AAS Medical Notes

هذا الجدول و الدوزات كلش راح تحتاجها هواي احفظها يمك

من تشوف هيج كلام، تحس كل أيام السهر و ساعات الكتابة كانت بذرة ثمرتها هذا الكلام. هذا الكلام، هو ل د فاروق بخصوص كتابي الصادر مؤخرا. الكتاب ما راح تعرف قيمته لحد ما تقرآه، راح تشوف شكد المواضيع السهلة و الصعبة على حد سواء مشروحة بطريقة مبسطة، سلسة، سهلة الحفظ و التطبيق. الكتاب يوجهك هواي انه "شلون تفكر بالكيس" و "شلون تخلي ddx لكل كيس" و "شلون تبدي تستثنيهم واحد واحد". اتمنى البقية ايضا ينطونا فيدباك، انا مستعد انزل الفيدباك السلبي قبل الإيجابي، فلا تنحرج انه تدز اي شي. الكتاب متوفر بمكتبة مشروع مثقف، و موجودة بالرسائل المثبتة.

Long Term Oxygen Therapy LTOT in COPD patients: Arterial blood gases are measured in clinically stable patients on optimal medical therapy on at least two occasions 3 weeks apart:  PaO 2 <7.3 kPa (55 mmHg) irrespective of PaCO 2  PaO 2 7.3–8 kPa (55–60 mmHg) plus pulmonary hypertension, peripheral oedema or polycythaemia (haematocrit >55%)  the patient has stopped smoking Use at least 15 hrs/day at the necessary flow rate to achieve a PaO 2 >8 kPa (60 mmHg) without unacceptable rise in PaCO2

الْـحَمْدُ للهِ الَّذِي لا يَبْلُغُ مِدْحَتَهُ القَائِلُونَ، وَلَا يُحْصِي نَعْمَاءَهُ العَادُّونَ، وَلَا يُؤَدِّي حَقَّهُ الْـمُجْتَهِدُونَ.

السلام عليكم الكتاب أكتمل بصورة 100% و غداً تتحضر طلبات الزبائن و بعد غد توصللكم الطلبات بأذن الله انا ما راح احجيلكم عن الكتاب و كثافة المعلومات و ترتيبها و طريقة سردها، زملائكم الي طلبوه خل هم يسولفوكم عنه. متوفر في مكتبة مشروع مثقف، و الرابط مال المكتبة موجود بالرسائل المحفوظة، او فقط تبحث عنه بالقناة.

ملاحظات مهمة عن Acute Aortic Syndromes and Aortic Dissection

DVT and duration of anticoagulation

The simplified Pulmonary Embolism Severity Index (PESI): The simplified PESI assigns 1 point for each of the following: age older than 80 years, history of cardiopulmonary disease, history of cancer, pulse rate 110/min or greater, systolic blood pressure less than 100 mm Hg, and oxygen saturation less than 90%. If none of these criteria are met, the patient is considered low risk, with a 30-day mortality of 1.1%; these patients can be considered for home anticoagulation treatment with either rivaroxaban or apixaban. American Society of Hematology ASH guideline.

موضوع مهم جدا Approach for treatment of hyper Na. من كتابي Ahmed for ward cases

أخوان احب انوّه ع نقطة ان جزء ال (ICU) يتكلم عن الكيسات الي تستحق دخزل عناية و علاجها اثناء الرقود في العناية يعني مو يتكلم عن ال ventilators أو ادوية التخدير. مثلا myasthenic crisis يحتاج ICU admission راح اتكلم عن العلاجات اثناء ال ICU. يعني الكتاب "باطني" بغض النظر عن رقود الكيس الباطني "سواء في العناية او الردهة".

السلام عليكم الإحبة الإصدقاء، كل عام و انتم بخير، و أسعد الله أيامكم. أخوتي الإحبة، اتمنى قرآة المنشور للأخير. بإيام العيد، واحدنا ما يقبل يشوف نفسه فرحان، و زميلة و جارة، و إبن جلدته، مهموم و ماكله المرض، و هو ما عنده أمكانية يراجع طبيب !! شيبة مباركة بلغت من العمر عتيا، عنده بنات فقط، و ما عنده اي دخل يومي، عدا الدخل الشهري (راتب العاطلين) الي يبلغ اقل 200 الف (و البنات طالبات كلية و تعرفون احتياجات الطالبات). بيتهم اقل ما يقال عنه "إنه متهالك" و ما اتعجب من يخابروني في يوم "إن البيت وقع على ساكنيه"، بدون أي مبالغة يا شباب. تتذكرون المطرة الي صارت قبل فترة, بيتهم لحد الآن غرگان بالمطر، و الشيبة المباركة هي الي تنظف الماي. ما اقول هذا الكلام حتى اجذب تعاطفكم، بس هو الواقع. ف اني-و بتوفيق الله و بتعاونكم- ناوي اساعدهم + اغير او ارمم بيتهم. ترا صدگوني هي هاي الدنيا، في يوم من الأيام، كلنا راح نغادر الحياة، و يبقى فقط الأثر الطيب و الذكرى الحسنة و العمل الصالح، فنحاول ان نعمل على ما يبقى. طريقة التبرع هي عن طريق الزين كاش، الرقم أدنا و الكود أول تعليق 07830835068 شوف انت راح تقرأ المنشور و راح "يفور" دمك و تتوعد ان تتبرع، لكن تتكاسل، و تخليها ع باجر، و تبرد و تنسى. ف اريد منك، بهاي اللحظة، تنطي تفاعل ع البوست، حتى يكون تفاعلك هو وعدك انه راح تتبرع. فكل تفاعل يا شباب، راح اعتبره تبرع، تمام. موفقين لكل خير  

