Chadi's Blog

What can you do to stay healthy while taking corticosteroids medications?

noreply@blogger.com (M Chadi Alraies) — Mon, 06 Oct 2014 17:26:00 +0000

While taking steroid medications such as prednisone, it may seem that your body’s reactions to the things you do and the food you eat are out of your hands. If you feel overwhelmed or frustrated with some of the outward effects of your medications, your doctor can help you to come up with some strategies to minimize side-effects. However, it is important to realize that you play the most important role in helping yourself to stay as healthy as possible. There are many things you can do on a daily basis to help minimize the side effects of both steroid medications and your pericarditis symptoms.

DIET

A healthy diet is important for everyone, but it is especially important for people with pericarditis and those taking steroid medications. While taking steroids, your cholesterol, triglyceride, and blood sugar levels may increase. For these reasons, it is absolutely essential that you not increase your calorie intake and follow a low sodium, low-fat, and low-carbohydrate diet. You do not need to cut out all of the foods you love, but concentrate on eating whole grain breads and cereals and lean sources of protein such as chicken and fish. When you need a snack, look to vegetables—they are low in sugar and calories and provide the perfect food for “grazing.” Try to eat them without Ranch dressing or vegetable dip, because these items carry lots of fat and calories. If you need something to accompany your vegetables, try lighter dips like hummus. It is also important that you minimize alcohol intake when taking steroid medications, since steroids may already irritate your stomach.

Steroids may deplete certain vitamins in your body, such as vitamins C, D, and potassium. Your doctor may recommend for you to take supplemental vitamins or increase your intake of certain foods in order to make up for these deficiencies. Usually it is beneficial to take a multivitamin every day, but speak with your doctor to see which one is right for you, since some vitamins can adversely affect certain conditions. For example, people with antiphospholipid antibodies, especially those taking anticoagulants such as warfarin (Coumadin), should avoid vitamin K because it can increase the risk of blood clots.

OSTEOPOROSIS

Steroids can also contribute to a thinning of the bones known as osteoporosis, which may put you at an increased risk for bone fractures. Your doctor may prescribe a drug for osteoporosis or advise you to take a calcium or hormone supplement. Bisphosphonates such as Actonel, Fosamax, and Boniva are commonly prescribed, as are parathyroid hormone (Forteo) and other medications. To help keep your bones as strong as possible, try to increase your intake of calcium and vitamin D. Calcium helps to keep bones strong and vitamin D helps your body make use of calcium. Foods high in calcium include milk and milk products, tofu, cheese, broccoli, chard, all greens, okra, kale, spinach, sourkraut, cabbage, soy beans, rutabaga, salmon, and dry beans.

STAYING ACTIVE

In addition to increasing your risk of osteoporosis, steroid medications can weaken your muscles. Staying as active as possible will help you to maintain strong muscles and bones. Weight-bearing activities such as walking, dancing, and running will help your muscles stay strong and healthy. Many people report that these activities make them feel better mentally as well. In fact, there are actually chemicals in your brain triggered by significant exercise (usually about 30 minutes per day) that help you to attain a “natural high.” Your doctor can help you to assess your personal condition and decide on an exercise routine that is best for you. However, you should never put yourself through more than reasonable discomfort when exercising.

SMOKING

People with pericarditis should never smoke due to their increased risk of cardiovascular disease. Steroid medications increase this risk by upping blood pressure, triglycerides, and cholesterol. Smoking, steroids, and pericarditis make a very bad combination.

INFECTION

Steroid medications can also increase the risk of infection; this risk increases if you are also taking immunosuppressive drugs. For this reason, it is important that you try to avoid colds and other infections. Washing your hands regularly is perhaps the best way to keep germs at bay. More serious infections can lead to serious—even fatal—illness. The infections that most worry doctors are kidney infection, a type of skin infection called cellulitis, urinary tract infections, and pneumonia. It is important to be on the lookout for any changes in your health, because people taking steroids may not run a fever even though they are very ill. If these infections go untreated, they could enter the bloodstream and pose an even bigger threat, so it is important that you notify your doctor at the first signs of an infection or illness. In addition, live virus vaccines, such as FluMist, the small pox vaccine, and the shingles vaccine (Zostavax) should be avoided because they may cause disease in individuals taking steroid medications.

EYE EXAMS

Finally, since medications can increase your risk of cataracts and aggravate glaucoma, especially when you take steroids for long time, try to get an eye exam twice a year. Notify your doctor of any major changes in your vision.

