My First Experience Presentation About Myxedema and Myxedema Coma

Hello Friends, My name's Royal. I'm a 4years medical student in Cambodia of IU.
Today, I'm going to share with you about myxedema. In these contents, I divide into 10 parts.
1. Definition of Myxedema
2.Epidemiology of Myxedema
3.Etiology of Myxedema
4.The factor of Myxedema coma
5.Pathophysiology of Myxedema
6.Signs and symptoms of Myxedema
7.Differential diagnosis of Myxedema
8.Diagnosis of Myxedema
9.Complication of Myxedema
10.Treatment
11.Prognosis of Myxedema
Before I'm going to talk about Myxedema. I will late you know Why I decide to write this topic? because I already research on many websites. They said this disease is so rare all over the world but I hope can see it at one time. If you see kind of this disease: don't forget to comment on my blog and late me know. 
If you read this as a medical student or a doctor don't forgive me If I'm wrong. Feel Free leave me a comment and Email also
1.Definition: Myxedema is skin and tissue disorder usually due to severe prolonged hypothyroidism.
Note: I make sure to understand two meaning difference between myxedema and myxedema coma(Crisis)
Myxedema refers to a swelling of the skin and soft tissue that occurs in the hypothyroid patients.
Myxedema coma occurs when the body's compensatory responses to hypothyroidism are overwhelmed by precipitating factors such as infection.
2.Epidemiology:
(rare) One study reports 200 cases in American: between 1953 and 1996.
The prevalence of myxedema is still unknown.
The Mortality rates: 30% to 60%
All hypothyroidism patients are female more than males to have myxedema four times and 80% of myxedema coma occur in females.
Myxedema is likely to have on both sexes, women, and men.
Ages: 60years and older.
3.Etiology
Myxedema from both hyperthyroid and hypothyroid conditions.
Hypothyroidism can be caused by Hashimoto's thyroiditis, surgical removal of the thyroid(thyroidectomy), and rarer conditions.
Hyperthyroidism is associated with pretibial myxedema and exophthalmos. in pretibial myxedema have 1-4% of patient with graves' disease.
4.Factors Known to precipitate Myxedema coma:
Burns(severe Hypothermia): late to brief period of bradycardias and more than 4 hours can lead to respiratory failure.
Gastrointestinal tract hemorrhage: cause by coagulopathy and microcytic anemia( Vit.B12 deficiency)
Infection: Pneumonia, Influenza, UTI/Urosepsis, Sepsis
Medication: Amiodarone(Cordarone), Anesthesia(in emergency cases), Beta-blockers, Diuretics
Stroke, Surgery, Trauma
5.Pathophysiology:
Results from the accumulation or increased amounts of hyaluronic acid and chondroitin sulfate in the dermis in both lesions and normal skin.
Describe a specific form of cutaneous and dermal edema secondary to increase the connective tissue component.
Connective fiber are separated by an increase amount of protein and mucopolysaccharides include glycosaminoglycans(Hyaluronic acid and chondroitin sulfate)
Protein-Mucopolysaccharides complex binds water to produce Non-pitting edema around eyes, hands, feet, and heart) leading to myxedema.
6.Signs and symptoms:
History: Taking the history of hypothyroidism, may have developed hypothyroidism after thyroidectomy or iodine therapy for hyperthyroidism.
Symptoms: fatigue, weight gain, cold intolerance, constipation, and dry skin, maybe elicited.
Patients have a depressed mental state with lethargy, delirium, or coma.
symptoms of precipitating illness can be seen such as infection(commonly pneumonia) stroke, myocardial infarction, trauma, or heart failure.
Physical Examination: Physical findings may include the following:
Hypothermia, Hypotension, Bradycardia, Decrease pulse pressure, normal systolic pressure and elevated diastolic pressure, Decreases respiratory rate, Periorbital puffiness, Macroglossia, coarse or thinning hair, small thyroid, slow respiratory rate, signs of pleural effusion, soft or distant heart sounds, diminished apical impulse and pericardial effusion.
Abdominal distension(ascites), Diminished or absent bowel sounds(ileus), Bladder distension, Cold extremities, non-pitting edema if upper and lower extremities, cool, pale, dry, scaly and thick skin, dry, brittle nails, ecchymoses, purpura, confusion, stupor, slow speech, delayed reflexes, seizures and coma.

