goodduck

-- 1000000 death around the world
-- nearly all death from Falciparum
2. What is severe malaria?

 Q1. 都是英文書,我擔心程度不好看很慢balabala,怎麼辦?

[Keneth Kuo]

1974.7.7 (0)  born in Taipei
1978        (4)  遇見cello
1986      (12) 曼哈頓音樂學院先修部, 師從Marion Feldman

1928.1.4 : born in Lawrence, Massachusetts -> NY city grow up
1942 (14): Drop out school
1944 (16): into US Navy 
1946 (18): discharge from US NAVY -> become profession boxer ->
1951 (23): University of Oklahoma 

[Two No]
1. no valve abnormal (43%~72%)
2. no IV drug related

remember:  ask  "from onset to recovery"

                                         seizure                        syncope
precipitating                   none                            Valsava, emotion, Hx of heart disease

1.  Norvasc
2.  Lipitor
3.  Diovan
4.  Plavix

[Morning]
1. to check: vital sign, lab data, ,PRN times
2. to see: chief complain relieve? Any complication? Tx response?
3. to reflection: Why else can I do? Is Tx appropriate?

[clinical picture]
under 40 or 45 y/o, male, smoker, complain of digital/toe pain/ischemia

[Symptom]

[S&S]

1. forward decrease -> low C.O -> fatigue / exertional dyspnea -> LV failure

ECG

during exercise
1. ST depression (看J point後2格) 

1. kidney: Lindsay nail (half and half nail)
                  a. proximal (40%~80%)-> white
                      distal ->red, pink, brown (depend on pressure)

Brugada Syndrome

[epidemiology]
1. most Asian, japan~ 1%
2. male : female = 9 : 1

1. amebiasis: infected by E. histolytica 
2. infectied -> 90% -> asymptom
                         10% -> dysentery, liver abscess..etc
# free-living amebas

1. EV bleeding 
2. hepati encephlopahty
3. hepatorenal syndrome