For The future Physicians

Atrial fibrillation in ED

2010-11-14T18:00:00.001+08:00

From: American journal of Emergency Medicine
In this study IV flecanide, propafenone and amiadarone were used. End points was time to conversion, duration of AF And side effects . Flecanide and propafenone caused conversion to SR compared to amiadarone .

i am back again

2010-06-01T15:59:00.000+08:00

i have had a long break and happy to be back again

NAFLD

2010-04-30T13:31:00.001+08:00

Vitamin E is better than placebo but pioglitazone does not produce any significant change

Atherosclerotic Renal Artery Stenosis - ASTRAL Investigators

2009-11-25T21:51:00.001+08:00

Strudy has shown not surprisingly that there is no worthwhile clinical benefit from opening the vessel.
Saves lots of money

VTE priphylaxis in cancer -guideline

2009-11-25T21:34:00.001+08:00

VTE in cancer patients is associated with increased morbidity and mortality. Recent review in JCO.
Consensus:
1)Prolonged prophylaxis for hospitalised high risk surgical patients
2) prophylaxis not recommended for ambulatory cancer patients or fir central lines
3)LMH is preferred for long term treatment of VTE

Extended release Niacin for carotid intima-media thickness

2009-11-20T14:52:00.001+08:00

When you add extended release niacin to statin therapy the mean HDL cholestrol increased by 18% and significantly reduced LDL cholestrol and triglycerides. Mean carotid intima media wad signifantly reduced.
From NEJM nov 15,2009

Early repolarisation

2009-11-20T14:35:00.001+08:00

In a Finnish study ECG showing J point elevation of 0.1mV and 0.2mV in the inferior leads was sugnificantly associated with cardiac death

Neiropathy and Diabetes

2009-11-10T23:05:00.001+08:00

To diagnose neuropathy in diabetics with mo foot ulcer follwing clinical tests should be done,
check vibration sense with 128 tuning fork, pressure sensation with 10 g monofilament over distal hallus, ankle reflex and tests for pin prick.

Why do people use alternate medicine?

2009-11-05T18:29:00.001+08:00

Are you not surprised so many people spend loads of money on alternate therapies?
The simple answer according to Rob is people want magic and alternate medicine promises magic
From distractible org

Anabolic steroids cause kidney disease

2009-10-31T11:03:00.001+08:00

According to a paper published in ASN annual meeting body building supplementd by anabuc steroid usage can lead to focal segmental glomerulisclerosis.
Cardiovascular serious side effects are well known. This includs heart failure, MI, and ventricular tachy arrythmias.

Assessment of Neuropathic pain

2009-10-31T10:53:00.001+08:00

Chronic pain falls into 3 categories;
1) pain due to tissue disease or damage( nociceptive pain)
2) pain due to somatosensory disease or damage( neuropathic pain)
3) pain without any somatic background
Chronic neuropathic pain is under recognised and under treated.
Treatment requires identifying type of pain, assessing it's components and determining appropriate treatment.
Am J Med 2009 Oct; 122(10 Suppl):S13-21

Peanut butter for vegetable resistant children

2009-10-31T08:33:00.001+08:00

Thus was study presented in recent obesity society meeting .
When peanut butterbwas given to children who are vegetable resistant their vegetable intake incresed substantially.
Conclusion is give your children peanut butter along with vege.

Post exposure prophylaxis in HIV

2009-10-30T22:25:00.001+08:00

Recommended regimen in combination of tenofovir with emtercitabine with or without boosted ritonovir - lopinovir. Duration of treatment is 28 days.

Resistant hypertension

2009-10-30T08:32:00.001+08:00

Defined as blood pressure that remains above the goal despite taking three antihypertensive medications or blood pressure that is controlled but requires four it more medications.
Treatment:
1) life style midificaions such as reduce salt intake, reduce weight, less alcohol
2) identify secondary causes
3) use of long acting diuretics
4) some patient may benefit from mineralicoticoid receptor antagonist(MRA)

Spontaneous Bacterial Peritonitis: what's new?

2009-10-29T12:03:00.001+08:00

A recent review is published in World Journal of Gastroentrology,March 7 th issue.
This condition seldom occurs with s
Small volume ascites or in those ascites unrelated to liver disease.
13% of patients have no direct symptoms.so diagnostic tap in patients admitted with large volume ascites in cirrhotic setting.
It is important to distinguish between primary and secondary peritonitis due to perforation of gut.
Applying a drop of ascitic fluid to the leucocyte esterase of a urine dip stick may help in rapid detection.
5 days of antibiotic is as effective as longer courses.
Albumin infusion us recommended for most patients, those with renal deterioation and those who undergo large volume paracentesis. Albumin is a volume expanded and binds to inflammatory mediators. 1.5G/kg on day 1 and 1G/kg for 3 days has been recommended.

