emergency funding to combat Zika. The Major League Baseball Association relocated its exhibition games due to take place in Puerto Rico after players expressed their fears over transmission of the virus (Puerto Rico has nearly 800 confirmed cases). Some nations are even considering pulling their Olympians from the summer Rio games, as the country’s populous southeast registered the most diagnoses of any region, with 35,505 likely cases according to <i>Reuters</i>. Others, like South Korea, have rolled out uniforms covering as much of the body as functionally possible, and include built-in repellant to dispel mosquitos.</p><p>While there is not yet an outbreak of Zika in Asia, the CDC does warn, “Zika virus will likely continue to spread to new areas.” Unfortunately, Vietnam’s trifecta of a dense population, sexual activity and sometimes less than hygienic practices, seem to offer a pretty easy in-road for the virus. This is, of course, pretty speculative. I spoke with Pediatrician Dr Serge Gradstein at Ho Chi Minh City’s Family Medical Practice…</p><p><b>Expert Advice</b><br/>Dr Gradstein met me outside the clinic in a maelstrom of bug spray. “It’s not news to have a few cases,” he tells me calmly. “We’re seeing and hearing a lot about the potential of the virus because of its strong concentration in Brazil and the associated cases of fetal defects. The eyes of the medical community are trained on Central and South America at the moment, not Asia.” I lower my spray can. It seems there have been only a handful of tested cases for the virus here in Ho Chi Minh City, and, perhaps, the clinics are happy for a much needed break from such viruses after last year’s outbreak of Dengue Fever (a reported 40,000 cases within the first nine months of 2015).</p><p>“The concern over Zika is relative to transmission in pregnant women,” adds Dr Gradstein. “While we don’t yet know how long after exposure someone can transmit the disease, the general rule is to keep a safety period of two months from exposure. The virus can live in semen for more than a month.”. He concludes our discussion with this advice: “If you are ever sick while pregnant, you must see a doctor, and be sure to avoid exposed areas while pregnant.” He’s not the only one saying this. The CDC and most embassies have such warnings, and will highly advise you travel or work elsewhere if planning to head into the mozzie’s den.</p><p><b>Dress Not to Impress</b><br/>The above information is all about what happens when you’ve contracted the virus, but an “ounce of prevention is worth a pound of cure”, said Benjamin Franklin. Avoiding transmission from an infected male during intercourse is easy – just wear a condom. If there wasn’t already enough reasons to wear one, Zika is another. All that’s left is the daunting task of avoiding mosquito bites.</p><p>Much of this is within our control: wear long sleeves and pants and use mosquito repellant that contains at least 20 percent DEET (or lemon and eucalyptus oil if you prefer an all-natural version). Shower regularly after excessive sweating – mosquitoes carrying Malaria are more drawn to those who have had sweat on their body for a day or two.</p><p>Some of this is, unfortunately, outside of our control. Mosquitoes are drawn to carbon dioxide emissions, which we all breathe out; some of us more than others, especially pregnant women or larger individuals. Additionally, a 2004 study revealed that type O blood types are 20 percent more likely to be bitten over type B, and even more likely than those with type A blood. Drinking beer in copious amounts is also linked to increased skeeter attention, either because of the increased body temperature or increased output of carbon dioxide while intoxicated.</p><p>Simply put, protect yourselves. In Vietnam it’s a bit of a watch-and-wait mentality, but you can still take all necessary precautions to be part of the prevention, not the transmission. </p><p></p><p><b>Dr. Serge Grainstein, Pediatrics, Family Medical Practice Ho Chi Minh City</b></p>"
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"value": "<p>COUNTING SHEEP</p><p></p><p>On Thursday May 31st, 2018, FMP's Head Pediatrician Dr. Jonathan Halevy will be addressing the Saigon International Mother Baby Association (SIMBA) community at the British International School and will be leading a discussion on the subject of proper sleep.</p><p>Sleep disorders are common in babies and even teenagers. It may have a significant impact on the development, behavior, learning and wellbeing of the child. We will discuss patterns of normal sleep, causes and prevention of sleeping disorders.</p><p>Attend our discussion to learn more about this crucial parenting issue.</p><p>⏰DATE: 31 MAY 2018<br/> TIME: 1.30–3.00 pm<br/> Registration Fee: VND100,000 (for charity)</p><p></p><p>LOCATION: Fundinotots room, L3, BIS Early Years and Infant Campus, 110 Thao Dien<br/>Visitors will need to bring ID, sign in with the guard and wear a visitors tag.<br/>Refreshments will be provided.</p><p>All simba parents, parents of children under 12 months and expecting parents are welcome to join.</p><p>Please contact our marketing department on marketing@vietnammedicalpractice.com to register early!</p><p>--- ---<br/> SIMBA aims to provide prenatal and postnatal advice, support and companionship in the early years of parenting to mothers and expecting parents. Spread the word, bring your babies for group play, and come to have fun together!</p><p>Joining SIMBA sessions costs just VND100,000 per family, which is contributed to a local charity selected by SIMBA moms at the end of each year. Light refreshments are provided.</p>"
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"value": "<p></p><p>FMP’s Head Pediatrician Dr. Jonathan Halevy presented a talk on NUTRITION AND FEEDING DISORDERS IN CHILDREN at the British International School’s Early Years and Infant Campus in Thao Dien yesterday. Held at FUNDINOTOTS, a comfortable and bright play environment setting with ample space for participants to join in the discussion, the talk was attended by a number of parents of the school, some of whom sought advice about their own children’s eating and dietary habits.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/NUTRITION_AND_FEEDING_DISORDERS_IN_CHILDREN__BIS_school_-_May_18_2018_8.jpg\" class=\"format-left\" /><p></p><p>Dr. Halevy’s discussion covered common eating disorders observed in children, opening the talk with a look at the problem of overfeeding and the potential for a child to suffer from obesity. He covered the various cultural and behavioral reasons why a child may develop an eating disorder, such as a refusal to eat. He presented a list of “Golden Rules for Better Feeding” to help parents encourage their children to eat better and enjoy the health benefits of eating well.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/NUTRITION_AND_FEEDING_DISORDERS_IN_CHILDREN__BIS_school_-_May_18_2018_3.jpg\" class=\"format-left\" /><p></p><p>The doctor also encouraged an awareness of food as the conduit for nutrition and the role that nutrition plays in a child’s early years of life. He led parents in a presentation on the nutritive value of different categories of food, as well as discussing related safety issues such as what kinds of food might present choking hazards to kids, urging parents to avoid feeding small children with food cut into large chunks or that are too soft and sticky to swallow safely.</p><p>The talk was well-received by parents who made light conversation with Dr. Jonathan at the end of the presentation, gaining further insights into these and related issues. On June the 6th, Dr. Halevy will present a further medical discussion on Basic First Aid for Young Children including Choking, which will also be held at Fundinotots.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/NUTRITION_AND_FEEDING_DISORDERS_IN_CHILDREN__BIS_school_-_May_18_2018.jpg\" class=\"format-left\" /><p></p><p>For more information, please contact our Marketing Dept. on (028) 3822 7848 or email marketing@vietnammedicalpractice.com.</p>"
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"value": "<p></p><p>At ISHCMC’s primary campus this morning, FMP doctors Agnes Viay and Anna Donovan presented an engaging discussion on FIRST AID FOR BABIES to a group of around 20 parents from the community of Saigon International Mother Baby Association (SIMBA). It was the first such presentation to be held at the school.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/First_Aid_for_babies_ISHCMC-_May_17_2018.jpg\" class=\"format-left\" /><p></p><p>Dr. Agnes led the group in a discussion of the signs and symptoms of choking in newborns, and how to properly administer back blows to clear a baby’s airways. FMP’s nurse from the the clinic was also present to demonstrate both this technique as well as how to perform CPR chest compressions on a baby-sized medical mannequin. Dr. Anna further illustrated these techniques and the circumstances under which they should be used, as well as other issues in emergency pediatric medicine such as the signs of anaphylaxis and the recovery position. Informative video presentations also served to familiarize parents with the subjects discussed.</p><p>After the talk, parents were given the opportunity to practice back blows and chest compressions on the mannequin under the supervision of the doctors.</p><p>The presentation was held in a relaxed setting on the school’s campus, with sufficient room for parents to sit with their babies while learning the medical information presented. While SIMBA gatherings are usually restricted to new and expecting mothers so as to put breastfeeding mothers at ease, on this occasion, fathers were also welcome to join the group and actively joined the discussion to learn the techniques that could equip them to save the lives of their children in the event of an unforeseen emergency.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/First_Aid_for_babies_ISHCMC-_May_17_2018_8.jpg\" class=\"format-left\" /><p></p><p>Please note that half-day first aid courses for children will be held on the 2nd of June (in English) and the 9th of June (in Vietnamese) at the FMP office at Diamond Plaza level 12. The course fee will be VND850,000/person.</p><p>For more information or registration, please email Family Medical Practice’s Marketing Dept.: marketing@vietnammedicalpractice.com or call (028) 3822 7848.</p>"
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"value": "<p><b>Learn about Helicobacter pylori, a bacteria that infects the stomachs of roughly 60 percent of the world’s adult population</b></p><p>Around 50 years ago, every doctor in the world believed that no bacteria could survive in such a hostile and acidic environment as the stomach. Even when pathologists and other doctors saw bacteria in stomach tissue samples, they presumed that those tissues were contaminated after removal. Eventually, two Australian doctors proved that there is a genus of bacteria— Helicobacter—that can survive in the stomach by neutralizing the acid around themselves with a special enzyme. This important discovery rightly won them the Nobel Prize, because it is now presumed that a very high proportion of stomach cancer is directly caused by Helicobacter pylori.</p><p>If you’re from a Western country and have lived most of your life there, you will probably never have come into contact with Helicobacter pylori. In those countries, cancer of the stomach is quite rare. If you’re living in Vietnam or Southeast Asia, your chances of being infected with this pathogen are greatly increased. This represents a significant problem, because most Westerners (as well as local Vietnamese people) have never heard of this threat and never get tested for it.</p><p>In my country, it is a well-known health concern. In Japan, about 80 percent of people over 80 have a Helicobacter pylori infection, and most likely they acquired it in their infancy from their mother, meaning they have carried this invader within them their entire lives. Accordingly, we have a very high prevalence of stomach cancer in Japan. Thanks to modern testing regimens and improved hygiene, fewer than 20 percent of people in their 20s have Helicobacter pylori.</p><p>So what does Helicobacter pylori do? Infected people are more likely to develop a peptic ulcer, which is an ulcer in the stomach or the duodenum, or stomach cancer. This doesn’t mean that you will surely develop an ulcer or cancer by having Helicobacter pylori. It just means that having this infection increases your risk. If you have a duodenal ulcer, there is a 90 percent chance that you have Helicobacter pylori. In addition, within a week or two after infection, you may experience minor discomfort or even severe stomach pain.</p><p>How do we find Helicobacter pylori? There are a variety of tests: blood, stool, breath, urine, and by running an endoscope. My professional opinion is that neither the stool nor the urine tests available in Vietnam are trustworthy. The blood tests are reasonably accurate, but the catch with those is that you can’t use them to evaluate the success or failure of eradication, because it takes the blood more than a year to change after the infection is gone. The breath test is the least invasive and most accurate test for Helicobacter pylori, however it will not work if you are taking specific medications.</p><p>If you have Helicobacter pylori, you should certainly eradicate it, in the same way as you would any parasite in your body. There is nothing good about having Helicobacter pylori. Eradication is relatively simple; you merely take a combination of antibiotics. However, being such resilient creatures, it takes at least two antibiotics to get rid of them, with supplemental acid medicine to control the method. Even so, the success rate is only about 70 percent. So after the eradication attempt, we must check again to see if you still have Helicobacter pylori or not. If the attempt was unsuccessful, we have to try a different regime, another combination of drugs.</p><p>Our clinic is the proud owner of a stateof-the-art BreathID breath test machine of the sort rarely seen outside of a large external laboratory. You don’t have to draw blood; there’s no pain—you just blow into a couple of bags before and after drinking a special agent that reacts with Helicobacter pylori, and then you can get the result immediately. Everyone concerned about their exposure to Helicobacter pylori should take this simple test, especially if you have had symptoms of abdominal pain or discomfort.</p><p>After eradication, you should also undergo an endoscopy. The reason for this is that we need to assess how much accumulated damage you have sustained to the stomach lining, and whether or not you are already in a high-risk category for stomach cancer or have already developed it. In my country, it is considered a malpractice to eradicate Helicobacter pylori without running an endoscopy.</p><p>By looking at the stomach lining through the endoscope, you can see if blood vessels are visible through the lining of the stomach, indicating some degree of atrophy or thinning. In more advanced cases, you can see strange growths—if you take cell samples from these areas, they look like cells from the intestine. These growths can be benign, but when they cross the border into malignancy, that is cancer. In the early stages we can remove it by endoscope, but at certain depths, it has to be a surgical operation.</p><p>In my country, we can now decrease the incidence of stomach cancer significantly—probably, we are already doing so. Local people and Westerners who are living long-term in Asia should at least know that Helicobacter pylori is a risk and consider testing. Those from Western countries wouldn’t even have to worry about this at home, but by living here, they have a different risk.</p><p><b>Dr. Masato Okuda - Internist, Family Medical Practice HCMC</b></p><p><b>Dr. Masato Okuda</b> joined Family Medical Practice in 2015. He is a graduate of Okayama University Medical School in Japan, where his appreciation for the rapid diagnosis and treatment that endoscopy offers led him to a specialty in gastroenterology.</p>"
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"value": "<p></p><p>Earlier this week, FMP convened a SEMINAR FOR INTERNATIONAL SCHOOLS at the Hotel des Arts, featuring presentations from our founder Dr. Rafi Kot; Business Development Director Mr. Ian Wilson; Head Pediatrician Dr. Jonathan Halevy; psychiatrist Dr. Miguel De Seixas, and road safety advocate Roy Eliezer. We were delighted to note that over 70 people participated in our clinic’s outreach.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Seminar_For_International_school_by_Dr_Rafi_hotel_des_arts_-_April_13_20_68AFZNF.jpg\" class=\"format-left\" /><p></p><p>After a welcome address that touched on the incredible changes Dr. Rafi has seen in Vietnam’s medical industry over his three decades here, Dr. Jonathan Halevy led the room with his presentation on “The School Nurse: A First Responder” which covered several likely areas of concern in the schoolyard—including the role of school nurses as first responders and new standards for OTC medications as well as protocols in specific medical situations such as managing allergies and asthma, teen issues and child abuse.</p><p>Following Dr. Jonathan, Dr. Miguel De Seixas spoke on the psychological challenges of being an international student, also addressing the lack of systemic support in Vietnam for people suffering from poor mental health—and the need for proactive support from the community of international schools to help ensure early recognition and treatment of mental illnesses such as ADHD, bipolar disorder, social pressure, stress and depression.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Seminar_For_International_school_by_Dr_Rafi_hotel_des_arts_-_April_13_20_Vw3y5Ca.jpg\" class=\"format-left\" /><p></p><p>In addition to the sessions presented by the doctors, Mr. Roy Ben Eliezer of the Interdisciplinary Center for Road Safety addressed the audience on the importance of safety for student pedestrians, cyclists, motorbike and car drivers on Vietnam’s perilous roads.</p><p>Rounding the session out, our Clinical Director Mr. Ian Wilson reintroduced the vital and lifesaving *9999 service to the audience, reminding them of our multilingual state-of-the-art service.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Seminar_For_International_school_by_Dr_Rafi_hotel_des_arts_-_April_13_20_oANAaib.jpg\" class=\"format-left\" /><p></p><p>During both the Q&A session and in our internal discussions later, it became apparent just how prevalent the need that schools in the community have for accurate and up-to-date medical information from dedicated professionals. As such, Family Medical Practice will be commencing a SCHOOL OUTREACH INITIATIVE designed to provide crucial and potentially life-saving advice to nurses, faculty and administrators (as well as directly to students themselves and their parents) at schools all around the city.</p><p>We welcome any enquiries into this initiative from schools around the city.</p><p></p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Seminar_For_International_school_by_Dr_Rafi_hotel_des_arts_-_April_13_20_mpAn2Qz.jpg\" class=\"format-left\" /><p></p><p>For more information, please contact Marketing at marketing@vietnammedicalpractice.com or call (028)3822-7848</p><p>--Family Medical Practice: <a href=\"https://www.vietnammedicalpractice.com/?fbclid=IwAR3oC__Kqcnp456iVrIat1ykLmIQYWmKE855JeTLe1FkLXypYIaWA6lWmag\">https://www.vietnammedicalpractice.com/</a></p>"
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"value": "<p>Humans are born with 270 bones. By the time we become adults, we only have 206 bones left because some of the bones join as we grow. Bones support and protect the organs in our body, produce blood cells, store minerals and allow our muscles and joints to move.</p><p>Our bone is alive and can repair itself if it is broken, a slow process that usually takes three weeks. Bones can get larger and stronger with exercise and smaller and weaker if we do not exercise enough.</p><p>Bones, muscles, ligaments, cartilages and joints together make us move, and movement is essential for life. All these elements work as a team called the “Musculoskeletal System”.</p><p><b>Who is an orthopedic surgeon?</b></p><p>Orthopedic surgeons are specialised doctors who treat musculoskeletal (bones, joints, ligaments or muscles) problems in adults and children. All orthopedic surgeons must finish six to seven years of medical school and then complete four to five years of residency (on-the-job) training in a hospital. After their residency, some surgeons complete one or two additional years of sub-specialty training (fellowship), among many other courses and academic programmes. On an average, they invest at least 12-15 years of their life improving their knowledge and skills to offer the best care to their patients.</p><p><b>When should I take my child to an orthopedic surgeon?</b></p><p>Orthopedic surgeons diagnose and treat a variety of problems with the arms, legs and spine. Problems in walking, crooked limbs, legs of different lengths, curves in the spine, broken bones, bone/joint infections or tumors and birth defects of the hands and feet are some examples of the conditions that may require an orthopedic surgeon.</p><p>Children with complex pediatric problems, such as developmental delay, skeletal dysplasias or other syndromes, are usually best managed by a multidisciplinary medical and surgical team.</p><p><b>Why does my child need a specialist?</b></p><p>Children are not small adults. Their growing bones pose different challenges than those of adults. Sometimes, what looks like a problem in a child is just a variation that the child will outgrow over time. Some common pediatric problems do not even occur in adults. Orthopedic surgeons, their offices and support staff are all equipped to deal with children and families to create a comfortable, patient-focused and family-friendly environment.</p><p><b>What are the most common orthopedic conditions that parents should be aware of?</b></p><p>Taking care of a child is not just about giving love, feeding him/her well and providing education, but also about preventing injuries and diseases. Orthopedic surgeons are prepared for early diagnosis. They can treat problems that might affect the musculoskeletal system of your child and give advice regarding your concerns.</p><p>An orthopedic surgeon must keep in mind the following screening protocols:</p><p><b>Hip Development Dysplasia (HDD):</b> All newborns should be examined by a pediatrician and referred to an orthopedic surgeon if HDD is suspected or if high risk factors are present. The specialist will check both the hips for signs and symptoms of dislocation. On the 28th day of the baby’s birth, a hip ultrasound must be done to confirm the diagnosis. If the child is one to three months old, a pelvic X-ray is mandatory. </p><p><b>Flat feet:</b> A common concern of many parents is the plantar arch formation. Flat feet is a condition considered normal in children under two. The pediatrician will refer grown-up children with flat feet to an orthopedic surgeon for diagnosis and treatment.</p><p><b>Internal-Rotated Gait:</b> Many parents notice than their children often fall because their feet seems to be pointing in when they walk or run. This situation should be evaluated by a specialist in order to apply the necessary measures. </p><p><b>Scoliosis and Kyphosis:</b> Many children and teenagers develop a wrong posture during their growing-up years. This is sometimes related to abnormal spine curvatures. Therefore, all children and teenagers (eight to 16 years) with wrong posture should be evaluated by a specialist.</p><p></p><p><b><i>Dr. Andres Sosa - Orthopedic Surgeon, Family Medical Practice Hanoi</i></b></p>"
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"summary": "What is important to remeber is that rosacea is a chronic condition and it not ever going to go away. It’s only natural that patients will hope for a cure, but this is not realistic in this case. Realistically, patiens afflicted with rosacea will always be dealing with it to some degree, especially if they are living in tropical climates like this one.",
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"value": "<p>Diseases that affect the face can be very difficult to live with. They can interfere with people’s social lives and even limit the careers of those who need to present a pleasant appearance in public. One particular inflammatory infectious disease of the face affects 1–2% of the population and is predominant in white females. It is known as <i>rosacea</i>, a red irritation of the face that seemingly never goes away by itself.</p><p>We’ve had a working definition of inflammation since Roman times. Celsius described tissue as being inflamed when it is hot, red, swollen, and painful. That’s why we describe rosacea as an inflammatory disease, because it gives people a red face that gets redder with blushing, pimples, bumps, and in some cases, an increase in skin volume.</p><p>There are four types of rosacea, each of which have their own groups of symptoms. The most prevalent form has the longest name: <i>erythematotelangiectatic rosacea</i> – it’s less severe than the other forms, but it is quite disabling, as these people are always red-faced with visible networks of veins, and it feels hot, tense, itchy and even painful. It gets worse with alcohol, spicy food, heat, and exercise. So the average Anglo Saxon living in Saigon who has rosacea and goes to the gym every day, drinks with friends and eats spicy food will suffer terribly from this condition.</p><p>The second most common form is similar, but complicated by the presence of pimples. We call this <i>papulopustular rosacea</i>, because sufferers have red bumps, some of them with white heads, which are called pustules. They can appear all over the face, but typically spare the area around the eyes and the mouth.</p><p>The third form, <i>phymatous rosacea</i>, is the one that increases the volume of the tissue in the face – usually the nose, but also other parts such as the forehead, the chin, the cheeks, or the ears. This condition was seen on the famous actor Walter Matthau, who had what we call a “potato nose.” Interestingly, we also see this condition in some paintings of the 16th century. The fourth kind is very uncommon in normal consultations, <i>ocular rosacea</i>, which involves weepy red itchy eyes, more commonly diagnosed in ophthalmologist settings.</p><p>The first two types of rosacea are most frequently seen here. Rosacea is most common in white-skinned people, although I have seen it in Asian skin. It is so rare in Asian people that it is often misdiagnosed and treated with steroids, which worsens the condition. In general, it is more prevalent in women than in men.</p><p>Most doctors agree that rosacea appears to be a genetic condition that sparks an overreaction to natural irritants (such as a bacterial infection, radiation from light, or heat) in the form of chronic inflammation. Biopsies on skin with rosacea tend to reveal vessels with increased permeability and volume surrounded by cells (especially lymphocytes and mastocytes) that produce high quantities of proteins related to inflammation. We see the same combination of inflammatory cells with asthma and in allergic reactions.</p><p>In many people who suffer from rosacea, we find unusually high numbers of saprophytic dust mites (<i>Demodex folliculorum</i>), a small arthropod commonly found in hair follicles. It’s likely that the body’s reaction to this mite is also increased in these people.</p><p>There are two approaches to treating rosacea – cosmetic vasoconstrictors and anti-inflammatory medicines. With erythematotelangiectatic rosacea, we focus mainly on reducing the dilation of the vessels, which will make the face less red. The most common treatment is brimonidine; it’s a product that cuts off or closes the vessels, similar to what you might take when you have a cold. A second substance that is starting to prove successful against rosacea is the same medication we use for the nose – otrivin, which contains oxymetazoline, used as a gel or cream rubbed into the face. After applying it in the morning, two or three hours later you will have a much whiter and paler face, and this may last for the whole day.</p><p>The problem with this is that there may be a rebound effect. If you close the vessels, you can’t close them forever. At the end of the day, they will open again, and they may be angrier; and perhaps there will be a point when they will no longer respond to this kind of treatment. As of now, we don’t have enough experience to say if this can be a long term treatment.</p><p>Another option for reducing redness in the face is vascular laser or intense pulse light (IPL) treatments. These light sources emit wavelengths that mostly affect middle and small-sized vessels, which collapse and make the face appear paler. Some of these devices can also reduce the population of bacteria and mites.</p><p>We can medically treat the inflammation itself with antibiotics and antiseptics. One of the classic rosacea treatments is an antibiotic cream called metronidazole; there are other topical treatments and systemic treatments (pills), as well as combinations of both. Some natural plant extracts have also proved effective.</p><p>One of the best combination treatments is topical metronidazole and oral doxycycline, although there are many others. Treatments commonly prescribed for acne, such as azelaic acid cream on the skin or oral retinoids for severe cases, are also useful. The biggest therapeutic discovery in recent years has been that ivermectin, an antiparasitic and anti-inflammatory drug, is extremely effective against mites. It is used as a cream, but in Vietnam only oral treatments are available.</p><p>What is important to remember in all this is that rosacea is a chronic condition and is not ever going to go away. It’s only natural that patients will hope for a cure, but this is not realistic in this case. Realistically, patients afflicted with rosacea will always be dealing with it to some degree, especially if they are living in tropical climates like this one.</p><p>The good news is that with modern medicine, we can manage it effectively and make these patients feel much better. Just because it will always be there does not mean that people should resign themselves to accept it and not fight it. I have seen people who believe that this is part of them. I say to those people, “no – that is not YOU.” You can be different. We can do something for your rosacea. Jump from the cosmetic approach in non-professional hands and see a trained dermatologist, get a diagnosis so that we know what you have, and build a strategy for the short term and the long term that is good for you.</p>"
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"summary": "It’s important to know that STIs are common, especially in young people, and sometimes there are no symptoms, so a person can’t tell if they’re infected. Some people are shy to go to the clinic and may throw a few antibiotics to try to rid the infection. However, current scientific data is showing how this may not be the best idea given the increasing amount of antibiotic resistance we’re seeing.",
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"value": "<p>Sometimes you do the dirty. Sometimes you do the dirty with a lot of people. Sometimes you do the dirty with a lot of people, and it leaves a trace. It’s absolutely normal for this to happen, but you gotta make sure you get checked for STDs.<br/></p><p>If you’ve had multiple partners, unprotected sex, or haven’t been tested, you put yourself at risk for catching, keeping, and sharing STDs. With the cultural stigma in Vietnam around sex, people are reluctant to speak up and get consult when it comes to problems surrounding sexual activity.<br/></p><p>This stigma is further perpetuated with the government’s repressive policy towards people with these diseases. For instance, if you are a carrier of HIV, you may be refused a work visa in Vietnam, although I’ve yet to meet a person firsthand who’s experienced this. Throw in the sex industry and the issue of married persons living double lives, and we’re left with a whole lot of uncertainty about what’s going on below the belt.<br/></p><p>Data on STDs in Vietnam is limited and hard to come by, so it’s difficult to understand of the full story. Information I’ve come by group the country as a total, so it doesn’t split data by city vs countryside or locals vs expatriates, further making it harder to grasp the scope of this issue.<br/></p><p>What makes Vietnam a special case in this region is its rise in antibiotic resistance, likely from the ease of purchasing and taking over-the-counter antibiotics. Huân Đồng – currently a NIH-Fogarty Global Health Fellow researching antibiotic resistance at Hanoi Medical University and a medical student at Charles R Drew/David Geffen School of Medicine at UCLA – shares some of his research:<br/></p><p><i>“It’s important to know that STIs are common, especially in young people, and sometimes there are no symptoms, so a person can’t tell if they’re infected. Some STIs are treatable with simple antibiotics but it’s important to get tested to know which one to treat specifically. Some people are shy to go to the clinic and may throw a few antibiotics to try to rid the infection. However, current scientific data is showing how this may not be the best idea given the increasing amount of antibiotic resistance we’re seeing (and what I am studying here in Vietnam).”</i><br/></p><p>To complicate things further, some studies indicate that different medications may be needed for say chlamydia in a person’s throat versus genitals. With different doctors and pharmacists in Vietnam suggesting differing tests and treatment plans, “it’s important to get proper information and not treat syndromically even though antibiotics are available from the drug stores,” says Đồng.<br/></p><p>While you can get STD testing at local clinics for very cheap, they may not readily offer the best tests. Some private and international clinics will charge a lot more, especially for treatment, so it’s best to ask around for test options and pricing.</p>"