What should you look for while on corticosteroids therapy?

noreply@blogger.com (M Chadi Alraies) — Mon, 06 Oct 2014 17:05:00 +0000

Possible side effects of taking these steroid medications are:

Changes in appearance

Acne
Development of round/moon-shaped face (sometimes called “Cushing’s syndrome” after the physician who first described it)
Weight gain due to increased appetite
Redistribution of fat, leading to swollen face and abdomen, but thin arms and legs
Increased skin fragility, leading to easy bruising
Hair growth on the face

Psychological problems

Irritability
Agitation, psychosis
Euphoria/depression (mood swings)
Insomnia

Increased susceptibility to infections

Stomach irritation, peptic ulceration

Irregular menses (periods)

Aggravation of the following preexisting conditions:

Diabetes
Glaucoma
High blood pressure

Increase in:

Cholesterol
Triglycerides

May suppress growth in children

Long term side effects:

- Avascular necrosis of bone (death of bone tissue due to lack of blood supply):
  - Usually associated with high doses of prednisone taken over long periods of time.
  - Produces pain, including night pain.
  - Occurs most often in hip, but can also affect shoulders, knees, and other joints.
- Osteoporosis
  - Thinning of the bones.
  - Can lead to bone fractures, especially compression fractures of vertebrae with severe back pain.
- Cataracts
- Glaucoma
- Muscle weakness
- Premature atherosclerosis – narrowing of the blood vessels by cholesterol (fat) deposits.
- Pregnancy complications –Doses of 20mg or more have shown to increase pregnancy and birth complications, such as preeclampsia.

Changes in Left Atrial Mechanics Following Pericardiectomy for Pericardial Constriction.

noreply@blogger.com (M Chadi Alraies) — Wed, 10 Apr 2013 07:54:00 +0000

Although impaired left ventricular (LV) filling in constrictive pericarditis (CP) is attributable to external constraints by a tethered pericardium, impaired left atrial (LA) function can further impair LV filling. This study evaluated LA mechanics in CP and assessed the impact of pericardiectomy on LA mechanics. Interesting study to read. Please click here to go to Journal of The American Society of Echocardiography.

Ulcerative cutaneous lesions... Look deeper that the skin!

noreply@blogger.com (M Chadi Alraies) — Wed, 10 Apr 2013 07:45:00 +0000

A 70-year-old man presented with multiple skin lesions as the first presentation of lung cancer. Please click here to go to the full case. Leave comments and questions.

An old drug with a new use

noreply@blogger.com (M Chadi Alraies) — Wed, 10 Apr 2013 07:32:00 +0000

Colchicine is a well-known anti-inflammatory medication. It is used for gout, pericarditis and other chronic inflammatory diseases. This study, colchicine suppressed the activated neutrophils in atherosclerotic plaques in patient with CAD and unstable angina and decreased cardiovascular events defined as acute coronary syndrome, out-of-hospital cardiac arrest, and non-cardioembolic ischemic stroke. Click here to to go to the study.

noreply@blogger.com (M Chadi Alraies) — Tue, 19 Feb 2013 08:09:00 +0000

Menthol overuse and toxicity is very rare. However, menthol toxicity has been linked with skin, gastrointestinal and neurological symptoms that is hard to discover. Please click here to learn more about this interesting case that one of my colleagues came across during his daily rounds.

Bronchoesophageal Fistula Secondary to Broncholith

noreply@blogger.com (M Chadi Alraies) — Mon, 27 Aug 2012 20:03:00 +0000

Another interesting case of an 85-year-old gentleman presented to us with recurrent pneumonia with history of TB and lung silicosis. CT scan of the chest declared the reason for this recurrent lung infections. Click here for full access to the recently published case. looking for your comments.

Unusual cause of bleeding in liver cirrhosis patient

noreply@blogger.com (M Chadi Alraies) — Sun, 12 Aug 2012 18:22:00 +0000

A 42-year-old man with occult GI bleeding presenting with weakness and fatigue. Initial work up was negative including upper GI scope. We published this interesting case to entertain unusual duodenal variceal bleeding. Please click here for the full print.

Adult Kawasaki disease.

noreply@blogger.com (M Chadi Alraies) — Fri, 10 Aug 2012 16:55:00 +0000

Please Click Here for the new published case of Adult Kawasaki Disease.