7.Diagnosis
Taking history and PE
Laboratory studies: Thyroid function test: TSH, Free Thyroxine(T4), Free Triiodothyronine(T3)
Adrenal Function Test: Serum Cortisol: very low below 3mcg/dl or high above 20 mcg/dl (normal 10-20mcg/dl)
Hyponatremia with low serum osmolality
Hypoglycemia
CBC
Imaging studies: Chest X-ray: signs of cardiomegaly, pericardial effusion, congestive heart failure or pleural effusion.
other tests: ECG: Bradycardia
8.Differential Diagnosis
Hypothermia, Hypoventilation syndrome, Septic shock
9. Treatment: is to see a doctor to treatment depending on location and protocol. but if you have hypoxygenation to ventilation as soon as possible and need serum for hyponatremia.
In my advice to need to see the doctor as soon as possible don't keep your health get worse.
10.Complication:
Respiratory failure, Myocardia ischemia, Renal Failure, Sepsis, GI hemorrhage, Coma.
11.Prognosis
The mortality rate:70-80%(in the past)
The mortality rate: 20%( last 10-15 years)
Recognized earlier
Receiving intensive supportive care
Treated with thyroxine early in the course of illness

How to Pass Exam for Into Medical School In Cambodia?(International University of Cambodia)

How to Pass Exam for Into Medical School In Cambodia? (International University of Cambodia)

Hello Friends, I'm Royal. I'm a years4 medical student in Cambodia. Today, I'm going to share about how can I pass the exam for Medical school. There are 5tips to learn from Khmer medical students.

Before I jump to the detail about this topic. I would like to describe what is subject to the exam? and how many subjects we have an exam for medical school in Cambodia. To pass medical school in Cambodia is really easy but you need to learn the Khmer language first before starting to apply. If you are the nationality of Cambodia, you need to pass the high school and nation medical school also a foreigner. The subject that we should focus on the exam is Chemistry, Maths, and Biology.

1. Chemistry: 5 Exercise and 15 questions.

2. Maths: 20 Excercise +questions

3.Biology: 5Exercise and 17question.

All the questions and exercises are from the ministry of health in Cambodia and also update every year. Usually is from grate 12 in high school.

Capacity(សមត្ថភាព)

 

តើអ្វីទៅជាសមត្ថភាព?

• និយមន័យ៖  សមត្ថភាពមានន័យថាសមត្ថភាពក្នុងការប្រើប្រាស់និងយល់ព័ត៍មានដើម្បីធ្វើការសម្រេចចិត្តនិងពិភាក្សាការសម្រេចចិត្តណាមួយ។                                                មនុស្សម្នាក់ខ្វះសមត្ថភាពប្រសិនបើចិត្តរបស់ពួកគេចុះខ្សោយឬរំខានតាមមធ្យោបាយណាមួយដែលមានន័យថាពួកគេមិនអាចធ្វើការសម្រេចចិត្តនៅពេលនោះបាន។ នរណាម្នាក់ដែលមានបញ្ហាខ្សោយបែបនេះត្រូវបានគេគិតថាមិនអាចធ្វើការសម្រេចចិត្តបានប្រសិនបើពួកគេមិនអាច៖              ១ យល់ពីព័ន៍មានអំពីការសម្រាចចិត្ត                                                                         ២ ចង់ចាំព័ន៍មាននោះ                                                                  ៣ ប្រើព័ន៍មាននោះដើម្បីធ្វើការសម្រាចចិត្ត                                           ៤ ពិភាក្សាការសំរេចចិត្តរបស់ពួកគេដោយការនិយាយប្រើភាសា                              សញ្ញាឬមធ្យោបាយផ្សេងទៀត

តើត្រូវវាយតម្លៃសមត្ថភាពដោយរបៀបណា?

សមត្ថភាពពេលខ្លះអាចផ្លាស់ប្តូរតាមពេលវេលា វាគួរតែវាយតម្លៃនៅពេលដែលត្រូវការការសម្រាចចិត្ត ជាធម្មតាត្រូវបានធ្វើឡើងដោយអ្នកជំនាញថែទាំសុខភាពដែលទទួលបានការបណ្តុះបណ្តាលនិងបទពិសោធន៍ត្រឹមត្រូវដែលមាន ផ្តល់អនុសាសន៍ការព្យាបាលឬការស៊ើបអង្កេត។