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"value": "<p></p><p>Last Thursday Family Medical Practice’s founder DR. RAFI KOT presented a fascinating talk at the first TEDx event held in Ho Chi Minh City for 2018, which was convened in the British International School theater in District 2.</p><p>In his presentation, “The Art of Cheating Death,” Dr. Rafi’s TEDx talk focused on the groundbreaking Vietnamese innovations that allowed his team to perform a complex medical evacuation that counts among the region’s first in its category, with local ingenuity surpassing the capacities of other nearby countries in terms of technical difficulty. No one in the region had ever undertaken such a move, and no one was willing to try, citing liability as a key concern.</p><p>“I sat with her father,” explained Dr. Rafi. “I explained to him the risks, and he said a phrase I will never forget: ‘Doctor, for you it is a risk. For me, it is a chance.’”</p><p>In this case, the risk was indeed critical. “How do you move a patient to another country, when she is simply unable to draw breath?” Dr. Rafi asked in his address. “But in an acute life and death situation where failure is not an option, ingenuity and innovation are paramount and it is amazing what kind of ideas you are able to come up with.”</p><p>“With just some scribbles on a notepad,” said Dr. Kot, “four hours later we had custom-built a rig that included a ventilator, a Dr. Lucas machine, two oxygen tanks, an ECMO monitor, a mounted mechanical heart and lung, four syringe pumps for ongoing medication, and thermo-blankets, all mounted on a custom built rig with its own working table.”</p><p>A forthright visionary in regional medical care, Tel Aviv native Dr. Rafi Kot is the C.E.O. and founder of FMP, first opening the practice in 1994 after running a number of health care projects for remote minority groups in the Vietnamese North. He has developed Family Medical Practice into one of the leading primary healthcare providers in Vietnam.</p><ul><li>About TEDx, x = independently organized event ▪<br/> In the spirit of ideas worth spreading, TEDx is a program of local, self-organized events that bring people together to share a TED-like experience. At a TEDx event, TED Talks video and live speakers combine to spark deep discussion and connection. These local, self-organized events are branded TEDx, where x = independently organized TED event. The TED Conference provides general guidance for the TEDx program, but individual TEDx events are self-organized. (Subject to certain rules and regulations.)</li><li>About TED ▪<br/> TED is a nonprofit organization devoted to Ideas Worth Spreading, usually in the form of short, powerful talks (18 minutes or fewer) delivered by today's leading thinkers and doers. Many of these talks are given at TED's annual conference in Vancouver, British Columbia, and made available, free, on <a href=\"https://l.facebook.com/l.php?u=http%3A%2F%2FTED.com%2F%3Ffbclid%3DIwAR1ckaUOR588wUCWnCKYHmz2S1uU0qejBYx3sEYKkFquhW2ZrkffdLXJRPs&h=AT0uCfYJQ4C5k8Blk5pQWBxCvPfqfDfsRBWTu5G1yTGMOopRK2bZS9LPybZwtls1AH_IUeUw9ZtvgDIypkXqSSuMuwBTU25e3rAt0DXs4yG4yV6OgwrWGroHxnUHTwe5KecZiJ8Q9NUtr8KN9vBRGI335b9K6z9cTMNnbDvCqju-MJkmoWQaNm9As4dtK2M9-7NoLJUN70uFOh9N3x-ewFdsSy-u4XxLBzF2_kS9PXokVB_IQXjXACYYOZ2HysIV_QTfN1D7fv2CnkDovAqEVHjJtj5SbTAa6Ytw5o0yhJtj0DaWuLzoRxpRRoz_Vj5tTjBV1R4qmogeGHwhVJM4QmiP1wf4dPPGC-zLYuHWISV9IiltYjWSk_3Fg5nqx2TkDxyjt5-iC_MSm6Ur62ztP09qUwEulXWHmZPabdznuFzheMKp9xJRZfKpwG7QITOUuPtupBq-AE2wBkr1aJyOumP8xoiE5YHU1ZROQJmmYGFha533g1yrRmkQ-AlK8xU8UlofdTmr9c4fftEgJqUn4u-PdzakaZniO8gkfa3oz11zzYWTAVxuFzYeu_7-cuP_PFevPiQijDwrwGWwQXnOn9ZsCdv6XRMKP7c7GH3XbSbZFNHIRNy62dobmK5p93lf0v1j-Uk\">TED.com.</a> TED speakers have included Bill Gates, Jane Goodall, Elizabeth Gilbert, Sir Richard Branson, Nandan Nilekani, Philippe Starck, Ngozi Okonjo-Iweala, Sal Khan and Daniel Kahneman.</li></ul><p>TED's open and free initiatives for spreading ideas include <a href=\"http://ted.com/?fbclid=IwAR22pMIRjsr8JM0Fk8x6brvmhkY5NXNI-8Fx1J5KjKVYhxJSrSqS9mBJNaI\">TED.com</a>, where new TED Talk videos are posted daily; the Open Translation Project, which provides subtitles and interactive transcripts as well as translations from thousands of volunteers worldwide; the educational initiative TED-Ed; the annual million-dollar TED Prize, which funds exceptional individuals with a "wish," or idea, to create change in the world; TEDx, which provides licenses to thousands of individuals and groups who host local, self-organized TED-style events around the world; and the TED Fellows program, which selects innovators from around the globe to amplify the impact of their remarkable projects and activities.</p><p>👉 Follow TED on Twitter at <a href=\"https://twitter.com/TEDTalks?fbclid=IwAR3b0WGnZsrhZCsQTvKGDf7n47cn3QLbHodKBut0asyhKM3N1IbPLSXj8q8\">http://twitter.com/TEDTalks</a>, on Facebook at <a href=\"https://www.facebook.com/TED/?__xts__%5B0%5D=68.ARBMZLGymT8vw-686xh7ef-fC5kCHsdFwiYdcxc6mR0CL_SnJTUXC6gntQcAsIDSfcBaHE252k7ku9yxoOamXTmlnLmLVtOF-b-99T8ORJVk6fS9LV9gNdiD_-l65jmtXTgHiGzmFB0qY_QvTS1wabO6svv82AfydfLQaNKbEWRZg4BSIf__SuFGjdB2J4iPlDjn0MkcD31QTshGJ4zlQNLAcvPbQl7D3pUVx48dQBXDflh9BfdttU8sJTcMRRE5Y8eg80JgIM85NkvAQEssyt5M1m_Fc2B3hDyTIj2NZlH4VTG3HPm_GPdoKc7NsDVNn0SEoLuBZVg_85GK4eIte2aUF7-Q&__xts__%5B1%5D=68.ARA1GCca8VIfDrjGzMuXDpZl12AQPTwUdG1ACp_hdJhp4884MaLFwTESuhnZCTaDX6wL9CSTkdEwOTD9eBr-a5nsVaP4AinFk35uKwGUynnFaNOhAfSj3ZaH5TdgJ5cUCB6rwiIlMTjBUyFanZB-YT9o7p5nm2yVKAlnJ6cOwmUydZtb1da9K2zIkPcgtHHd3kTrX4Lw_wImQpNHbnbU9D1TByoUAh6UDipa33_pKA3QzIj7R2NkJ8gSHD5RTuOJl4UbUL9loutvpsSyXVBS1dayWVGbTzm22K4SsQ0OXU8i7Y3BRV4WJI3MocQt0k0o6Nm6rgDIM9FZtzYcSWyhTrk-ZlS_&__tn__=K-R&eid=ARDDcaXEftzj9A0wkl55wumFgAksDadiH07EbaOlh6aSn3k9hrd-mk1QHaw5xjp4nGuQgngoTSZfI9v0&fref=mentions\">http://www.facebook.com/TED</a> or Instagram at <a href=\"https://instagram.com/ted?fbclid=IwAR3mmFgRt47CRnZQwhqzrQD-m1k0Pjrl87_qV2RrA2TqRnO2OdWkGi2l74Y\">https://instagram.com/ted</a>.</p>"
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"title": "Hair Loss in Ho Chi Minh City",
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"summary": "While it may be easy to jump to the conclusion that your hair loss is being caused by water pollutants, the truth is that around 50% of people will suffer some degree of pattern hair loss before turning 50.",
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"value": "<p>In an average day, people lose up to 100 hairs from their scalp. This is completely normal and in most cases the hairs grow back. But if your hair is not growing back at the normal rate, it is likely that you are beginning to experience Androgenic Alopecia – or put simply, ‘hair loss’. While it is completely natural to experience this as part of the ageing process it can be alarming when it happens prematurely.</p><p>Hair loss can be attributed to many causes: it can be hereditary; it can follow a period of excessive stress, for example a major surgery; serious illness; pregnancy or drastic weight loss; or it can be the result of a sudden change in diet or lifestyle. You can also lose your hair if you have certain diseases, such as thyroid problems, diabetes, or lupus. The weather and pollution can also have an impact on the health of one’s hair. But there is one other factor that people living or spending a lot of time in Vietnam question – and that is water quality.</p><p>Many expats or newcomers to Vietnam believe their sudden and unprecedented hair loss upon arrival is the consequence of the poor quality of water in which they are showering, with many claiming that changing one’s shower filter produces remarkable results. But the truth is there is no scientific evidence this is the case. Beyond impacting the quality of one’s hair, poor shower water quality has not been scientifically linked to the phenomenon of hair loss.</p><p>That being said, it must be acknowledged there are significant health concerns relating to Vietnam’s water quality. Water pollution in Vietnam is the serious result of rapid urbanisation without adequate environmental considerations. The Saigon-Dong Nai river system is a significant source of water for the 15 million people living in Ho Chi Minh City – an alarming fact considering the high levels of waste discharged into the basin, some 29,700 cubic meters a day in 2017, in fact. According to a study by the Institute for Environment and Resources, Dong Nai is severely polluted by discharge from residential areas, hospitals, mining companies, factories, waterway transport vessels, farms – even garbage dumps.</p><p>Furthermore “hard water”, which describes the type of water used by residential households across much of Ho Chi Minh City, contains large amounts of chemicals and metals such as magnesium, barium, calcium, silica and dissolved minerals, as well as organic micro-pollutants that can cause disruption to the reproductive system, central nervous system or immune system.</p><p>According to Family Medical Practice internist Dr. Ruben Martinez-Castejon, the main pollutant that can affect hair growth is arsenic, and the problem of arsenic poisoning was solved by health authorities many years ago.</p><p>“It was found that Red River water in Hanoi was rich in arsenic — tens of times higher than internationally accepted for drinking,” he said. “Now it is only those people drinking from natural sources – in other words, rural, untreated water – who could be at risk of arsenic exposure. Anyhow environmental arsenic influence on hair growth is something that takes a very long time to happen.”</p><p>Dr. Martinez-Castejon added that acute exposure to high quantities of thallium could also lead to acute and severe hair loss, but many other symptoms will occur before hair loss.</p><p>“Cadmium exposure also looks to be related to chronic telogen effluvium, and in such a case it would be good to check levels in your water supply,” he added. Overall, Dr. Martinez-Castejon concluded that the quality of water coming from household taps and showers in Ho Chi Minh had not been proven to affect hair loss, but rather hair quality.</p><p>“It’s true that there are hard and soft waters and that distilled waters will lead to a lower amount of calcium carbonate deposition on hair, which makes hair look thicker and nicer,” he said.</p><p>While it may be easy to jump to the conclusion that your hair loss is being caused by water pollutants, the truth is that around 50% of people will suffer some degree of pattern hair loss before turning 50, with the most common causes of hair loss experienced in Ho Chi Minh City being androgenic alopecia in men, female pattern hair loss, female androgenic alopecia, telogen effluvium acute and chronic, and alopecia areata, all of which are normally associated with infection, general autoimmune or rheumatic disease.</p><p>Hypothyroidism, ringworm of the scalp – even your haircare routine may be responsible for your hair loss, and it is important to rule these out before anything else.</p><p>Health professionals recommend consulting with your doctor to explore exactly why you are experiencing hair loss.</p><h4><b>WHAT KIND OF HAIR LOSS ARE YOU EXPERIENCING?</b></h4><p><b>Telogen effluvium</b>: rapid hair loss (by handfuls), normally occurs after severe weight loss, stress, sickness or post-pregnancy</p><p><b>Female pattern hair loss</b>: hair thins on sides and apex, slowly and progressively, supposedly a result of increased activity of an enzyme called 5-alpha reductase on the scalp.</p><p><b>Male or androgenic alopecia</b>: caused by the same as female pattern hair loss, but instead the front line and apex recedes.</p><p><b>Alopecia areata</b>: an autoimmune but not scarring alopecia and may be associated to other autoimmune diseases such as diabetes or thyroiditis. </p>"
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"title": "Influenza A",
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"value": "<p><i>MEDICAL ALERT: OCTOBER 2018</i></p><h2><b>Influenza A</b></h2><p>Influenza A is a serious and highly transmissible strain of the flu virus, which is more severe than the common cold. We advise any patient suffering from the symptoms of a respiratory illness to remain at home to avoid transmitting this virus to other people.<br/></p><p><b>WHAT IS INFLUENZA A?</b></p><p>Influenza A is the most virulent form of the flu. It is highly adaptable and constantly evolving. It can adapt to infect animals as well, including birds and swine, and can give rise to serious pandemics. In some cases, people infected with influenza A can develop pneumonia and other more serious conditions.<br/></p><p><b>WHAT ARE THE SYMPTOMS?</b></p><p>If you contract influenza A, you may suffer from:</p><ul><li>Fever and chills</li><li>Headache and muscle aches</li><li>Feeling tired and weak</li><li>Sneezing, and stuffy or runny nose</li><li>Sore throat and cough.</li></ul><p><b>WHAT IS THE RISK?</b></p><p>The current risk of catching influenza A in Ho Chi Minh City is very high. You should reduce contact with anyone manifesting cold symptoms. Thoroughly wash your hands as frequently as possible, and consider getting the most recent flu vaccination.<br/></p><p><b>WHAT SHOULD I DO IF I’M INFECTED?</b></p><p>If you contract influenza A, stay at home and get as much rest as possible. Drink plenty of fluids and take pain relief medication to relieve your symptoms if you experience any discomfort. Eat light, healthy meals and take plenty of fluids. If you have any chest pain, shortness of breath, dizziness or confusion, or vomiting, you should visit your doctor. Stay well away from children, elderly people, pregnant women, and people who live in countryside areas with less comprehensive medical care, as these groups are particularly susceptible to this disease.<br/></p><p><b>The new influenza vaccine will be available at our medical facilities in 1–2 weeks. Our supplier is waiting for</b></p><p><b>approval from the Ministry of Health.</b></p>"
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"summary": "Influenza can cause severe illness or other complications like otitis media, pneumonia and even death.",
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"value": "<p>Millions of people around the world get sick with the flu every year. In tropical regions like Vietnam, influenza may occur throughout the year, causing outbreaks to be more irregular than they are elsewhere.</p><p>Seasonal influenza (or “flu”) is an acute respiratory infection caused by influenza viruses which circulate in all parts of the world. It is characterized by a sudden onset of fever, headache, muscle and joint pain, malaise, sore throat, a runny nose and non-productive cough. The cough can be severe and can last two or more weeks. The disease is contagious during the 24 hours before the onset of symptoms.</p><p>Most people recover from fever and other symptoms within a week without requiring medical attention. However, influenza can cause severe illness or other complications like otitis media, pneumonia and even death.</p><p>The flu is a very contagious illness that spreads easily, especially in crowded areas such as schools; public places like markets; auditoriums and public transportation; and nursing homes. When an infected person coughs or sneezes, droplets containing viruses are dispersed into the air and can spread up to one meter, and infected persons nearby can breathe these droplets in. The virus can also be spread by hands contaminated with influenza viruses. You can also get the flu through personal contact (handshakes or hugs), saliva (kissing or sharing drinks), and by touching contaminated surfaces (doorknobs or faucets).</p><p>Bed rest and adequate fluid intake are important supportive measures. Control of fever with antipyretics is important. Specific therapy for influenza is offered to patients with severe and progressive infections, and to those with underlying medical conditions. It may also be given to shorten the duration of the illness, especially if the benefits outweigh the side effects of the drugs.</p><p>The most effective way to prevent the disease is vaccination. Safe and effective vaccines are available and have been used for more than 60 years. Immunity from vaccination wanes over time, so annual vaccination is recommended to protect against influenza.</p><p>Annual vaccination is recommended for:</p><ul><li>Pregnant women at any stage of pregnancy</li><li>Children aged between 6 months to 5 years</li><li>Elderly individuals (aged more than 65 years)</li><li>Individuals with chronic medical conditions</li><li>Health care workers.</li></ul><p>In addition to vaccination and antiviral treatment, public health management including personal protective measures to reduce the spread of infection is essential:</p><ul><li>Regular hand washing with proper drying of the hands</li><li>Good respiratory hygiene—covering mouth and nose when coughing or sneezing, using tissues and disposing of them correctly</li><li>Early self-isolation of those feeling unwell, feverish and having other symptoms of influenza</li><li>Avoiding close contact with sick people</li><li>Avoiding touching one’s eyes, nose or mouth</li><li>Avoid crowded places. By avoiding crowds during peak flu season, you reduce your chances of infection. And, if you’re sick, stay home for at least 24 hours after your fever subsides so that you lessen your chance of infecting others.</li></ul><p><b><i>Dr. Elvie Joy Atanque-Basa - Pediatrician, Family Medical Practice Danang</i></b></p>"
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"summary": "Lower back pain is a common issue during the two last trimesters of pregnancy. The female pelvic bone increases its diameter to allow the baby’s transit during labour.",
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"value": "<p>Lower back pain is a common issue during the two last trimesters of pregnancy. The female pelvic bone increases its diameter to allow the baby’s transit during labour. This process begins around the thirty fourth week. After birth, the pelvic ring closes, but usually does not reach its original size. This is the reason why many women with children notice a small increase in the size of their hips after pregnancy.</p><p>During the third trimester, the female pelvic bone opens like a hinge thanks to the sacroiliac joints that allow more space for the baby to descend and find a good position for delivery. This situation can cause severe pain on both sides of the lower back (sacroiliac joints) and the lower abdomen above the genitals (pubic area). This pain makes walking, sitting and sleeping very difficult.</p><p>It is important to say that this pelvic opening process is a normal biological change that prepares your body to have your baby in a natural way.</p><p><b>What can I do if I am pregnant and I have lower back pain?</b></p><p>Most painkillers are not recommended during pregnancy. Therefore, if you feel lower back pain, take a rest laying down on your left side for a couple of hours, meanwhile applying a warm bag or cushion on your lower back to relax the muscles. If this does not work, visit a doctor.</p><p>First, a gynecologist/obstetrician needs to ensure that everything is all right with you and your baby. If all is well, you can be referred to an orthopedic surgeon, who can offer a safe option to treat the pain.</p><p>In the meantime, try to keep a good posture. This is difficult because your body is different and heavier, but you need to avoid flexing your hips as much as possible, specifically when trying to pick something up from the floor. Keep your back straight, no matter if you are walking, sitting or sleeping.</p><p><b>What might the orthopaedic surgeon offer?</b></p><p>An orthopaedic surgeon can offer a safe, quick and minimally-invasive pain management therapy directly applied to both of your sacroiliac joints. This procedure is 100 per cent safe for your baby and also for you because the applied medicines will not reach your bloodstgream. It is also safe after delivery for breast-feeding mothers who feel pain.</p><p>During the procedure you will feel the same as with any other injection, like a blood test or vaccination. Pain relief can be immediate and it may last for 60 to 90 days on average. Taking painkillers will be unnecessary and you will feel more comfortable while walking, sleeping or resting until the end of your pregnancy. — <b>Family Medical Practice Vietnam</b></p><p></p><p><b><i>Dr. Andres Sosa</i></b> <b><i>- Orthopedic Surgeon, Family Medical Practice Hanoi</i></b></p>"
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"summary": "Vaccination will not prevent 100% of cases of otitis, but it will prevent some, and decrease the risk of cases that slip past its effects due to those resistant and virulent bacteria.",
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"value": "<p>Behind the eardrum is a space called the middle ear. It’s a resonating chamber, like the body of a violin or guitar. It amplifies sounds coming from the outside through the eardrum, and within it is a system of small bones that transmit sound signals to the inner ear and onward to the brain.</p><p>This space is connected to the nasopharynx (nasal cavity) by a canal, one of the spaces in the upper respiratory tract that can fill with mucus or pus whenever inflammation occurs. When this happens in the middle ear, the surrounding tissues become engorged by mucus or swelling, and this impairs drainage toward the nasal cavity—creating ideal conditions for bacteria to proliferate there and causing a condition we call otitis media.<br/></p><p>It’s very common in small children for a number of reasons. Some kids are always getting congested, and because of their smaller anatomy, the drainage canal is narrow and can block easily. The middle ear is not a sterile space, so if it fills with fluid, it’s easy for flora from the nasal and oral cavities to spread there and cause a serious infection, as well as a constant sensation of pressure and painful discomfort within the ear.<br/></p><p>There are a few types of bacteria that are generally responsible for this condition. The most dreaded of these is now a thing of the past: the Haemophilus influenzae bacteria, a very virulent organism that used to be an enormous problem in children’s medicine before the advent of the HIB vaccine—which is now given to almost every child, including kids in Vietnam.<br/></p><p>An efficient HIB vaccine was difficult to create. Haemophilus proteins alone cannot stimulate a strong immune response, so an ingenious vaccination method had to be used to jolt the body’s immunity into action. To do this, researchers tried combining Haemophilus with a protein issued from an unrelated pathogen like diphtheria, known to have a powerful impact on the immune system. The vaccine that resulted stimulated a protection that worked strongly against Haemophilus. Nowadays, Haemophilus infections have dropped to almost zero, so this vaccine was very successful.<br/></p><p>Unfortunately, vaccination has not been as effective against the second bacteria in the list that usually causes otitis media: pneumococcus. The problem with pneumococcus is that it has a lot of serotypes, which means that no single vaccine can work against all the varieties that exist. But there are around a dozen types that are more common, and the vaccines we have against these are actively sufficient.<br/></p><p>Vaccination is extremely important in fighting serious infections and also has a beneficial effect in reducing the incidence of otitis media, because it is a very good preventive measure against Haemophilus influenzae—and to some extent, also against pneumococcus. By contrast, treating the condition after it takes hold is quite problematic.<br/></p><p>The trouble with otitis is that it occurs within an enclosed space that is not well irrigated by blood vessels. Normally to treat a bacterial infection, we administer antibiotics that will be carried by the blood to the site of the infection. With otitis, because you don’t have blood vessels in the middle ear, you’ve got nothing that can deliver the medicine.<br/></p><p>It’s not enough to have a good antibiotic that kills the bacteria in the lab; you need one that you can give in higher doses without being toxic—such as antibiotics from the penicillin family. Derivates of penicillin (amoxycillin, cefuroxime, etc.) have a particularly safe profile that enables us to increase their dosages significantly without the risk of increased side effects, so we often prescribe these kinds of antibiotics for children. Pneumococcus, however, develops a resistance to penicillins quite easily. This sometimes makes treating otitis more difficult.<br/></p><p>First of all, we need to use high doses to address the low-grade resistance of the bacteria, or prescribe antibiotics that can overcome that resistance. If the simple antibiotics don’t work, perhaps we have to escalate and use a more potent medicine. But due to the problem of poor irrigation within the middle ear, even this treatment can fail. The pus and fluid within the middle ear will continue to build up and cause pain, discomfort and disorientation.<br/></p><p>Nature has a solution for this problem, in that there is a little triangular membrane in the eardrum that is a bit weaker than the rest, like a security door. It can perforate when the pressure builds inside the middle ear without causing functional damage, and then the pus can drain out and the tissue will eventually heal. It’s the body’s answer to how not to get an ear infection that can’t be controlled.<br/></p><p>Of course, when the child’s mother sees the pus draining out of the ear, she will certainly panic. In fact, the baby will feel much better at that point, because the pressure will immediately vanish. This is where the ENT doctor is sometimes necessary—when we have a child with unbearably painful otitis who is not responding to antibiotics, we may decide to do the perforation surgically. Generally once the pus has been removed, you don’t need any more antibiotics.<br/></p><p>The procedure hurts, but it lasts a fraction of a second, and after that there is no further pain. It’s painful because the exquisitely tender eardrum is particularly sensitive to pain, as a membrane that is supposed to feel delicate vibrations. After it’s over, thankfully, the pain is gone. The difficult thing is to get the child to accept the surgeon to get to the ear!<br/></p><p>Young children are at risk because of their anatomy; secondly, their immune system is immature, which is why they cannot mount a good immunological response on their own. After the age of two or three years, infection by Haemophilus influenzae and pneumococcus is naturally less of a problem. Older children and adults have a natural way to cope against these bacteria because of the maturation of their immune system. Children below the age of two have no good defense. This is why it’s important to vaccinate against HIB and pneumococcus early, and this will also protect your young child against otitis media. After a certain age, it’s not as important anymore.<br/></p><p>When the otitis is not treated, there are sometimes complications. The most serious of these is that the infection can spread to the brain and cause meningitis or a brain abscess. In the era of vaccines, antibiotics and good access to medical care, this should not happen. Thanks also to the perforation, it is a rare event. But sometimes it still does happen. Some particularly virulent bacteria can occasionally cause a very fast-spreading infection, where all the security systems, including the antibiotics, have no time to control the infection, and so it rapidly enters the brain. By that point, treatment becomes very complicated and an intensive care setting is necessary. The emergence of bacteria more resistant to antibiotics is another argument in favor of prevention via vaccines rather than a reliance on antibiotics.<br/></p><p>The bottom line is, it’s important to vaccinate. Vaccination will not prevent 100% of cases of otitis, but it will prevent some, and decrease the risk of cases that slip past its effects due to those resistant and virulent bacteria. As always, prevention is the most important way to fight diseases and their consequences.</p><p></p><p><b><i>Dr. Serge Gradstein - Pediatrician, Family Medical Practice Ho Chi Minh City</i></b></p><p><i>A French native with over three decades of experience in medicine,</i> <b><i>Dr. Serge Gradstein</i></b><i> received his MD from the Rene Descartes University Paris 5, and completed his residency in pediatrics at Israel’s Kaplan University.</i></p>"
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"value": "<p><b>What is dengue fever?</b></p><p>Dengue fever is an acute mosquito-borne viral infection. It is currently regarded as the most important mosquito-borne disease internationally. In its classic form, Dengue is a flu-like disease, though more severe. It is caused by a virus that is transmitted by the female Aedes aegypti mosquito and, to a lesser extent, its cousin Aedes albopictus. This mosquito also transmits chikungunya, yellow fever, and the Zika virus. At one time, dengue was considered an uncommon and relatively benign disease. In recent decades, however, that picture has changed dramatically. Today, epidemics of dengue are more frequent and virulent—even potentially fatal—and they affect larger numbers of people than ever. </p><p><b>What's the risk of me catching Dengue Fever in vietnam?</b></p><p>Dengue occurs year-round in Vietnam, however, as Dengue epidemics tend to be seasonal (with peak transmissions times occurring during warmer the rainy season), with Vietnam's coast covering more than 3,000 kilometres travellers intending to explore the length and breadth of the country during their vacation will most likely experience a rainy season somewhere along the way. For central Vietnam and Hoi An the warm monsoon months from June/July through December pose the greatest risk. Before setting out, check the I Am At Web site <a href=\"https://www.iamat.org/country/vietnam/risk/dengue\">(www.iamat.org) </a>for specifics on your destination. </p><p>On the whole, the risk of catching dengue while travelling in Vietnam is fairly low if you take all the correct precautions. Your risk, of course, depends on where you're going and how. Are you paddling up the Mekong Delta in a canoe or relaxing in a Four Seasons villa? </p><p><b>What preventative measures should I be taking?</b></p><p>For prevention, travellers should take meticulous measures to prevent mosquito bites during the daytime (the Dengue mosquito feeds from dawn to dusk). </p><p>The measures to follow:-</p><p>Wear light, breathable clothing in neutral colours </p><p>Covering exposed skin with mosquito repellents (20-30% DEET or 20% Picaridin). If you are using sunscreen, apply this first and wait for twenty minutes before applying a layer of mosquito repellant on top.</p><p>In holiday rentals and at hotels, be wary of water containers situated around dwellings - these form the perfect breeding grounds for the Dengue mosquito and should be thoroughly cleaned out and emptied weekly.</p><p>Check rooms and indoor living areas are well screened and utilise fans, air-conditioners and mosquito nets if you are taking a nap.</p><p><b>How long after exposure does the virus begin to show symptoms?</b></p><p>For those that suffer symptoms (some do not) they usually present themselves four to seven days after the bite. This is handy to know for an early diagnosis as Dengue is a disease with a wide array of clinical symptoms, which often go unrecognised or are misdiagnosed as other fever-causing tropical diseases. Early diagnosis enables the doctor to get the patient on the correct treatment course immediately and to monitor further symptoms (and act upon them) should the virus progress or worsen.</p><p><b>What are the symptoms of dengue?</b></p><p>Classic dengue fever begins with the sudden onset of fever, chills, a severe aching of the head, back, and extremities (termed “breakbone”) and retro-orbital pain. Others may lose their appetite, develop diarrhea and a red skin rash. The fever usually lasts 3–7 days, and may reach 41°C.</p><p><b>Should I see a doctor?</b></p><p>For tourists or international travelers, we highly recommend that they be aware of these symptoms and seek medical attention should they occur. Some people may not develop the classic dengue symptoms. I would advise everyone that once any fever persists for more than 48 hours, they have to seek medical consultation.</p><p>For those who have no immediate medical access, we highly advise them to keep themselves hydrated, take fever medications, and monitor for any signs of bleeding such as nosebleeds, gum bleeding, and skin rashes.</p><p><b>What is the treatment for dengue?</b></p><p>The majority of the population experience a self-limiting course of dengue that doesn’t develop into the severe forms (such as dengue hemorrhagic fever or dengue shock syndrome). Recovery takes time, with fatigue and exhaustion persisting after the fever has subsided.</p><p>There’s no specific antiviral treatment for dengue. Supportive treatment such as paracetamol tablets can help to control the fever and body aches; fluid replacement and bed rest is usually enough to see a patient through to recovery. No specific dietary change is necessary.</p><p><b>Can't I just get a vaccination?</b></p><p>In terms of the vaccine, Dengvaxia by Sanofi Pasteur is the first available dengue vaccine against all the four strains of dengue virus. It is approved in 10 Dengue endemic countries.</p><p></p><p><b><i>Doctor Christopher M. Suazon, Director, Danang Family Medical Practice</i></b></p>"
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"summary": "Many people around or after their fifties complain about knee pain that occurs apparently without reason and it is described as an uncomfortable sensation that comes and goes but not bad enough to visit a doctor.",
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"value": "<p>Many people around or after their fifties complain about knee pain that occurs apparently without reason and it is described as an uncomfortable sensation that comes and goes but not bad enough to visit a doctor.</p><p>Sometimes pain becomes aggressive, causing difficulties in daily activities like using the stairs, bending down or standing up from a chair. Most people will think that visiting a doctor is now necessary.</p><p>After consulting with a specialist and hearing some new words like Knee Osteoarthritis, people immediately wonder if pain will decrease somehow and if they could ever be able to move freely again. Under the appropriate orthopedic care the answer is “YES” for both questions.</p><p>Inside our knees, bones are covered by cartilage, a spongy soft tissue that protects bone surfaces from touching each other, acting like a shock absorber. Space between bones is filled by articular liquid, a fluid that serves as a lubricant, facilitating bone displacement during movement.</p><p>There are many circumstances in later life in which cartilage cannot support weigh bearing, articular liquid looses its lubricant properties, space between bones becomes narrow and bones begin touching each other with movement. This is known as initial knee osteoarthritis.</p><p>If nothing is done to improve this condition, repetitive rubbing will change bones surfaces, cartilage damage will continue and the local inflammatory response will be to overproduce bad quality articular liquid. This translates into symptoms such as severe pain, swelling, limited range of motion, tenderness and mild deformity of the knee.</p><p>The goal of medical treatment is to reduce pain, allowing the patient to get back to common activities but the outcome strongly depends on how early it is diagnosed and treated. Initial knee osteoarthritis (stage I) can be treated conservatively, improving lifestyle and using specific medication.</p><p>Mild knee osteoarthritis (stage II) may require intra-articular injections with steroids and local anesthetics, a very effective option to manage pain and improve movement. Injections are also useful to drain the excessive quantity of articular liquid and to replace it with a high-lubricant synthetic fluid to prevent additional cartilage damage. Some other treatment options like platelet rich plasma or stem cells matrix are commonly applied at this stage.</p><p>Advanced knee osteoarthritis (stage III) may be treated using arthroscopy techniques, a minimally invasive video-camera assisted procedure that allows the surgeon to check the joint from inside, repairing or removing the affected tissues. Severe knee osteoarthritis (stage IV) involves irreparable cartilage damage and the knee may need to be replaced using a joint prosthesis, a surgical procedure that is very safe and successful nowadays. </p><p>Lastly, it is very important to remark that treatment for all stages of knee osteoarthritis require dedicated physical therapy for better results.</p><p>If you have been feeling knee pain, the best thing you can do is to arrange an appointment with an orthopedic surgeon. Meanwhile, try applying coldpacks three times per day for 10 minutes but do not forget to use a cloth between the coldpack and your skin to avoid burns. Cold therapy will help to decrease inflammation and pain.</p><p>Avoid applying heat on a painful knee. Knee osteoarthritis is related to inflammatory conditions and a warm environment around the joint can only make things worse. Try also to avoid using expensive ointments and creams that will make you lose your time and money. — <b>Family Medical Practice Vietnam.</b></p><p></p><p><b><i>Dr. Andres Sosa - Orthopedic Surgeon, Family Medical Practice Hanoi</i></b></p>"