Distinguishing cellulitis from its mimics

noreply@blogger.com (M Chadi Alraies) — Mon, 06 Aug 2012 19:49:00 +0000

Please click here for the new published review paper at the Cleveland Clinic Journal of Medicine titled: distinguishing cellulitis from its mimics

Dermatotillomania

noreply@blogger.com (M Chadi Alraies) — Mon, 06 Aug 2012 19:42:00 +0000

a case describing a disease called "Dermatotillomania". Please click here to learn more.

β-Blockers and Cardiac Events in Noncardiac Surgery

noreply@blogger.com (M Chadi Alraies) — Mon, 06 Aug 2012 19:04:00 +0000

Beta blockers are known for their cardioprotective properties when used in noncardiac surgeries. This was one of the main principles in the perioperative medicine. However, lately this concepts being questions and this cardio protective properties have almost fallen of the AHA/ACC guidelines giving the risk of increased mortality for patient using this medication around the surgery time.

Let me know what you think.

β-Blockers and Cardiac Events in Noncardiac Surgery

Tachycardia Approach and Management

noreply@blogger.com (M Chadi Alraies) — Mon, 06 Aug 2012 19:01:00 +0000

In this lecture I am going to go over different types of tachycardia and how to identify each type. This presentation also is going to help managing these arrhythmia at the bedside.

Please feel free to let me know if you have any comments or additions.

Thank you

Tachycardia Approach and Management

Factor v Leiden

noreply@blogger.com (M Chadi Alraies) — Mon, 06 Aug 2012 18:54:00 +0000

Factor v Leiden

Tip of The Day

noreply@blogger.com (M Chadi Alraies) — Sat, 29 Aug 2009 17:38:00 +0000

In the Literature The Latest Research You Need to Know :: Article in The Hospitalist News Letter

noreply@blogger.com (M Chadi Alraies) — Thu, 11 Jun 2009 14:19:00 +0000

Readers want to know timely, concise updates of medical literature relevant to hospital medicine. Additionally, they want the take home message without reading the article with the shortest time. The goal of this column is to alert readers to the important research that is being published. I had the chance to review few studies in the latest edition of The Hospitalist. Please click on the link below.

In the Literature The Latest Research You Need to Know :: Article

Hope you are going to find it useful for you in you daily practice.

ارتفاع ضغط الدم الشرياني

noreply@blogger.com (M Chadi Alraies) — Thu, 19 Mar 2009 13:49:00 +0000

ارتفاع ضغط الدم الشرياني

Hypertension

ما هو ضغط الدم المرتفع؟

يشير مقياس ضغط الدم إلى مقدار الضغط الذى يبذله الدم على جدران الشرايين التى تقوم بنقله من القلب إلى سائر أجزاء الجسم. وفى بعض الحالات، لايستطيع الدم أن يمر يسهولة من خلال الشرايين نتيجة ضيقها وإصابتها بالتصلب، وفى هذه الحالات سيرتفع الضغط حتى يضمن إستمرارية مرور الدم من خلال هذه الشرايين المصابة. هذا هو ما يسمى بمرض "ضغط الدم المرتفع"

حقائق علمية عن مرض "ضغط الدم المرتفع"

1. ضغط الدم المرتفع مرض شائع ولكنه فى نفس الوقت مرض خطير للغاية - يطلق عليه إسم "القاتل الصامت" لأن معظم المصابين به لايشعرون بأية أعراض، بينما إذا لم يعالج هذا المرض وظل ضغط الدم مرتفعا فسيؤدى هذا إلى الإصابة بالأزمات القلبية والصدمات الدماغية وأمراض الكلى وغيرها من الأمراض الناتجة عن إتلاف الشرايين بالجسم.

2. لهذا يعتبر علاج ضغط الدم المرتفع وإبقاء ضغط الدم مستقرا على معدلاته الطبيعية أمرا هاما وحيويا لمنع حدوث هذه المضاعفات الخطيرة.

3. ضغط الدم المرتفع ليس له سبب معروف فى أغلبية المرضى (حوالى 90 % من المرضى).

4. تلعب العوامل الوراثية وأسلوب الحياة مثل زيادة الملح فى الطعام دورا هاما فى حدوث ضغط الدم المرتفع.

