The Clinician, Lusaka (2025)

20/09/2025

About Essential

Essential hypertension, also known as primary or idiopathic hypertension, is a form of high blood pressure that has no identifiable cause. It is the most common type of hypertension, accounting for about 95% of all cases.

Hypertension is defined as persistently elevated blood pressure in the arteries. According to the most recent World Health Organization (WHO) guidelines:

- Normal: Less than 120/80 mmHg
- Elevated: 120-129/80-84 mmHg
- Grade 1 hypertension: 130-139/85-89 mmHg
- Grade 2 hypertension: ≥140/≥90 mmHg

Note: The WHO emphasizes that the diagnosis of hypertension should be based on multiple blood pressure measurements taken on several occasions.

Epidemiology

- Affects approximately 1.28 billion adults aged 30-79 years worldwide (WHO, 2021)
- Only 42% of adults with hypertension are diagnosed and treated
- Prevalence increases with age
- More common in low- and middle-income countries

Risk Factors

While the exact cause is unknown, several factors increase the risk:

1. Age: Risk increases with advancing age
2. Family history: Genetic factors play a role
3. Ethnicity: Prevalence varies among different ethnic groups
4. Obesity: Excess body weight strains the cardiovascular system
5. Sedentary lifestyle: Lack of physical activity
6. High sodium intake: Excess dietary salt
7. Low potassium intake: Inadequate dietary potassium
8. Alcohol consumption: Excessive alcohol use
9. Stress: Chronic stress may contribute to hypertension
10. Smoking: To***co use damages blood vessels

Pathophysiology

The exact mechanisms are not fully understood, but may involve:

1. Increased sympathetic nervous system activity
2. Overactivation of the renin-angiotensin-aldosterone system
3. Endothelial dysfunction
4. Altered renal sodium handling
5. Insulin resistance

Clinical Presentation

Often called the "silent killer" because it typically has no symptoms. When symptoms occur, they may include:

- Headaches
- Shortness of breath
- Nosebleeds
- Visual changes
- Dizziness

Diagnosis

Diagnosis is based on consistent blood pressure readings:

1. Office BP measurements: Multiple readings over several visits
2. Home BP monitoring: Provides a more comprehensive picture
3. Ambulatory BP monitoring: 24-hour monitoring for a detailed assessment

Additional tests may include:
- Blood tests (electrolytes, creatinine, lipid profile)
- Urinalysis
- Electrocardiogram (ECG)
- Echocardiogram

Complications

If left untreated, essential hypertension can lead to:

1. Coronary artery disease
2. Heart failure
3. Stroke
4. Chronic kidney disease
5. Peripheral artery disease
6. Retinopathy

Management

Treatment aims to lower blood pressure and reduce cardiovascular risk. It includes:

Lifestyle Modifications

1. Weight reduction
2. Healthy diet rich in fruits, vegetables, and whole grains
3. Sodium restriction (

20/09/2025

You have failed as a community if a thief or a ra**st is taken to the police before he lands at emergency bay at the hospital.

19/09/2025

Where is this? Those who travel a lot

The Clinician

18/09/2025

About Hypertension of the Newborn ( )

Hypertension of the Newborn (HOTN) is a rare but potentially serious condition that affects neonates. While hypertension is more commonly associated with adults, it can occur in newborns and requires prompt recognition and management to prevent complications.

Definition

Hypertension in neonates is defined as a systolic blood pressure (BP) greater than the 95th percentile for gestational age, birth weight, and s*x. The exact values can vary, but generally:

- For term infants: systolic BP > 95 mmHg
- For preterm infants: systolic BP > 80 mmHg

Incidence

The incidence of HOTN is relatively low, estimated at:
- 0.2% to 3% in the general neonatal population
- Up to 9% in neonatal intensive care units (NICUs)

Causes

HOTN can be caused by various factors:

1. Renovascular
- Renal artery stenosis
- Renal vein thrombosis
- Congenital renal malformations

2. Cardiac
- Coarctation of the aorta
- Patent ductus arteriosus

3. Endocrine
- Congenital adrenal hyperplasia
- Hyperthyroidism

4. Neurological
- Intracranial hemorrhage
- Seizures

5. Medications
- Dexamethasone
- Caffeine
- Phenylephrine eye drops

6. Others
- Bronchopulmonary dysplasia
- Extracorporeal membrane oxygenation (ECMO)

Clinical Presentation

HOTN is often asymptomatic and discovered during routine monitoring. When symptoms occur, they may include:

- Irritability
- Poor feeding
- Tachypnea
- Seizures
- Heart failure (in severe cases)

Diagnosis

Diagnosing HOTN involves:

1. Blood Pressure Measurement
- Use appropriate cuff size (cuff width should be 40-50% of arm circumference)
- Take multiple readings to confirm hypertension

2. Physical Examination
- Check for signs of underlying causes (e.g., heart murmurs, abdominal masses)

3. Laboratory Tests
- Complete blood count
- Electrolytes
- Renal function tests
- Endocrine studies as indicated

4. Imaging Studies
- Renal ultrasound with Doppler
- Echocardiogram
- Cranial ultrasound (in preterm infants)

Management

The management of HOTN depends on the severity and underlying cause:

1. Treat Underlying Cause
- Surgical intervention for renovascular or cardiac causes
- Medication adjustment if drug-induced

2. Pharmacological Treatment
- First-line: Calcium channel blockers (e.g., amlodipine)
- Second-line: ACE inhibitors (with caution in neonates)
- Beta-blockers
- Diuretics

3. Supportive Care
- Fluid management
- Electrolyte balance

4. Monitoring
- Regular BP checks
- Assessment of end-organ damage

Long-term Outcomes

With proper management, the prognosis for most neonates with HOTN is good. However, some may require long-term follow-up and treatment.

Challenges in HOTN Management

1. Diagnosis: Accurate BP measurement in neonates can be challenging.
2. Limited Data: Few large-scale studies on HOTN treatment exist.
3. Medication Safety: Many antihypertensive medications are not extensively studied in neonates.

The Clinician

17/09/2025

After I asked him why he doesn't want to be circumcised.

Him: most women don't like circumcised men.

Me: i think that's an assumption, do you have a proof?

Him: yes.

Me: okay, what was your sample size, what sampling method did you use and what was the mode of your data collection?

Him: what are you talking about?

Me: so, you don't have a proof?

Lesson: unless you have statistical data, don't use "MOST". We don't assume in science.

The Clinician

16/09/2025

Patients with non communicable diseases need more education than drugs.

15/09/2025

If you were not lazy to do kegel exercises, you wouldn't be looking for some concoctions and shortcuts to tighten your flower.

14/09/2025

13 Types of clinical officers

1. Data banks.
These have deep knowledge about medicine. They're too academic, very good at discussing medicine but rarely make the right diagnosis, they will explain stuff and even quote the pages of books as a reference, they always have scary and out of world diagnoses.

2. Diagnosis machines.
They rarely miss diagnosis, it takes a few minutes to come up with a diagnosis. Is like they instinctively know your illness, they prescribe the right treatment. They however have difficulties communicating with patients.

3. Pseudo consultants.
These are quite smart, they have data but it won't come out unless they're not with the patient. Present a case to them and ask their opinion, they will give you the right diagnosis. Ask them to clerk a patient, they will misdiagnose😬

4. Ask-holes.
These have no faith and confidence in themselves, they always ask a colleague about everything and anything. it doesn't matter how long the queue is, they will always move next room to consult about every patient. If there is no one around, they will phone a colleague who is usually unemployed.

5. Patients/Kids favorite.
Usually with charming smile, simplified language, they make a patient understand their condition and encourage them to finish the course of drugs. They stay away from academic discussions.

6. Criminal officers.
Overly confident, they always misdiagnose patients, they will prescribe until the pen runs out of ink. They over prescribe because they usually don't know the right treatment hoping one of them will work.

7. Help me lord type.
These are never sure about anything they write or think, they just wish to see the patient out of their sight and wish them well, but somehow and miraculously their treatment works.