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"summary": "There are so many different types of cough medications that it can be quite confusing to choose the right one for you. As my mentor used to say: when you have so many medications to treat one symptom, it usually means that none of them really works.",
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"value": "<p><b>A simple guide to cough medications</b></p><p>When you walk into a pharmacy, you’ll notice that the majority of medications on the shelves are for cough. There are so many different types of cough medications that it can be quite confusing to choose the “right one” for you. As my mentor used to say: when you have so many medications to treat one symptom, it usually means that none of them really works.</p><p>Cough medications are a four-billiondollar-a-year industry in the US alone, so the urge to sell them is very high. But the simple truth that many doctors and pharmacists won’t tell you—and this may come as a surprise—is that most cough medications are completely ineffective.</p><p>As a pediatrician, when I prescribe medication to my little patients, I must always consider the benefits of the medication versus the possible side effects. If the potential harm is greater than the benefit, then this medication should not be given.</p><p>Cough can be a symptom of many different conditions and disorders. The most common of these is viral respiratory tract infection, causing cold or flu symptoms. Unfortunately, many children will be prescribed antibiotics for this condition, even though they have no effect on viruses.</p><p>“Post viral cough” is another common cause. Sometimes, a cough may last for several weeks after a viral infection. The cause is not clear, and usually the cough gradually improves with time.</p><p>Air pollution is one of the most common causes of chronic respiratory problems. Sadly, Saigon is one of the most polluted cities in the world—if you live in Saigon and you don’t cough, something is wrong with your lungs! In a similar vein, children of smoking parents suffer much more from respiratory problems, infections and asthma than others. If you or your spouse smoke, you are going to be seeing your pediatrician quite frequently.</p><p>Asthma is another common cause of chronic cough—more than 10 percent of children suffer from it, and it remains one of the most misdiagnosed conditions around, often mistaken for bronchitis, bronchiolitis or pneumonia. Many parents (and doctors) believe that asthma always comes with wheezing or breathing difficulties—actually, the most common symptom is just a cough that goes on and on, and when you listen to the child’s lungs they may be clear. Asthma does not respond to regular cough or allergy medications, and some may even worsen asthma (e.g. cough suppressants).</p><p><b>Cough Medications</b></p><p>Cough medications presumably work in different ways:</p><p>Expectorants: These are medications that increase the volume of water in the mucus (phlegm) and thus loosen it so it’s easier to cough out. The most common expectorant is guaifenesin. Unfortunately, studies have not proven that guaifenesin has any effect at all, while potential side effects of guaifenesin are urinary retention (difficulty to pee) and kidney stones.</p><p>Oral Decongestants: These are medications that constrict blood vessels in the nasal membranes and reduce the production of mucus. They include pseudoephedrine, which was commonly used in cough medications combinations and was very effective—however, since it is very easy to turn this chemical into the narcotic methamphetamine, it has been removed from the market in most countries.</p><p>Phenylephrine has replaced pseudoephedrine as a systemic decongestant. It has been used for years as a medication to raise blood pressure, administered by infusion into the vein. However, many studies have demonstrated no effect when taking this medication orally, since most of it breaks down in the stomach when swallowed. It also has the potential for serious side effects, including high blood pressure, low heart rate, loss of appetite, restlessness and difficulty falling asleep.</p><p>Nasal Decongestants: These include steroid sprays, which are very effective in reducing nasal congestion and relatively safe to use even for several weeks. The effect is built up over several days, so it takes time to achieve the maximum effect. It is usually given for 7–10 days. Nasonex spray is somewhat better, since it can be used once a day and there is no absorption into the blood.</p><p>These sprays are the first line in treating allergic rhinitis (hay fever), and are helpful in treating colds.</p><p>Oxymetazoline (Otrivin and similar) is a very effective spray decongestant, and it works fast. However, if used for more than 3–4 days, it can worsen congestion. Use of this spray must be stopped after four days, and not be used more than once a month.</p><p>Antihistamines: There are two types of antihistamine medication.</p><p>The “old” generation antihistamines have many side effects, including drying up the nose and mouth; causing drowsiness, sleepiness or irritability; behavioral problems; and increased heart rate. An overdose on these medications can cause a baby to suffer seizures, become comatose, reduce blood pressure, stop breathing, or even die. Babies below two years old are at higher risk, and these medications are not approved for them. They are used as cough medications, not because of their anti-allergic effect, but actually because of their side effects in reducing mucus and drying the membranes, as well as causing drowsiness and suppressing the cough reflex. Studies have not shown significant effects in improving “cold” symptoms in babies and little children; moreover, suppressing the cough and causing the mucus to become thicker can worsen asthma and should be avoided in asthmatic children.</p><p>The “new” generation antihistamines don’t have the side effects common to the old generation varieties. Therefore, they are only useful in coughs caused by allergic rhinitis. They don’t have any effect on coughs caused by colds, viral or bacterial infections, or asthma. Mucolytics: These are medications that break down chemical connections between proteins within the mucus, making it thinner, less sticky, and easier to expel. The most commonly used are Bisolvon (bromhexine); Mucomyst and Azimuc (acetylcysteine) and Halixol (ambroxol). Mucolytics have been shown to have some benefit in treating the common cold and bronchitis, and they are relatively safe. Acetylcysteine may cause spasms of the airways, so if a child has wheezing or asthma, it’s better to avoid this medication.</p><p>Ambroxol: This is an exceptional medication: besides its mucolytic action, a few studies have shown that it also has an antiviral effect, reducing the ability of certain viruses to multiply; an anaesthetic effect, giving relief from sore throat; and an antioxidant and anti-inflammatory effect, reducing tissue damage. It has even been shown to reduce injury to the lungs after heart surgery. It is the only cough medication that has been safely studied in little babies, and it has even been shown to be effective in reducing chronic lung disease in preterm babies. Recent studies suggest that Ambroxol may have a protective effect on brain cells, and this year a large study in the US is being conducted to see if ambroxol can improve brain function in Parkinson’s disease. Ambroxol is my personal choice of medication to treat cold and flu, and as a secondary treatment in pneumonia, sinusitis and asthma.</p><p>Herbal Medications: Among the many “herbal cough medications” you may find in local pharmacies (some are real and some are fake), only “Prospan” (ivy leaf extract) has been studied and shown to have some benefits in treating cough.</p><p><b>What to Avoid</b></p><p>There are some simple precautions that you should follow when taking cough medications or administering it to your children:</p><ol><li>Avoid any cough medication that has more than one ingredient (for example, Ameflu, Toplexil, Theralene, and so on).</li><li>Antihistamines (Aerius, Zyrtec Loratadine, Benadryl, Phenergan etc) are only effective against an allergy-induced cough. They are useless in respiratory infections or asthma.</li><li>Cough suppressants should be avoided in children (medications to “stop” the cough).</li><li>Salbutamol (Ventolin) is a specific medication for asthma. It has no effect in respiratory infections. If your child has asthma, he or she should receive this medication only by inhalation, not as a syrup! Oral treatment is not effective and may cause significant side effects such as tremors, fast heart rhythm, loss of appetite and more.</li><li>Singulair is another specific medication to treat asthma only. It has no effect on respiratory infections. It is only given to children with chronic asthma (not for an acute attack).</li></ol><p><b>What’s Safe</b></p><p>The following medicines may be used without a doctor’s prescription:</p><ol><li>Ambroxol (Halixol) is an excellent medication for productive cough of different causes. It has been proven to be effective and safe in many studies. It also has antiviral and anti-inflammatory effects.</li><li>Prospan (ivy leaf extract) is the only tested herbal medication for cough that has been shown to have benefits and is safe to use. It can be used for dry cough or in combination with Ambroxol.</li><li>Nasal washing (Sterimar, Physiomer, Xixat, Saline) is an efficient way to clean your baby’s nose and give relief. Proper nasal washing has been shown to improve infections and reduce the risk of developing sinusitis. (There is no need to use suction on your baby’s nose after proper washing).</li></ol><p>For any other medication, you should consult with your pediatrician first!</p><p></p><p><b>Dr. Jonathan Halevy, Head of Pediatrics, Family Medical Practice Ho Chi Minh City</b></p>"
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"summary": "The overuse and misuse of antibiotics has created a serious problem: bacteria are growing stronger and more resistant to modern medicine. Many drugs that are used to fight bacterial infections are no longer effective.",
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"value": "<p>Antibiotics are life-saving drugs that have been improving health outcomes since 1928, the year Alexander Fleming discovered penicillin. But the overuse and misuse of antibiotics has created a serious problem: bacteria are growing stronger and more resistant to modern medicine. Many drugs that are used to fight bacterial infections are no longer effective. While this is not a new problem, public consciousness seems to be waking up and wondering what to do next. </p><p>Multi-disciplinarian experts agree that antimicrobial resistance is a huge public health threat, and most nations have committed to developing strategies to combat it. The strategies listed by the American Centre for Disease Control include preventing infections, tracking drug-resistant infections, improving antibiotic prescription stewardship, and developing new drugs and diagnostic tests. However, implementing these strategies in developing countries has proven especially difficult. In emerging economies, there are usually fewer regulations, fewer well-trained medical practitioners, less-educated patients, and far fewer research studies. Vietnam is no exception.</p><p>In 2013, a situation analysis of the issue was undertaken by a group of researchers. Vietnam was chosen as a case-study due to its large population, high infectious disease burden, and relatively unrestricted access to medication.</p><p>The analysis explained that while market reforms have improved healthcare outcomes, access has been accompanied by excessive antibiotic use in hospitals and within the community. Their report, published in BMC Public Health, stated “Prescribing practices are poor and self-medication is common – often being the most affordable way to access healthcare. Many policies exist to regulate antibiotic use but enforcement is insufficient or lacking.”</p><p>The Ministry of Health has been keeping an eye on this matter for nearly a decade. In 2010, the MOH released a survey of 3,000 pharmacies which indicated 88% of antibiotics sold in cities and 91% of antibiotics sold in rural areas were not accompanied by a prescription.</p><p>The survey also reported that Amoxicillin, Cephalexin, and Azithromycin were the three antibiotics sold most often. Vietnamese health officials have been encouraging citizens to use antibiotics only when prescribed by a doctor and to cut down on the use of these drugs for livestock, but their suggestions fall short of inducing actual behavioral change.</p><p>The World Health Organisation has declared antimicrobial resistance a major problem in Southeast Asia and named Vietnam among the countries with the highest rate of antibiotic-resistant infections. Saigoneer reported in 2015 that resistance to carbapenems, the strongest form of antibiotics, had risen to 50%, and powerful third-generation cephalosporins had a resistance rate of 60%.</p><p>Dr Serge Gradstein, a pediatrician at Family Medical Practice, says the rates of resistance are only getting higher. “In countries like Vietnam, where there is a high demand from the population to get antibiotics coupled with the tendency of practitioners to prescribe them, it is no surprise that rates of bacterial resistances to antibiotics are huge. Add to this the weak implementation of regulations and the ability to get these drugs over-the-counter and you have a recipe for disaster. Ten times higher rates of resistance compared to northern Europe is probably an understatement.”</p><p>You don’t have to swear off antibiotics forever to keep yourself and your family safe, but it is wise to limit them. Developing healthy habits to prevent infections is the first goal. Make sure to wash your hands regularly, stay up-to-date with your vaccinations, and prevent the spread of disease through water and food. When you are sick, use antibiotics in the right way. Flus, colds, sore throats, many respiratory conditions, and bronchitis are all caused by viruses and untreatable with antibiotics. Unneeded antibiotics may lead to future infections that are drug-resistant.</p><p>Dr Gradstein hopes for a future where regulations are tighter and both doctors and patients are more educated. “The emphasis should be on prevention by restricting and regulating the use of antibiotics and by educating ourselves as doctors to prescribe the right antibiotic at the right dose for the right duration and only when absolutely necessary. Also, we have to educate our patients to use antibiotics only when prescribed – and even then should they question their doctors about the absolute necessity of it and not hesitate to be critical.”</p><p>Above all, stop self-diagnosing and see a doctor if you are ill. Doctors are there to help and have the necessary tools and knowledge to prescribe medicine if, and only if, it is necessary.</p><p></p><p><b>Dr Serge Gradstein - Pediatrician, Family Medical Practice Ho Chi Minh City</b></p>"
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"summary": "In Asia, many people view food additives as a major food threat. However, in terms of health risk, food additives come in at the end of the line, after food-borne microorganisms (like salmonella), inappropriate hygiene and eating habits, environmental containments and naturally occuring toxins.",
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"value": "<p>A student turned traveller turned up at the FMP clinic on Saturday night at 10.45pm with pains across the chest and an uncomfortable heartbeat; he'd spent the day with friends walking the streets of Hanoi looking at some of the old buildings and having great fun. He told the staff he'd had a few late nights with friends drinking the local beers and enjoying the new tasty food. He was having a really great time; but now he felt strange with pains and dizziness.</p><p><b>Welcome to Holiday Heart Syndrome!</b></p><p>You are on holiday, first time in Asia and there are always lots of reasons to celebrate and enjoy the holiday spirit. Unfortunately, it is often a time in which many people end up going to the emergency department because of too much holiday in the heart. We often see patients presenting themselves with atrial fibrillation or a very rapid abnormal heart rhythm in the upper heart chambers associated with symptoms of palpitations, shortness of breath, chest pain, light-headedness, stroke and heart failure.</p><p><b>Factors & Causes?</b></p><p>The honest answer is we don't fully know. Dehydration; change of temperature, new food, food additives, coffee, alcohol, MSG and tiredness are just the start of the contributing factors. Several factors may contribute to Holiday Heart syndrome. Over-Eating. Eating a large amount of food at one sitting causes the stomach and bowels to stretch and distend to accommodate it. This activates the nervous system in our body called the vagal or parasympathetic nervous system we use to digest food, rest and sleep. This nervous system, when activated, typically slows the heart rate. However, in people susceptible to atrial fibrillation, small areas in the upper chambers of the heart are actually triggered and beat very fast, leading to the abnormal heart rhythm. These areas often reside in the small veins that drain blood from the lungs into the left upper heart chamber. Salt Consumption: Our bodies need salt, but when we consume a lot of salt our bodies can retain fluid and our blood pressure can rise. In people with a history of high blood pressure, heart valve problems, or heart failure, the increase in blood pressure and higher amount of fluid in the body stretches the upper heart chambers, and atrial fibrillation develops. MSG & Food Additives: Sensitivity to particular food additives can also give you reactions like hives or diarrhoea. This doesn't mean all foods containing additives need to be automatically treated with suspicion, as foods with naturally occurring chemicals can also use issues. Many food additives occur naturally within foods people eat every day; for example, MSG is found naturally in Parmesan cheese, sardines and tomato. People with food allergies and intolerances are also often sensitive to chemicals found naturally in certain foods, such as nuts or shellfish. Everyday foods that contain natural MSG or glutamate include: corn, green peas, grapes, grape juice, mushrooms, Parmesan, Roquefort, tomatoes and tomato juice.</p><p><b>How to stay safe?</b></p><p>If you have a history of heart symptoms, go to the hospital early. Take everything in moderation and avoid excess. Try to minimize eating large quantities of food at once. Avoid adding salt to your diet and finally, if you know someone who is depressed, alone, or isolated during the holiday season, reach out and cheer them up, it may be the best thing you do for them. But there are worse things to fear than food additives. In Asia many people view food additives as a major food threat. However, in terms of health risk, food additives come in at the end of the fine, after food-borne microorganisms (like salmonella), inappropriate hygiene and eating habits, environmental contaminants and naturally occurring toxins.</p><p><b><i>Dr Michael Santos is an internist at Family Medical Practice Hanoi.</i></b></p>"
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"title": "Japanese Encephalitis",
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"summary": "The duration of the Japanese encephalitis vaccine protection is unknown. For persons aged 17 years and older, a booster dose should be given if the primary dose vaccination series was given one year or more previously and if there is risk of exposure. There are several other vaccines available in Asian countries, so it’s advisable to consult your doctor about whether this vaccine is right for you.",
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"value": "<p>Japanese Encephalitis is a potentially severe neurological infection. It is caused by the Japanese encephalitis virus, and occurs in rural areas of Asia and the western Pacific. The disease is spread through these regions by mosquito bites.</p><p>The Japanese encephalitis virus is transmitted to humans via the bite of infected Culex mosquitoes. These mosquitoes breed in pools of water (typically in rice paddies) and there is a high risk of infection in rural areas. The mosquitoes prefer to bite outdoors, and are more active in the evening and at night, when the risk of infection is greatest. Pigs and aquatic birds serve as amplifying hosts. Humans are incidental and dead-end hosts, since the mosquito cannot transmit the virus from one person to another.</p><p>Japanese encephalitis is a seasonal disease that occurs mostly in rural and agricultural areas. In subtropical areas, Japanese encephalitis can occur all year round, with a peak in the summer and fall (from March to October, with most cases occurring from June to September).</p><p>In endemic countries, the annual incidence is about 5.4/100,000 in children aged 0-14 years, and 0.6/100,000 in individuals older than 15 years. In developing countries, the mortality rate of Japanese encephalitis is high, and can exceed 35%. There are around 10,000 deaths attributable to Japanese encephalitis reported worldwide per year.<br/></p><p><b>Japanese Encephalitis in Vietnam</b></p><p>In Vietnam, the first case of Japanese encephalitis was reported in 1952. The disease can occur throughout the country, but mostly in rural and agricultural areas in the North of Vietnam where people cultivate rice, fruit, vegetables, and farm pigs. In the past, it has been estimated that there were 2000-3000 cases of encephalitis annually, among them Japanese encephalitis accounting for 61.3%. Thanks to the Vietnam National Immunization program, the Japanese encephalitis vaccine is now provided to Vietnamese children.</p><p>Nowadays, only 10–15% of encephalitis diseases are caused by the Japanese encephalitis virus. From January 2017 until now, there have been 325 encephalitis cases in 31 provinces across Vietnam and five deaths reported. The incidence of encephalitis is at 65.8%, 12.3%, 17.5% and 4.4% in the Northern, Central, Southern, and Highlands regions respectively. Japanese encephalitis accounts for 15% of all encephalitis cases.</p><p></p><p><b>Signs and Symptoms</b></p><p>The symptoms of Japanese encephalitis vary. Infected individuals are likely to have been exposed to mosquitoes in an endemic area. The symptoms may include fever, headache, vomiting, and/or myalgia. After this, symptoms become worse with the onset of neurological signs such as altered mental states, seizure, flaccid paralysis, hyperpneic breathing and cranial nerve findings.</p><p></p><p><b>Management</b></p><p>No antiviral agent is effective to treat the Japanese encephalitis disease. The treatment focuses on supportive care, including management of intracranial pressure, airway protection and seizure control.</p><p></p><p><b>Prevention</b></p><p>A Japanese encephalitis vaccine is available. Other modes of prevention such as avoiding mosquito bites, decreasing the mosquito population and viral spread should be implemented.</p><p>Avoidance of mosquito exposure, particularly at night, is another good mode of prevention. People living in or traveling to endemic areas should strongly consider the use of bednets while sleeping and mosquito repellents with diethyltoluamide (DEET) during times of risk of mosquito contact. Wearing long-sleeved shirts and pants in endemic areas is also important.</p><p>Decreasing the mosquito population and controlling viral spread can include the use of insecticides and larvae-killing agents, breeding larvivorous fish in rice paddies, and draining the rice paddies.</p><p></p><p><b>Vaccines</b></p><p>There are about four classes of Japanese encephalitis vaccines worldwide, including inactivated mouse brain vaccines, inactivated Vero cell-derived vaccines, live attenuated vaccines and live recombinant (chimeric) vaccines, which are derived from the yellow fever virus strain. The dosage schedule for vaccines vary by country and also depend on the kind of vaccine that is used. For example, the schedule for the Vietnamese vaccine is three doses administered intramuscularly: the first dose when the child is above one year of age and the second 1–2 weeks after the first shot. The third dose is given one year after the second shot. Then child will need a booster shot after every 3–4 years until 15 years of age.</p><p>In adults, if they have not had the vaccine in the past, they will need three primary shots as per the child schedule. If they have previously had the vaccine, they will need a booster shot.<br/>The duration of the Japanese encephalitis vaccine protection is unknown. For persons aged 17 years and older, a booster dose should be given if the primary dose vaccination series was given one year or more previously and if there is risk of exposure. There are several other vaccines available in Asian countries, so it’s advisable to consult your doctor about whether this vaccine is right for you.</p><p></p><p>FMP Pediatrician <b><i>Dr. Truong Hoang Quy</i></b><i> has core medical competencies in internal medicine, nutrition, vaccination and infectious disease. He studied at Thai Binh Medical University, Hanoi Medical University and at the Queensland University of Technology in Australia.</i></p>"
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"id": 895,
"title": "SIMBA Charity 2018",
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"value": "<p></p><p>For our ANNUAL CHARITY DRIVE, Family Medical Practice visited Linh Xuan orphanage last week with proceeds of more than VND10,500,000 donated by mothers from our Saigon International Mother Baby Association (SIMBA). The funds were used to provide gifts of milk, dry food, sauces, shower gels, and candies. To extend this contribution, our District 2 clinic called for additional offerings from the public, who presented donations of new and used toys, clothes, shoes, dry food, and other necessities.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Simba_Charity_2018_1.jpg\" class=\"format-left\" /><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Simba_Charity_2018_2.jpg\" class=\"format-left\" /><p></p><p>Our charity drive was kindly supported by the European International School HCMC, which generously provided two vans to help transport the goods and our team—the FMP medical team, staff, and various members of our community.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Simba_Charity_2018_5.jpg\" class=\"format-left\" /><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Simba_Charity_2018_8.jpg\" class=\"format-left\" /><p></p><p>FMP also hired a magician clown who amused the children with magic, jokes, and balloons as well as doing some tricks with a live pigeon and rabbit. The joy and excitement of the orphans at receiving their gifts was highly moving to all present, and we were amazed at how much the kids we’d met last year had grown, from as young as newborns ranging to toddlers and secondary school students.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Simba_Charity_2018_6.jpg\" class=\"format-left\" /><p></p><p>What mattered most to us all on that day was to see the smiles and laughter of these brave children, and in this small way to share in the festivity of a wonderful day with them.</p><p>The center was very welcoming and invited us to come back next year. We met the center VP, who also serves as the resident GP of the center—she warmly welcomed us and showed our FMP doctors and staff members around the facility.</p><p>There are 117 children being cared for at the orphanage, from babies to teenagers (the older children were attending school during our visit). All of the children suffer from long term illnesses, including disabilities, mental illness, and other ailments caused by immune deficiency.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Simba_Charity_2018_12.jpg\" class=\"format-left\" /><p></p><p>The center usually needs donations twice a year, most urgently for books and stationery in July before the new school term, and new clothing before the Tet holiday. Over the course of the year, it is also in need of basic over-the-counter medications (including painkillers, cough/flu medicines and dermatological creams (anti ringworm/fungal, scar/wound treatments, etc). Linh Xuan also requires cooking ingredients and utensils; pillows & blankets; and cleaning detergents.</p><p>Anyone interested in making their own contribution may contact the center directly at 30/3 Street 5, Linh Xuan Ward, Thu Duc District, HCMC.</p>"
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"summary": "Chicken pox affects both children and adults. It is generally a mild disease, but it can cause severe complications, especially in babies, adolescents, elderly people, pregnant women and people whose immune system is compromised (e.g. those under steroid treatment, cancer therapy, who have certain genetic disorders, or who suffer from HIV).",
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"value": "<p><b>Chicken Pox</b></p><p>Chicken pox affects both children and adults. It is generally a mild disease, but it can cause severe complications, especially in babies, adolescents, elderly people, pregnant women and people whose immune system is compromised (e.g. those under steroid treatment, cancer therapy, who have certain genetic disorders, or who suffer from HIV). Typically, chicken pox presents as a mild fever and rash that spreads over a period of 5–6 days and then resolves. It takes about 10–21 days from the time of infection until the time when symptoms appear. A person can be infectious to others while still well, a day or two before becoming sick. The infective period lasts until all the lesions become crusted and dry.</p><p>Chicken pox is known to suppress the activity of the immune system and can cause rare but severe complications:</p><p><b>ENCEPHALITIS:</b></p><p>Infection and inflammation of the brain, that may lead to severe neurological damage and death.</p><p><b>PNEUMONIA:</b></p><p>Due to the virus itself or a secondary bacterial complication. The pneumonia can be severe and lead to respiratory failure and need of mechanical ventilation support.</p><p><b>SECONDARY SKIN INFECTIONS:</b></p><p>Chicken pox lesions can allow bacteria to penetrate through the skin and cause severe skin and soft tissue infections. It may even spread throughout the body and develop into a multi system failure and shock.</p><p><b>PREGNANCY COMPLICATIONS AND CONGENITAL MALFORMATIONS:</b></p><p>Pregnant women tend to develop much more severe chicken pox, and are at a higher risk of developing the above complications.</p><p>The chicken pox virus can endanger the fetus as well. It can affect the skin, skeleton, brain and eyes. It causes neurological damage, a smaller head (microcephaly) and a smaller baby. It may even lead to miscarriage. Later on, the child may suffer from cataracts,</p><p>blindness, learning disabilities and mental retardation. If the mother contracted the virus close to delivery, the baby is at high risk to develop a severe chicken pox infection.</p><p>The chicken pox vaccine can significantly reduce the risk of contracting the disease and can prevent these complications.</p><p>Every child needs two doses (the first is given between 12–18 months) at least three months apart.</p><p>Every woman who plans on becoming pregnant should have her immunity checked, and if needed, receive a booster prior to conception. Since the vaccine is live attenuated, it is not recommended during pregnancy.</p>"
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"id": 900,
"title": "Orphanage Visit at Linh Xuan Orphanage",
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"value": "<p></p><p>For our annual charity drive, Family Medical Practice visited Linh Xuan orphanage today with proceeds of approximately $700 donated by mothers from our Saigon International Mother Baby Association (SIMBA). To extend this contribution, our District 2 clinic called for additional donations from the public: members of the community and representatives from the AIA life insurance group responded by joining us to present gifts of stationery, clothes, toys, books, milk, diapers, food, and other necessities.<br/> FMP also hired an entertaining clown who made balloon animals for the children. The joy and excitement of the orphans at receiving their gifts was highly moving to all present.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/ORPHANAGE_VISIT__Linh_Xuan_Orphanage_Dec_21_2017_5_L8BubHh.jpg\" class=\"format-left\" /><p></p><p></p><p>There are 117 children being cared for at the orphanage, from babies to teenagers (the older children were attending school during our visit). All of the children suffer from long term illnesses, including disabilities, mental illness, and other ailments caused by immune deficiency.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/ORPHANAGE_VISIT__Linh_Xuan_Orphanage_Dec_21_2017_15.jpg\" class=\"format-left\" /><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/ORPHANAGE_VISIT__Linh_Xuan_Orphanage_Dec_21_2017_16.jpg\" class=\"format-left\" /><p></p><p>The center usually needs donations twice a year, most urgently for books and stationery in July before the new school term, and new clothing before the Tet holiday. Over the course of the year, it is also in need of basic over-the-counter medications (including painkillers, cough/flu medicines and dermatological creams (anti ringworm/fungal, scar/wound treatments, etc). Linh Xuan also requires cooking ingredients and utensils; pillows & blankets; and cleaning detergents.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/ORPHANAGE_VISIT__Linh_Xuan_Orphanage_Dec_21_2017_13.jpg\" class=\"format-left\" /><p></p>"
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"title": "Pain and Needles",
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"slug_vi": "pain-and-needles",
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"post_date": "2017-12-17",
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"summary": "Many parents are very anxious when it comes to giving vaccinations to their baby. They don’t like causing pain, even though they know how important it is. Many parents are afraid of letting their child get several shots at the same time, and they try to postpone the vaccines and only give them just one at a time... but is that the smart way to go?",
