-كيف تذاكر بدون ملل

- علاج التشتت الذهني والسرحان .

- كيف تتغلب على الفشل.

-خطوات علاج القلق وتفكير الزائد .

- كيف تحافظ على صحتك النفسية.

_كيف تكتب السيرة الذاتية

_كيف تكتب البحوثات العليمة

✅تجدون مقالاتي في مدونتي 👇👇🌹

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اسأل الله ان يوفقكم إلى مافيه الخير للناس 🌹

https://whatsapp.com/channel/0029VaGWhVm7DAWsfEJacd2m/3422
يااا منعاااه ادخل على الرابط واعمل على اسمي اعجاب عشان الفوز بل منحة الدراسية على اسم /محمد مصلح الحميدي

كيف تتخلص من الحوار السلبي مع الذات👇👇
https://r.search.yahoo.com/_ylt=AwrjIsRCrWpnWlAMYbZx.9w4;_ylu=Y29sbwNncTEEcG9zAzYEdnRpZAMEc2VjA3Ny/RV=2/RE=1735073218/RO=10/RU=https%3a%2f%2ftatwwiraldhat.blogspot.com%2f2024%2f08%2fblog-post.html/RK=2/RS=XGKkQEeGudRZF1ZmM2jX7l.cpQY-

علاج القلق وتفكير الزائد 👇
http://youtube.com/post/UgkxWT4N00L9Jub8pAyTylA2ncUYbOW4DNub?si=nKNx3qnMS1AwRYMD

https://whatsapp.com/channel/0029VaGWhVm7DAWsfEJacd2m/3422
يااا منعاااه ادخل على الرابط واعمل على اسمي اعجاب عشان الفوز بل منحة الدراسية على اسم /محمد مصلح الحميدي

صوتو لهذا خلوه يفوز زميكم فضلا وليس امرا

محمد مصلح الحميدي

افتحو رابط بتشوف اسمه👇👇

✍️ITP Immune thrombocytopenic purpura has been reported to be associated with AF .A low platelet count does not protect from thrombosis; in general, thrombotic complications are more dangerous than bleeding complications

*A reduced-dose direct oral anticoagulant (rivaroxaban 15 mg once daily, or apixaban 2.5 mg bid) is effective and safe with mild thrombocytopenia (platelet count between 50,000 and 100,000/µL).*-

🎯الارقام المستهدفه فى مريض السكر طبقا للجمعيه الامريكيه للسكر 2025 ببساطه🎯

🟫🟫🟫🟫🟫🟫🟫🟫🟫🟫🟫🟫🟫🟫🟫
Goals and Targets in diabetic patients according to last ADA guidelines 2025
🟫🟫🟫🟫🟫🟫🟫🟫🟫🟫🟫🟫🟫🟫🟫

1️⃣ Glycemic targets

✍️ Target A1C in most adults is < 7

✍️ Target A1C in patients with good health and function , and low treatment risks is < 6.5

✍️ Target A1C in Healthy older adults is up to 7.5 ( < 7.5)

✍️Target A1C in older adults with complex/intermediate health is < 8

✍️ Target A1C in older adults with very complex ( poor health ) and any adults with limited life expectancy --> No A1C goal

Note ✍️
Target A1C < 7 is consistent with target fasting BG ( FBG : 80 - 130 mg/dl )and target 2hr PPBG : (90 - 180 mg /dl)

2️⃣ BP targets

Officially target BP in diabetic patients with Hypertension should be less than 130/80

3️⃣ Lipid targets

✍️ Target LDL(C) in treated diabetic patients
is < 100 mg/dl with initial reduction to 30 - 50 % of the baseline ( ADA 2023) if the patient has DM without ASCVD or high risk for ASCVD

✍️ Target LDL(C) in treated diabetic patients
is < 70 mg/dl in diabetic patients with high risk for ASCVD

✍️ Target LDL(C) in treated diabetic patients
is < 55 mg/dl in very high risk patients with ASCVD ( like ACS/CAD & multiple CV events )

✍️ Target Triglycerides should be < 150 mg/dl

خطوات مضمونة للحفظ بسرعة وعدم النسيان 👇
وفقكم الله وسدد خطاكم🌹 https://r.search.yahoo.com/_ylt=Awrg1hr9Oo5n82k0imBx.9w4;_ylu=Y29sbwNncTEEcG9zAzkEdnRpZAMEc2VjA3Ny/RV=2/RE=1737403261/RO=10/RU=https%3a%2f%2ftatwwiraldhat.blogspot.com%2f2024%2f12%2fblog-post_8.html/RK=2/RS=C5yCF_FhSEQ3LU5FLsAPUKfC0Wk-

-خطوات كتابة البحوث العلمية بشكل صحيح
-كتابة  السيرة الذاتية بشكل صحيح

-خطوات ترتيب الأفكار
-تعرف كيف تنظم وقتك
-كيف تختار شريك حياتك
- همية الوظيفة وتحسين فرص العمل

تجدون كل مقالاتي هنا 👇

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وفقكم الله وسدد خطاكم  طلابي 🌹

علاج القلق وتفكير الزائد 👇👇وفقكم الله
https://tatwwiraldhat.blogspot.com/2024/09/anxietyoverthrowing.html

Document from Dr/Mustafa Mohammed

All about BNP (natriuritic peptide ).

#Notes:
✍Difference Between Calcium Gluconate and Calcium Chloride in Hyperkalemia


---

Dilution & Administration

Can It Be Given Directly?

