ملح الباطنيةDr.Ahmedjuwair

💎in management of acute ischemic stroke :- ●Blood pressure lowering during the first 72 hours is generally avoided. ● If systolic blood pressure exceeds 220 mm Hg, it may be lowered with IV labetalol, nicardipine, or clevidipine to 170–200 mm Hg, then after 72 hours reduced further to less than 140/90 mm Hg. ●Adequate hydration should be maintained. ✅️Current 2026

💎Cluster headache:- ●Cluster headache causes severe unilateral periorbital pain with ipsilateral autonomic symptoms and marked restlessness agitation. ● Attacks typically occur at night, last 15 minutes to 3 hours, and occur in clusters over weeks. ●Acute treatment is classically 100% oxygen or sumatriptan SC/intranasal. ● Verapamil is a key preventive drug, but it requires ECG monitoring because of PR interval prolongation risk. ● Prednisone is commonly used as transitional therapy while preventive treatment becomes effective. ✅️CURRENT 2026

💎 Tension-type headache:- ● is the most common primary headache and is classically tight/pressure-like, not pulsatile. ● It is usually generalized and commonly centered in the neck or back of the head without focal neurologic deficits. ●Amitriptyline is a classic preventive treatment, while simple analgesics are usually sufficient for acute attacks. ✅️CURRENT 2026

💎Preventive therapy of migraine is indicated when attacks occur > 2–3 times/month or cause significant disability. ✅️CURRENT 2026

💎To differentiate between Migraine and Cluster headaches during acute attacks:- 🍓give patient high flow 100% O² therapy for at least 15 minutes, if the attack of pain improved , this is Cluster Headache. Best to use non-rebreather mask.

💎New guidelines on Migraine:- 🍓 it can occur bilaterally(Diffuse), but most often unilateral. ✅️CURRENT 2026

💎 For prevention of Migraine, Common Preventive Options can be used as :- • Topiramate: 100 mg/day divided twice daily. • Valproic acid: 500–1000 mg/day divided twice daily. • Candesartan: 8–32 mg once daily. • Guanfacine: 1 mg once daily. • Propranolol: 80–240 mg/day divided 2–4 times daily. • Verapamil: 120–240 mg/day divided 3 times daily. • Amitriptyline: 10–150 mg at bedtime. ✅️CURRENT 2026

💎in management of acute attacks of migraine:- ●Opioids should be avoided, because they cause rebound headache and medication overuse headache. ● Metoclopramide IV 10–20 mg is useful, especially in the emergency department. ✅️Current 2026

SOON

💎Drug Allergy (IgE -mediated Immediate Hypersensitivity Reactions)(as Penicillin Allergy) ---> Occurs mostly on re-exposure to Penicillins •IgE-mediated anaphylaxis requires prior sensitization. But :- • non-IgE reactions such as radiocontrast or vancomycin reactions can occur on first exposure. ✅️CURRENT 2026

💎Management of Radiocontrast Media Reactios: • Using low-osmolality contrast. • Giving prednisone 50 mg orally every 6 hours, starting 13 hours before the procedure. • Giving diphenhydramine 25–50 mg orally, IM, or IV 60 minutes before the procedure. ✅️CURRENT 2026

💎Management of Vancomycin infusion reaction:- • Diphenhydramine 25–50 mg IV or IM. • Restarting vancomycin at no more than half the previous infusion rate. • In patients with a prior reaction, premedication 1 hour before infusion is recommended with: • --> An H1 blocker such as diphenhydramine 50 mg orally or IV. • --> An H2 blocker such as cimetidine 200 mg orally. • Vancomycin skin testing is not validated. ✅️CURRENT 2026

💎Constitutional symptoms in Spinal TB (Pott Disease) are usually absent. ✅️CURRENT 2026

💎The oral lesions of reactive arthritis are typically painless, unlike the ulcers of Behçet disease which are typically painful. ✅️CURRENT 2026

دافدسون الطبعة الأخيرة 2027

💎Catastrophic APS:- ● Treat with either IVIG or plasmapheresis, plus intravenous heparin and high-dose corticosteroids. ● Resistant disease may require rituximab or eculizumab, although evidence is limited to case series. ✅️CURRENT 2026

💎Pregnancy-associated APS:- ● Standard prophylaxis is prophylactic-dose LMWH plus low-dose aspirin 81 mg. ● In pregnant patients with a history of thrombosis outsid pregnancy, use full-dose LMWH. ● Anticoagulation is generally continued throughout pregnancy and the early postpartum period.

💎In management of APS:- ● Patients with positive antiphospholipid antibodies alone but no clinical events should not receive anticoagulation. ◆Thrombotic APS◆ ● Most patients with macrovascular or microvascular thrombosis require lifelong anticoagulation. ● Warfarin is preferred, with a target INR 2.0–3.0. ● DOACs are not recommended because they are less effective than warfarin, especially for arterial thrombosis. ● Patients with recurrent thrombosis despite warfarin may require a higher INR ≥ 3.0, but bleeding risk rises substantially. ●Low-molecular-weight heparin (LMWH) is used in patients who develop thrombosis despite therapeutic warfarin