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"value": "<p>I’ll be honest with you. I don’t like needles. I don’t like getting a shot myself, and I hate having to give one to a baby. It’s one of the reasons why I think very carefully every time I need to do a blood test for my patients, making sure it’s really necessary.</p><p>Of course, I’m not the only adult who doesn’t like needles. Many parents are very anxious when it comes to giving vaccinations to their baby. They don’t like causing pain, even though they know how important it is. Many parents are afraid of letting their child get several shots at the same time, and they try to postpone the vaccines and only give them just one at a time... but is that the smart way to go?</p><p><b>The Effect on the Immune System</b></p><p>From the moment a baby is born, his immune system is exposed to thousands of different types of germs, every hour of every day. Every time the baby breathes, eats or puts his hand in his mouth, bacteria and viruses enter his body, his nose, his mouth, his lungs and stomach. While millions of germs are constantly inhabiting his skin, his immune system has no difficulty protecting him from any harm. Compared to that, a vaccine containing only a few particles of bacteria or viruses (and sometimes only in fragments) is no challenge to the immune system at all. Giving multiple vaccinations at once doesn’t make our immune system weaker; on the contrary, it’s an excellent boost to immunity. And despite what parents may think, it doesn’t increase the risk of any significant side effects.</p><p><b>The “Fear of Needles”</b></p><p>This is the main concern of most parents. They’re afraid that giving a child several shots at the same time will cause more pain to their child. Actually, the major problem with getting a shot is the <i>fear</i>, the anxiety that comes with the knowledge that something painful is going to happen. The actual pain itself is very brief. It only lasts for a second or two.</p><p>From a psychological point of view, it’s much better for the child to endure one stressful visit to the doctor, getting a few shots and being done with it, than having to go through this unpleasant experience again and again and again. If a parent decides to give a child only one shot at a time, he actually causes the child to experience even more stress and anxiety.</p><p><b>Missing the Opportunity</b></p><p>When a parent decides to postpone vaccinations, it means it will take a much longer time for the baby to reach protective levels of immunity. Occasionally, the baby will miss the vaccine altogether. It is much safer and much better for the baby’s health to receive all the vaccinations at the recommended scheduled time rather than delaying the inevitable.</p><p><b>What can we parents do to help our child?</b><br/>There are a number of ways to reduce a child's anxiety and fear of needles.</p><p>One of the most important factors in a child’s response to stress or pain is the parents' reaction. When a child runs and falls, his first reaction will be to look at one of his parents. If the parent is calm and relaxed, the baby will usually just stand up and keep on running. If the parent acts in an anxious way, the baby will become anxious and will start crying. If a parent stays calm while his child is getting a vaccination, the baby often won't cry or only cry for a very short time and quickly relax.</p><p>Distractions are another means of dealing with the stress and pain—including hugging the baby and singing him a quiet song; allowing the child to hug her favorite toy or comfort object; or playing a cartoon. These can be used depending on the child's age.</p><p>Anesthetic cream (EMLA) can be used to reduce pain, and sometimes putting ice on the location of the injection just before giving the vaccination can be helpful in minimizing a painful sensation.</p><p></p><p><b>Dr. Jonathan Halevy, Head of Pediatrics, Family Medical Practice Ho Chi Minh City</b></p>"
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{
"id": 581,
"title": "Early Melanoma Detection",
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"post_date": "2017-12-01",
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"summary": "Screening the moles on your body substantially reduces the chances of succumbing to skin cancer thanks to early diagnosis. If a melanoma grows unchecked into the skin to a depth of 4 mm, this reduces your chances of survival by 20% at five years. The importance of dermoscopy is about specificity, helping doctors to cut out early malignant tumors and not to cut out benign lesions.",
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"value": "<p>“My wife has been bugging me to get this checked out for a while, what do you think?”</p><p>I lean forward and peer at the dark, ugly mole. It appears to be what we call a seborrheic keratosis, something completely harmless. But clinical experience tells me that it pays to be thorough, so I fetch my dermatoscope from my pocket.</p><p>My patient suddenly appears nervous. “What’s that, doctor?” he asks. “Will it hurt?”</p><p>“Not at all,” I reassure him. “This will just help me to distinguish if you have a good or a bad mole.”</p><p>“Is it like a biopsy?”</p><p>“No, but it’s almost as accurate as a biopsy in good hands,” I tell him. “This is just an augmentation lens with polarized light so that I can get a closer look. If your mole looks benign under the dermatoscope, then we don’t need to make a cut.”</p><p>“That’s great!” he says.</p><h3>Dermoscopy</h3><p>He’s certainly not the only patient I’ve had this conversation with. Skin tumors are probably the most common cancers in the world, and one of my most frequent tasks is to examine moles such as these. The skin is a very large organ, frequently exposed to the sun and to viral infections—and these two factors put together are chiefly responsible for the emergence of skin cancer. The danger is especially high in fair-skinned people of northern European origins who live and work in the subtropical zone (as do many Western expatriates in our community here) because their skin is not genetically prepared for solar radiation levels in these parts. For these people in particular, early diagnosis of melanoma is critical.</p><p>This is why dermoscopy is so important. A dermatoscope is a magnifying lens with a polarizing light. The way you position the lens and whether or not you use polarization reveals different tissue structures within the mole with great clarity. This simple instrument makes it much more straightforward to diagnose and distinguish melanomas that need to be removed from benign lesions, which do not need to be removed at all.</p><p>When I place the dermatoscope on the patient’s mole, I get a very different picture of the seemingly benign tumor. Through the lens, I see variations in color. I see irregular blue-white veil. I see a honeycomb-like structure at the edges. I see whitish areas of atrophy. All of this tells me that there is nothing benign about this mole after all. This patient is in fact harboring a malignant melanoma in his skin—a mass of cancerous tissue that will certainly kill him if he doesn’t have the whole tumor removed as soon as possible.</p><p>My point is this: you can’t always trust the naked eye when it comes to distinguishing a melanoma from a harmless mole. That’s a problem, because there are people out there with hundreds of moles all over their body, and you can’t simply dig them all out. I had another patient who was covered in moles, and there was melanoma history in her family, which meant that her risk was higher than normal. When I examined her, I did indeed find a lesion that I suspected to be a melanoma, which had to be removed. But there were also other lesions that may or may not have been cancerous; it was too hard to tell just by looking. To make things more complicated, this patient suffered from keloids—meaning that every surgical procedure would leave an ugly scar. If we removed too few, it might kill her eventually—she would die from a melanoma. But if we cut out too many, she would become a Frankenstein.</p><h3>On the Safe Side</h3><p>You’d think that a dermatologist would carry a dermatoscope like a cardiologist would a stethoscope, but in fact the whole field of dermoscopy isn’t widely practiced outside of Europe and Australia. I would say that probably half of American dermatologists wouldn’t use it regularly. This is a pity, because it’s an incredibly effective diagnostic method.</p><p>Dermoscopy has been known since the seventeenth century, but consistent research really got going around 40 years ago, with most activity based in Graz, Austria. It was conducted to increase the accuracy of skin cancer diagnosis by classifying structures in moles that are visible under a dermatoscope against biopsy findings from confirmed melanomas and other cancers. By slowly matching their data to the results of tissue examination, these researchers confirmed that dermoscopy could be used to accurately identify a melanoma. This is why we can trust this medical field, because it has been subjected to a rigorous scientific process based on a very large number of cases.</p><p>Screening the moles on your body substantially reduces the chances of succumbing to skin cancer thanks to early diagnosis. If a melanoma grows unchecked into the skin to a depth of 4 mm, this reduces your chances of survival by 20% at five years. The importance of dermoscopy is about specificity, helping doctors to cut out early malignant tumors and not to cut out benign lesions.</p><p>Early diagnosis is only possible if you check suspicious moles regularly, at least once a year, or even more frequently if you have a family history of melanoma. Dermoscopy ensures that you will only get a biopsy if necessary. Our facility is one of the few in Ho Chi Minh City that offers this diagnostic opportunity.</p>"
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"title": "How to Prevent Common Diseases During Raining Season",
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"summary": "High rainfall [during the rainy season] can cause widespread flooding, and stagnant water can be a breeding ground for all sorts of bacteria as well as mosquitoes, increasing the transmission of a number of communicable diseases.",
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"value": "<p>The weather is changing and the traditional November rain has arrived. We can feel the cool breeze and the quality of the air is improving. However, high rainfall can cause <b>widespread flooding</b>, and <b>stagnant water</b> can be a breeding ground for all sorts of <b>bacteria</b> as well as <b>mosquitoes</b>, increasing the transmission of a number of <b>communicable diseases</b>.</p><p>Direct contact with <b>polluted water</b> carries a high risk of infection by <b>waterborne diseases</b> such as dermatitis, conjunctivitis, and ear, nose and throat or wound infections. Eating or drinking anything contaminated by floodwater can cause <b>diarrhea</b>. One particular infection that can cause an outbreak that spreads directly from contaminated water is <b>leptospirosis</b>, a zoonotic bacterial disease—transmission occurs when water, damp soil or mud contaminated with rodent urine comes in direct contact with the skin or mucosal membranes.</p><p>Flooding may lead to an increase in the indirect transmission of diseases via the expansion in the number and range of <b>breeding grounds</b> for organisms that transmit pathogens or parasites. Standing water caused by heavy rainfall or river overflows can serve as breeding sites for mosquitoes, and thus increase the chances of exposure to infections such as dengue, malaria, chikungunya or Japanese encephalitis. Flooding may initially flush out mosquito breeding, but it comes back in force when the waters recede.</p><h3>Prevention and Control</h3><p>Basic precautions should be taken by people travelling to or living near risk areas. To protect yourself, your family, and your community:</p><ul><li>Always maintain good hygiene (handwashing) after contact with flood water.</li><li>Do not allow children to play in flood water areas.</li><li><b>Wash children’s hands</b> frequently (always before meals).</li><li>Do not allow children to play with toys that have been contaminated by flood water and have not been disinfected.</li></ul><p>The proximity of mosquito breeding sites to human habitation is a significant risk factor for diseases that these species transmit. <b>Disrupting the mosquito life cycle and habitat</b> may reduce the number of mosquitoes around you and your environment.</p><ul><li>Find and remove any puddles of water or standing water around your home to reduce breeding sites.</li><li>Puncture unusable tires in the yard to prevent pools of water from forming inside them.</li><li>Wipe out your bird-bath and pet water bowls every few days.</li><li>Keep grass and shrubs trimmed short; this will reduce places for flying mosquitoes to rest.</li><li>Consider adding mosquito fish to your water garden or small pond if it’s not connected to natural water.</li><li>During outbreaks, insecticides may be sprayed to kill flying mosquitoes.</li></ul><h4><i>To prevent mosquito bites:</i></h4><ul><li>Cover exposed skin by wearing long-sleeved shirts, long pants, and hats.</li><li>Use an appropriate <b>insect repellent</b> as directed to exposed skin or on clothing.</li><li>Always follow product directions and re-apply in strict accordance with product label instructions.</li><li>If you are also using sunscreen, apply sunscreen first and insect repellent second.</li><li>Follow package directions when applying <a href=\"https://www.fda.gov/default.htm\">repellent on children.</a> Avoid applying repellent to their hands, eyes, and mouth.</li><li>Stay and sleep in screened or <b>air-conditioned rooms</b>.</li><li>Use a <b>bed net</b> if the area where you are sleeping is exposed to the outdoors.</li><li><b>Mosquito coils</b> or other insecticide vaporizers may also reduce indoor biting.</li></ul><p>Open wounds and rashes exposed to flood water can become infected. How can we prevent this?</p><ul><li>Always <b>wear slippers or shoes</b> when walking along flood or stagnant water.</li><li>Avoid exposure to flood water if you have an open wound.</li><li>Cover clean, open wounds with a waterproof bandage to reduce chances of infection.</li><li>Keep open wounds as clean as possible by washing well with soap and clean water.</li><li>If a wound develops redness, swelling, or drainage, seek immediate medical attention.</li></ul><p>We should all be safety-conscious. Wear appropriate footwear that allows better traction; don’t wear shoes or slippers that have worn, smooth soles or high heels during the rainy weather. Being alert and responsible for our surroundings is the surest way to reduce these different diseases.</p><p></p><p><b>Dr. Elvie Joy Atanque-Basa - Pediatrician, Family Medical Practice Danang</b></p>"
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"summary": "Colds often last longer than most people think: The average length of a cold is 10 days, but the length of symptoms can vary widely.",
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"value": "<p>What we commonly call a cold is a benign and frequent infection of the nose and throat. The medical term is viral rhinitis or acute rhino-pharyngitis. The cause is a virus. There are over 100 different viruses that can cause a cold.</p><p>This infection is different from the flu, which is also a viral infection (influenza virus) but with more generalized and intense symptoms (high fever, body and muscle pain, fatigue, headaches).</p><p>The main symptoms of a cold include sore throat — often the first sign to arise — sneezing, nasal congestion, runny nose with clear secretions, mild tiredness, mild headache and sometimes cough and mild fever.</p><p>Colds often last longer than most people think: The average length of a cold is 10 days, but the length of symptoms can vary widely.</p><p>Doctor Mathieu Nalpas.— Photo Courtesy of Family Medical Practice</p><p>There are clear risk factors for catching a cold. Stress and tiredness are a very significant risk factor. Stress weakens the immune system and makes you more vulnerable to virus infection. Smoking, too, is an important risk factor. It weakens the immune system as well and causes a local irritation, which allows virus to penetrate more easily into your body. Recent travel by flight, long exposure to dry air and the practice of very intense physical activities are also known to be risk factors for colds.</p><p>A cold is a contagious infection. Contamination occurs through saliva, nasal secretions and contaminated hands or surfaces (glass, toys etc…). The virus cannot penetrate through healthy skin but can easily enter your body through contact with mucous membranes of the nose, the mouth and the eyes. Very thin drops of infected secretions can reach your mucous membranes after someone coughs or sneezes next to you.</p><p>The incubation period is short, from 12 hours to a few days.</p><p>It is usually not necessary to see the doctor in case of a simple cold. Symptoms will clear by themselves after a few days.</p><p>In some cases, you should see your doctor. Complications are rare but possible. Symptoms like very high fever with sweats and shivering, intense ears, throat and face pain, persistent symptoms more than 10 days, and persistent cough more than seven days after all other symptoms are gone are all cause for concern and should lead you to seek the opinion of a doctor.</p><p><b>Treating the pesky cold</b></p><p>No treatment can kill the virus or make it clear faster. In most cases, a cold will clear on its own.</p><p>Antibiotics are completely useless during a cold, as they attack bacteria and not viruses. Taking antibiotics will increase the risk of side effects and will disrupt your normal bacterial flora, which can lead to more health problems. And you will not recover faster.</p><p>Instead, treatment focuses on reducing the effects of symptoms. Paracetamol (acetaminophen) is a medicine that reduces all kind of pain and lowers fevers. Ibuprofen is an anti-inflammatory medicine with the same effects. Without a doctor’s opinion, it is better to use paracetamol alone for children because they will tolerate it more easily than an anti-inflammatory medicine. Nasal sprays of saline water should be used to drain and wash the nose. In case of severe nasal congestion, use a decongestant but not for more than three days. Decongestants should not be used in young children because they might cause side effects like chronic irritation of the nose.</p><p>You should not use aspirin in case of a cold. Its action is similar as paracetamol but with more side effects. Aspirin is contraindicated for children.</p><p>About coughs, try to be patient and avoid taking anti-cough medicine. Cough is a natural symptom that helps to evacuate all the infected secretions from the bronchus. Taking an anti-cough medicine can increase the risk of infection and bronchitis. Anti-cough syrup or tablets can help only in case of very irritating dry cough.</p><p>Simple measures are very effective, too. Rest a lot, increase intake of water (at least 2 liters a day), drink hot tea and soups, gargle with warm salty water three or four times a day and drain and wash the nose as often as necessary. Take warm showers or baths and stay in a warm atmosphere.</p><p>Prevention is simple. It includes basics hygiene and lifestyle habits. Wash your hands regularly, especially before manipulating any objects or food that could be share with other person. Teach children to do the same.</p><p>Avoid sharing personal objects (glass, dishes, towel, tooth brush etc…) during the time of the infection. Cover your mouth and nose with a tissue in case of cough and sneeze. If you do not have a tissue, it is better to cover your mouth with the inside of the elbow than with your hands.</p><p>Stay home if possible, rest and avoid very close contact with your friends and family for the time of the illness.— <b>Family Medical Practice Vietnam</b></p><p></p><p><b>Dr. Mathieu Nalpas - Internist, Family Medical Practice Hanoi</b></p>"
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"id": 733,
"title": "Take My Breath Away",
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"summary": "The construction site doesn’t have to be next door. It can even be hundreds of meters away and still have a heavy effect on your children’s health. The same goes for construction sites near schools and kindergartens.",
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"value": "<p>What happens when you live near a construction site? Here is a typical story. I recently saw a three-year-old child who has been suffering from a recurrent runny nose, ongoing cough, sneezing, and sometimes sticky red eyes for the past three months. Previously he was a very healthy kid, but now he has these symptoms almost daily. He was prescribed many different types of medications (cough medications, allergy medications, and antibiotics) which sometimes helped a little—but as soon as he stopped taking them, he would become sick again. His mother was very concerned that his immune system was weakening. Upon questioning the mother, we found out that just before the child became sick, a construction site had been set up not far from their home.</p><p>If you have lived in Hanoi or Ho Chi Minh City over the past decade, you almost certainly had this problem at some point—a site in your neighborhood where an apartment building, house, road or bridge was demolished, built up or renovated.</p><p>How does this affect your health and your children’s health? As it turns out, it’s much more than just the noise at night that won’t let you sleep.</p><ul><li>The heaviest toll on our health of having a construction site near home is the air pollution. This is not just the regular dust that you might find in any home: construction dust contains many different types of chemicals, including cement dust, heavy metals, synthetic fibers, sawdust and even asbestos (a known cause of lung cancer) and silica (a cause of chronic lung disease).</li><li>Fumes from cars, trucks, bulldozers, generators and other fuel-operated machinery in and around the site can significantly contribute to the pollution of the air you breathe.</li><li>Radon is a radioactive gas which is released from the soil. In construction sites, its levels tend to increase as it is released into the atmosphere. Radon is one of the leading causes of lung cancer (second only to cigarette smoking).</li><li>Aspergillus is a fungus (mold) that is ubiquitous in the soil. During the construction, renovation or demolishment of buildings, it spreads easily into the air and may cause significant respiratory problems and chronic allergic symptoms to those people who live nearby.</li><li>Construction sites promote infestations such as rats and cockroaches. These animals can shed their skins into the environment. These are known to be strong triggers of allergies and asthma.</li><li>Chemicals and heavy metals from construction sites can be absorbed into the soil and water in the neighborhood and cause further pollution and health problems.</li><li>Airborne chemicals and dust particles can also cause irritation to your skin and eyes as well as dermatitis (skin inflammation) and eye infections (stye, conjunctivitis).</li></ul><p>The construction site doesn’t have to be next door. It can even be hundreds of meters away and still have a heavy effect on your children’s health. The same goes for construction sites near schools and kindergartens.</p><p>I see many children from different areas of the city who suffer from chronic nasal congestion, sinusitis and enlarged adenoids, chronic bronchitis, asthma, and eye infections—and it’s not because their immune system is weaker, it’s because their immune system is desperately trying to fight a losing battle with air pollution.</p><p>What can we as parents do? We can’t stop the construction obviously, but there are ways to reduce your child’s exposure to dust.</p><ul><li>If you live near busy roads or construction sites, you may need to keep your windows closed.</li><li>If you use air conditioners, make sure the filters are cleaned frequently, at least monthly. These filters tend to accumulate dust and mold and spread them into the room.</li><li>Vacuum your home with proper vacuum cleaners (with HEFA filters) daily.</li><li>Remove objects that may accumulate dust from your child's room (carpets, heavy curtains, furry toys, pillows)</li><li>Clean and air bedsheets and mattresses frequently.</li><li>If you live near construction sites, busy roads or in a dusty neighborhood, use a special mask (N95) every time your child leaves home. They may help reduce exposure to large dust particles (unfortunately, most are not useful against tiny particles, chemicals or gases).</li></ul><p>Sometimes, taking a holiday on the beach where the air is clean can do wonders for your health.</p><p></p><p><b>Dr. Jonathan Halevy, Head of Pediatrics, Family Medical Practice Ho Chi Minh City</b></p>"
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"id": 596,
"title": "Nothing to Sneeze At",
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"post_date": "2017-10-26",
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"summary": "The fact that influenza spreads so easily is what makes it such an important health problem. People become contagious from the very beginning, one or two days before the onset of symptoms... You can still pass on the virus to others for the next four or five days after the onset of symptoms.",
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"value": "<p>Everyone gets the flu now and then. You know the symptoms—sore throat, fever, coughing, a runny nose, and a lack of energy that will likely see you bedridden for a couple of days. Most people call this the flu, which comes from the word “influenza”—but for doctors, that word refers to a very specific group of viruses that are a particularly dangerous subset of the various common colds and flus we’re familiar with. While many countries undergo an annual flu season, Vietnam doesn’t have one; you can get it at any time of the year.</p><p>True influenza is actually a very specific and serious respiratory infection that can result in hospitalization and death. The most common complication of influenza is bacterial pneumonia, but it can also aggravate chronic diseases such as asthma, chronic rhinitis, and diabetes. It’s a highly contagious viral infection transmitted by coughing, sneezing, or contact with someone who is infected, and it can also be transmitted by direct contact if you touch surfaces on which infected influenza droplets have landed. After being exposed, it usually takes an average of two days to develop symptoms, but it can range from one to four days. Typical influenza disease causes the onset of fever, headache, a runny or stuffy nose, eye pain, and sensitivity to light. Kids may also suffer from nausea, vomiting and diarrhea.</p><p>The fact that it spreads so easily is what makes it such an important health problem. People become contagious from the very beginning, one or two days before the onset of symptoms—so you can be contagious even though you don’t yet know you have it. You can still pass on the virus to others for the next four or five days after the onset of symptoms.</p><p>The virus group falls into three basic categories. There are two common types, which we label A and B. There’s also a C-type, but it’s detected much less frequently and is only a mild infection. At our clinic we use nasal swabs to test for A and B—influenza A can cause a moderate to severe illness in all groups, and affects people and some animals; while influenza B causes mild disease and usually affects only humans.</p><p>Once you’re infected, there’s no going back. The virus will collect in the upper respiratory tract, producing phlegm in the airway in response to the inflammation of the surrounding organs. Your immune system (provided it’s functioning normally) will start to detect the presence of the virus multiplying in your body, and get to work on developing an antibody to fight it. The symptoms you experience are a combination of the spread of the virus and your body’s countermeasures, which will cause inflammation, fever and discomfort. Once your body has produced these antibodies, you’ll be protected from reinfection—and if you ever do contact the same virus again, it will be swiftly and invisibly dealt with.</p><p>So how is it that you can get the flu again and again? It’s not just that there are different types of influenza (your antibodies to type A influenza won’t work at all against influenza B); it’s also that each virus type gradually morphs into different forms as it spreads, making it resistant to antibodies that worked against it before. This means that every time the body catches a new strain of influenza, it must start from the beginning.</p><p>How can people protect themselves from a shape-shifting disease that keeps turning out new forms to infect us again and again? Firstly, we can try our best not to put ourselves and others at risk in the first place, considering how virulent this illness is. For a start, remember to cover your nose and mouth with your sleeve or a tissue when you cough or sneeze. Wash your hands often with soap and water—and if you’re not near water, you can also use alcohol-based hand cleansers. Stay away from people who are sick as much as possible. If you already have influenza, you should stay at home from work or school for at least 24 hours after the fever has ended.</p><p>Secondly, there is specific medication for influenza—tamiflu, which protects against both A & B type influenza. If you suspect you have have been infected, tamiflu is very useful if taken during the first 48 hours after coming into contact with the virus, significantly reducing recovery time and preventing complications of the illness. Unfortunately, it’s largely ineffective during the later stages of infection.</p><p>The best way to prevent influenza, of course, is vaccination. Because the strains of viruses change every year, pharmaceutical companies conduct research to find out which strains will be typical for the coming season worldwide. According to their results, they produce a new vaccine to match the circulating strains. Every year, we receive new vaccines that are different from the older ones and more effective against the forms of influenza that are likely to be ascendant during the following twelve months.</p><p>In accordance with international supply, we usually receive our annual vaccines in October, which is the best time to get vaccinated. We use an inactivated vaccine (made from killed viruses) produced by Influvac that doesn’t cause the disease. Unlike some vaccines, Influvac does not contain eggs, meaning those with egg allergies (including pregnant women) can take it safely. This vaccination is given intramuscularly, and it usually contains three or four types of viruses considered to be the most dangerous in the coming year. It will protect you only from the more common strains of the influenza virus, however—if you’re unlucky, you could still contract a less prevalent strain.</p><p>It is my recommendation that all people aged six months and older should get the influenza vaccine, unless they suffer from an immunodeficiency condition. Kids under six months old should not get vaccinated because they’re too small—usually at that age, however, the mother is breastfeeding, so she can pass on some immunity to the baby if she is vaccinated. It’s recommended that everyone in a family with a baby should get vaccinated while the baby is still too young to receive or develop its own antibodies. It’s also important to note that kids under eight years old who receive their first-ever flu vaccine should get two shots one month apart to fully trigger their immune response.</p><p>If all else fails and you do get influenza, it’s simple: drink a lot of water, rest, stay at home, and don’t go to school or work. Take some medication to treat the fever and symptoms, and wait for your body to beat the disease back. The most important thing is to keep to yourself, and don’t pass it on to anybody else—that is ultimately the best way we have to contain this sometimes lethal virus.</p><p><b><i>Dr. Kate Naumova</i></b><i> from Moscow focused on pediatrics early in her career, drawn by her love for children. She joined Family Medical Practice in 2014.</i></p>"
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"id": 713,
"title": "Medical Tests Every Woman Must Have",
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"post_date": "2017-10-23",
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"summary": "As modern-day women, it’s all too easy to use the “I’m too busy” excuse, so you may be tempted to let your annual breast screening or a lipid profile test slip. Don’t let that happen.",
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"value": "<p><b><i>October is Breast Cancer Awareness Month</i></b></p><p>As modern-day women, it’s all too easy to use the “I’m too busy” excuse, so you may be tempted to let your annual breast screening or a lipid profile test slip. Don’t let that happen. As busy as you are as a modern women, there is no reason why you cannot have a healthy life. Here are five of the most important medical tests that all women should take:</p><p><b>Pelvic Examination and Pap smear</b></p><p>With cervical cancer said to be the second leading cause of death for women, uterine and pelvic health should be given prime importance. It is always advisable that you visit your gynecologist periodically and have a complete pelvic examination and a Pap smear test.</p><p>Do not get scared as most do on hearing about these tests. A pelvic exam checks for abnormalities such as growths while Pap smear is a simple screening test to check if any cancerous cells are present in the cervix, which is the connecting part of the vagina to the uterus. A swab is inserted into the vagina to remove cells from the cervix. The cells are then examined in a laboratory for signs of pre-cancerous or cancerous changes. Any female who is sexually active requires this test. Age is no limit but generally it is required for those females who are sexually active.</p><p><i>How often:</i> Ideally, the testing should be done every year after 30.</p><p><i>Tips:</i> For the most accurate Pap results, avoid having sex or using vaginal medications (such as anti-yeast creams) one to two days before your appointment.</p><p><b>HPV (Human PapillomaVirus) Test</b></p><p>You might be surprised to learn that Human Papilloma Virus (HPV) is the second-most common cause of female cancer after breast cancer. Do you also know that 80 per cent of all males and females up to the age of 60 get infected with human papilloma virus at least once in their lifetime? For women, screening is critical to detect most HPV-related diseases. Now, HPV vaccines offer the best protection. All young women from 9-26 years old, should get the 3-dose vaccine to protect themselves against this potentially fatal disease.</p><p><b>Physical Breast Examination</b></p><p>Breast cancer cases have been rising steadily in the last decade, and it is now the most common cancer in women, way ahead of cervical cancer. Both the incidence of as well as deaths due to breast cancer are more than that of cervical cancer. Hence, regular physical breast examination becomes compulsory. Females undergo many hormonal changes starting from puberty to menopause, which causes changes in her breasts and glands around them. These changes can be examined physically by noticing it or by touching and feeling the changes. Checking breasts for lumps, skin changes, thickening, and nipple discharge is the best way to be vigilant about preventing breast cancer.</p><p><i>What should be done:</i> Palpation of the breast and underarm area to check for lumps, dimpling, pain or tenderness, inflamed skin, and any other changes in the breasts. A nipple exam checking for discharge, crustiness, or blockage. A self-breast examination is also recommended.</p><p><i>When to get it done:</i> Around the age of 18 years and above. Do them about a week after you start your period, when breasts tend to be less swollen and tender. </p><p><i>How often;</i> Once a year for women in their 30s, if you’re healthy, to make sure there haven’t been any changes for the worse. Younger women may not need a yearly screening if they’re healthy.</p><p><b>Mammography</b></p><p>Mammograms are low-dose X-rays that can often find a lump before you ever feel it, though normal results don’t completely rule out cancer. It is recommended that while you’re in your 40s, you have a mammogram every year. Then during your 50s through your 70s, you can switch to every other year. Of course, your doctor may recommend more frequent screenings if you’re at higher risk.</p><p><b>Lipid Profile</b></p><p>This test checks for good (LDL) and bad cholesterol (HDL) along with triglycerides and total cholesterol levels. Cholesterol is a fat molecule, which if present in higher levels can get accumulated in the blood vessels and can affect the health of your heart, blood vessels, and brain. These tests help determine your level of risk for heart disease (the number-one killer of women) and stroke.</p><p>When to get it done? A lipid profile is best done after fasting for 9 to 12 hours, so book a morning appointment and skip breakfast.</p><p>How often? This test is advised after the age of 30 years and should be done once in five years if previous test results were in normal range. However, high levels require regular screenings, for instance, once in six months. Women who have other risk factors such as family history of heart disease, diabetes, and blood pressure would also be advised other specific tests such as high-sensitivity CRP test (hs-CRP), which measures inflammation, an indicator of heart health. If you have a history of depression, you may have increased levels of inflammation.</p><p>FMP Hanoi not only focuses on quality treatment, but also puts strong emphasis on preventive care services. To fit into your busy life, we offer one stop services and tailor female checkup packages to suit your age, family history, and personal risk factors. – <b>Family Medical Practice Vietnam</b></p><p></p><p><b><i>Dr. Catherine Gonzalez - Internist, Family Medical Practice Hanoi</i></b></p>"