Screening for type 2 DM: Screening for type 2 diabetes in the general adult population is indicated because (1) type 2 diabetes is often preceded by a prolonged asymptomatic hyperglycemic period in which microvascular and macrovascular damage may occur, (2) lifestyle interventions and medications have demonstrated the ability to delay or prevent onset of type 2 diabetes in persons with prediabetes, and (3) early intensive glucose control and management of hyperlipidemia and hypertension may prevent or reduce the progression of microvascular disease and macrovascular cardiovascular disease (CVD). The American Diabetes Association recommends screening for type 2 diabetes in A. adults aged 35 years or older B. and considering screening in adults of any age with a BMI of 25 or greater (or ≥23 in Asian Americans) who have one or more additional risk factors for diabetes. These risk factors include — a first-degree relative with diabetes, — high-risk race or ethnicity (e.g., African American, Latino, Native American, Asian American, Pacific Islander), — history of cardiovascular disease, — physical inactivity, — hypertension (≥130/80 mm Hg or taking antihypertensive therapy), — HDL cholesterol level less than 35 mg/dL (0.90 mmol/L), — triglyceride level greater than 250 mg/dL (2.82 mmol/L), — polycystic ovary syndrome, or other conditions associated with insulin resistance. The preferred screening tool is HbA1c.

(الذكاء الاصطناعي والتشخيص الطبي) انطوا برنامج الـ ChatGPT 150 حالة طبية لغرض تشخيصها فشل بتشخيص ٥١٪؜ من الحالات ولهذا يجب عدم الأعتماد عليه كليا من قبل الأطباء. رابط الدراسة: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0307383&type=printable

انا جدا احب اقرء على ال algorthim لأن يلخص الكلام بطريقة انسيابية يسهل على الدماغ استدعائها عند الحاجة لكن بنفس الوقت، ما اعرف شلون اسوي flow chart مرتب. هذا ال algorthim بلشت بيه ساعة ١١:٣٥ و خلصته الساعة 1:47 مع ذلك اهواي اشياء تمنيت اكتبها، ما گدرت. ما اسولفلكم، اجه اخوي و نقذني ببرنامج (كان عندي سابقا، بس ما انطيته اهتمام، طبعا انتم اقترحتوه اليه)، برنامج Xmind. هذا البرنامج استعملته سابقا، بس كرهته لأن حجم الخط يقل كلما يزداد طول الچارت و غيرها من الاسباب. طلعت جميع هاي الاسباب الها حل و جدا بسيط، و اني ما اعرف. و هسه خلال ١٥ دقيقة سويه Algorithm for thyroid nodule assessment بالرغم هو اعقد من الكورثم مال RA، لكن شوف عامل الوقت شكد فرق بسبب برنامج بسيط !!!

ما اعرف يمكن ما واضح ال algorthim بس هذا ال algorthim يبين management of rheumatoid arthritis RA بطريقة كلش حلوة و سلسة

The Junior Doctors (Rotators) are the cornerstone of the hospitals شاء من شاء، و أبى من أبى.

Amiodarone and thyroid: Amiodarone has the following effects on thyroid function: (1) acute, transient suppression of thyroid function; (2) inhibition of T 4 to T 3 conversion causing either euthyroid hyperthyroxinemia or increased dosage requirement in LT4-treated hypothyroid patients (3) hypothyroidism in patients susceptible to the inhibitory effects of a high iodine load; and (4) thyrotoxicosis The initiation of amiodarone treatment is associated with a transient decrease of T4 levels, reflecting the inhibitory effect of iodine on T4 release. Soon thereafter, most individuals escape from iodidedependent suppression of the thyroid (Wolff-Chaikoff effect), and the inhibitory effects on deiodinase activity and thyroid hormone receptor action become predominant. These events lead to the following pattern of thyroid function tests: increased T4 , decreased T3 , increased rT3 , and high TSH. Hypothyroidism: The pathogenesis appears to involve an inability of the thyroid gland to escape from the Wolff-Chaikoff effect in autoimmune thyroiditis. Consequently, amiodarone-associated hypothyroidism is more common in women and individuals with positive TPO antibodies. It is usually unnecessary to discontinue amiodarone for this side effect, because LT4 can be used to normalize thyroid function. TSH levels should be monitored, because T 4levels are often increased. Amiodarone-induced thyrotoxicosis AIT: There are two major forms of AIT. Type 1 AIT is associated with an underlying thyroid abnormality (preclinical Graves’ disease or nodular goiter). Thyroid hormone synthesis becomes excessive as a result of increased iodine exposure (JodBasedow phenomenon). Type 2 AIT occurs in individuals with no intrinsic thyroid abnormalities and is the result of drug-induced lysosomal activation leading to destructive thyroiditis with histiocyte accumulation in the thyroid; the incidence rises as cumulative amiodarone dosage increases. Mild forms of type 2 AIT can resolve spontaneously or can occasionally lead to hypothyroidism. Color-flow Doppler ultrasonography shows increased vascularity in type 1 AIT but decreased vascularity in type 2 AIT. In AIT, the drug should be stopped, if possible. Discontinuation of amiodarone will not have an acute effect because of its storage and prolonged half-life. High doses of antithyroid drugs can be used in type 1 AIT but are often ineffective. Potassium perchlorate, 200 mg every 6 h, has been used to reduce thyroidal iodide content. Glucocorticoids, as administered for type 2 AIT, have modest benefit in type 2 AIT and are generally initiated as prednisone 40 mg PO daily.