           ប្រសិនបើអ្នកជំនាញថែទាំសុខភាពយល់ថា អ្នកមានសមត្ថភាពផ្តល់ការយល់ព្រមរបស់អ្នក ការសម្រេចចិត្តរបស់អ្នកនឹងត្រូវបានទទួលយក ហើយបំណងប្រាថ្នារបស់អ្នកនឹងត្រូវបានគោរពទោះបីជាអ្នកបាត់បង់សមត្ថភាពនៅដំណាក់កាលក្រោយក៏ដោយ។                                            ប្រសិនបើអ្នកជំនាញថែទាំសុខភាពយល់ថាអ្នកបច្ចុប្បន្នមិនមានសមត្ថភាពក្នុងការយល់ព្រមហើយ អ្នកមិនបានធ្វើការសម្រេចចិត្តជាមុនឬតែងតាំងនរណាម្នាក់ជាផ្លូវការដើម្បីធ្វើការសម្រេចចិត្តសម្រាប់អ្នក ពួកគេនឹងត្រូវពិចារណាដោយយកចិត្តទុកដាក់នូវអ្វីដែលជាផលប្រយោជន៍ល្អបំផុតរបស់អ្នកមុនពេលធ្វើការសម្រេចចិត្ត។ 

ការគោរពជំនឿផ្ទាល់ខ្លូន

ប្រសិនបើនរណាម្នាក់ ធ្វើការសម្រាចចិត្តអំពីការព្យាបាលដែលមនុស្សផ្សេងទៀតគិតថា វាខុសដោយសារតែជំនឿរបស់ពូកគេ នោះមានន័យថា ពួកគេខ្វះសមត្ថភាពក្នុងការសម្រាចចិត្ត។

ឧទាហរណ៍ មនុស្សម្នាក់បដិសេធមិនធ្វើ Blood Transfusion ព្រោះវាប្រឆាំងនឹងសាសនារបស់ពួកគេ និងមិនត្រូវបានគេគិតថាខ្វះសមត្ថភាពទេ។

ប៉ុន្តែអ្នកដែលមានជំងឺ Anorexia អ្នកដែលខ្វះអាហារូបត្ថម្ភធ្ងន់ធ្ងរនិងបដិសេធការព្យាបាលព្រោះពួកគេបដិសេធមិនទទួលយកការព្យាបាលទេ។

ផលប្រយោជន៍ល្អបំផុតសម្រាបអ្នកជំងឺ

 ប្រសិនបើមនុស្សពេញវ័យខ្វះសមត្ថភាពក្នុងការផ្តល់ការយល់ព្រមការសម្រេចចិត្តអំពីថាតើត្រូវបន្តការព្យាបាល អ្នកជំនាញថែទាំសុខភាពដែលកំពុងព្យាបាលពួកគេនឹងត្រូវសម្រាចចិត្តដោយគ្រូពេទ្យ។

ប្រសិនបើមនុស្សម្នាក់មានអារម្មណ៍ថាខ្វះសមត្ថភាពហើយគ្មាននរណាម្នាក់អាចជួយធ្វើការសម្រេចចិត្តអំពីការព្យាបាលដូចជាសមាជិកគ្រួសារឬមិត្តភក្តិអ្នកតស៊ូមតិផ្នែកសមត្ថភាពផ្លូវចិត្តឯករាជ្យ (IMCA) ត្រូវតែពិគ្រោះយោបល់។

ការផ្លាស់ប្តូរសមត្ថភាព  

សមត្ថភាពក្នុងការយល់ព្រមរបស់មនុស្សម្នាក់អាចផ្លាស់ប្តូរបាន។ ឧទាហរណ៍ពួកគេអាចមានសមត្ថភាពធ្វើការសម្រេចចិត្តខ្លះ ប៉ុន្តែមិនមែនរឿងផ្សេងទៀតទេរ។ 

ក្នុងករណីខ្លះមនុស្សអាចត្រូវបានគេចាក់ទុកថាមានសមត្ថភាពក្នុងការសម្រាចចិត្តព្យាបាលរបស់ពួកគេប៉ុន្តែ មិនមែនអ្នកដទៃទេ។

 

 

4 Mistakes medical students in Cambodia make

4 Mistakes medical students in Cambodia make

• Little focus: Some of the medical students spent a little time during the study focus on their subject because they think that they have more time to study before the exam but that is the problem. Don't be a student nearby exam!
• Gaming during class: In 21 decades the technology became famous and sprite in anywhere. some of the student they use the internet for study, social media, and works also. To make easy for student and relax the technology also make the video game that why some of the student they play during class. they don't listen to the lecturer.
• Talkative with a classmate: Time is limited for students to learn from lectures so many students they play in class not only primary school include 2nd school, high school, and also university students. They're trying to talk with silence to their friends without looking to the whiteboard. 
• Come to class late: not everyone comes to school late all the time, we just talk about the mistake made by the student that they use time wrong something like the girls. but not every girl at this point that I talk about. I'm focusing on the girl like to make up a lot. Some of the medical student girls they like to make up because of beauty. Yep, It's right I'm also want to be handsome but you should look forward to knowledge first before trying to be beautiful. Everyone they already have their units.