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"title": "The Rise of Diabetes",
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"summary": "Asians are at risk from diabetes due to a lower Body Mass Index (BMI) than Caucasians, meaning looks can be deceiving. You may look relatively healthy, but inside your body, you may already be suffering the consequences without showing the signs that you might expect.",
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"value": "<p>30 years ago Vietnam suffered from widespread malnutrition. Now its type 2 diabetes that is affecting people’s health.</p><p>Inside a shopping mall on a Saturday afternoon in Tan Phu District, Ho Chi Minh City, several groups of Vietnamese children and their families are perched on plastic chairs eating burgers and fries and sipping fizzy drinks. Outside in the shade, a group of men take a smoke break from shopping. It’s a sign of the times in Vietnam, and it’s a scene that reveals several red flags for diabetes.</p><p>The Vietnam Association of Diabetes and Endocrinology (VADE) recently reported that in Vietnam there are now 5 million diabetics, which accounts for around 5.4% of the population. It’s believed that the real figure could be closer to 10%, after factoring in those who are living undiagnosed. It’s an alarming rise from the figure of 3.3% just three years ago, and it means that Vietnam has one of the fastest- growing rates of diabetes in the world.</p><p>The main concern is type 2 diabetes, which used to be called Adult-Onset Diabetes before its rapid rise began to be charted in children. Unlike the genetic nature of type 1 diabetes, type 2 is characterised by lifestyle choices; eating refined sugars and flour, high-fructose corn syrup, heavily processed food, lack of dietary fibre and smoking. Fast-food outlets get most of the blame, but look around your local Family Mart or Circle K and see how much of the food and drink is quietly crammed with sugar.</p><p>The problem is stark; just 30 years ago, Vietnam was in the grip of malnutrition, and now it faces obesity and diabetes problems, with over 50,000 deaths attributed to diabetes in Vietnam in 2015, according to the World Health Organisation (WHO). That number is sure to rise as the country gets wealthier. The list of complications of diabetes is long; ulcers, gangrene and resulting amputations, cardiovascular diseases, blindness and kidney failures.</p><p>Dr Pedro Trigo, a hepatology and internal medicine specialist at Family Medical Practice in District 1, has been practising in Vietnam for seven years, and in that time he’s seen great changes in lifestyle for the general population. Vietnam is on the road to becoming a developed country, and a burgeoning middle class have new money in their pockets.</p><p>“When the culture says ‘wow you are wealthy, you have to enjoy your time, your car etcetera’, they become lazy, eat more proteins and fatty foods and become obese,” he says.</p><p><b>Cigarettes and Alcohol</b></p><p>Another key risk factor in developing type 2 diabetes is smoking, but the link between smoking and diabetes is one that is often overlooked by both the public and by doctors.</p><p>“I think sometimes even doctors are not aware [of the risk],” says Dr Trigo.</p><p>A 2015 Global Adult Tobacco Survey (GATS) survey estimated that 22% of Vietnam’s population are smokers (45% of men, 1.1% of women), a figure that is not declining, as in the West. The link between drinking alcohol and type 2 diabetes is disputed. In moderation, many studies suggest you are safe. But doctors agree that binge drinking and excessive consumption of alcohol is a big risk factor, particularly when looking at the link between diabetes, pancreatitis and heavy drinking.</p><p>With new eating, drinking and overall lifestyle habits come many differing risk factors, which are now combining to create a perfect storm for diabetes in the country. Dr Trigo says these can create further problems, such as depression and anxiety, which can also contribute to the disease.</p><p>Worse, Asians are at risk from diabetes due to a lower Body Mass Index (BMI) than Caucasians, meaning looks can be deceiving. You may look relatively healthy, but inside your body, you may already be suffering the consequences without showing the signs that you might expect.</p><p><b>Symptoms</b></p><p>Symptoms of diabetes are often subtle and range from irritability to increased thirst to frequent urination. But Dr Trigo says patients are never surprised when they receive the diagnosis.</p><p>“Nowadays everyone knows, if you have bad habits you will get in trouble,” he says. “Even poor people know that if you eat well, sleep well, you will be healthy. If you drink and smoke a lot it will be a problem. Human beings pretend this will not happen to them.”</p><p>Additionally, with resources stretched, many diabetics may be too far from the services that they require, which Dr Trigo says has cost lives in Vietnam. Diagnosis rates are also low, as it’s uncommon in Vietnam for people to go for a check-up.</p><p>“The people live quite far [away], and the roads are often bad,” he adds. “The problem is how much they comply with the treatment, even to pick up the medication. They don’t go because, an hour and a half on a motorbike [is too far] so they don’t go, and they die.”</p><p><b>Living with Diabetes</b></p><p>Dang Ngoc Tran is 56 years old, and was diagnosed with type 2 diabetes towards the end of last year.</p><p>“I felt tired. I was losing weight without control for a couple of months,” says Tran.</p><p>“I drank three to four times per week. That is the big factor plus family medical history. I smoke, but I’m not a smoker, and only smoke one when seeing friends and I wasn’t aware of the link between them [smoking and diabetes],” he adds.</p><p>“Of course, it was difficult at the beginning when I had to care about what I eat.”</p><p>Even though he worries about complications that may arise from his diagnosis, he is retired and still hopes to enjoy life. “You can’t ask people to stop eating nice food or stop drinking which is the fun part when you hang out.”</p><p>Marvin Mesina is 35 and was born in the Philippines but grew up in Canada. He was diagnosed with type 2 diabetes aged 24 and it came as a big shock.</p><p>“The main symptoms were sudden weight loss, always thirsty and hungry, frequent urination, especially at night and being unable to concentrate,” he says, “My family has a history of diabetes. My father and grandfather had it, but I think what triggered it was that level of stress I was under back at that time.</p><p>“I felt devastated when I heard the news, I thought I was going to be immune from it regardless of our family history, so when I heard the confirmation from the doctor, I felt depressed and was in denial for a while.”</p><p>Living as a foreigner with diabetes in Vietnam comes with its own challenges. Mesina struggled to find a proper endocrinologist when he first arrived in the country, and it was also difficult to find the same brand of medication that he was taking back in Canada; the cost of his insulin and oral medication is higher than it was back home. But Marvin says the hardest aspect of life for a diabetic in Vietnam, is trying to maintain a suitable diet.</p><p>“I feel like it’s hard to adopt a diet here in Vietnam, in Saigon in particular,” he says. “People here love eating rice and anything sweet. I feel like they put sugar in everything. I have yet to try an authentic <i>ca phe sua da</i>.”</p><p><b>Hospitals</b></p><p>Marvin and Tran are fortunate in that they both receive their care at a local clinic, but diabetes is a condition where the poorest suffer disproportionately. According to the International Diabetes Federation, in 2015 diabetes-related expenditures in Vietnam were on average US$162.70 per patient, per year. This is more than the average monthly salary of US$150 in Vietnam, and the public hospitals that treat the poorest are not being built and new doctors are not being trained at a rate that can support the need.</p><p>“To create a new generation of doctors takes six years, but to build a hospital takes one year,” says Dr. Trigo. “There are massive needs. They are building new universities but there is a big gap between the needs and the ability to support these needs. It’s very difficult.”</p><p>He adds: “When I arrived in Vietnam I was in shock when I visited a local hospital. There were horrible corridors, horrible beds, no mattresses, everything dirty, chaos. Now it’s the opposite, except the chaos. Because they have everything new but the doctors and nurses are extremely overloaded. You can have the best F1 race car, but if you don’t have someone who can manage the car, it’s a disaster.”</p><p>Dr Trigo believes it’s inevitable that there will be more and more blind people in Vietnam due to diabetes, and there will be more cases of diabetics who require kidney dialysis or amputations.</p><p>“The best is to be prepared to avoid this, not to deal with the consequences,” he says. “The doctors have good training, but it’s not enough.”</p><p><b>Malnutrition and Obesity</b></p><p>Vietnam’s lightning-fast but unequal development means that it is a country that deals with malnutrition at one end of the economic scale, and obesity and diabetes at the other.</p><p>Efforts to educate the citizens on the consequences of an unhealthy lifestyle have so far been ineffective, and the diabetes rates are relentlessly climbing. If old habits die hard, then new habits will die even harder.</p><p></p><p><b><i>Dr. Pedro Trigo -</i></b> <b><i>Internal Medicine, Family Medical Practice Ho Chi Minh City</i></b></p>"
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"summary": "Cervical cancer is preventable if precancerous cell changes are detected and treated early. This is done with regular screening.",
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"value": "<p><b><i>Cervical cancer</i></b> <i>was one of the most common causes of cancer death among women worldwide several decades ago. This situation significantly improved over time however, primarily due to the use of</i> <b><i>Pap tests</i></b> <i>– a screening procedure that can find changes in the cervix before cancer develops.</i></p><p><b>Risk Factors</b></p><p>Infection by the <b>Human Papilloma Virus (HPV)</b> – a very common virus – is the most important risk factor for cervical cancer. Most sexually active individuals will have HPV infection at some point. It is transmitted through sexual contact (oral, genital or anal) with an infected partner. HPV is usually harmless, most people have no symptoms of HPV infection and most are cleared by the body in a year or two.</p><p>Some types of HPV may cause genital warts (HPV types 6 and 11) and cervical lesions (HPV type 16 and 18) which over a period can develop into cervical cancer if undetected.</p><p>Other things can increase your risk of cervical cancer:</p><ul><li>Smoking: Studies have shown that <b>women who smoke</b> are twice as likely to have cervical cancer as opposed to non-smokers.</li><li>Having <b>HIV</b> or another condition that makes it hard for your body to fight off health problems such as autoimmune diseases and after an organ transplant.</li><li>Using <b>birth control pills</b> for a long time (five or more years).</li><li>Having given <b>birth to three or more children</b>.</li><li>Having <b>several sexual partners</b>.</li></ul><p><b>Screening</b></p><p>Cervical cancer is preventable if precancerous cell changes are detected and treated early. This is done with <b>regular screening</b> through:</p><p>– <b>Pap Smear/Test</b><br/>A test to find abnormal cell changes on the cervix before they turn into cancer. A small brush or cotton tipped applicator is used to take a sample of the cervical cells. These cells are then examined for abnormal cell changes.</p><p>– <b>HPV Test</b><br/>This test can detect “high-risk” types of HPV which lead to cervical cancer and help healthcare providers know which women are at greater risk.</p><p><b>When to get tested?</b></p><p>It is recommended that women aged 21-29 years should have Pap test every 3 years.</p><p>Women 30-65 years should have a Pap test and an HPV test (co-testing) every 5 years (preferred) although it is acceptable to have Pap test alone every 3 years.</p><p>Women should stop having cervical cancer screening after age 65 if they do not have any history of cervical cell changes or cancer. In addition, if they have had either three negative Pap test results in a row or two negative co-test results in a row within the past 10 years, with the most recent test within the past 5 years, then they need no further screening.</p><p><b>HPV Vaccines</b></p><p>There are currently two <b>HPV vaccines</b> available in the market namely:</p><p>– <b>Gardasil</b>: for both males and females, is close to 100 % effective at preventing infection associated with HPV types 6,11,16 & 18.</p><p>– <b>Cervarix</b>: vaccine just for women, is also close to 100% effective in preventing infection associated with HPV 16 &18.</p><p>It is recommended that <i>ALL females</i> between the ages of 9 to 26 get an HPV vaccination.</p><p>The majority of women diagnosed with cervical cancer either have never had a Pap test or did not have one in the last five years. Cervical cancer is completely preventable if precancerous cell changes are detected and treated early, before cervical cancer develops.</p><p></p><p><b><i>Dr. Hazel Gallardo-Paez - Family and Community Medicine, Family Medical Practice Danang</i></b></p>"
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"title": "Peripheral Artery Disease",
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"summary": "The incidence of diabetes, high blood pressure and cholesterol is escalating at an alarming rate. It’s not the pure numbers that are so dramatic; it’s the speed at which this is growing.",
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"value": "<p>In the 21st century, Vietnam has entered an age of relative prosperity. One of the immediate benefits of this is that life expectancy has soared, at least for the time being. But with the good comes the bad; there’s more smoking, less walking, and more fatty fast foods. The number of cars and bikes is growing almost every day, and people are happy to have more Western comforts. How many people have cheered that we <i>finally</i> have McDonald’s in Saigon? But with all this, the incidence of diabetes, high blood pressure and cholesterol is escalating at an alarming rate. It’s not the pure numbers that are so dramatic; it’s the speed at which this is growing. Going from poor to wealthy in Europe and America was a smooth transition that took 30 to 50 years, allowing the development of a health system to match gradually unfolding needs. But in Vietnam, it’s happened within just 10 years. That’s why the rise in number of patients with these problems is making a big impact on the health system. In the West, if you’re considered obese, the risk for many diseases sharply increases. But in Asia, we see diseases such as diabetes in people who are nowhere near as chubby as Westerners can be, which indicates that the number of those affected here may grow even higher. In the case of diabetes, it’s expected that more than 10 percent of the Vietnamese population will be affected.</p><p><b>Amputations</b></p><p>One of the most visible consequences of diabetes is the development of peripheral artery disease (PAD), which can lead to foot amputations. It’s said that in Western countries, between 10 to 15% of the diabetic population will one day face amputation. Here in Saigon, where people commonly wear open sandals that expose their feet to friction and dust, the expectation is that the incidence of PAD and foot amputation will be much higher. The population of Vietnam is more than 90 million; if the incidence of diabetes reaches 10 percent, this means that at least 90,000 to 135,000 amputations are on the way!</p><p>With PAD, everything starts from a tiny spot with some discomfort that you don’t pay much attention to. From there, it develops into a little blister that becomes infected. The infection starts to grow deep and can reach the bone. At that point, even the best antibiotic cannot reach the lesion, because the arteries become obstructed. Finally, the only way to prevent the infection from spreading and killing the patient is to cut off the lower leg.</p><p><b>Prevention</b></p><p>Prevention is not difficult, and information is everywhere. I don’t know the exact percentage of the population with a smartphone, but in Vietnam, it’s one of the highest — almost everyone on the streets seems to have one. That means the information is in their <i>hands</i>. There are so many websites on how to take care of your skin when you are a diabetic. The issue is that people have to jump from Instagram and Facebook to read educational material. The key problem comes down to human behaviour.</p><p>Fifty percent of amputations caused by PAD can be prevented with just a few easy steps. Firstly, take a look at your feet every day. Check between the toes, and keep them dry and clean. Secondly, before putting your shoes on, check that there is nothing inside. Not even a tiny stone. Pull on the tongue of each shoe to make sure that there isn’t any kind of fold. Wear snug-fitting cotton socks to avoid friction, and make sure that both shoes and socks fit comfortably.</p><p>Why all of this? It’s because the early biology of the amputation starts with the tiny nerves around your skin. Normally, you can feel any light touch, but when you have diabetes, your high blood sugar prevents these nerves from working properly. This is called neuropathy. At the same time, the high sugar also pushes up your cholesterol levels, which can obstruct the arteries. A minor blister or ulcer in the foot can start to grow, and if the area is even slightly dirty, bacteria can infect the lesion. It may not look so bad on the surface, but it can spread deep beneath the skin. By the time you see the doctor, it can be enormous.</p><p><b>Consultation</b></p><p>Consult your doctor early if you notice something unusual on your feet. A small ulcer can be treated to remove the necrotic tissue, and special dressings can be applied to promote regrowth of the removed area — we stock these at our clinic. In serious cases, immersion in a hyperbaric chamber can force oxygen into tissue with insufficient arterial reach.</p><p>As with most such diseases, it’s best to avoid the complications of diabetes by leading a healthy lifestyle. For diabetes type two, the medication isn’t enough — you need to decrease your food intake and burn off extra weight. Besides avoiding smoking, the treatment for diabetes really rests on four pillars: diet, exercise, medication, and water. Eat well, move your body, and take the proper amount of water, and your reliance on medicines will decrease. I have seen successful cases where patients have stopped taking medicine altogether after adopting healthy living practices. All it takes is a little discipline.</p><p></p><p><b><i>Dr. Pedro Trigo -</i></b> <b><i>Internal Medicine, Family Medical Practice Ho Chi Minh City</i></b></p>"
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"summary": "Constipation has a significant impact on a child, both physically and psychologically. A child who has passed painful stools will try to avoid going to the toilet again to prevent pain. That creates a vicious cycle that will cause the retention of more stool in the colon, stretching it to a point at which the colon doesn’t function properly and the constipation will get worse.",
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"value": "<p><b>Constipation in toddlers can lead to an unhappy little one, so learn how to keep them regular and happy</b></p><p>Constipation is a common problem that almost every child will experience at some point in time. It is a condition where a child infrequently passes hard painful stools over a long period of time. Unfortunately, in many cases this problem goes unnoticed. Recently a mother brought her three-year-old child to the clinic. Her concern was her child’s loss of appetite. He would often start eating and then suddenly stop and refuse to continue. When I examined the child, I noticed hard masses in his belly. He hadn’t passed stools for three days, and the mother told me that when he did, they were usually hard and painful. Constipation can cause abdominal pain and loss of appetite in children. Normally when we eat, a bodily reaction called the gastrocolic reflex will cause the colon (large intestine) to constrict, creating the urge to defecate. If a child’s colon is filled with hard stools, this reflex will cause pain, and the child will stop eating. Eventually, he will refuse eating altogether to avoid this painful sensation. Constipation has a significant impact on a child, both physically and psychologically. A child who has passed painful stools will try to avoid going to the toilet again to prevent pain. That creates a vicious cycle that will cause the retention of more stool in the colon, stretching it to a point at which the colon doesn’t function properly and the constipation will get worse. A child that suffers from long-standing constipation may lose the ability to control his anal sphincter and may suffer from “leakage” of small amounts of loose stools and staining of his underpants.<br/>This problem has a great emotional impact on a child. It causes the child to be afraid of the toilet. It will cause a child to feel embarrassed, to try to avoid certain social situations (avoiding public toilets at school, avoiding visiting friends) and to suffer from low self-esteem.</p><p><b>Constipation In Babies</b></p><p>Constipation is a common condition in toddlers and children, but it’s quite uncommon in little babies. Sometimes, normal phenomena might be mistaken for constipation:<br/>• Breastfed and formula-fed babies can pass stools anywhere from six times a day to even once a week. Usually, when they do pass a stool, it is soft and not painful.<br/>• A baby might seem to be struggling to pass stools, grunting and straining, even turning red, eventually passing soft stools. This is a result of uncoordination between the abdominal muscles pushing the stool out and the squeezing of the anal sphincter, which makes it difficult to defecate. Eventually, the baby learns to relax his sphincter and the straining situation is resolved.</p><p><b>Reasons</b></p><p>If a baby does suffer from true constipation, we need to search for a cause:<br/>• Constipation may be the only sign of milk allergy in little babies. Sometimes there can be blood in the stool.<br/>• Anatomic conditions such as bowel obstruction, Hirschsprung disease, or hernia.<br/>• Hypothyroidism (Low thyroid hormone)<br/>• Dehydration, Malnutrition<br/>• Botulism (from exposure to honey)<br/>• Rare metabolic disorders</p><p><b>Treatment</b></p><p>The treatment of constipation involves three aspects:</p><ol><li><b>Nutrition</b><br/>• Avoid sugary sweet foods and drinks (including fruit juices); fatty foods; large amounts of white rice; and bananas. These may worsen constipation.<br/>• It’s better to blend the whole fruit than to provide only the juice; your child will get more vitamins, minerals and fiber this way.<br/>• Give your child foods rich in fibers (whole rice, cereals such as oats, whole fruits and vegetables, whole grain bread).<br/>• Blended prunes (especially dried prunes) can sometimes help with constipation.<br/>• Adding 1–2 spoons of olive oil to your child’s food may help.<br/>• Make sure your child drinks plenty of water (not juice!).</li><li><b>Stool Softeners</b><br/>If nutritional changes don’t help, the next step is to use stool softeners. There are different types on the market: I usually recommend Duphalac or Lactulose. This is a special type of sugar that is not absorbed, retaining water inside the gut and loosening the stool. I prefer not to prescribe suppositories (such as microlet or glycerine) as they are less effective, and sometimes may even be traumatic for the child. The goal is to get stools as soft as toothpaste—not firm, and not too loose. Start with a low dose (0.5–1 sachet) and gradually increase every 2–3 days until you reach the desired goal. Continue this dose daily for at least 3–4 months. The treatment usually lasts for several months for a couple of reasons:<br/>• It takes time for the dilated rectum to get back to its normal size and function.<br/>• It takes even longer for the child to forget the pain of passing hard stools.<br/>• There is no risk of “addiction” or “getting used to” this treatment.</li><li><b>Behavioral Plan</b><br/>• Encourage your child to sit on the toilet twice a day after breakfast and after dinner. This way you can take advantage of the gastrocolic reflex that occurs after eating. Let the child sit there for a few moments even if nothing happens, just to get him familiar with the situation.<br/>• Remember, when your child is on the potty or the toilet seat, make sure his knees are higher than his hips. Squatting is even better. This position makes it easier to pass stools.<br/>• Make it fun—in toddlers and preschool children, prepare a calendar. Every time your child successfully passes stools, put a little sticker there. Let him choose a little gift as a reward for every seventh sticker. This will motivate the child to “make an effort”!</li></ol><p><b>Dr. Jonathan Halevy, Head of Pediatrics, Family Medical Practice Ho Chi Minh City</b></p>"
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"summary": "When a child is fighting off an infection, one of the most common side effects is fever... As the mercury rises, parents will often become greatly distressed and seek to treat the fever as quickly as possible. It’s a pity that sometimes, despite their best intentions, these efforts can end up being contrary to the needs of the child, and can even make the symptoms worse.",
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"value": "<p>When a child is fighting off an infection, one of the most common side effects is fever. As the body’s natural immune response gets to work, the heat given off and the energy expended in the defense effort will raise a child’s body temperature and cause significant drowsiness and suffering. As the mercury rises, parents will often become greatly distressed and seek to treat the fever as quickly as possible. It’s a pity that sometimes, despite their best intentions, these efforts can end up being contrary to the needs of the child, and can even make the symptoms worse.</p><p>Firstly, it's important to remember that fever is not a disease, it’s just a symptom. Although a child may be suffering during an episode of fever, it’s really a positive indication that the body is actively fighting off an infection. There are many root causes that can bring on a fever—including viral, bacterial, and sometimes even parasitical infection. Sometimes a fever is caused by other more serious diseases such as cancer, while at other times it’s the result of taking medication for another illness.</p><p>While it’s certainly important to monitor your child during a fever, parents are sometimes overly concerned when their child has a temperature, and they will try to do everything within their power to reduce it. Sometimes the fever is brought on by taking unnecessary or inappropriate medication, leading the parent to think that the fever was caused by the original illness rather than the attempted cure. Bronchiolitis in children under two, for example, is mostly caused by viruses—which as most parents should know cannot be treated with antibiotics (in fact, we do not yet have a medicine that kills viruses within the body). In some case, if antibiotics are given for bronchiolitis, they can inadvertently cause excessive coughing and difficulty in breathing.</p><p>Some parents will wake up their child to give medicine or apply wet towels to reduce a fever. In fact, if a child has fever during sleep, everything is already being managed by the nervous system, so there is no need to wake them up to do anything at all. The fact that a child can sleep during fever is an indication that everything is under control—if not, the child would certainly wake up independently.</p><p>Another common mistake parents make is to use medicine to prevent the onset of fever. Medicine taken to reduce fever is only effective if the temperature is higher than 38.5. Lower than that, and it doesn’t work at all. Some mothers administer the medicine out of concern that the child’s temperature may be about to rise, but there is actually no medical benefit to the child in doing this.</p><p>It’s important to pay attention to what other symptoms the child has, such as a runny nose, coughing, or diarrhea. If the child is coughing a lot, has a rash, finds it difficult to breathe and also has a fever, or if a fever lasts longer than three days, then that’s certainly a cause for concern. That is the point when a child should be taken to see a doctor for an assessment. A baby under three months old who has a fever at any stage should be taken to see a doctor immediately, as fevers can be very dangerous at that age. Otherwise, especially if a fever is the only obvious symptom, it’s best to let the child rest and wait until the symptoms subside, providing plenty of rest and water.</p><p>If you do see a doctor regarding a fever, it’s still not always necessary to prescribe medicine. According to information I have learned from my colleagues in local Vietnamese hospitals, when a child is taken to see a doctor for symptoms of upper respiratory infection (such as cough, runny nose and/or fever), antibiotics will be prescribed 99% of the time. This is despite the fact that antibiotics are only effective against a limited number of the illnesses that cause fever.</p><p>Many doctors feel a sense of obligation to provide medication rather than send a child home without it. Parents can be very upset if a doctor examines their sick child and then sends them away without drugs. Unfortunately, this practice has given rise to very dangerous levels of antibiotic resistance in Vietnam—and this is a very serious issue, as a child who has developed resistance to antibiotics may not be able to benefit from them at later times when they are urgently needed.</p><p>This problem is compounded by the fact that antibiotics are easily available over the counter in Vietnam, meaning parents who do not want to take their children to see a doctor will go direct to a pharmacy or a private clinic for their medicine. If the child’s problem is not resolved within a couple of days, the parent may then decide to take him or her to hospital—but during the intervening time, the antibiotics may have altered the symptoms of the illness, making it far more difficult for the doctor to diagnose.</p><p>Sometimes I tell Vietnamese parents who go to a public hospital or clinic that a very good question is to ask the doctor is whether their case needs antibiotics or not. If the parent asks this question, the doctor will consider whether this case can perhaps wait.</p><p>In any case, it is certainly counterintuitive for a parent to try to persuade a doctor to give medicines, making them feel that they must prescribe something that may make matters worse. Sometimes, the only fever medicine necessary is simply to wait for it to go away.</p><p></p><p><b><i>Dr. Truong Hoang Quy - Pediatrician, Family Medical Practice Ho Chi Minh City</i></b></p>"
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"id": 605,
"title": "Common Sexually Transmitted Infections",
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"summary": "The problem with being infected without having any symptoms is that you can pass a disease on to someone else—and even if you are just keeping it to yourself, the effects of carrying a long-term bacterial STI that you don’t even know you have can be very serious. In short, if you’ve had any kind of risky contact at all, it’s not a bad idea to get tested for these infections so that you can be sure you’re clear.",