5. يعتبر ضغط الدم المرتفع أحد عوامل الخطورة الهامة التى تزيد من نسبة الإصابة بأمراض الشرايين التاجية المغذية لعضلة القلب وكثيرا ما يكون ضغط الدم المرتفع مصاحبا بقصور الشرايين التاجية سواء كان ظاهرا أم خفيا- وفى الحالة الأخيرة كثيرا ما يكون أول صورة لمعاناة هذا المريض هى الإصابة بإحتشاء عضلة القلب أو حدوث السكتة القلبية.

6. من أجل ضمان نجاح علاج ضغط الدم المرتفع، يجب أيضا علاج أى أمراض مصاحبة له و السالف ذكرها فمرض السكر وإرتفاع نسبة الكوليسترول فى الدم، كل منهما يساعد على إرتفاع ضغط الدم.

7. أكثر من 99 % من حالات إرتفاع ضغط الدم لايمكن شفاؤها ولكن يمكن بالعلاج المستمر السيطرة على إرتفاع ضغط الدم، بمعنى إعادته لصورته الطبيعية.

8. فى أغلب الأحيان، يستمر ضغط الدم المرتفع مدى الحياة، ولايوجد شفاء كامل من هذا المرض فالسيطرة على ضغط الدم بالعلاج لاتعنى الشفاء الكامل منه- لذا يحتاج المريض دائما إلى متابعة علاجية مستمرة.

9. إن ارتفاع ضغط الدم ليس نتيجة للعصبية أو التوتر ولذلك فإنه يستدعى العلاج بأدوية خاصة وليس مجرد المهدئات.

10. ضغط الدم المرتفع ليس له أعراض فى معظم الحالات، فالصداع، إحمرار الوجه، الدوار، الدوخة، وطنين الأذن والإغماء كلها أعراض تحدث بنسبة متقاربة فى مرضى ضغط الدم المرتفع وغير المرضى على حد سواء ولذلك يجب ألايعتمد الشخص على هذه الأعراض أو مايشعر به لكى يعرف مستوى ضغط دمه- والطريقة الوحيدة لمعرفة ضغط الدم هى قياسه بواسطة الجهاز المعد لذلك. وفى حالة الحاجة لقياس الضغط بصفة متكررة، يمكن قياسه بجهاز القياس المتواصل لضغط الدم لمدة 24 ساعة.

ماذا يحدث إذا ترك ضغط الدم المرتفع بدون علاج؟

إن إرتفاع ضغط الدم يقوم بإتلاف شرايينك أو شعورك بهذا. وكلما طالت مدة إرتفاع ضغط الدم، كلما زادت نسبة إصابة الشرايين بهذا التلف ويتسبب هذا فى إتلاف القلب والكلى والمخ والأوعية الدموية وكلها مضاعفات خطيرة للغاية. والجدير بالذكر أن الشخص الذى يعانى من ضغط الدم المرتفع يكون أكثر عرضة للإصابة بالأزمات القلبية خمسة أضعاف الشخص الطبيعى. لذا فإن علاج ضغط الدم المرتفع يمنع حدوث المضاعفات ويقلل من إحتمالات الوفاة المبكرة.

تعديل أسلوب الحياة و علاج إرتفاع ضغط الدم:

الحد من تناول الملح فى الطعام

إنقاص الوزن الزائد

ممارسة الرياضة بإنتظام

الإقلاع عن التدخين والعادات الصحية السيئة فى الأكل

الإمتناع عن الكحوليات

هى جزء هام فى علاج ضغط الدم المرتفع، وقد تؤدى فى بعض الأحيان إلى الإقلال من جرعات الدواء التى يحتاجها المريض للسيطرة على إرتفاع ضغط الدم.

نصائح وإرشادات هامة يجب على المريض إتباعها:

1. يجب ألا يزيد ضغطك عن 89 / 139 مم زئبق فى أى حال من الأحوال. أما إذا كنت تعانى من مرض السكر فيجب ألا يزيد ضغطك عن 84 / 129 مم زئبق وفى حالات وجود زلال فى البول بكميات كبيرة نتيجة مضاعفات مرض السكر يجب ألا يزيد ضغطك عن 74 / 124 مم زئبق.

2. لاتأخذ نصيحة من شخص غير مؤهل أو ليس مختصا.

3. علاقتك مع طبيبك:

- يجب أن تشارك طبيبك وتساعده على العناية بك وعلاجك.