Subclinical Hypothyroidism 1. Definition: high TSH and a normal free T4. The normal range for TSH increases with age; a TSH level of up to 10 μU/mL (10 mU/L) is within the normal range for persons 80 years and older. 2. Next: Repeating the measurement in 6 to 8 weeks confirms persistent TSH elevation is required. 3. When to treat: A. TSH greater than 10 μU/mL (10 mU/L) may be a risk factor for coronary artery disease and heart failure and its an indication for treatment. B. Treatment for TSH less than 10 μU/mL (10 mU/L) should be considered in: 👉 younger patients (<30 yrs). 👉 those attempting to become pregnant, 👉 if significant symptoms are present. B. Note: No evidence indicates that treating subclinical hypothyroidism improves quality of life, cognitive function, blood pressure, or weight, but in patients with elevated LDL cholesterol, normalization of the TSH will lower LDL. Subclinical Hyperthyroidism 1. diagnosed by TSH suppression with normal T4 and T3 levels. The most common cause is toxic MNG. 2. Risk: increases the risk of atrial fibrillation, and cardiovascular events. There are higher rates of hip fracture with subclinical hyperthyroidism. Whether treatment of subclinical hyperthyroidism reduces fracture risk is unknown. 3. Next: TSH normalizes after 6 weeks in more than 25% of patients with subclinical hyperthyroidism. Therefore, observation and rechecking thyroid function before treatment is reasonable unless the risk of complications, such as cardiac disease, is high. 4. When to treat: A. all patients with symptoms. B. Treatment is recommended for TSH less than 0.1 μU/mL (0.1 mU/L), cardiac risk factors, heart disease, osteoporosis, or high risk for osteoporosis, regardless of symptoms.

Diabetic Kidney Disease: 1. The American Diabetes Association (ADA) recommends an ACE inhibitor or an angiotensin receptor blocker (ARB) to slow progression of diabetic kidney disease and to prevent cardiovascular disease in nonpregnant women with type 2 diabetes mellitus and a modestly elevated urine albumin-to-creatinine ratio (UACR) (30-299 mg/g). The ADA also strongly recommends this approach for patients with UACR 300 mg/g or greater or an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2. Treatment with an ACE inhibitor or ARB is not recommended for patients with type 2 diabetes who have normal blood pressure, UACR less than 30 mg/g, and eGFR level greater than 60 mL/min/1.73 m2. 2. In a consensus statement, the ADA and Kidney Disease: Improving Global Outcomes (KDIGO) recommend adding a nonsteroidal mineralocorticoid receptor antagonist (finerenone) for patients with type 2 diabetes, normal potassium levels, an eGFR of 25 mL/min/1.73 m2 or greater, and persistent albuminuria (albumin-creatinine ratio ≥30 mg/g) despite maximally tolerated doses of ACE inhibitors or ARBs to reduce the risk for chronic kidney disease progression. 3. For patients with type 2 diabetes and chronic kidney disease (CKD), the ADA recommends that physicians consider a sodium-glucose cotransporter 2 inhibitor (such as empagliflozin) or glucagon-like peptide 1 receptor agonist (such as liraglutide) to reduce risk for CKD progression and cardiovascular disease as part of the antihyperglycemic regimen. Furthermore, empagliflozin is FDA approved to reduce the risk for sustained eGFR decline, end-stage kidney disease, cardiovascular death, and hospitalization in adults with CKD at risk for progression even in the absence of diabetes.

In the Diabetes Prevention Program, metformin was not as effective as lifestyle modification but reduced the incidence of diabetes by 31% compared with placebo and by 18% at 10-year follow-up. Metformin may be considered for prevention of type 2 diabetes in patients with prediabetes unresponsive to lifestyle modifications, particularly in patients aged 25 to 59 years with BMIs of 35 or greater, higher fasting plasma glucose levels (≥110 mg/dL), and higher hemoglobin A1c (≥6%), and in persons who have had gestational diabetes.