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"value": "<p>People are far more worried about contracting HIV than they are about getting any other sexually transmitted infection (STI).<br/></p><p>Maybe that’s because this disease is better known than any other STI, but it’s also because of the seriousness of HIV and the implications of contracting it. This doesn’t mean that the rest of the STIs can be safely ignored — the others are not only much more common, they’re far more infective too.<br/></p><p>The thought of getting an STI tends to freak people out. From the moment it strikes them that whatever risky behaviour they’ve enjoyed may have real-world consequences, they tend to seek a diagnosis and solution immediately. That panic is usually out of proportion to the severity of whatever they may have picked up, and it’s often brought on by a mixture of stigma and a lack of knowledge — but when you know the facts, that’s part of the solution.<br/></p><p>Some common conditions are bacterial urethritis and vulvovaginitis — both of which are the unpleasant result of an infection by either one or a cocktail of bacteria — usually chlamydia and/or gonorrhea. These bacterial infections are more symptomatic in men than in women; there will be discomfort, pain, or an unusual discharge that alerts the infected person that they have an STI. Gonorrhea tends to be more severe — more pain, more discharge, and eventually a higher risk of systemic symptoms like fever, dissemination and rash — but it’s very difficult to tell just by looking at the symptoms alone what the infection is. In both sexes, it can also be entirely asymptomatic, and you can be a carrier without knowing at all.<br/></p><p><b>Transmission</b><br/></p><p>The problem with being infected without having any symptoms is that you can pass a disease on to someone else — and even if you are just keeping it to yourself, the effects of carrying a long-term bacterial STI that you don’t even know you have can be very serious. In short, if you’ve had any kind of risky contact at all, it’s not a bad idea to get tested for these infections so that you can be sure you’re clear.<br/></p><p>The stakes are even higher now that another bacterial STI is making a big comeback — syphilis. This disease had its heyday in the era before there were antibiotics. It’s super-easy to treat, as the bacteria isn’t particularly resistant to any antibiotic (even penicillin will do the trick) but because it has been off the scene for so long, neither patients nor doctors are looking for the signs anymore, and so it can often be missed.<br/></p><p>While it’s really the bacterial infections I see most often, they’re still not the most common STIs around. That honour goes to HPV genital warts, with the majority of cases being entirely invisible. I would say that roughly only 2% of people who contract the infection will get the warts, so the vast majority of people don’t know they have it at all. This is why it’s spreading so much — it can infect up to 70% of sexually active adults.<br/></p><p>The good news is that genital warts resolve themselves spontaneously — at least the warts do, if not the infection itself. They’re also quite different from the female genital tract lesions that can eventually become cancerous, which are caused by a different strain of the HPV virus. They’re contracted the same way and they are related, but they’re not the same thing at all.<br/></p><p><b>Easy Treatment</b><br/></p><p>If your diagnosis is positive for an STI, the treatment is usually straightforward. HIV is treatable, even though it’s still not curable. This is a far better prognosis than it was 15 years ago when HIV was considered a death sentence — with medication, you can now expect to live an (almost) normal life, and it seems likely that a cure will be developed within your lifetime. All the bacterial diseases can be resolved with antibiotics, including syphilis, as long as it’s diagnosed early enough. Chlamydia in particular is important to treat, because you can still infect other people and it may cause complications, such as pelvic inflammatory disease or sterility — at least in women.<br/></p><p>With HPV genital warts, there’s no reason to treat the infection, but you can still burn off the warts with liquid nitrogen. I try to reassure people with warts by welcoming them to the club — “you’re among the 70% of people who carry the virus!” At the same time, I advise them to do a screening for everything else. If you’re in my clinic, you’ve proved you’re not a monk or a virgin — at least once in your life, you’ve done the deed, and here we are. Warts may be the least of your problems.<br/></p><p>It’s quite possibly more dangerous to cross the street in Saigon than it is to engage in sexual relations. However, the simple fact that you’ve been exposed (whether you have symptoms or not) should prompt some kind of screening.</p>"
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"title": "What it Takes to Work in an Emergency Room",
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"summary": "In the ER room, you need a certain kind of compassion just as much as a heart of stone. You can’t get attached to death. It’s not colds and flu that we see here, but the real challenging cases—trauma, vehicular crashes, motorcycles, a little violence.... It’s like this every night—the skies darken and the streetlights flicker to life, while those of us on night shift steel ourselves for another round of trauma, injury, and saving lives.",
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"value": "<p>In the ER room, you need a certain kind of compassion just as much as a heart of stone. You can’t get attached to death. It’s not colds and flu that we see here, but the real challenging cases—trauma, vehicular crashes, motorcycles, a little violence. Some high-projectile mechanism of injury; like speeding on the road. It’s like this every night—the skies darken and the streetlights flicker to life, while those of us on night shift steel ourselves for another round of trauma, injury, and saving lives.</p><p>The worst case I saw here was a drunk tourist who jumped from the 5th floor of a classy hotel. Once he hit the ground, his bone was totally exposed, gushing blood, and squirting—and if a wound is squirting, it must be very, very deep. He was pale, he was still mumbling, but the sounds were incomprehensible. We really needed blood and pain relief. But it was also a hazard for my staff and me, because when there’s so much blood everywhere, we have to protect ourselves. I had to manage all the bystanders as well, all the people who wanted to stop and take photos and then publish them online. If you’re the doctor on site, you’re the first responder, the captain of the ship. You’re responsible for everything.</p><p>In the evening, you have to be fast, it has to be “blink and think.” If a patient comes in convulsing, is he having a febrile fever seizure? Is he intoxicated? Did he take isoniazid drugs? You have to diagnose the cases fast, especially in Vietnam where they dispense medicines left and right, where everything is complicated and people don’t know what prescription drugs they’re taking. Then, if the emergency bell rings, you have to drop everything; quickly hand over to your nurse and the backup doctor, get on the ambulance, and just go.</p><p>You can’t always tell what’s waiting for you at the end of the ride. Sometimes when an English-speaking patient has an emergency, they ask their driver or someone Vietnamese to call us. But Vietnamese people don’t always like to give so many details over the phone. On one call, the information we received was “someone has stomach pain”. When we got there, we found ourselves having to deliver a baby in the bathroom.</p><p>It was about two in the morning. She was British, it was her second child, so she knew the pain. Her water had broken, and she thought she could do it by herself, but of course, the toilet was dirty, and with all the blood spilling out, the baby coming out, and the placenta, how would you get it?</p><p>The mother was really submissive. PUSH! The baby popped out, it only took about 20 minutes. That was my first home delivery in Vietnam. Of course, in my home town in the Philippines, we do it a lot, on the floor, everywhere. But here, yes, the baby was well, crying and pinkish; we cut the cord, we delivered the placenta, then we let the mother hold the baby to her breasts to smell the mother’s pheromones for attachment. Then of course we took them to definitive care, all before the sun came up.</p><p>There’s a cultural barrier here, a cultural difference. We have to understand how they perceive life in Vietnam. We also have to understand that, when someone dies, we have to sterilize the room, even if the patient died from cancer, something not infectious. People do die in here—not as often as you might imagine, but when it happens, they like to bring relatives back home to rest there. We have to compromise as well. They want to apply some heating oil, some coins, they ask us about this. Part of our job here is to get immersed with the old ways of traditional medicine.</p><p>We’re lucky here in Vietnam that we don’t have so many mass casualty incidents. My specialty may be emergency, but in my sub-specialty, I’m really inclined toward disaster medicine. In my home town, we see terrorist activities. There was a policeman who ran amok because he got fired from his job, so he held an entire busload of tourists hostage and then he killed five people. It was a rainy night, and I was just in training at the time, working that night shift. The whole ER was so congested because it was under renovation. Then, boom! Five dead, three critical, and others moaning. You don’t just see the critical cases, you also see the patients from the tear gas, from the blast injury. They have shrapnel, hot glass. The noise, the heat, the pale light of the ER room lamps.</p><p>Another mass incident was a bomb blast. Someone had left a bag with explosives outside an examination center. They brought about 30 people into our hospital, and everyone was in pain. Of course, the parents were wailing. There was a young student, first year in college, who lost both of her legs. She was shaking, her blood pressure was going down, and she was asking, “Doctor, I cannot feel my legs”. What could I say? I wanted to turn around and shout for a doctor, but I was the emergency specialist at that time. That’s when it hit home, that realization of the responsibility of my role. Here, we don’t have many incidents like that. That’s very good. But we’re still prepared for them if they occur.</p><p>If it’s the middle of the night, and you have an emergency, then do call us. Our number is ∗<b>9999</b>. We will respond to your calls. House call, road call, hotel call—we will get there with a prepared team. Give us good information, vital, pertinent information. Give us the easiest route to get to where you are. If possible, have someone wait outside your door on the ground floor—for example, so that we don’t get stuck at your elevator without an access card. Meet us, keep your phone line open, be mentally and emotionally strong, because we need that, and your patient needs it too at that moment. Even though it’s late at night, we all need to think sharp.</p><p>In an emergency case, if there’s a problem with the airways, breathing, circulation… patients go straight into ER, they get prioritized. It’s going to be very busy during the first few minutes. Nurses are going to be hovering around them. A lot of questions, a lot of activities—like inserting an IV line, doing a chest ECG, administration of oxygen, lights flashing, X-ray—a lot of movement. It’s difficult for the patient and for the family, because they’re anxious already, and they want to get treated. But bear with us. We have to know what’s going on. We have to ask pertinent questions. Other things can be left for the secondary survey, but for the primary survey, there may be a lot of questions—last medicine intake, last food intake, what happened within the past five hours, things like that. ER has to be fast. So bear with us if we ask straight-to-the-point questions, if we seem heartless sometimes. This is our job. We have to save you, we have to do what you’re paying us for, in order to save your life, right?</p><p>Our job is to protect people whenever a medical emergency strikes, no matter what time of night it is. We doubled our ambulance fleet recently, and the real beauty in that is more community education. I believe we’re making this community a healthier place, and that people are becoming more aware of their health. ∗9999 is an ambitious project, I think it’s very courageous. The ambulances may be expensive, but it’s a sacrifice for the community, it’s how we give back. High visibility of medical access. It feels like Saigon will be a safer place to live.</p><p></p><p><b>Dr. Allan Paras, Emergency Medicine, Family Medical Practice Ho Chi Minh City</b></p>"
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"id": 592,
"title": "First Year of Life",
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"summary": "In Western countries, newborn screening is usually routine, while in Vietnam this is not guaranteed... medication can be prescribed that should ensure the child leads a normal, healthy life. This is the importance of the well-baby check, to find clues that can help us to intervene and make dramatic changes to improve a child’s lifelong health.",
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"value": "<p>As pediatricians, we see children every day—that’s the joy of this profession. Of course, we usually see children when they are sick, but it’s also very important that we see them when they’re healthy. Wellness checks are our main tool to monitor the growth and development of a child from birth until late adolescence, not only physically but also mentally. We need to ensure that they’re achieving their milestones, looking for red flags that may indicate an underlying problem. As with everything, prevention is better than cure, so if we catch something earlier, we can then address it earlier—which is far better than catching it late.</p><p>A good example of this is language acquisition. Research is very clear about what a developing child should be able to express linguistically at each stage in their growth. Sometimes a child may be a bit slower than is normal, and this could be because the child suffers from a condition such as autism spectrum disorder. It could also be due to completely benign reasons—it’s not uncommon for a child growing up in a multilingual household to fall short of their milestones while their speaking skills develop in two or more languages at once. It’s also less of a concern if a child has difficulty expressing him or herself verbally, but is still perfectly capable of understanding complex instructions such as “go into the bedroom and bring me my phone.”</p><p>Sometimes a problem can be caught during a wellness check and corrected easily—if you notice that a two-year-old child has the linguistic capacity typical of a one-and-a-half-year-old, there is only a six-month gap between what is expected and what the child is able to do. With special attention this issue may be resolved, whereas if a child does not receive a wellness check until four years old and is discovered to have the developmental level of a two-year-old, that’s a far more challenging problem. If we see things that are not quite right, we advise parents to see a specialist.</p><p>During the first year of life, there are many things happening—so the frequency of wellness visits is higher compared to when a child is older. Children should ideally receive the first wellness check straight after birth following being discharged from hospital. This should be followed by checks at one month, two months, four months, six months, nine months and then at 12 months; and then after that, every three months until 18 months; and then at two years, 30 months, and then yearly after that.</p><p>In Western countries, screening for illnesses at birth is usually routine, while in Vietnam this is not guaranteed. One example of a congenital condition that will be screened for is hyperthyroidism. If you catch this condition early, medication can be prescribed that should ensure the child leads a normal, healthy life. This is the importance of the well-baby check, to find clues that can help us to intervene and make dramatic changes to improve a child’s lifelong health.</p><p>Normally we do wellness checks, especially for younger kids, together with vaccinations. This is a perfect opportunity to discuss with parents any concerns they might have. We can ask about developmental milestones as well as checking nutrition and other physical attributes, such as head circumference. As we administer the vaccinations, we give appropriate advisory guidance on topics such as healthy eating or accident prevention if a child has just started to crawl or walk.</p><p>Parents usually appreciate professional advice, although not always—sometimes for cultural reasons we run into differences of opinion. In this culture, an overweight baby might be seen as being healthy and happy, whereas as a doctor I find myself having to warn parents of the potential for heart disease, diabetes, and other serious problems later in life brought on by childhood obesity. I often refer parents of overweight children to a specialist.</p><p>So far, I’ve never come across a parent who refuses vaccinations in Saigon, although there are some who choose only certain vaccines that they want and refuse others. Some parents do not understand why we vaccinate against certain diseases here when this is not done in their home country. In fact, it is always recommended to follow the immunization schedule of the country where you are living, because the dangers can vary from place to place. In the case of chickenpox, for example, the best protection is gained by contracting the virus naturally in childhood, so in areas where it is common it is not normal to vaccinate against it. However in Asia, where chickenpox is far less common, it is advisable to vaccinate—contracting the disease naturally later in life, especially during pregnancy, can be a far more serious problem.</p><p>International schools here usually specify a list of vaccinations a child must have before being admitted. A physical examination is also required—different schools have different forms, but the format of these wellness checks is generally the same. It used to be the case that we would need to run skin tests and check for TB, but blood and urine testing are no longer required. Usually these kinds of study-placement tests are only asked for by parents sending their children to schools overseas.</p><p>Parents should be very careful to ensure their child receives all their wellness checks, especially during the early stages of life. We can monitor physical growth, cognitive skills, eyesight, and a number of issues that are most easily resolved following correct diagnoses as early in life as possible. A child should also visit a dentist six months after the eruption of the first tooth. By looking at the overall picture when a child is well rather than only focusing on healing when he or she is ill, we can help to ensure a healthy passage into adulthood.</p><p></p><p><b><i>Dr. Agnes R. Viay - Pediatrician, Family Medical Practice Ho Chi Minh City</i></b></p>"
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"id": 711,
"title": "Keeping Fit in the Vietnamese Summer",
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"summary": "Exercising in hot weather puts extra stress on your heart and lungs. Both the exercise itself and the air temperature increases your body temperature.",
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"value": "<p></p><p>Ever seen the exhausted runners staggering around Hoàn Kiếm Lake, Hà Nội, on a hot summer evening? Outdoor exercise can be challenging when the temperature soars and the pall of humidity descends on the city. So stay safe during hot-weather exercise by drinking enough fluids, wearing proper clothing and timing your workout to avoid extreme dehydration.</p><p>Even during that friendly round of golf, you might not notice the temperature rising — but your body will. If you exercise outdoors in the heat, use caution and common sense to prevent heat-related illnesses.</p><p>Exercising in hot weather puts extra stress on your heart and lungs. Both the exercise itself and the air temperature increases your body temperature. To dissipate heat, more blood circulates through your skin. This leaves less blood for your muscles, which increases your heart rate. If the humidity is high, your body faces added stress because sweat doesn’t readily evaporate from your skin — which only pushes your body temperature higher.</p><p>Under normal conditions, your skin, blood vessels and perspiration level adjust to the heat. But these natural cooling systems may fail if you’re exposed to high temperatures and humidity for too long. The result may be a heat-related illness, such as heat cramps, heat exhaustion or heatstroke.</p><p><b>How to avoid heat-related illness</b></p><p>To keep “cool” during hot-weather exercise, keep these basic precautions in mind:</p><p>1. <b> Slow and Easy.</b> If you’re used to exercising indoors or in cooler weather, take it easy at first. As your body adapts to the heat, gradually increase the length and intensity of your workouts. If you have a chronic medical condition or take medication, ask your doctor if you need to take additional precautions.</p><p>2. <b>Drink plenty of fluids.</b> Your body’s ability to sweat and cool down depends on adequate rehydration. Drink plenty of water while you’re working out — even if you don’t feel thirsty. Consider sports drinks for longer work outs. These drinks can replace the sodium, chloride and potassium you lose through sweating. Avoid caffeine or alcohol, which both actually promote fluid loss.</p><p>3. <b>Dress appropriately.</b> Lightweight, loose-fitting clothing promotes sweat evaporation and cooling by letting more air pass over your body. Avoid dark colors, which can absorb the heat. Wear a light-colored hat.</p><p>4. <b>Avoid midday sun.</b> Exercise in the morning or evening — when it’s likely to be cooler outdoors — rather than the middle of the day.</p><p>5. <b>Wear sunscreen.</b> Sunburned skin decreases your body’s ability to cool itself. If you’re concerned about the heat or humidity, stay indoors. Work out at the gym, walk laps inside the mall or climb stairs inside an air-conditioned building.</p><p><b>How do I know when I need to stop exercising?</b></p><p>During hot-weather exercise, be on the lookout for heat-related illness. Signs and symptoms may include: Weakness, headache, dizziness, muscle cramps, nausea or vomiting. Rapid heart beat. If you suspect a heat-related illness, stop exercising and get out of the heat. Drink water, and wet and fan your skin. If you don’t feel better within 30 minutes, contact your doctor. If you develop a fever higher than 102oF (38.9oC) or become faint or confused, seek immediate medical help.</p><p>Regular physical activity is important — but don’t let hot-weather workouts put your health at risk.Be sensible about exercising in the heat.</p><p></p><p><b><i>Dr. Catherine Gonzalez - Internist, Family Medical Practice Hanoi</i></b></p>"
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"title": "Autism: A Lonely World",
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"summary": "There are so many misconceptions about autism, and so many things that have been blamed for causing it, from vaccinations to poor parenting. But what is it, and what is the real cause?",
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"value": "<p>There are so many misconceptions about autism, and so many things that have been blamed for causing it, from vaccinations to poor parenting. But what is it, and what is the real cause?</p><p>A child with autism has difficulty learning social and communication skills. Such a child will have trouble understanding and developing language, will not be interested in communicating with other children or adults, and won’t be seeking their attention or even pay attention to them. The child will have difficulty interpreting gestures, body language, expressions, and emotions. Autistic children are not mentally retarded—in fact, many of them exhibit higher intelligence than average, and some have extraordinary capabilities in different fields, such as memory, mathematics, the arts, and physics.</p><p>Today in the US, the prevalence of autism is estimated to be 30 times higher than it was 40 years ago. In part, this is because our understanding and definitions of autism have changed over the years. Children who were wrongly considered mentally retarded in the past are now recognized as being autistic. Children who were thought to be “very shy and introverted” in the past actually had mild symptoms of autism. But this still doesn’t explain the exponential rise in the condition.</p><p>Over recent years, science has shown that autism has a genetic basis. We also know that environmental factors make a significant impact on the stability and quality of our genes— advanced paternal age, air pollution, Vitamin D deficiency, heavy metals, and exposure to certain infections during pregnancy have all been related to a higher risk of autism. But even these factors do not explain why the incidence of autism has risen so much over the last decades. So what is it in our environment that can explain this rise? What do we have now so abundantly, that we didn’t have 40 years ago?</p><p>Exposure to electromagnetic radiation through mobile phones, Wi- Fi routers, cellular networks, radio and TV antennas—and even high voltage electricity lines—has rapidly increased over the past four decades. Today it is all around us, in our pockets, in our homes, on the streets, in shopping malls, cafés and restaurants. You can’t escape it. Open your Wi-Fi app on your phone and see how many routers are currently transmitting to you. You can be in a remote village in the countryside and still be surrounded by this radiation. Even if you never use a cellular phone in your life, you will still be heavily exposed.</p><p>Proving that EM radiation is a direct cause of autism is very difficult. It’s impossible to quantify exposure, and to eliminate the influence of other factors such as different types of environmental pollution that definitely could be contributing to the rise in autism. But the circumstantial evidence is accumulating: Increases in RF exposure rates and autism rates have closely correlated over the years; cellular examinations and behavioral studies on rats have suggested negative effects from EM radiation exposure; some studies indicate that carrying mobile phones affects the quality of sperm; while others link early cellular phone use with the development of brain tumors later on in life. Pediatric neurologist Professor Martha Herbert has published several articles showing the connection between EM radiation and autism.</p><p>I am certain that in the near future, more studies will reveal more evidence of the effects of EM radiation on our health. The question is, what can we do about it? Unfortunately, at the moment, no one has a good answer.</p><p>Autism should be detected at an early age to allow for early intervention, which is very important for both autistic children and their parents. Teaching and raising a child with autism is very different from raising an ordinary child—these parents need to learn a new way of teaching their children, showing them how to behave and how to cope in different situations.</p><p>Red flags for autism include:</p><ul><li>A baby who doesn’t have a “social smile” by the age of two to three months (such as smiling back at a parent).</li><li>A baby who avoids long eye contact.</li></ul><p>By the age of two to three months, most babies should be able to gaze at their parents and even try to imitate facial expressions.</p><ul><li>A baby who doesn’t show interest in his or her environment within six months. Most babies at this age will try to reach for new objects and explore them, manipulate them, turn them around, pass them from hand to hand, and so on.</li><li>No babbling back to parent or communicative expressions by nine months.</li><li>No “separation anxiety” or fear of strangers by nine months. Children with autism will not show anxiety when their parents leave them alone or with a stranger.</li><li>No understanding of nonverbal communication (such as gestures) after one year—blowing a kiss, waving bye- bye, or pointing at objects of interest to get the parent to notice them. Babies with autism will rather draw the parent by the hand toward the object, or stare at the toy and grunt.</li><li>Not saying a word by 16 months.</li><li>No imaginative play at 18 months (e.g. pretending to talk on the phone, pretending to feed a doll).</li><li>No meaningful two-word sentence by two years old (not just repeating words).</li><li>Restricted behavior (doing the same activity over and over again—for example, walking around in circles or flapping the hands repeatedly).</li><li>Restricted interest (showing interest in only certain objects and neglecting others).</li><li>Unusual play (e.g. continuously banging cars together instead of “driving” them).</li><li>Showing no interest in other children by 18 months old.</li><li>Any loss of previously acquired social or communicative skills.</li></ul><p>If your child shows any of these red flags, this does not automatically mean that he is autistic—hearing loss is another possible cause of these behaviors. In any case, he should certainly be evaluated by his pediatrician, as early diagnosis and early intervention will result in a much better outcome.</p><p></p><p><b>Dr. Jonathan Halevy - Pediatrician, Family Medical Practice HCMC</b></p>"
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"id": 1203,
"title": "Family Medical Practice Invests in New Ambulance Fleet for HCMC Emergency Response",
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"post_date": "2017-05-31",
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"value": "<p></p><p><b><i>Ho Chi Minh City, Vietnam, May 31, 2017:</i></b> Family Medical Practice today announced the investment of $800,000 into four new ambulances to augment its state-of-the-art vehicle fleet that services residents of Ho Chi Minh City every day. This brings the company's total investment into emergency care in the city to over US$2 million, and ensures near-citywide coverage for incidents and accidents for Saigon residents.</p><p>The four additional Mercedes Benz Sprinter 2500 ambulances bring the company's total fleet to eight. Each ambulance is equipped with automatic CPR machines, monitored defibrillators, stair chairs, large-capacity portable oxygen tanks, fast vacuum splints, trauma kits, floodlights, and full telecommunications links between dispatch and ambulance to monitor patient vital signs. Each vehicle is similar to a mobile ICU, staffed by professional teams who maintain a constant telemedicine communications link with the alarm center and the emergency teams in the clinic.</p><p>Family Medical Practice’s Founder, Dr. Rafi Kot, said of the investment: <i>"These are simply the finest ambulances on the road in Vietnam today. No other company has made such an investment into Vietnam's emergency care."</i></p><p>The ambulances play a central role in the *9999 EMR system that Family Medical Practice launched in 2016.</p><p><i>"It is worth noting that we have earmarked another $1.5 million for further investment in our fleet. Our goal is to eventually have a fleet of some 26 vehicles for Ho Chi Minh City in the near future. However, under current Vietnamese legislation, there is no recognition of the paramedic profession, and this hampers our ability to resource our fleet. Amendments to this oversight – which no other country imposes – will see us rapidly invest further into this industry, and importantly, offer citizens of Vietnam far superior early intervention and emergency care,"</i> Dr. Kot continued.</p><p>Indeed, Vietnam has an urgent need for improved and enhanced emergency care. The country notably has an alarmingly high rate of road casualties and traffic incidents. In 2016, there were 3,962 traffic accidents in HCMC with 805 people killed and 3,204 people seriously injured, an increase of 5.5% over the same period of 2015. EMR services are also invaluable with cardiac arrests, which increase by 15-20% each year; strokes, which take around 200,000 lives each year; and even drownings, which take a frightening 32 Vietnamese lives each day. All of these can be reduced with early intervention and superior emergency care.</p><p>*9999 leads the way in offering this service to people in Ho Chi Minh City, with the emergency hotline number offering bilingual services to Vietnamese citizens and foreign residents for prices as low as 575,000 VND per person for a full year. Subscription to the EMR *9999 service will entitle the subscriber to unlimited 24/7 emergency call service from anywhere in HCMC, with proven life-saving support and response protocols – including free ambulance transportation and emergency care en route – within the HCMC coverage zone.</p><p><i>"We opted for this rate to make our services accessible to everyone here,"</i> Dr. Kot said. <i>"Call-out fees for non-subscribers start from 1,840,000 VND, so we really do urge everyone to subscribe to protect themselves and their families."</i></p><p>The additional vehicles sees *9999 able to service Districts 1, 2, 3, 4, 5, 6, 7, 8, 10, 11, Phu Nhuan, Binh Thanh, Go Vap, and Tan Binh.</p><p>For information about subscription, visit <a href=\"http://www.star9999.vn/\">www.star9999.vn</a>, email emr@star9999.vn or call Customer Service Hotline: +84 932 776971</p><p>--------------------------------------------------------------------------------------------------------------------</p><p>Family Medical Practice, the first foreign-operated, multi-disciplinary primary medical health care provider in Vietnam, opened in Hanoi in 1994 and owns and operates five modern clinics based in Hanoi, Danang and HCMC. FMP is the only private medical provider in Vietnam with such national coverage. All Family Medical Practice clinics have fully-equipped ambulances described as “state-of-the-art emergency medical units” on standby 24 hours a day.</p>"
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"id": 729,
"title": "Vomiting in the Pediatrics Age Group",
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"post_date": "2017-05-29",
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"summary": "Vomiting is a highly-coordinated reflex process that may be anticipated by increased salivation and begins with involuntary retching. Both children and adults may experience it.",