- فى بداية الأمر سيكون الأمر صعبا بعض الشىء عندما تغير من عاداتك اليومية لإدخال البرنامج العلاجى.

- سيقوم الطبيب بالإستفادة من زيارتك لكى يتابع تطور حالتك وللتأكد من أن قلبك يعمل بطريقة فعالة.

نظام الغذاء

1- الإقلال من ملح الصوديوم فى نظامك الغذائى. لذا يجب عليك مراعاة الأتى:

الإقلال من إستخدام ملح الطعام.

الإقلال من إستخدام الأغذية المحفوظة (لإحتوائها على نسب عالية من الصوديوم كمادة حافظة ).

الإبتعاد عن الوجبات الخفيفة كثيرة الملح مثل الشيبس والبسكويت المملح والمكسرات المملحة والبسطرمة

تجنب تناول الوجبات السريعة "Fast Foods" لأن كثيرا منها يحتوى على نسبة عالية من الصوديوم

تجنب أية مصادر للملح مثل الجبن الرومى والزيتون والمخلل والأسماك المحفوظة.قراءة الورقة الملصوقة بالأطعمة المختلفة الموجودة بالأسواق للتأكد من نسبة الصوديوم فيها

الإقلال من السكر والحلويات لأن ذلك يؤدى إلى زيادة الوزن.

2. الإمتناع عن الأطعمة الغنية بالكوليسترول مثل: اللحم الأحمر - اللحوم السمينة مثل الضأن، والمخ والكبدة والكلاوى والسجق والهامبرجر - صفار البيض - البط والإوز والحمام وجلد الطيور - المكرونة المجهزة بالبيض أو اللبن أو المواد الدسمة الأخرى كالباشمل والسمن والقشدة والألبان الدسمة والآيس كريم والجبن الدسم الجمبرى والاستاكوزا والأسماك عالية الدهون.

3. الإكثار من تناول زيوت الأسماك متعددة التشبع "Fish Oil" أو التعود على تناول عدد ثلاث وجبات أو أكثر من الأسماك بإنتظام كل أسبوع. إستخدام زيت الذرة أو زيت عباد الشمس أو زيت الزيتون فى الطعام والإمتناع عن المسبكات والدهون والأكلات الدسمة.

3- الإكثار من تناول الأطعمة الغنية بالألياف مثل الخضراوات والفاكهة الطازجة.

4- الإمتناع عن المشروبات الغازية والمشروبات ذات السكر العالى.

5- الإقلال من الشاى والكاكاو والقهوة والنسكافيه - ويمكن تناول النوعيات الخالية من الكافيين.

6- الإمتناع عن المشروبات الكحولية بمختلف أنواعها فالكحول يساعد على إرتفاع ضغط الدم.

7-ليس من الضرورى الحد من تناول السوائل طالما كان تدفق البول طبيعيا.

التدخين

يجب الإمتناع عن التدخين بمختلف أنواعه

إذا كنت مدخنا فيجب أن تقلع فورا عن التدخين.

التدخين مرتبط إرتباط مباشر بحدوث أزمات القلب والصدمات الدماغية.

التدخين يحد من كمية الأ**يجين فى الدم ويتسبب أيضا فى تقلص الأوعية الدموية مما يقلل من كمية الدم التى تصل إلى عضلة القلب.

التدخين يضر بالرئتين.

زيادة الوزن - السمنة (Obesity)

السمنة تساعد على إرتفاع ضغط الدم كما أنها تجعل القلب يعمل بصورة أشد

السمنة تساعد على إرتفاع نسبة الكوليسترول فى الدم.السمنة تساعد على حدوث مرض السكر

يجب الإنقاص من وزن الجسم الى الوزن الطبيعى اذا ماكان المريض بدينا، وذلك بإتباع النظام الغذائى الخاص بالسمنة مع مراعاة إحتياجات الجسم اليومية من العناصر الغذائية الهامة

قلل من نسبة الدهون فى نظام غذائك

أكثر من الخضراوات والفواكه الطازجة

قم بممارسة التمرينات الرياضية حسب إرشادات الطبيب

قم بمتابعة وزنك بإستمرار.

