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.
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Anabolic steroids cause kidney disease
October 31, 2009
Assessment of Neuropathic pain
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
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
October 30, 2009
Recommended regimen in combination of tenofovir with emtercitabine with or without boosted ritonovir - lopinovir. Duration of treatment is 28 days.
Resistant hypertension
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?
October 29, 2009
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
October 28, 2009
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
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
October 27, 2009
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
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
October 25, 2009
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
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
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
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
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.
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