ملح الباطنيةDr.Ahmedjuwair

💎About APS:- ● In general, IgG anticardiolipin antibodies are thought to be more pathologic than IgM. ●In women < 50 years with thrombotic stroke, the odds ratio for having lupus anticoagulant is 43.1. ● Lupus anticoagulant is a stronger risk factor for thrombosis and pregnancy loss than anticardiolipin or anti β2-glycoprotein 1 antibodies. ● A clue to lupus anticoagulant is a prolonged PTT, which paradoxically is associated with thrombosis, not bleeding. ●Testing for lupus anticoagulant uses phospholipid dependent coagulation assays, such as the Russell viper venom time (RVVT). ✅️CURRENT 2026

💎In management of APS:- For thrombotic APS, warfarin is recommended over DOACs. ✅️CURRENT 2026

💎in SLE:- ●ANA ≥ 1:80 is the entry criterion in the 2019 EULAR/ACR classification; without positive ANA, SLE is generally not classified. ●Joint symptoms occur in > 90%, but lupus arthritis is usually nonerosive; only about 10% develop radiographic erosions. ●Anti-dsDNA is specific but not sensitive (only presents in two thirds 50-75%)and often correlates with disease activity/lupus nephritis, while anti-Smith is highly specific but not sensitive. ● In lupus flares, ESR rises but CRP is often normal; a high CRP without arthritis or serositis should raise concern for infection. ●Key drug doses: hydroxychloroquine 200–400 mg/day (max 5 mg/kg/day), prednisone 5–15 mg/day for mild flares, methylprednisolone 250–1000 mg IV daily for 3 days for severe disease, and mycophenolate 1000– 1500 mg BID for lupus nephritis. ✅️CURRENT 2026

💎 Leflunomide in treatment of RA:- •is an alternative for patients who cannot take methotrexate. • Dose: 20 mg orally once daily. • Common side effects are diarrhea, rash, reversible alopecia, and hepatotoxicity. • Some patients develop marked unexplained weight loss. • It is teratogenic. • It has a half-life of 2 weeks, but active metabolites may persist for up to 2 years. • Therefore, it is contraindicated in premenopausal women who wish to become pregnant. ✅️CURRENT 2026

💎 RA can affect the cervical spine, but it spares the rest of the spine and does not involve the sacroiliac joints. ✅️CURRENT 2026

💎Podagra is the classic presentation of gout: acute nocturnal monoarthritis of the first MTP joint. ✅️CURRENT 2026

💎A normal serum uric acid during an acute flare occurs in ≥ 25% of patients and does not exclude gout. ✅️CURRENT 2026

💎in treatment of Gouty arthritis:- Start urate-lowering therapy for ≥ 2 attacks/year, tophi, or CKD stage 2 or worse; target uric acid is < 6 mg/dL, and sometimes < 5 mg/dL in severe disease.

• Starting urate-lowering therapy during an acute flare is not contraindicated, but the flare itself still requires anti inflammatory treatment. ✅️CURRENT 2026

Normal uric acid during an acute attack does not exclude gout. Can be normal in >=25% of cases. ✅️CURRENT 2026

●Hospitalized patients often develop gout attacks because of fasting, changes in diet, fluid intake, or medications that rapidly alter serum urate levels. ✅️Current 2026

Urate deposition occurs when serum uric acid is supersaturated, usually at levels > 6.8 mg/dL (404.5 mcmol/L). • Secondary gout is associated with acquired causes of hyperuricemia such as: • Medications: especially diuretics, low-dose aspirin, cyclosporine, and niacin. •there are many other causes of 2ry gout. ✅️current 2026

Acetaminophen, glucosamine/chondroitin, fish oil, vitamin D, arthroscopic surgery, and repeated intra articular injections do not provide meaningful long term benefit in routine osteoarthritis. ✅️Current 2026

📌#الجديدفيSGLT2Inhibitors .. 📌 طبعا كلنا عارف انه اشهر side effect لمجموعه ال الـ SGLT2 inhibitors هو انها بتسبب UTI وده راجع لـ ميكانيزم عملها وهي انها ببساطه بتخرج الـ Glucose في الـ Urine. .. 📌 هل العلماء اكتفوا بقي بـالـ SGLT2 inhibitors بس ؟!‼️ .. 📌 لا .. طوروا كمان الـ دوا جديد وهو SGLT2 and SGLT1 .. 📌 دوا جديد بيشتغل علي الـ SGLT 2 في الكلي بالاضافه كمام انه بيشتغل علي SGLT1 في الـ Intestine ‼️ .. 📌 وبكده الدوا الجديد ده اللي اسمه Sotagliflozin هيخرج الجلوكوز من الـ Urine وكمان الـ Stool وبعد ما كان بيعمل UTI بس بقي يعمل كمان Diarrhea ‼️ .. 📌 طبعا دوره قوي زي SGLT2 inhibitors في علاج الـ HF ,CKD . .. 🚩🚩 Reference: ADA2025 .. 🚩🚩🚩Educational content for healthcare professionals only .. #ClinicalPharmacyTraining #PharmacyCareer #ClinicalPharmacist #MedicalTraining #PharmD #FutureStartsHere .. #ClinicalPharmacyTraining #PharmacyCareer #ClinicalPharmacist #MedicalTraining #PharmD #FutureStartsHere

Paracentesis is not contraindicated in patients with an abnormal coagulation profile. The majority of patients with ascites due to cirrhosis have prolongation of the prothrombin time and some degree of thrombocytopenia. There are no data to support the use of fresh frozen plasma before paracentesis although if thrombocytopenia is severe (<40 * 109 /l) most clinicians would give pooled platelets to reduce the risk of bleeding. ✅️European guidelines.

Approach to pancytopenia

💎For diagnosing H.pylori disease with H.pylori Ag in stool, Patient should stop PPIs 14 days and Antibiotics 28 days before testing.

💎H.pylori Eradication Therapy is associated with 46% reduction in gastric cancer risk. ✅️Current 2026

💎 Unexplained overt bleeding after upper endoscopy/colonoscopy → repeat scopes first(Upper & Lower GI endoscopes), then capsule endoscopy if stable .