ممارسة التمرينات الرياضية

إن القلب عبارة عن عضلة فهى تحتاج إلى تمرينات منتظمة لتجعلها قوية وتعمل بكفاءة. تؤثر التمرينات الرياضية بصورة إيجابية على معدلات الكوليسترول بالدم. تساعد التمرينات الرياضية على إقلال الوزن و علاج السمنة.إن التمرينات الرياضية تساعد على خفض ضغط الدم ولكن لن تكون هذه التمرينات مجدية إلا إذا كانت تمارس بصورة منتظمة. مارس التمرينات الرياضية حوالى نصف ساعة أو أكثر فى اليوم لمدة ثلاثة أيام على الأقل أسبوعيا حتى تساعد على خفض ضغط الدم ومعدلات الكوليسترول فى الدم. إن أفضل رياضة للقلب هى المشى بانتظام يوميا لمدة ساعة على الأقل فى جو مناسب. يجب تجنب الرياضات العنيفة خاصة رفع الأثقال. إستشر طبيبك عن نوعية وحجم التمرينات الصحية لك.

تذكر الآتى

إن ضغط الدم المرتفع يعتبر مشكلة فقط إذا ترك بدون علاج فلا تنزعج من إصابتك بهذا المرض فهو يمكن علاجه وهو لا يعوقك أو يؤثر فى طبيعة حياتك اليومية أو نوع العمل الذى تؤديه

يجب أن يصبح العلاج جزء من روتين يومك

حتى إذا كنت تشعر إنك معافى، يجب عليك:مراجعة طبيبك بصفة دورية.إتباع تعليمات طبيبك المعالج.الإلتزام بالنظام الغذائى وبرنامج التمرينات الرياضبة الموصوفين لك

الإقلاع عن التدخين

أخذ الدواء الموصوف لك حسب إرشادات طبيبك المعالج

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Carotid Intima-Media Thickness Can IT Be a New Predictor of Cardiac Risk

noreply@blogger.com (M Chadi Alraies) — Sun, 08 Mar 2009 17:36:00 +0000

I was reading the latest issue of Mayo Clinic Proceedings and I came across two interesting studies talking about new approach to predict the risk of cardiovascular disease. Both studies were proposing that the carotid intima-media thickness has the tendency to predict the cardiac risk even in patients with low Framingham Risk Score (FRS). I will leave you with the abstract and please follow the links at the end of the abstract for the full text.

A Cross-sectional Study of Intima-Media Thickness, Ethnicity, Metabolic Syndrome, and Cardiovascular Risk in 2268 Study Participants.

Allen Adolphe, MD, PhD, Linda S. Cook, PhD and Xun Huang, MS

Abstract:

OBJECTIVE: To describe the association between intima-media thickness (IMT) and metabolic syndrome (MetS) and to examine if the addition of IMT to a traditional MetS definition adds value to the assessment of predicted cardiovascular disease (CVD) risk in a large multiethnic population.
PARTICIPANTS AND METHODS: In this cross-sectional study, carotid IMT was measured in 2268 men and women as part of a wellness physical examination between August 1, 2000, and October 1, 2001. The wellness examination included a fasting lipid panel, physical examination, and medical history. Mean IMT was described by sex, ethnicity, and the MetS. Predicted risk for CVD was determined with IMT as a component of the diagnostic criteria for MetS.

RESULTS: Intima-media thickness increased with each additional component of the MetS, increasing from 0.516 mm for 0 components to 0.688 mm for 4 or more components (P<.001). In each ethnic group (non-Hispanic whites, blacks, Hispanics, and Asians), those with the MetS had higher mean IMT (increased by 0.084 mm to 0.134 mm) than those without MetS. The addition of IMT as a “new” component in the diagnosis of MetS allowed us to identify 78 (3.4%) participants who were not previously diagnosed as having MetS but who had a high 10-year estimated risk of MetS as measured by the Framingham risk score (11.67%).

CONCLUSION: The addition of IMT to the traditional criteria for the diagnosis of the MetS may help identify individuals who otherwise would not have been identified to be at high risk of CVD.

Full article: Click here

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Carotid Intima-Media Thickness and Coronary Artery Calcium Score as Indications of Subclinical Atherosclerosis

Steven J. Lester, MD, FRCPC, Mackram F. Eleid, MD, Bijoy K. Khandheria, MD and R. Todd Hurst, MD

Abstract:

OBJECTIVE: To determine the ability of carotid intima-media thickness (CIMT) and coronary artery calcium score (CACS) to detect subclinical atherosclerosis in a young to middle-aged, low-risk, primary-prevention population.

