AAS Medical Notes

طبعا منطيكم ريست لأن عيد و دائما اتذكروا المقوله الشهيرة There is no rest in medicine because the diseased have no rest .

كل عام و الجميع بخير

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Can anyone tell me what is the dx of this condition 24 yo male with hx of chronic heel pain for more than 11 months , he is feverish, anorexic, and markedly loss his weight . ESR was elevated . Foot X ray was done as above . I am waiting @AhmedAbdSam

This CXR show : 1) pseudotumore of the lung . 2) batwing sign . 3) cardiomegaly . This is 100% due to congestive heart failure

Genu varum in 4 years old female with Ricket (vitamin D deficiency) .

بس اخذوا بالكم من هاي النقطه ابليز Digitalis have mesenteric vasoconstrictor effect so they can push the pt into ischaemic colitis 👉🏽👉🏽 abdominal pain و النقطه الثانيه Digoxin can cause AF 👉🏽👉🏽 mesenteric ischaemia👉🏽👉🏽 abdominal pain و النقطه الثالثه Digoxin will stimulate vagus nerve👉🏽👉🏽 abdominal pain . يعني نختمها ب ملاحظه اصغيره Any abdominal pain in a pt who is on digoxin, this pain is digoxin-mediated regardless the mechanism

Any patient receiving digitalis who presents with GI symptoms, such as anorexia, nausea, or vomiting, should be suspected of having digitalis toxicity. The nausea and vomiting are thought to be mediated by stimulation of the area postrema in the medulla oblongata of the brainstem rather than by any direct effects of digitalis on the GI mucosa. These GI manifestations may occur in patients receiving excessive oral or IV doses of digitalis for the management of heart failure or rapid AF or both. Another diagnosis to consider in an elderly man receiving digoxin and with known peripheral vascular disease presenting with worsening GI symptoms is acute mesenteric ischemia, which is precipitated or worsened by digoxin's mesenteric vasoconstrictor effect. Early clinical suspicion and diagnosis followed by prompt and effective treatment of acute mesenteric ischemia are critically important to improve the clinical outcome. Acute mesenteric ischemia is a life-threatening vascular emergency associated with a 60–80% mortality and is almost uniformly fatal if unsuspected and not effectively and promptly treated.

HCV and its proteins

#LIVER_LECTURES_ #part 6 hepatitis C virus اليوم المحاضرة السابعه من محاضرات الكبد و الي تخص ال HCV و طبعا جدا بسطتها الكم . ال HCV يعود الى مجموعة ال flaviviridea الي هي enveloped RNA . يعني ال RNA محاط بال capsid و لكون بروتينات الكابسد متغيرة بأستمرار فلهذا لا يوجد لقاح لهذا الفيروس حاله حال ال HIV ولهذا يعتبر ال HCV اخطر انواع ال hepatitis. بشكل عام، هالفيروس يتكون من enveloped proteins which are E1 and E2, و Core proteins, و ال non structural proteins(2,3,4,5A, 5B)، اضافه الى ال RNA-dependent RNA polymerase . و حاليا العلاجات الجديده كلها تشتغل ع هاي البروتينات . طرق_انتقال_الفيروس_ -- about 50-60% of HCV transported via parenteral drug administration -- sexual transmission is rare from male to female but significant from male to male --vertical transmission (from mother to her fetus) is rare (5%) --breast feeding not way for transmission #THE_pathogenesiS_ ال HCV يشبه ال HBV ، اثنينهم يسببن acute and chronic infections و تقريبا 70% من الاشخاص الي يصير عدهم HCV و هذا عامل ثاني من خطورة هذا الفيروس . خلي بالك اغلب الي عدهم ال HCV هم اصلا ما يدرون انهم حاملين للفيروس لان مقل ما كلنه هو ب اغلب الحالات completely asymptomatic . بس مرات ممكن ينطي اعراض شبيه لل HBV من ال fever, tender liver, jaundice, polyarthritis و ال cryoglobulinaemia و مرات ايكون associated with lichen planus and DM, و نعيد و نكرر هاي الاعراض مو شائعه لأن هو ب اغلب الاحيان عديم الاعراض . و بما انه اغلب ال HCV ينتهي بكرونك انفكشن ف الرسك مال ال HCC عالي مقارنة بال HBV . How u confirm presence of HCV ?? The most important one is HCV-RNA (which is elevated in first week) then anti HCV antibodies (which begin to be elevated in 6-8th wks) + abnormal LFT (elevated ALT, TSB, AST) طبعا قبل كلشي خلي بالك نقطه مهمه من تشك عند هذا المريض هيباتيتس سي ، تذكر HCV viraemia is fluctuant يعني مو دائما من تفحص ال blood لل HCV راح تلكه بوزتف، بمعنى أخر negative HCV RNA not exclude HCV (انسى كلشي و احفظلي هاي) لذلك لازم تسوي serial investigations . و لهذا مرات مريض عنده ارتفاع بانزيمات الكبد و يسوي فايرل سكرين، ويطلع كلشي نورمل فهو يطمئن لان ميعرف هالملاحظه . How r u gonna to treat it ?? HCV is CURABLE disease (interferon-independent virus) . طبعا هذا كلش recently لان هو قبل سنوات كان uncurable ، الادويه مو هي نفسها مال ال HBV ، اكو ادويه خاصه بال HCV الي تشتغل ع البروتينات الي ذكرناهن بالبدايه . 1)NS3 inhibitors or protease inhibitors like Simepravir 2) NS5A inhibitors like Ledipasvir 3) RNA polymerase inhibitors like Sofosbuvir Treatment of HCV is determined according to genotypes of HCV . #AhmedAbdSam

Normal ECG changes with therapeutic levels of digitalis include the following: • T-wave changes (often the earliest sign), ranging from flattening to inversion or peaking of the terminal portion of the T wave • Shortening of the Q-T interval • ST-T segment flattening or depression, resulting in the classic concave (“scooped”) appearance (often more pronounced in ECG leads with tall R waves) • Increased U-wave amplitude

Let begin a series of notes about #DIGOXIN