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"value": "<p><b>VOMITING IN THE PEDIATRIC AGE GROUP</b></p><p>During the summer season, many kids are brought to clinics or hospitals because of vomiting. Due to the heat, kids often want to drink too many fluids—cool refreshing drinks such as fruit juices or shakes—or, sometimes while at the beach, they can unconsciously put a foreign object in their mouth, such as a small toy, some nuts, or even a pebble, and eventually swallow it.</p><p><b>Why Vomiting Occurs</b></p><p>Vomiting is a highly-coordinated reflex process that may be anticipated by increased salivation and begins with involuntary retching. Both children and adults may experience it. Although the overall sequence of these processes is quite stereotypical, each can occur independently of the others.</p><p>The following is some information about vomiting, the most common causes of vomiting, and what to do in cases of vomiting.</p><p>It is accepted that the ability to vomit developed as a protective mechanism to rid the body of ingested toxins. Unfortunately, vomiting also frequently occurs in circumstances not related to the ingestion of noxious agents. Vomiting can be a sign of many different diseases, an adverse reaction to a certain medication, psychiatric disorders, pregnancy, or stress.</p><p>Vomiting during the first day of life suggests obstruction in the upper digestive tract or increased intracranial pressure. Vomiting may also be a nonspecific symptom of an illness such as septicemia. It is a common manifestation of overfeeding, inexperienced feeding technique, or normal reflux. Vomitus containing dark blood is usually a sign of serious illness, and the possibility of swallowed maternal blood should also be considered.</p><p><b>Common Causes</b></p><p>The most common cause for vomiting is often gastrointestinal (GI). It can be helpful to think of the GI tract as a long tube stretching from the mouth to the anus, with four buds sticking out in the middle: the liver, the gallbladder, the pancreas, and the appendix. Anything that either obstructs or inflames the tube or any of its buds may cause vomiting.</p><p><b>Acute gastroenteritis (AGE)</b> is the most common cause of vomiting in the pediatric age group. Most cases of gastroenteritis are associated with some degree of vomiting. The child will develop a fever, vomiting, and abdominal pain followed by diarrhea after a few hours. Significant vomiting lasting longer than 48 hours needs to be evaluated for something other than AGE.</p><p><b>Appendicitis</b> is the most common surgical emergency in childhood, and vomiting is the most common symptom, followed by fever and abdominal pain. If these signs and symptoms are seen in your child, bring him or her to the clinic for proper evaluation and assessment.</p><p>The most common <b>foreign body (FB) ingestion</b> in children worldwide is the swallowing of coins, which will usually result in vomiting. Fortunately, here in Vietnam coins are rarely used, so other small objects such as buttons, small toys and nuts are the more common culprits of FB ingestion.</p><p>Children who have ingested FBs are noted for drooling and may have difficulty breathing, and must be rushed to a nearby hospital for the removal of the FB by a specialist. If the child is neither drooling nor vomiting, he or she can be observed for 24 hours to see if the FB passes into the stomach spontaneously. If not, the child should be referred to a gastroenterologist for removal. In the case of ingested sharp FBs and button batteries, the child should be referred to a specialist immediately.</p><p><b>Remedy</b></p><p>The most important consideration in assessing the child is the degree of dehydration. To prevent it, give small amounts of water or an oral rehydrating solution. No laboratory tests are needed in the vast majority of cases, except for random blood sugar or a set of electrolytes in cases of moderate or severe dehydration. Hypoglycemic children are commonly fussy and refuse to drink, and therefore will often need intravenous fluids and admission to a hospital. Owing to the self-limited nature of vomiting associated with gastroenteritis, no therapy is usually needed. If the child goes to daycare and if anyone in the family works as a food handler, the importance of good hand washing should also be stressed.</p><p></p><p><b>Dr. Elvie Joy Atanque-Basa - Pediatrician—Family Medical Practice Danang</b></p>"
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{
"id": 617,
"title": "Counting Sheep",
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"post_date": "2017-05-22",
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"summary": "About 30 percent of children initially diagnosed with ADHD actually have a sleeping disorder, such as obstructive sleep apnea. Sleep deprivation and bad sleep quality can cause an inability to concentrate and pay attention; it may cause irritability and hyperactivity, which are symptoms similar to ADHD. In these cases, once the sleep problem is treated, the attention and hyperactivity symptoms resolve themselves.",
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"value": "<p>Why sleep is important in a child’s development</p><p>When it comes to sleep, most of us aren’t getting enough—far less than the recommended daily dose of 8–9 hours per night. Many of us suffer from chronic sleep deprivation. While this is a serious issue in adults (for example, it increases the risk of heart disease), it is even more detrimental in children.</p><p>Chronic sleep deprivation directly affects our cognitive functions—our ability to learn, memorize and solve problems. In teenage students, this may interfere with their academic achievements. In the developing child, it may have potentially alarming consequences on their development and behavior.</p><p>About 30 percent of children initially diagnosed with ADHD actually have a sleeping disorder, such as obstructive sleep apnea. Sleep deprivation and bad sleep quality can cause an inability to concentrate and pay attention; it may cause irritability and hyperactivity, which are symptoms similar to ADHD. In these cases, once the sleep problem is treated, the attention and hyperactivity symptoms resolve themselves.</p><p>Babies need to sleep between 12–16 hours a day. This is essential for brain development and the release of growth hormone, which mainly occurs at night, during sleep. Insufficient sleep may impair the baby’s growth and development. Sleep deprivation can also cause the release of stress hormones such as cortisol, and one of its side effects is hunger. For this reason, children and adults who suffer from sleep deprivation tend to be obese.</p><p>Babies naturally have lighter sleep and tend to wake up several times during the night and fall back to sleep. Some parents make the mistake of “intervening”—checking the baby, picking him up and trying to rock him back to sleep. This intervention interferes with the baby’s ability to fall asleep independently, and creates a habit that will be very hard to break. The next time the baby wakes up, he will expect the parent to come and “intervene” again.</p><p>Parents should not “rush” to their babies when they wake up at night. They need to wait a few minutes and then quietly and briefly make sure he is fine (no picking up, no talking or interacting) and then let him fall back to sleep by himself.</p><p>By the age of four, pre-school age, children still need between 12 and 14 hours of sleep to stay healthy. The daily naptime at this age gradually shortens, and usually after four years old most children won’t need it anymore. Sleeping during the day may push forward the normal sleeping time at night, and make it more difficult to fall asleep.</p><p>At age six, the amount of recommended sleep drops to between 9 and 11 hours, then falls for teenagers to between 8 and 10, and ends up at the 7 to 9 for fully-developed adults.</p><p>Keeping a “bedtime routine” is very important for babies, children and even teenagers. Having the same routine (dinner, bath, book, milk and then sleep, for example) makes it easier for little kids to adjust and fall asleep. Any screens—televisions, smartphones or tablets—should be avoided for at least two hours before going to bed, as the light from the screens inhibit the release of melatonin, the natural sleep hormone.</p><p>In Vietnam, teenagers are under tremendous pressure to be advanced at school. This results in school-aged children having schedules that would burn out most adults. They get up at 5am to be at school at 6:30am, and they don’t finish until 4pm—and then their parents often send them to extra classes, such as English and math. Once they get home, sometimes as late as 10pm, they will eat supper and then do their homework. They might get to bed by midnight or even later, get only a few hours of sleep, and wake up at 5am to another sleepless day. Parents need to know that sleep is essential for the academic success of their child. If they want him to do better in the tests, they need to make sure he sleeps better. The same way a parent will not deny his child food, he should not deny his child sleep.</p><p>Sleep deprivation is a common cause of sleeping disorders but by no means the only one. Physical and environmental conditions may cause difficulty to fall asleep or maintain sleep. Other issues such as obstructive sleep apnea may cause poor quality sleep. Common medications like cough medicines can cause sleeping problems. Even certain foods and drinks (energy drinks, caffeine etc.) may cause a child or teenager to lose sleep.</p><p>If your child seems to be tired when he wakes up, if he has difficulties concentrating or paying attention, if he has a tendency to “doze off ” during the day, if it takes him longer than 30 minutes to fall asleep at night, or if he sleeps for many hours during the weekend, then he probably suffers from a sleep disorder—and he should be properly evaluated by his pediatrician.</p><p></p><p><b><i>Dr. Jonathan Halevy - Head of Pediatrics, Family Medical Practice Ho Chi Minh City</i></b></p>"
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{
"id": 571,
"title": "The Business of Medical Evacuation",
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"slug_ko": "business-medical-evacuation",
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"post_date": "2017-05-09",
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"summary": "The industry of air ambulances is abusing Vietnam. It sours our reputation abroad and flouts our tax laws ... there are enough local providers here who have the knowledge, experience, and expertise to perform these transfers safely while putting the interests of the patient first, not those of foreign businesses.",
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"value": "<p>Imagine you’re a foreign tourist who has had the misfortune to fall terribly ill during your visit to Ho Chi Minh City. You’ve been admitted to hospital, you’re lying in the ward, and a team of people wearing white coats arrives to tell you that they’ve come to pick you up and evacuate you to Thailand—where they say you’ll get superior treatment. Before you know it, you’re on an air ambulance touching down in Bangkok, being taken to a facility with a nicer room and a softer pillow. The charge for this transfer to a bed upgrade 750 kilometers away was probably somewhere between $15,000–$20,000.</p><p>More likely than not, your flight had nothing to do with medical emergency—and everything to do with the business of medical evacuation.</p><p>International evacuation by air is a mega-million dollar industry. According to local air traffic controllers, at least one or more air ambulances enter Vietnam’s airspace every single day. Just as ambulances on the road are given right-of-way in order to save lives, so too do air ambulances enjoy priority clearance at international airports, and Vietnam is no exception. Unfortunately, this safety protocol makes the industry enormously difficult to regulate, and leaves Vietnam open to exploitation by foreign operators who neither pay taxes on their activities stemming from here, nor do any service to this country’s reputation among the international community—who have been indoctrinated to presume that no significant medical procedures are possible in Vietnam; and that if they are, they are too risky.</p><p>The fact is that a company can make a lot of money by convincing foreign patients of their need to be transferred abroad for medical treatment, even if that patient does not fully understand why. Most such patients are “evacuated” simply because they have been told by people in lab coats that it is necessary. Local doctors are also offered lucrative referral fees as incentives to recommend patients for medical evacuation, informing the air ambulance operators whenever they have an eligible case.</p><p>This “business” is further propped up by the sale of “evacuation cards” to tourists, which pronounces them “eligible for evacuation” if anything happens to them. Even for non-cardholders, regular insurers usually cover medevac expenses anyway. The cases are generally approved by doctors sitting in comfortable offices many thousands of kilometers away who have also been indoctrinated that every case in Vietnam has to be flown out. Why? Because that was what their predecessors believed, and the ones before them, and so on. Why be the one to take the risk and restrict medevac coverage in Vietnam? As a result, this practice continues.</p><p>In Vietnam, this industry is largely captured by Thai providers who fly into Vietnam on a daily basis to perform a service on Vietnamese territory without being asked to declare earnings on those activities, and therefore paying zero tax here. Millions of dollars that should have been submitted to Vietnam for many years by a company that operates here nearly every day remain unpaid. This also serves to perpetuate the impression overseas that almost any traveller who falls ill in Vietnam somehow needs a medevac.</p><p>Some of the pickup teams are extremely ill-equipped. In one case, a Thai air ambulance doctor came to our clinic to collect a reassessed patient, carrying a blood pressure machine purchased from a Boots pharmacy! A patient wired to everything imaginable, and she came with over-the-counter equipment and claimed “this is now my patient”. Last month, a Thai team was kicked out of a hospital in Danang for being under-equipped, unprepared, and without any prior understanding of the case.</p><p>The legality of such teams working in Vietnam, even for short periods of time, is highly questionable. Few of the cases they deal with are REAL emergencies. Genuinely life-threatening emergencies are usually rejected by air ambulance providers for a myriad of reasons, usually none of which are actually related to health risks. The list of do’s and don’t’s seems to be very clear in the world of medical evacuations. In this region, air ambulances obviously prefer to fly only the non-risky cases.</p><p>The industry of air ambulances is abusing Vietnam. It sours our reputation abroad and flouts our tax laws. Local medical providers should block the surrender of their patients to unlicensed foreign operators, and evacuations should be performed by local companies that are already regulated by the Vietnamese administration. There are enough local providers here who have the knowledge, experience, and expertise to perform these transfers safely while putting the interests of the patient first, not those of foreign businesses who deliberately breed fear among international visitors, damaging our reputation for the sake of profit.</p><p><i>This opinion piece by FMP founder Dr. Rafi Kot originally appeared in VietCetera.</i></p>"
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{
"id": 580,
"title": "Acne Agony",
"slug": "acne-agony",
"slug_en": "acne-agony",
"slug_vi": "acne-agony",
"slug_ko": "acne-agony",
"slug_ja": "acne-agony",
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"id": 228,
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"post_date": "2017-05-03",
"category": {
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"name": "Media & Press",
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"name": "Articles by our Doctors",
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"summary": "There is no evidence to suggest that acne is caused by poor diet or hygiene. It’s no more common in Vietnam than it is anywhere else. And, while it is an infectious disease, it is not a transmissible one.",
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"value": "<p>“Mom, what’s happening with these pimples on my face?” “Oh, don’t worry, I had them too…”</p><p>Many people feel acne is a natural condition that should be accepted. It happens to almost 80 percent of the population between 15 and 30 years of age. That’s why they feel that one day it comes, if you’re unlucky, and that it will most likely eventually go away without leaving any permanent sequelae—or instead, it may leave scars or permanent pigmentation. In the meantime, it might make you feel like a monster and cause psychological trauma, because normally it happens during the building of a teenager’s self-esteem and confidence.</p><p>Acne arises from four main factors. The first is an overproduction of grease, which makes the skin look oily. The second is a blockage of follicles where hair grows from the skin. Therefore, the excess grease and the occlusion of the follicles bring about the third factor, inflammation. An infection is then produced by a resident bacteria on the skin called <i>Propionibacterium acnes</i>. All together, this is what we need to treat. There is no evidence to suggest that acne is caused by poor diet or hygiene. It’s no more common in Vietnam than it is anywhere else. And, while it is an infectious disease, it is not a transmissible one.</p><p>The overproduction of fat, the occlusion of the follicles, the inflammation and the infection— these have been traditionally treated with antibiotics and peelers, which work to peel the skin, making it more diffusely red and dry. So we dry the skin, we irritate the skin, and we will see the skin become flaky. That’s also something that people don’t like, but it has been considered part of the price to pay to get rid of the pimples—by having dry, irritated, burning skin.</p><p>For many years, acne has been treated with antibiotic creams or pills. Unfortunately, a good deal of resistance to the antibiotics has occurred, because normally the treatment is so long. This is something that we need to tell everybody who has acne, and who has the will to treat it—they must be patient. You don’t see improvements in acne even with the more efficacious treatments before 12 weeks. The full treatment should normally take place within the course of one year, and there can be relapses, so this can be very hard to cope with.</p><p>The good news is that the best medications available on the market today are used earlier, when the disease is not so advanced. That’s a new trend—ten years ago, after-the-fact treatment from powerful medicines (such as retinoid creams, benzoyl peroxide, adapalene creams, and antibiotics) were used in an escalating manner—and when the disease was really advanced, then people were put on oral retinoids. These are the best treatment for acne, because retinoids interact with inflammation, infection, occlusion, and sebaceous production— all four causes of acne.</p><p>Retinoids were formerly used in very high doses. In some cases, the reaction was so violent that you would need to inject steroids into some of the lesions. This is why retinoid treatment is sometimes associated with psychological trauma, mostly because it was used when people were already desperate from the disease.</p><p>The modern trend is to use the oral retinoid earlier and in smaller doses. Today, what we have learned is that you can help people feel less anxious about the acne and prevent the scars and the pigmentation, which is important, especially with teenagers from Asian countries whose skin is more easily tanned from exposure to the sun (in general, the darker the skin, the more risk you have of post-inflammatory pigmentation, or PIP). These days, we don’t want to treat only the acute problem, we want to treat the whole thing—we want to treat the person and their experience of life. If we can prevent the acne from becoming violent by starting with low doses and using oral retinoids with appropriate controls, we can prevent scarring and PIP from the beginning, and greatly reduce the chance of relapses of the disease.</p><p>Some are reluctant to have their acne treated, seeing it as a cosmetic problem. I completely disagree with considering acne as a cosmetic issue. We are not talking here about “wanting a smaller nose” or “bigger lips.” We are talking about “wanting skin to appear healthy.” Some people can be disfigured or even lose their jobs because they are facing the public and can be seen as dirty and untidy.</p><p>Parents who see their child starting to show a growing number of pimples on their face should consider preventive treatment. An adolescent does not have to suffer an inflammatory disease; medical options are available to greatly reduce the severity of this condition.</p><p>Parents have the power to lead their children in having a first consultation and starting treatment before acne really becomes a problem. Some early decisions, made on time, will spare kids from going through physical and psychological issues that will distract them from concentrating on learning, socializing and becoming successful in their teenage life, which is important in building the personality.</p>"
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"summary": "At our clinic, we now have a highly experienced medical evacuation team and have become regarded as an authority in these matters. Although we started with small cases, we have established Vietnam as one of only seven countries worldwide capable of doing ECMO evacuations.",
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"value": "<p>Medical evacuations are difficult to pull off, but in terms of complexity, there’s nothing that goes beyond extracorporeal membrane oxidation (ECMO). In these evacuations, a patient needs to be moved from one country to another while their heart is disconnected from their body.</p><p>Just like an organ transplant, it takes a team of 12 to 14 people to pull one off, involving a multidisciplinary bioengineering team, a nursing team, and a medical team. The difference is that in an operating theatre, the specialists come and go as they’re needed — while on a plane, they’re all there together, all the time. Anything can go wrong at any moment, and everyone has to rely on their sight because it’s extremely difficult to hear anything over the noise of the engine.</p><p>ECMO refers to the action of the heart and lung machine a patient is attached to while their organs are disconnected. ECMO represents the Everest of capacity when it comes to medevacs, with patients who are hanging on a thread between life and death. When a patient reaches an ECMO, it means their heart cannot pump blood any more and it has to be supported by a medical device which imitates the organ’s function. After the heart has been arrested, they will be connected to the machine in the hope that, with some time to rest and heal, things will go back to normal, so the heart can then be reconnected to the body.</p><p>Sometimes the patient will need specialized medical attention that is not available in Vietnam; in these cases, he or she must be transferred overseas.</p><p><b>Making the Impossible Possible</b></p><p>Our first ECMO medevac case was a Russian patient who collapsed at Tan Son Nhat Airport. She was rushed to the Heart Center in Saigon, but it was clear that she would need attention from a major facility abroad. At the time, there were no providers in the region who had the capacity to perform an ECMO medevac. Meeting up with her father, who flew in, we explained the situation to him and that this was a complicated procedure which we had never done before. Doable, but risky. Very. I remember her dad saying: “This is my only daughter. It’s a risk for you, but a chance for me.”</p><p>With no options available, we decided the only thing we could do was fly the patient out ourselves. Hospitals in Bangkok said they could admit the patient, as long as we found a way to transport her there. Bangkok was the choice as we opted for the shortest route.</p><p>We built an entire stretcher with machines on it, wires protruding, oxygen tanks, only to remember we had a patient to insert into all this. The end result was a stretcher with a tower of equipment on top and on both sides. It took five hours to move the patient from her bed and to reconnect her to our systems.</p><p>Thanks to Vietnam Airlines, we procured an ATR aircraft, an aircraft with a large cargo door, and together with their technicians we reconfigured the inner part of the plane, leaving an island of chairs in the mid-section for the stretcher to be installed on top, while the support team sat at the back. We took the flight with around five doctors and a nurse. We had a biomedical engineer, who controlled the electricity supply — we had to carry a lot of batteries — plus we also had a lab technician with a portable unit, just in case. We landed in Bangkok having successfully kept the patient well and alive.</p><p>The Thai Hospital proved to be another challenge as they had never moved a patient from one ECMO unit to another. Worse, the units were not of the same make. So, over the ensuing three hours, we had to do it for them.</p><p>Only on the flight back did we start to grasp the success of the transfer and the implications of it. The patient? She stayed in hospital for three months, survived and returned home.</p><p><b>In Safe Hands</b></p><p>Following this evacuation, we had another from Hanoi to China, and as I write this we’re working on another case. The one thing that makes these cases manageable is that there’s no rush to get from here</p><p>to there. While ECMO patients may be holding on by a thread, they’re not dying as long as they’re properly connected to the machine. You can usually wait another couple of days if there’s a delay. Vietnam Airlines have been a tremendous help, and we thank them for their cooperation. We have our agreements with airport authorities; we have our own gates, we have our own evacuation systems; whatever we need to clear.</p><p>At our clinic, we now have a highly experienced medical evacuation team and have become regarded as an authority in these matters. Although we started with small cases, we have established Vietnam as one of only seven countries worldwide capable of doing ECMO evacuations.</p><p></p><p><b><i>Dr. Rafi Kot - Founder and CEO, Family Medical Practice</i></b></p><p><b><i>Published in Word Magazine</i></b></p>"
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"title": "Heart Attacks and Stroke/Emergency Medical Response",
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"summary": "In cases of an ischemic stroke, prompt medical response can be very effective. If a victim can be taken to hospital within the first three hours of the incident, we can administer a blood clot-dissolving medication called tPA (Tissue Plasminogen Activator) that is able to restore the blood flow.",
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"value": "<p>When a Western tourist collapsed outside the Independence Palace last January, media outlets widely reported that the foreign visitor had suffered from a stroke. This wasn’t quite accurate—according to the emergency doctor who arrived on the scene by ambulance just minutes after receiving the alert, the patient had clearly suffered from a heart attack before going into cardiac arrest and was accordingly taken into intensive care at a nearby cardiology unit.<br/><br/>What stood out about this particular incident wasn’t only the misdiagnosis on the part of the media, but also the fact that the victim suffered from the attack in a prominent public place in full view of multiple passers-by, most of whom were unable to offer any assistance whatsoever. It’s sadly the case that few members of the public in Ho Chi Minh City—whether they be locals or expat residents—have the basic medical awareness required to assist in any such emergency.<br/><br/>Dr. Bui Nghia Thinh, emergency medical director at Family Medical Practice, has been an integral part of the development of Ho Chi Minh City’s first private emergency medical response system, <b>∗9999</b>. While in this case his unit was able to respond immediately to the call for help after a bystander dialed the emergency number, Dr. Thinh remains deeply concerned about spreading awareness in HCMC about the basic protocols necessary to deal with medical crises. According to Dr. Thinh, it’s mostly a lack of understanding that makes bystanders hesitant to act—resulting in delays that often cost lives.<br/><br/>Fortunately, the differences between a stroke and a heart attack are relatively simple to understand—and in the moments leading up to a cardiac incident, there are several easily-distinguishable clues that can identify what the problem is likely to be.<br/><br/>“When you’re talking about stroke, you’re talking about a cardiovascular accident in the brain,” says Dr. Thinh. “If a blood vessel supplying blood to the brain gets a clotted, that’s called an ischemic stroke. “Ischemic” means that the brain doesn’t get enough blood. If the vessel is bleeding, that’s called a hemorrhagic stroke. So there are two kinds of stroke. Both of them usually occur directly in the brain, which causes a neurological defect. You have slurred speech, you can’t pronounce words properly, you cannot raise your hand; you can feel a tingling numbness, until eventually you go into a coma. So if you see signs associated with neurological defects, that’s a stroke.”<br/><br/>“Heart attacks are different,” he continues. “If you have chest pain, discomfort in the chest, in the upper part of the body, that is the beginning of a heart attack. Usually you will see someone clutching at their chest, complaining of difficulty breathing, or breaking out into a cold sweat. The function of the heart is to pump blood throughout the body, and if it doesn’t pump enough to the brain, then the brain gets involved. The patient will then also go into a coma. At that point, it can be confused with a stroke. Before that, as the one involves neurological symptoms and the other chest pain, it’s usually easy to separate the two.”<br/><br/>While a stroke and a heart attack are two very different medical events, the end point is the same—cardiac arrest. By the time someone’s heart has stopped and they’ve lost consciousness, however, it’s no longer immediately obvious what the cause is. In either case, the response of a bystander should be the same.<br/><br/>“If you see someone lying there, you have to check before you can make any confirmation,” says Dr. Thinh. “If there’s no response, and the victim doesn’t appear to be breathing or gasping for air, then you should proceed to CPR right away. But if you check for a response and the victim is still breathing and still responds to you, then there are several questions to ask that should help determine if it’s a heart attack, a stroke or some other medical crises. Regardless, I urge people in this situation to dial our emergency number ∗9999, because in any case you will get free and proper instruction. The call-taker will question you one by one, and then lead you to the correct action.”<br/><br/>The most crucial element is time. In many acute cases—and this applies anywhere in the world, not only Ho Chi Minh City—an ambulance can take half an hour or more to arrive on the scene. Even the ambulance gets to the scene in five to ten minutes, it might be too late, as during this time the lack of oxygen to the brain can cause permanent, irreversible brain damage or death. This is why the default response to an emergency in Vietnam—attempting to take a cardiac arrest victim to hospital by taxi—very often results in death before the patient arrives at the medical facility.<br/><br/>“If you call the emergency number ∗9999, the call-taker can instruct you to assist the patient,” explains Dr. Thinh. “If there’s no response in the patient, they will assume it’s cardiac arrest, and they will coach you on how to do CPR. If there is some sort of response—it depends on how the patient responds to the caller—then the call-taker will instruct you on what to do next, and can identify the necessary management before the ambulance even gets there.”<br/><br/>One issue that proved problematic in the establishment of a 911-style emergency response system in Vietnam is that there is a degree of scepticism about the usefulness of medical instruction over the phone, especially in the case of lifesaving techniques such as CPR. “For people in Vietnam, it seems too new”, says Dr. Thinh, “but people can really do it—this has been proven in America and all over the world. The most important thing for people at that time is not to panic and to call for instructions. It’s certainly not easy at all to make a proper assessment without a medical background. If you call the emergency line, the question and response protocols can give you the best assessment possible. CPR is an essential first response in cases of cardiac arrest, and I would advise everybody to learn it—we actually run a monthly course in FMP’s District 2 medical center instructing in this technique—but if you don’t know CPR, call ∗9999, and the call-taker will talk you through it.”<br/><br/>In cases of ischemic stroke, prompt medical response can be enormously effective. If a victim can be taken to hospital within the first three hours of the incident, a blood-clot-dissolving medication called tPA (Tissue Plasminogen Activator) can be administered that is able to restore the blood flow. Dr. Thinh has already successfully treated a number of stroke victims using this method: “Within the first three hours, we save most of the cases,” he says. “We can do it here in Saigon—in this medical center we have three cases already. You can see the patients come in with hemiplegia—paralysis of half the body—and within 5-6 hours, they can walk.”<br/></p><p>In all events, time is the most critical component in emergency response. Regardless of whether or not you know CPR or have enough information about the victim to be able to figure out what has happened, do call ∗9999 within Vetnam for professional emergency assistance and stay calm. The speed of your response is likely to be the difference between life and death for the victim.<br/></p><p><b>Dr. Bui Nghia Thinh - Emergency Medical Director ∗9999, Family Medical Practice Ho Chi Minh City</b></p>"
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"title": "How To Beat the Summer Heat",
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"summary": "As the thermometer climbs and we rapidly morph out of winter into summer, all of us need to remind ourselves about what we need to do to stay healthy in the summer heat.",
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"value": "<p>As the thermometer climbs and we rapidly morph out of winter into summer, all of us need to remind ourselves about what we need to do to stay healthy in the summer heat.</p><p>The danger for some is heat exhaustion, which is a condition whose symptoms may include weakness, headache, dizziness, muscle cramps, nausea or vomiting and rapid heart beat. All of this is a result of your body overheating. Causes of heat exhaustion include exposure to high temperatures, high humidity and strenuous physical activity (golfing!).</p><p>Without prompt treatment it may become a life-threatening condition. In hot weather, your body cools itself mainly by sweating. Evaporation of sweat lowers body temperature. However, when you exercise strenuously especially in hot, humid weather, your body is less able to cool itself efficiently. If you suspect a heat-related illness, stop exercising and get out of the heat.</p><p><b>Treatment:</b> In most cases, you can treat heat exhaustion yourself by doing the following:</p><p><b>Rest in a cool place.</b> Get to an air-conditioned building or at the least, find a shady spot. Rest on your back with your legs elevated higher than your heart level.</p><p><b>Drink cool fluids.</b> Stick to water or sports drinks (Gatorade). These (sports) drinks can replace the sodium, chloride and potassium you lose through sweating. Don’t drink any beverages that have alcohol or caffeine which can promote fluid loss. Your body’s ability to sweat and cool down depends on adequate rehydration. Drink plenty of water while you’re working out — even if you don’t feel thirsty</p><p><b>Apply cool water to your skin.</b> If possible, take a cool shower, sponge down or soak in a cool bath.</p><p><b>Loosen clothing.</b> Remove any tight unnecessary clothing<b>.</b></p><p>Contact your doctor if your signs or symptoms worsen or if they don’t improve within 30 minutes. </p><p><b>Prevention</b></p><p><b>Wear loose-fitting, lightweight, light-colored clothing.</b> Dark or tight clothing holds in heat and doesn’t let your body cool properly because it inhibits sweat evaporation.</p><p>Lightweight, loose-fitting clothing promotes sweat evaporation and cooling by letting more air pass over your body. </p><p><b>Avoid the midday sun:</b> Wear a lightweight, wide-brimmed hat. Use an umbrella to protect yourself from the sun. Apply sunscreen to exposed skin. Exercise in the morning or evening — when it’s likely to be cooler outdoors — rather than the middle of the day </p><p><b>Drink plenty of fluids:</b> Staying hydrated will help your body sweat and maintain a normal body temperature. Don’t wait until you feel thirsty!</p><p><b>Slow and Easy:</b> If you’re used to exercising indoors or in cooler weather, take it easy at first. As your body adapts to the heat, gradually increase the length and intensity of your workouts. If you have a chronic medical condition or take medication, ask your doctor if you need to take additional precautions. — <b>Family Medical Practice Vietnam</b></p><p></p><p><b><i>Dr. Mathieu Nalpas - Internist, Family Medical Practice Hanoi</i></b></p>"