PATIENTS AND METHODS: Patients aged 36 to 59 years who underwent determination of CIMT and CACS at our institution between May 1, 2004, and April 1, 2008, were included in the study. Those with diabetes mellitus or a history of coronary, peripheral, or cerebral vascular disease were excluded. Other information, such as Framingham risk score (FRS), was obtained by a review of clinical and laboratory data.

RESULTS: Of 118 patients, 89 (75%) had a CACS of zero and 94 (80%) were men; mean ± SD age was 48.9±5.7 years. The mean FRS of this group was 4.0; 86 patients (97%) were considered at low risk (<1% class="blsp-spelling-error" id="SPELLING_ERROR_56">CIMT above the 75th percentile was found in 12 (13%) of age-, sex-, and race-matched control patients. Of the 40 patients with low-risk CIMT (below the 50th percentile), 4 (10%) had a CACS at or above the 50th percentile.

CONCLUSION: Subclinical vascular disease can be detected by CIMT evaluation in young to middle-aged patients with a low FRS and a CACS of zero. These findings have important implications for vascular disease screening and the implementation of primary-prevention strategies.

Full article: click here

TNF Blockers in RA and Risk Of Serious Infections

noreply@blogger.com (M Chadi Alraies) — Wed, 21 Jan 2009 13:17:00 +0000

Because tumor necrosis factor-alpha (TNF-alpha) is an important component of the immune system's response to a variety of infections, TNF inhibitors can cause serious infections. These include bacterial infections (particularly pneumonia), tuberculosis, and opportunistic infections. Because of the increased risk of tuberculosis, a chest radiograph and purified protein derivative (PPD) test should be performed before the initiation of TNF inhibitor therapy. Till now there is no clear correlation between these medications and infections. Data from individual randomized clinical trials failed to demonstrate a consistent increase in treatment-related infections.

Recently (in January of 2009) C. Salliot and colleagues published in Annals of Rheumatic Disease Journal a meta-analyses of randomised placebo-controlled trials addressing the infection risks during rituximab, abatacept and anakinra treatments for rheumatoid arthritis. In summary, these meta-analyses did not reveal a significant increase in the risk of serious infections during rituximab or abatacept treatments in patients with rheumatoid arthritis; however, high doses of anakinra may increase this risk, especially when patients have comorbidity factors. Large studies must be performed to confirm this safety profile in daily practice.

To go to the ARD journal please click here

ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use

noreply@blogger.com (M Chadi Alraies) — Wed, 12 Nov 2008 19:00:00 +0000

A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Please remeber the following point about this expert consensus document. Click here for more.

100% Internal Medicine Board Passing Rate

noreply@blogger.com (M Chadi Alraies) — Fri, 07 Nov 2008 17:23:00 +0000

Early October was a great moments for all St. Vincent Charity Hospital / Case Western reserve University 2008 class graduates. All class passed the ABIM (American Board of Internal Medicine) exam. This is the second year in a row St. Vincent has been achieving this passing rate.

I served as a third year and chief resident at the same time for 2007-2008 academic year. We (all residents) played like champions to achieve this honor. Early 2008 was the start for this plan. Please click here to log in to the ABIM planner that you might find helpful for passing the boards.

Good Luck

Blood management summit 2008 - CCF

noreply@blogger.com (M Chadi Alraies) — Mon, 03 Nov 2008 20:58:00 +0000

I learned the following points that I would like to share with you. I recommend this summit for everybody in the medical field especially hospital medicine (in-patient medicine). Please click here to get to the related page.

Dementia More Prevalent in Women Than Men After Age 90

noreply@blogger.com (M Chadi Alraies) — Thu, 09 Oct 2008 12:17:00 +0000

After age 90, dementia becomes more common with age in women but stabilizes in men, a study in Neurology suggests. Among some 900 mostly white, upper-middle-class subjects who were 90 or older, about 41% of women and 28% of men had dementia. Moreover, the odds of dementia in women approximately doubled from ages 90–94 to ages 95 and up, but remained stable in men. Higher education levels correlated with lower dementia rates in women, but not in men. The authors speculate that the discrepancy between men and women might be due to differences in dementia risk factors or in education levels, to a healthy-survivor effect in men, or to a longer duration of survival after dementia diagnosis in women than in men.

Neurology article.