Revised Criteria for Hepato-Renal syndrome

2009-10-28T17:16:00.003+08:00

Revised criteria for HRS has been published in Gut, 2007. This is presented here for revision:
1) cirrhosis with ascites
2) serum creatinine > 133 mmol/L
3) no improvement in serum creatinine after atlesst diuretic withdrawal and volume expansion with albumin
4) Absence of shok
6) no current or recent use of nephrotixic drugs
7) absence of renal parenchymal disease

PSA Sceening / do the benefits outweigh risks

2009-10-28T17:16:00.001+08:00

To screen or not to do PSA in screening for prostate cancer Is still going on. Two studies have reported recently.
First study from North America reported in NEJM march 2009 looked at PSA and DRE on the rate of death from prostate cancer. Result was after 7 to 10 years if screening did not differ significantly.
Second study was an European Study that looked at PSA and death from prostate cancer. Conclusion was PSA based screening reduced death rate by 20% with considerable over diagnosis .

Ideal and adjusted weight

2009-10-27T12:59:00.003+08:00

Calculation of ideal and adjusted body weight is essential when treating electrolyte disorders:
Ideal weight: females: 45 kg+2.3 of for every inch over 5 feet (males 50kg)
Adjusted weight: ideal weight +0.4(actual body weight - ideal weight)

When to intervene in NSTE-ACS

2009-10-27T12:59:00.001+08:00

ABOARD study results were presented at the ACC scientific Sessions,2009.
Primary endpoint was the rate of MI defined by peak rise in treponin-I levels .
The median time of intervention was 1.1h in immediate group and 20.5h in the delayed group.
The primary outcome was similar tobogg groups
Conclusion;
1) risk stratification in NSTE-ACS is mandatory
2)in real emergency situations - pulmonary edema, ventricular arrhythmias primary PCI I'd indicated
3) in high risk cases PCI can be performed within next 72 hours

Diet modifications to prevent nephrolithiasis

2009-10-25T14:59:00.001+08:00

Ureteric colic is very painful
And secondary prevention is often overlooked.
There are few dietary measures have been shown to reduce the risk of stones;
1) drink plenty of water(keep urine out put > 2.5L/day
2)eat low animal fat diet
3) eat low sodium diet
4) avoid excess oxalate rich foods like spinach, beets, rhubarb & chocolalate
In a recent study published in JASN : oct;20, 2009:authors report DASH style diet Is associated with reduction in kidney stone risk.
Source : Renal fellow network

Length of time to defer surgery after stents

2009-10-25T11:20:00.001+08:00

This Is an important question that's always asked by cardiologists and surgeons . This study published on line in AJC.
This cohort study looked at tick of major peri operative cardiac events in patients undergoing NCS,
Risk of cardiac events after NCS are substantial after stent even on dual anti-platelet therapy. Noncardiac surgery should be delayed as long as possiblein post stent ( atleast 1.5 months in BMS and 1 year in DES).

FOUR Coma Scale

2009-10-25T11:06:00.001+08:00

Four stands for Full outline of UnResoinsivrness. It is a new coma scale consists of 4 components( eye reponse, motor response, brain stem reflex and respiratory pattern ).
This score was tested agsianst GCS . Useful score in patients when they are intubated.
The FOUR score is a good predictor of prognosis in critically Ill patients.

Drugs Associated Hyperkalemia

2009-10-25T10:25:00.001+08:00

1) drugs that cause movement of K from inteacelular to the extracellular fluid
Succinyl choline
Minoxidil
Betablickers
2)potassium sparing diuretics
3) renin angiotensin inhibitors
4)osmotic diuretics
5)NSAIDs lower renin levels
6)bactrim inhibits ENAC
7)calcineurin inhibitors
8)heparin and ketakonazole
8) digitalisby inhibiting Na-K ATPase

Bed Side Eye Exam more sensitive for Stroke than MRI

2009-10-25T09:47:00.001+08:00

Patients who present with dizziness may actually have stroke. This Is an important concern when you see patients on take.
In this prospective study they looked at 3 tests checking vestibulo- ocular reflex on horizontal head impulse, nystagmus, and ocular alignment during prism cross over.
The researcher report a normal head impulse test, direction changing nystagmus or skew deviation was highly predictive if stoke.

CAP and its treatment

2009-09-19T20:57:00.002+08:00

This study evaluated the guideline concordant therapy on in hospital survival in adults patients treated for CAP. Of 54 619 non–intensive care unit inpatients with CAP hospitalized at 113 community hospitals and tertiary care centers, 35 477 (65%) received initial guideline-concordant therapy. After adjustment for severity of illness and other confounders, guideline-concordant therapy was associated with decreased in-hospital mortality (odds ratio [OR], 0.70; 95% confidence interval [CI], 0.63-0.77), sepsis (OR, 0.83; 95% CI, 0.72-0.96), and renal failure (OR, 0.79; 95% CI, 0.67-0.94), and reduced both length of stay and duration of parenteral therapy by approximately 0.6 days (P < .001 for both comparisons).
Guideline-concordant therapy for CAP is associated with improved health outcomes and diminished resource use in adults. Abstract of study..
ISDA GUIDELINE