8. Tortoise/Moma's boy/girl.
These are always slow, they will take even history of your ancestors and still miss diagnosis. They cry when frustrated, if patients shout at them, they cry. They're always tired. They don't want to be in the hospital but can't quit because their parents connected them there.

9. Drunks
Rarely at the work place, always look drunk, everyday is weekend for them. They're as smart as the devil himself, even when drunk, they get the right diagnosis and treatment.

10. Models
these dress to kill, they pay attention to details on their outlook, their wigs, beards, shoes, clothes, etc are always clean. Theirs iPhones don't fit in the pockets. if they don't put on a lab coat you might think they're bankers. They hate being called clinical officers but doctors even when their brains disagree.

11. Flirts.
These have data and a certain level of ego that doesn't allow them to be social. they're crooked, they flirt with patients and co-worker. Their mind is so collapt ba mambala but you can't tell because they look innocent.

12. Professors.
These have enough data to work on their own, they're nice people, come to work, do their job and go home. They mind their business. If they want to talk to you they will. They're taken advantage of by coworkers because they're workaholics and usually single.

13. Chief advisors.
These find pleasure in shouting at patients, you hold some information because you don't know what they will say to you next. If you have STI be prepared for a long lecture. They're usually found gossiping with other health workers including cleaners.

Some may fall in more than one category.

Which type have you come across?

The Clinician

14/09/2025

About

Dementia is a broad term used to describe a decline in cognitive function severe enough to interfere with daily life. It's not a specific disease, but rather a general term that describes a wide range of symptoms associated with a decline in memory or other thinking skills.

Types of Dementia

1. Alzheimer's Disease
- Most common form, accounting for 60-80% of cases
- Characterized by amyloid plaques and neurofibrillary tangles in the brain

2. Vascular Dementia
- Second most common type
- Caused by reduced blood flow to the brain, often due to stroke

3. Lewy Body Dementia
- Characterized by abnormal deposits of the alpha-synuclein protein in the brain

4. Frontotemporal Dementia
- Involves degeneration of the frontal and temporal lobes of the brain

5. Mixed Dementia
- Combination of two or more types of dementia

6. Other forms
- Parkinson's Disease Dementia
- Huntington's Disease
- Creutzfeldt-Jakob Disease

Risk Factors

1. Age: The risk increases significantly after age 65
2. Genetics: Certain genetic factors can increase risk
3. Cardiovascular health: High blood pressure, high cholesterol, and smoking
4. Head injuries: Especially repeated concussions
5. Alcohol abuse: Excessive alcohol consumption over many years
6. Education level: Lower levels of education are associated with higher risk

Signs and Symptoms

Symptoms can vary depending on the type of dementia, but common signs include:

1. Memory loss that disrupts daily life
2. Challenges in planning or solving problems
3. Difficulty completing familiar tasks
4. Confusion with time or place
5. Problems with visual perception
6. New problems with words in speaking or writing
7. Misplacing things and losing the ability to retrace steps
8. Decreased or poor judgment
9. Withdrawal from work or social activities
10. Changes in mood and personality

Diagnosis

Diagnosing dementia involves several steps:

1. Medical history: Including family history and changes in behavior or personality
2. Physical examination: To rule out other conditions
3. Cognitive tests: Such as the Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA)
4. Neurological evaluation: To test reflexes, coordination, and balance
5. Brain imaging: CT, MRI, or PET scans to look for evidence of strokes or tumors
6. Laboratory tests: Blood tests to check for vitamin deficiencies or thyroid problems

📌 Treatment

While there's no cure for most types of dementia, treatments can help manage symptoms:

1. Medications
- Cholinesterase inhibitors (e.g., donepezil, rivastigmine)
- Memantine
- Medications to manage behavioral symptoms

2. Non-pharmacological approaches
- Cognitive stimulation therapy
- Reminiscence therapy
- Music therapy
- Art therapy

3. Lifestyle modifications
- Regular exercise
- Healthy diet
- Social engagement
- Mental stimulation

Care and Support

Caring for someone with dementia can be challenging. Support strategies include:

1. Establishing routines
2. Creating a safe environment
3. Using memory aids (e.g., labels, calendars)
4. Encouraging independence where possible
5. Providing clear, simple instructions
6. Offering emotional support

Prevention

While not all risk factors can be changed, some strategies may help reduce the risk of dementia:

1. Regular physical exercise
2. Healthy diet (e.g., Mediterranean diet)
3. Mental stimulation and lifelong learning
4. Social engagement
5. Managing cardiovascular risk factors
6. Avoiding excessive alcohol consumption and not smoking

The Clinician

11/09/2025

What are the most common causes of acute non bloody diarrhea in children and, in adults?

10/09/2025

About Diarrhea and treatment.

Diarrhoea refers to excess frequency of bowel movements with stools more liquid than usual.

Severe diarrhoea can cause electrolyte disturbances and is a major cause of mortality in children worldwide.

Acute cases are usually due to infections or dietary indiscretion, whereas chronic diarrhoea often has more serious causes.

Acute diarrhoea is defined as at least 3 liquid stools per day for less than 2 weeks.

•There are 2 clinical types of acute diarrhoea:
1. Diarrhoea without blood, caused by viruses in 60% of cases (rotavirus, enterovirus) , bacteria (Vibrio cholerae, enterotoxigenic Escherichia coli, non Typhi Salmonella, Yersinia enterocolitica) or parasites (giardiasis).

Diseases, such as malaria, acute otitis media, respiratory tract infections, etc. can be accompanied by this type of diarrhoea.

2. Diarrhoea with blood, caused by bacteria (Shigella in 50% of cases, Campylobacter jejuni, enteroinvasive or enterohaemorrhagic Escherichia coli, Salmonella) or parasites (intestinal amoebiasis).

•Infectious diarrhoeas are transmitted by direct (dirty hands) or indirect (ingestion of contaminated water or food) contact.

•The high mortality rate from diarrhoeal diseases, even benign, is due to acute dehydration and malnutrition. This can be prevented by adequate rehydration and nutrition.

Treatment
• Prevent or treat dehydration: rehydration consists of prompt replacement of fluid and electrolyte losses as required, until the diarrhoea stops. Use of Oral rehydration solutions (ORS) is used to replace fluids and electrolytes to those who are able to drink.

• Zinc sulfate to children under 5 years. Zinc sulfate is given in combination with oral rehydration solution (ORS) in order to reduce the duration and severity of diarrhoea, as well as to prevent further occurrences in the 2 to 3 months after treatment.

• Prevent malnutrition. Continue unrestricted normal diet. In breastfed children, increase the frequency of feeds. Breast milk does NOT replace ORS. ORS should be given between feeds.

• Do not systematically administer antimicrobials (e.g. flagyl, septrin, amoxyl, etc): only certain diarrhoeas require antibiotics (keep reading).

• Do not administer anti-diarrhoeal drugs or antiemetics (drugs that stop vomiting) unless in non infectious diarrhea that may lead to severe dehydration (e.g. chemo induced).

• Treat the underlying condition if any (malaria, otitis, respiratory infection.

WHEN TO GIVE ANTIMICROBIALS IN DIARRHEA?

1. Diarrhoea without blood:
Most acute diarrhoeas are caused by viruses unresponsive to antimicrobials. Antimicrobials can be beneficial in the event of cholera or giardiasis.

2. Diarrhea with blood:
• Shigellosis is the most frequent cause of bloody diarrhoea (amoebiasis is much less common). If there is no laboratory diagnosis to confirm the presence of amoebae, first line treatment is for shigellosis.

• Amoebiasis: antiparasitic treatment only if motile Entamoeba histolytica amoebae are found in stools or if a correct shigellosis treatment has been ineffective.

Dear, patients flagyl is not the treatment for diarrhea. It can only be given if your healthcare provider thinks, it will get rid of what is causing that diarrhea.

The Clinician

10/09/2025

In which diarrhea cases are anti diarrheals indicated?

The Clinician

20/09/2025

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10/09/2025

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