ABIM 2008 Study Group

noreply@blogger.com (M Chadi Alraies) — Sun, 23 Mar 2008 04:00:00 +0000

As third year internal medicine residents we prepared for the 2008 ABIM (American Board of Internal Medicine) exam as one group. I initiated this project as a personal planner to prepare for the board. Later on, I introduced this plan to my colleagues who found it helpful. I am blogging this since we have 100% passing rate that year and to share the plan with other board takers.

When did we start? We started in April since majority of my class have finished call rotations and can comply more with the plan agenda.

Reading materials: This is was hard choice since many board review books and series are available in the marker and few residents started preparing from different sources. However, I was looking for something concise, focused and brief. I sent questionnaires to former graduates of our program who passed the boards asking for their recommendations. I came to conclusion that MedStudy published by MedStudy Corporation has the best reviews among our residents and across the US medical residents.

Questions materials: Again having the same issue finding the right one, but we concluded that MKSAP 14 multiple choice questions published by the American College of Physician (ACP) was one of the best and covers majority of the ABIM topics and has the similar style as well. Other source that I personally used as well were: MedStudy MCQ’s book and Medscape board review self assessment questions from acponline.org. Click here to download.

Schedule: We planned to finish reading and discussing the 5 books of MedStudy within 2 months period (before graduation) by assigning 15-20 pages per week. We finished as planned.

Follow-up: weekly meeting (Thursday morning) for 1 hour discussing the pages we read and doing an average of 10-20 questions from MKSAP bank. These meeting kept us on the same reading pace. Questions and unclear points were discussed and shared with our faculty attendings.

Result: 100% ABIM passing rate.

ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use

noreply@blogger.com (M Chadi Alraies) — Sun, 12 Nov 2000 19:01:00 +0000

Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin (ASA), are the most widely used class of medications in the United States.
As the use of any NSAID—including COX-2-;selective agents and over-the-counter doses of traditional NSAIDs, in conjunction with cardiac-dose ASA—substantially increases the risk of ulcer complications, a gastroprotective therapy should be prescribed for at-risk patients.
The use of low-dose ASA for cardioprophylaxis is associated with a two- to fourfold increase in upper gastrointestinal event (UGIE) risk. Enteric-coated or buffered preparations do not reduce the risk of bleeding. For patients at risk of adverse events, gastroprotection should be prescribed. The risk of UGIE increases with ASA dose escalation; thus, for the chronic phase of therapy, doses greater than 81 mg should not be routinely prescribed.
The combination of aspirin and anticoagulant therapy (including unfractionated heparin, low molecular weight heparin, and warfarin) is associated with a clinically meaningful and significantly increased risk of major extracranial bleeding events, a large proportion from the upper GI tract. This combination should be used with established vascular, arrhythmic, or valvular indication; patients should receive concomitant proton pump inhibitors (PPIs) as well. When warfarin is added to aspirin plus clopidogrel, an international normalized ratio (INR) of 2.0-2.5 is recommended.
Substitution of clopidogrel for ASA is not a recommended strategy to reduce the risk of recurrent ulcer bleeding in high-risk patients and is inferior to the combination of ASA + PPI.
The combination of clopidogrel and warfarin therapy is associated with an increased incidence of major bleeding when compared with monotherapy alone. Use of combination antiplatelet and anticoagulant therapy should be considered only in cases in which the benefits are likely to outweigh the risks. When warfarin is added to aspirin plus clopidogrel, an INR of 2.0-2.5 is recommended.
PPIs are the preferred agents for the therapy and prophylaxis of NSAID- and ASA-associated GI injury.
Testing for and eradicating H. pylori in patients with a history of ulcer disease is recommended before starting chronic antiplatelet therapy.
Decision for discontinuation of ASA in the setting of acute ulcer bleeding must be made on an individual basis, based on cardiac risk and GI risk assessments, to discern potential thrombotic and hemorrhagic complications.
Endoscopic therapy may be performed in high-risk cardiovascular patients on dual antiplatelet therapy, and collaboration between the cardiologist and endoscopist should balance the risks of bleeding with thrombosis with regard to the timing of cessation of antiplatelet therapy.
Overall, in appropriate patients, oral antiplatelet therapy decreases ischemic risks, but this therapy may increase bleeding complications.
Communication between cardiologists, gastroenterologists, and primary care physicians is important to weigh the ischemic and bleeding risks in an individual patient who needs antiplatelet therapy, but who is also at risk for or develops significant GI bleeding.

Circulation 2008;118;1894-1909; originally published online Oct 3, 2008;