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"title": "Cervical Cancer",
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"summary": "Most people who have an HPV infection do not show any outward signs until it’s too late... Once that happens, symptoms such as irregular menstrual bleeding, bleeding after sex, and pain can occur, depending on the size and location of the cancer.",
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"value": "<p></p><p>One of the most devastating experiences a physician faces is to see a patient with a condition that is completely preventable and treatable—but because the patient presented it too late in the course of the disease, that condition is no longer curable, or can only be partially treated even with the most invasive/aggressive techniques. Cervical cancer is exactly that kind of condition.<br/></p><p>Cervical cancer is the result of an infection by the Human Papillomavirus (HPV)—anyone who is sexually active (including vaginal, anal, or oral sex) is at risk. Even having sex just once can put someone at risk, although repeated contact at a young age with different partners does pose a much higher risk.<br/></p><p>There are many types of this virus, including about 40 that cause the majority of infections leading to cervical cancer in women and penile warts or cancer in men. Two of the types that are especially harmful (causing the most cancers) are HPV type 16 and 18. Cervical cancer is the second most common cancer in Vietnamese women after breast cancer.<br/></p><p>HPV infection has two stages: (1) a person is exposed to it; and (2) the body responds to it. If it can fight the infection off, the person will not develop cancer; otherwise the HPV will overcome the person's immune system and cause cancerous changes in the person's normal cells and malignant transformation of those cells. It can take many years between exposure and the development of cancer.<br/></p><p>“Wait a minute,” you might ask, “wouldn't I know if someone I'm having sex with someone who has a raging ‘HPV infection”?<br/></p><p>Unfortunately, no—most people who have an HPV infection do not show any outward signs until it’s too late. First of all, the cervix where the infection/cancer initially occurs is not visible to the naked eye, being well-hidden inside the vaginal canal. Secondly, even where early malignant changes do occur, it is still not visible to the naked eye. Thirdly, this infection does not cause any symptoms until the cancer has progressed. Once that happens, symptoms such as irregular menstrual bleeding, bleeding after sex, and pain can occur, depending on the size and location of the cancer.<br/></p><p>So what can be done to prevent or treat cervical cancer/penile warts in the early stages so that it doesn’t progress to a point that is harder to treat or incurable?<br/></p><p>There are two methods—receiving the HPV vaccine, and detecting the onset of cancer at an early stage when it is completely curable (compared to cancer that has progressed to the later stages, becoming bigger in size and infiltrating the surrounding organs).<br/></p><p>At this time, there are three vaccines that are FDA approved—all three of them targeting types 16 and 18, the most virulent strains of the HPV virus. Receiving one of these vaccines is recommended in the U.S. for girls and boys starting from 11 to 26 years old to help your body make antibodies that fight against HPV virus when your body is exposed to them, which is why it’s better to get it before someone becomes sexually active.<br/></p><p>“So if I'm 21 years old and already have had sex, can I still benefit from this vaccine?”<br/></p><p>Absolutely! Just because you’ve had sex already does not mean that you’ve been exposed to the strains of HPV that are virulent, such as types 16 and 18—and if you do get the vaccine, your body still has a chance to make antibodies that can fight against the virus if you’re exposed to it in future. The vaccine is also recommended for gay and bisexual men up to the age of 26 years old, as well as anyone who has a condition that makes their immunity low (such as HIV).<br/></p><p>“Now that I’m 28 years old, have not received the HPV vaccine and am sexually active, what can I do to prevent cervical cancer?”<br/></p><p>It is now possible to be directly tested for HPV 16 and 18 infections as well as the other strains most commonly associated with cervical cancer. This screening test has now been shown to be more effective than traditional Pap smear testing. Many institutions, including our own medical centers, have made the transition to replace routine Pap testing with HPV screening.<br/></p><p>Condom use can be beneficial in preventing the spread of HPV, but are not enough to protect against all HPV infections—as any skin-to-skin contact can spread the virus.<br/></p><p>The HPV vaccine, HPV testing and Pap smear testing are all available in Vietnam.<br/></p><p>There is a lot of information available on this topic, and we’re not able to include it all in one sitting; also, information is changing at a rapid pace, so new updates are available all the time. Please keep yourself updated, and don't hesitate to contact a healthcare professional with any further questions.<br/></p><p>Remember, cervical cancer is preventable!</p><p></p><p><b><i>Dr. Jane Shadwell-Li - Internist, Family Medical Practice Ho Chi Minh City</i></b></p>"
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"value": "<p>Việt Nam là một trong các nước có tỷ lệ mổ bắt con cao nhất thế giới. Theo thống kê chính thức thì tỷ lệ mổ bắt con lên đến 40-50% nhưng thực tế con số còn lớn hơn nhiều. Một khảo sát tại Family Medical Practice cho thấy hơn 80% bé đến khám tại phòng khám ra đời bằng phương pháp sinh mổ. Để so sánh thì theo Tổ chức Y tế Thế giới WHO, tỷ lệ mổ bắt con chung khoảng 15%. Ở Mỹ khoảng 32%, Anh 25%, Thụy Điển 17%.</p><p>Có nhiều nguy cơ và biến chứng có thể xảy ra khi chọn phương pháp mổ bắt con (kể cả việc mang thai lần sau). Có một điều mà bạn và bác sĩ của bạn nên ý thức khi chọn phương pháp mổ đẻ.</p><p>Chúng ta thấy có một một mối liên hệ mật thiết giữa sinh con bằng phương pháp mổ bắt con và nguy cơ bất thường chức năng hệ miễn dịch của trẻ. Tại Đan Mạch, một nghiên cứu lớn với trên 2 triệu trẻ trong vòng 35 năm từ 1973 – 2012 chỉ ra rằng những trẻ được sinh ra bằng phương pháp mổ bắt con có nguy cao bị bệnh: Hen suyễn, dị ứng, viêm khớp dạng thấp, viêm đại tràng, khiếm khuyết hệ miễn dịch và bệnh bạch cầu (tất cả đều liên quan đến các bất thường chức năng hệ miễn dịch).</p><p><b>Tại sao các nguy cơ đó lại xảy ra?</b></p><p>Như chúng ta đều biết những vi khuẩn có lợi trong cơ thể có vai trò rất quan trọng đối với chức năng của hệ miễn dịch. Các vi khuẩn có lợi tương tác với các tế bào hệ miễn dịch và điều chỉnh hoạt động của chúng. Khi thiếu các vi khuẩn có lợi, các tế bào miễn dịch sẽ mất kiểm soát và bắt đầu gây ra phản ứng viêm và gây tổn hại đến các bộ phận khác nhau của cơ thể chúng ta. Ví dụ: Phổi – Hen Suyễn; Da - Viêm da dị ứng; Khớp – Viêm khớp, Tuyến tụy – Tiểu đường.</p><p>Khi trẻ được sinh thường, bé nhận được các vi khuẩn có lợi từ khoang âm đạo người mẹ. Các vi khuẩn này nhanh chóng cư ngụ trong ruột và tương tác đến hệ miễn dịch của trẻ. Điều này một mặt giúp bảo vệ trẻ khỏi các nhiễm trùng và mặt khác tác động đến hệ thống miễn dịch.</p><p>Một trẻ sinh bằng phương pháp mổ bắt con là sinh ra một cách vô trùng. Bé không nhận được các vi khuẩn có lợi. Thực tế, các bé này phải tiếp xúc với các vi khuẩn có hại trong môi trường bệnh viện. Những vi khuẩn gây bệnh điển hình này (nguyên nhân gây bệnh) không tác động có lợi cho hệ thống miễn dịch mà còn có thể tạo thêm nguy cơ cho bé.</p><p>Các bà mẹ tương lại thân mến, hãy nhớ rằng: quyết định chọn phương pháp mổ bắt con khi không cần thiết có thể để lại hậu quả lâu dài đến sức khỏe của bé sau này.</p><p></p>"
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"title": "Sexually Transmitted Infections VND 3,965,000",
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"value": "<p></p><p>In Vietnam, unsafe sexual practices are widespread. It is quite possible to have an STI for a long time before symptoms occur. Some can be transmitted even with condom use.</p><p>Our comprehensive testing package and full lab analysis for the diagnosis and treatment of sexually transmitted infections (STIs) are recommended for anyone who has any reason to suspect that they may have been exposed. Untreated STIs can weaken the immune response in your genital area or open sores, increasing your risk of contracting another STI (such as HIV).</p><p>The sessions take about one hour and include a full consultation with an infectious disease specialist and tests for HIV, syphilis, chlamydia and gonorrhea. Additional tests depend on the doctor’s advice with 10% discount on published rates.</p>"
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"title": "Cardiovascular Assessment: VND 6,900,000",
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"value": "<p>Coronary disease is one of the leading causes of death worldwide. If you have been assessed by your doctor for a high risk of having a cardiac event, a full cardiovascular examination by a trained cardiologist is critical.</p><p>Your cardiovascular screening and consultation session will include a full consultation, ECG, heart echocardiography, and carotid artery Doppler ultrasound. The cardiologist will advise you if any further procedures or courses of medication are required at the time of your consultation or as soon as possible thereafter.</p><p></p>"
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"title": "Have You Heard of Sleep Hygiene?",
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"summary": "There are a number of simple things that anyone can do to help get a good night’s sleep. The first is to find out what you are actually doing when going to bed.",
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"value": "<p>“The worst thing in the world is to try to sleep and not to,” said F. Scott Fitzgerald.</p><p>There are a number of simple things that anyone can do to help get a good night’s sleep. The first is to find out what you are actually doing when going to bed. Keeping a sleep diary can be very helpful in clarifying any patterns and habits that may be disrupting your sleeping.</p><p>Consider questions such as:</p><p>¨ What time do I go to bed and get up? Is it the same every day?</p><p>¨ Do I wake up during the night and why?</p><p>¨ What habits do I have around bedtime?</p><p>¨ What helps me go to sleep?</p><p>¨ What stops me going to sleep?</p><p>¨ Do I sleep during the day?</p><p>The answers to some of these questions may be useful in thinking about how to establish good sleep patterns.</p><p>You’ve heard of food and water hygiene, but did you know there is also such a thing as sleep hygiene. Sleep hygiene is all about the habits and practical things you can do to improve the quantity and quality of your sleep. Remember that with all habits, they take time to form and changes don’t happen overnight but within a week or two of trying establishing a new pattern most people will see some improvement.</p><p><b>Tips for good sleep hygiene</b></p><p>1. Routine – regular bed times, even on the weekends, can really help to establish and maintain habits. This includes doing the same things each night before you get into bed too.</p><p>2. Environment – a cool, quiet, comfortable place to sleep is very important. Particularly during summer in Hà Nội, when the temperatures reach up to 40 degrees at times, using your air-conditioner or fan wisely may help you sleep better and be able to cope with the heat during the day as well! Noise is a perennial problem in this city but a pair of earplugs may be a life-saver when your neighbours decide to renovate their bathroom at 3am.</p><p>3. Exclusivity – this means that your bed is only for sleeping (and other horizontal activities of the night). No working, reading or watching TV from bed! This helps your body to recognise that lying in bed equals sleep time not time to work on that last-minute presentation for the next day’s meeting.</p><p>4. There are some things to avoid to help you sleep better:</p><p>a. Alcohol – although you may feel that it helps you fall asleep, actually alcohol often causes disrupted sleep and wakes people during the night – best only in moderation.</p><p>b. Caffeine and other stimulants – We all love the sweet strong Vietnamese coffee with ice, but reconsider that last one of the day as caffeine blocks one of the hormones in your brain that tells you its time for bed. And just a quick reminder that coke, chocolate and green tea also have caffeine so stick to other herbal teas if you want a hot drink in the evening.</p><p>c. Meals – eating a heavy meal right before sleep can disrupt your sleep and exacerbate any reflux or indigestion you might have, so eat earlier in the evening, or have your main meal at lunch.</p><p>d. Stress – a big one and difficult to avoid! Try to stop work at least 30 minutes before you go to sleep and do something relaxing, a short walk or read a book. In fact any significantly stimulating activity such as strenuous exercise or watching a scary movie can impact your brain’s ability to unwind and get off to sleep.</p><p>e. Clock-watching – although it is so tempting to keep looking at the clock, it doesn’t help and usually makes you feel more frustrated at not being asleep. If you are not relaxed in bed then get up for 30 minutes and do some quiet activity in dim light before trying to go back to bed. Even lying in bed relaxed counts for something but tossing and turning will not help you get to sleep!</p><p>5. Some things that may help:</p><p>a. Early morning sunlight on your face – can help to reset the light/dark sensors of your brain so take your sunglasses off when going to work early in the morning.</p><p>b. Warm milk or herbal teas – yes, mother was right, a glass of warm milk before bed can really help. Chamomile or other herbal teas can also be effective.</p><p>c. Nap time – if you have to sleep during the day then take a nap early. Late afternoon naps will mean that your body is just not tired enough to get to sleep and can cause you to stay up late.</p><p>d. “Worry time” – if you are anxious about something and find yourself tossing and turning in bed worrying about it, then keep a notebook and pen beside the bed. You can write down any thoughts or concerns you might have in the book, which are then “safe” for you to remember tomorrow and you can tell yourself there is no need to keep thinking about them now. Schedule some “worry time” for yourself during the earlier part of the day to think about these things rather than just before going to bed.</p><p>e. Herbal remedies – there are some herbal remedies available in Việt Nam that some people find useful including Valerian, Melatonin and Rotundin. As with all herbal preparations, it is advisable to see your doctor to make sure these are safe for you to take. Herbal remedies are also a kind of medicine and may be contra-indicated in some people or interact with other medications you may be taking.</p><p>Some or all of these things will certainly help you to get a good night’s sleep, but again it takes time and practice just like any other skill. Perseverance is the key and the rewards are great!</p><p>However, if you have tried these all these things and are getting nowhere then please go and see a doctor to discuss the issues further. There are other medical problems that may be affecting your ability to sleep and some medications may also cause problems. Further investigations or treatments may be required, so don’t put it off.</p><p></p><p><b><i>Dr. Catherine Gonzalez - Internist, Family Medical Practice Hanoi</i></b></p>"
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"id": 712,
"title": "Losing sleep over insomnia?",
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"summary": "The amount of sleep needed depends mainly on how old you are. Newborn babies up to 1 year old sleep about 16-18 hours per day, school age children about 11-13 hours/day and adults 7-9 hours/day.",
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"value": "<p><b><i>A good night’s sleep…an impossible dream or a nightly reality? For those whose every night is a blissful drift off into peaceful rest you may not need to read any further, but for many of us, getting a good night’s sleep is as elusive as a traffic-free commute on a Monday morning. Hà Nội may not yet be the city that never sleeps, but the hammering of construction at all hours, loud truck horns and the odd roster crowing certainly makes it feel that way sometimes. When counting sheep no longer works, Dr. Catherine Gonzalez of Family Medical Practice Hanoi has some tips and advice.</i></b></p><p><b>What is sleep and why do we need it?</b></p><p>Sleep is a natural state of rest for the body, and is common to all mammals, birds and many reptiles and fish. Sleep is not just about energy conservation. In fact, the amount of energy saved during eight hours of sleep is about 50 kCal (the amount of energy in a piece of toast!). Sleep also serves a number of different functions in the body, including hormone regulation and metabolism, wound healing, and immune function and memory consolidation. So the old advice about getting a good night’s rest before those important exams or meetings may be more than just not feeling tired the next day!</p><p>But why do we need it? In fact, no one really knows why and most of our conclusions come from observing what happens with lack of sleep. After 17 hours of being awake, your cognitive function is the same as having a blood alcohol level of 0.05 per cent - which is the legal limit for driving in many countries around the world. Most people can testify to feeling pretty awful after staying up all night too.</p><p><b>How it works</b></p><p>The body is controlled by an internal “clock” which runs on an approximately 24 hour circadian rhythm. This “body clock” is controlled by a special part of the brain which regulates body temperature, sleepiness and the release of certain hormones. These hormones (cortisol, melatonin and adenosine) rise and fall in a regular pattern to cause wakefulness and sleepiness. External stimuli such as light or a busy work schedule can also affect and interrupt these patterns. The best night’s sleep occurs when all our internal and external signals are aligned. And the opposite is true too, which is why jet lag occurs.</p><p>Not all sleep is the same. There are actually several different stages in a sleep cycle, which lasts about 90-110 minutes in total. Sleep is divided into REM (rapid eye movement) and nonREM sleep. Most of the night is spent in varying stages of nonREM sleep, but most people will have about 3-4 periods of REM sleep during the night – the time of dreams.</p><p><b>How much sleep we really need</b></p><p>The amount of sleep needed depends mainly on how old you are. Newborn babies up to 1 year old sleep about 16-18 hours per day, school age children about 11-13 hours/day and adults 7-9 hours/day. Of course this will vary slightly from one person to the next but the amount of sleep we require is what we need not to be sleepy the next day.</p><p>Feeling well rested the next day requires adequate time but also good quality sleep.</p><p><b>What can go wrong with sleep</b></p><p>There are many different types of sleeping disorders. Some cause too much sleep like Narcolepsy, some too little, like Insomnia, and some just poor quality sleep such as Obstructive Sleep Apnoea or Restless Legs Syndrome. Poor sleep can also be an effect of other medical conditions such as heart disease, asthma, reflux, chronic pain, drug and alcohol abuse and mental illness, especially depression and anxiety. If you are concerned about any of these conditions please go and see your doctor to discuss them further, as these issues are beyond the scope of this article.</p><p></p><p><b><i>Dr. Catherine Gonzalez - Internist, Family Medical Practice Hanoi</i></b></p>"
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"id": 672,
"title": "Born to Run",
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"summary": "I live in an age of smartphones that help me to check my speed, the calories spent on my training, my heart rate, and to stay in contact with the friends of my childhood, sharing our battles again with the monsters and dragons always behind us, training on the streets and feeling the power of our legs, the strength of our breath trying to catch as much oxygen as possible, the heavy beating of our hearts in our chest, exactly as it was all those decades ago.",
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"value": "<p>I am a lucky man.<br/></p><p>I was born in a little province close to Chile—San Juan, one of the poorest in my country. Without smartphones, without internet, with only a few hours of cartoons each week on TV, I grew up running.<br/></p><p>It was a desert. The adults would nap during the middle of the day, it was too hot to do anything else. But we kids, we did not like to nap. We climbed to the tops of the trees during sandstorms to feel the force of the swaying boughs. We imagined the hot wind at our backs to be the fiery breath of monsters and dragons, forever chasing us. We ran like free, wild animals.<br/></p><p>At high school, we played sports. Basketball, football—and running. None of us were overweight; the food we ate, we grew ourselves, high in calories—but we burned all those calories, especially in the winters when it was so extremely cold.<br/></p><p>The opportunity to do a medical checkup was quite scarce, but I got checked at 18. Life is not always kind; I was diagnosed with a serious illness. After a complicated surgery, I was close to the end of my life—fever, shaking, infections. So many needles. The pain was unbearable. But I was fit. Unexpectedly, my symptoms disappeared. After five days without fever, they sent me home.<br/></p><p>It was two years before I could run again. Slowly at first, just a few kilometers at a time, to keep active. I ran because I wanted to be as fit as possible, because I knew that at some point, my illness would return. After my surgery, they told me that if I were lucky, I would survive maybe 10 or 15 years maximum. I knew I had to survive, and that death was always near.<br/></p><p>As I ran, the energy, power, and wellness returned to my body, and so too came the memories and joys of my childhood. I felt the monster’s breath at my back again, and I ran.<br/></p><p>I am a doctor. There is a certain magic about running and its power to heal, but I cannot ignore my profession and my medical knowledge. In fact, scientific information about the benefits of exercise has really only come to light in the last ten years. The calories you burn even after you work out. The endorphins released while running that combat depression and anxiety. The highly oxygenated blood that boosts toxin removal. The heightened neurogenesis that sharpens mental acuity.<br/></p><p>Running is linked to lower risks of cancer, longevity, and higher quality of sleep. Running is now known to help prevent and treat diabetes, high blood pressure, high cholesterol, osteoporosis, migraines, strokes, myocardial infarctions, Alzheimer's, and cancer. It improves memory, eyesight, sexual activity, self-esteem, and job productivity.<br/></p><p>In my own field—hepatology—fatty liver is one of the most common diseases worldwide. The fat inflames the liver chemically, similar to that caused by heavy drinking. It is the number one cause of liver transplantation. The leading cause of fatty liver is a poor diet and a sedentary lifestyle. The best treatment for this disease is to run.<br/></p><p>We are biologically prepared to run. Our forebears survived by persistence hunting and avoiding predators. We are like a machine shaped to run every day in an environment where food was scarce. Many modern diseases have their basis in the fact that we are not active anymore, and we eat a lot.<br/></p><p>I am a lucky man. They said I would live for 10 or 15 years. It has already been 32. Never in my dreams did I imagine I would live to reach 50. I am now 52, and I’m running half marathons.<br/></p><p>I live in an age of smartphones that help me to check my speed, the calories spent on my training, my heart rate, and to stay in contact with the friends of my childhood, sharing our battles again with the monsters and dragons always behind us, training on the streets and feeling the power of our legs, the strength of our breath trying to catch as much oxygen as possible, the heavy beating of our hearts in our chest, exactly as it was all those decades ago.</p><p></p><p><b>Dr. Pedro Trigo, Internist, Family Medical Practice Ho Chi Minh City</b></p>"
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"summary": "The overuse of antibiotics leads to a surge of bacteria which are resistant to multiple drugs. An audit of all of Family Medical Practice's children's urine cultures over an entire year revealed that more than 25% of the pediatric urine infections were caused by multi-resistant bacteria.",
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"value": "<p>Việt Nam is among the world’s worst countries in terms of overuse of antibiotics. Much has been written about the worldwide epidemic of antibiotic abuse and the rise of "superbugs", but even against a backdrop of international attention, the excessive use of antibiotics in Việt Nam is alarming.</p><p>I once treated a Vietnamese baby who, at the age of one, had been given more courses of antibiotics than I have received in my entire lifetime. And this child is not an exception.</p><p>The overuse of antibiotics leads to a surge of bacteria which are resistant to multiple drugs. An audit of all the urine cultures carried out by Family Medical Practice over an entire year revealed that over 25 per cent of the paediatric urine infections were caused by multi-resistant bacteria.</p><p>According to studies done in Việt Nam, in local hospitals the prevalence of multi-resistant bacteria is up to 70 per cent. By comparison, in developed countries, this figure is generally under 2 per cent.</p><p><b>Interaction</b></p><p>Besides creating "super-violent bacteria", antibiotics abuse damages our immune system’s function. The "good bacteria" in our guts interacts with the immune system cells and plays an important role in balancing immune system functions. Overdoses of antibiotics kill the "good bacteria" and destroy this balance. This can lead to the development of allergies, asthma, atopic dermatitis and other chronic inflammatory conditions.</p><p>There are several factors contributing to antibiotics abuse in Việt Nam. Quite often we see doctors prescribing antibiotics, medicines which attack bacteria, for viral conditions, even when they do diagnose the infection as viral (e.g. flu, bronchitis). Antibiotics are completely ineffective in these cases.</p><p>And even when prescribed for bacterial infections, the choice of antibiotics and length of treatment are often wrong. Another important factor is the fact that up to two-thirds of antibiotics in Vietnam are sold over the counter by pharmacies. People simply skip the doctor and go straight to the pharmacist - who is not qualified to make diagnoses, but nonetheless will sell antibiotics to patients based on their symptoms alone.</p><p>Parental demand also plays a role. Sometimes parents expect antibiotics and are dissatisfied when they don’t get them. They are conditioned to receive a bag-full of medicine each time they visit a doctor, whether they need it or not. They demand antibiotics, and sometimes doctors give in and prescribe, just to pacify the parents.</p><p><b>Shopping Spree</b></p><p>Another major problem in Việt Nam is shopping around for doctors. If a doctor still insists on not prescribing antibiotics, some parents will go to another doctor.</p><p>Many times, a child will not improve after a day or two and the parents, instead of going to the same doctor, will try a different one. That doctor in turn will prescribe yet another dose of antibiotics. It is common in our clinic to see babies who have visited three or four doctors in a short period of time before coming to us.</p><p>Super-resistant bacteria are a concern for the whole community, because they affect even children who have never received antibiotics in their lives. Bacteria can share genetic information in the same way we share digital information using a USB flash drive. This is called a "plasmid". It’s a little ring of DNA that bacteria can send to each other. A plasmid can contain genes that help other bacteria resist the effect of antibiotics. When a child receives antibiotics and the bacteria develop resistance, this can be spread to other children who come in close contact with them - for example at school or kindergarten.</p><p>We should all participate in the effort to reduce antibiotic overuse. We need to educate both our doctors and our parents on the appropriate use of antibiotics. Governments should be responsible for controlling antibiotic access, making sure pharmacies are not allowed to sell them without proper prescriptions from the attending physician. — <b>Family Medical Practice Vietnam</b></p><p>****</p><p><i>*</i><b><i>Dr Jonathan Halevy</i></b> <i>is a senior pediatrician at Family Medical Practice in HCM City. He specializes in pediatric emergency medicine and neonatal intensive care.</i></p>"
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"title": "This Year, Don’t Just Lose Weight, Get Healthy",
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"summary": "Many expats think Vietnamese food is an excellent “diet” because meals include many vegetables. But beware! The fried green vegetables can have as much fat as french fries.",
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"value": "<p>It’s the New Year and guess what’s on (almost) everyone’s minds: Losing weight and dropping some of the kilograms they put on, especially during the holiday season.</p><p>Most people think they will lose weight when they come to Việt Nam. And why not? A typical Vietnamese person is quite slim. But for many expats in Việt Nam, a combination of factors can often build up to a surprising weight gain.</p><p>For those working in Việt Nam, business lunches including large amounts of food and alcohol can be the norm. Even Vietnamese people are beginning to get heavier because of increasing wealth and eating out more frequently.</p><p>Many expats think Vietnamese food is an excellent “diet” because meals include many vegetables. But beware! The fried green vegetables can have as much fat as french fries. On top of eating too much, chances are that you spend a lot of time sitting in meetings or on the computer, or riding in a car or on motorbike through the endless traffic and bumpy roads.</p><p>Or perhaps you are too busy with work. You don’t feel like venturing out into the hustle and bustle of Hà Nội after a long working day. It’s easier to buy packaged foods and cook things that are familiar in the comfort of your home. Unfortunately, in many countries, the fast foods we enjoy are not always the healthiest choices, nor best for the waistline and Việt Nam is not an exception.</p><p>It is easy to see how many variables with health condition affecting metabolism, such as hypothyroidism and age, can contribute to weight gain among expats in Hà Nội. </p><p>The solution may be more difficult. Weight loss is not easy, especially when you are in a new environment with unfamiliar food. The good news is that it can be done, but it does not come in a pill or some other quick fix! </p><p>Weight loss, most simply, is achieved by spending more energy than you take in. That means you have to burn more calories than you eat. Nature helps a good bit. In order to be alive, to breathe, to digest your food, etc., you need to burn calories for energy. Add to those calories whatever you need to maintain your physical activity. For example, if you just climb the stairs around your house and maybe occasionally around your neighborhood, you probably burn an extra 300-400 calories per day. For most people, however, this is not enough to help with weight loss, because their intake is still much higher than their energy needs.</p><p>That leaves you with two options: Eat less and exercise more! Neither of the options is particularly easy because it requires a change in lifestyle. Real and healthy weight loss should be gradual and permanent. </p><p>In order to reduce your calorie intake it is helpful to first know your goal weight. This can be attained by calculating your BMI. Body Mass Index is a measure of weight according to one’s height and can give you an idea of whether you are currently overweight or obese. You need to determine how many calories you should be eating to achieve your goal weight, as well as estimate your current intakes by doing a nutrition assessment. </p><p>Tempted by products that promise weight loss without changing your diet? Supplements that promise rapid and significant weight loss should be avoided as they are often unhealthy, and weight loss is primarily due to dehydration rather than reduction of fat. As you return to normal, the weight returns, too. Safe and healthy weight loss should be about 1/2 - 1kg per week. </p><p>As a general rule, choose foods that are higher in fiber (fruits, vegetables, and whole grains) and prepared with little or no oil. Limit foods that are fried, fatty meats, butter, cheese, and large portions of starches (noodles, rice, potatoes, and bread). Even if you don’t “count calories,” following these guidelines can be a good start to eating fewer calories. </p><p>Expats in Hà Nội can buy fresh fruits and vegetables at a fraction of the cost in many other countries. Challenge yourself to go to the local market and try one new fruit and vegetable per week.</p><p>The second half of the equation is to increase how much energy you burn. This can be challenging in Hà Nội, but certainly not impossible. If you are fortunate enough to have access to fitness facilities, by all means, use them. But if you can’t afford a membership at a gym, or just prefer to be outdoors, there are several good parks in town to walk, run, or ride a bike. If you have lived here long enough to feel brave, hop on your bicycle instead of taking a motorbike or car. </p><p>Setting goals can help you keep on track to adopting a healthier lifestyle. Try to exercise three days per week for 30 minutes, and gradually increase the length of your activity and number of days. It can also be helpful to have a partner to exercise with and share your struggles and ideas together. Lasting behavior change is generally more successful when you have somebody to do it with. </p><p>If you are committed to make a few adjustments to your diet and exercise, you will soon find yourself feeling more energetic and beginning to loose weight and becoming healthier this New Year.</p><p></p><p><b><i>Dr. Catherine Gonzalez - Internist, Family Medical Practice Hanoi</i></b></p>"
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