👉Calcium Gluconate:

Can be given undiluted IV push over 5–10 minutes (in emergencies)

Can also be diluted in 50–100 mL of D5W or NS and infused over 10–20 minutes


👉Calcium Chloride:

Must be given via a central line (if peripheral, use a large vein)

Can be given undiluted IV push over 5–10 minutes

Can also be diluted in 50–100 mL of D5W or NS and infused over 10–20 minutes



Why Dilution?

Reduces risk of local irritation

Preferred for non-emergency situations
Avoids complications like tissue necrosis with calcium chloride

#تعال_استفيد

#البرشامة

💠💠Sixty important sticky notes in cardiology

🌸🌸1-RHD : almost always involve mitral valve with or without other Valves

🌸🌸2-HF with impaired LV function: Keep serum Potassium above 4.5meq to avoid precipitation of ventricular arrhythmia

🌸🌸3-Atrial flutter carries the Same thrombo-embolic risk as AF and should managed as AF as regards indication of anticoagulation

🌸🌸4-Always ask for CXR in patient with chest pain and normal ECG

🌸🌸5- Always check for lead AVR in ECG before interpretation (you may activate primary PCI cath team based on wrong ECG)!

🌸🌸6-ECG leads V1-V2 in the fourth intercoastal space (not the second space)

🌸🌸7-In left sided infective endocarditis , ask for multislice CT cerebral angiography to exclude mycotic aneurysm

🌸🌸8-In reading CXR , always look for lung apex it is frequently missed

🌸🌸9-In infective endocarditis,a always ask for serology for aspergillus, Bartonella, Brucella, Coxiella, legionella

🌸🌸10-Hypotension after Coronary angiography
Either due to :
A-Hypovolemic shock:
bleeding from sheath or retroperitoneal hematoma
B-Cardiogenic shock:
Acute instent thrombosis
C-Anaphylactic Shock:
From contrast
D:Vasovagal: pain during sheath removal

🌸🌸11-Any hospitalised patient who develop new onset AF during hospital stay, you should suspect Pulmonary embolism

🌸🌸12-Enoxaprin is contraindicated if GFR is less than 15 m
And if GFR is from 15-30 we give 1mg/Kg every 24 hours as a therapeutic dose

🌸🌸13-Any wide complex tachycardia in patient with ischemic heart disease should be managed as VT until proved other wise

🌸🌸14-Causes of very high ESR(more than 100 In first hour) includes:
🩺🩺-TB
🩺🩺-Connective tissue disordes
🩺🩺-Malignancy

🌸🌸15-D-Dimer is a good negative test in pulmonary embolism but not specific

🌸🌸16-Uro-sepsis is the most common cause of delirium in elderly

🌸🌸17-Anemia in old age carries the possibility of malignancy and ideally upper and lower GIT endoscopy should be done

🌸🌸18-It is recommended to do lipid profile within 48 hours of onset of ACS as after that there is a possibility of false low cholesterol levels due to enhanced sympathetic activity and lipolysis

🌸🌸19-You can calculate the LDL level from this equation (LDL=Total cholesterol -(HDL + Triglycerides/5)

🌸🌸20-You can calculate the creatinine clearance from this equation (140-ageX weight)/
72X serum creatinine
And multiply by 0.85 if female

🌸🌸21-Metolazone is the only thiazide that can be used in Renal impairment

🌸🌸22-It better to avoid Tienam and Tavanic in elderly as the former can causes convulsions and the latter can precipitate encephalopathy

🌸🌸23-The most common congenital heart disease is bicuspid aortic valve

🌸🌸24-Bicuspid aortic valve can be associated with
-Aortopathy and aortic aneurysm
-Aortic coarctation
-Aneurysm in circle of Willis

🌸🌸25-Never wait for cardiac enzymes in patient with STEMI

🌸🌸26-Congenital complete heart block carries the best prognosis among the all causes of CHB and sometimes can be managed conservativly for years

🌸🌸27-Always check for BP equality on both sides in patient with acute Coronary syndromes to exclude dissection

🌸🌸28-Alway ask about history of sildenafil use before using nitrates

🌸🌸29-Never use sublingual Nifedipine

🌸🌸30-Do not diagnose Rheumatic fever based on arthralgia that is associated with elevated ESR
You should use modified Jones criteria

🌸🌸31-Diagnosis of DM
-FBS more or equal to 126 mg/dl in two separate occasions
Or
-Postprandial blood glucose more or equal to 200mg /dl on two separate occasions
Or
-HbA1c is more or equal to 6.5%
or
-Random blood glucose more or equal to 200 mg/dl in presence of symptoms (Polyurea,polyphagia and loss of weight)

🌸🌸32-Targets in DM control

👉👉-HbA1c less than 7%
👉👉-FBS bw 80 -130mg/dl
👉👉-2Hours post prandial less than 180mg

🌸🌸33-Light's criteria for diagnosis of etiology of pleural effusion
-Pleural fluid protein/serum protein more than 0.5
-Pleural Fluid LDH/Serum LDH more than 0.6
-Pleural fluid LDH more than 2/3 of the upper normal value for the serum LDH
One criteria is sufficient to diagnose exudate
And all the three criteria must be negative to say that it is transudate

🌸🌸34-The most common cause of convulsions in elderly is stroke

🌸🌸35-unilateral Horner syndrome with ipsilateral neck pain is suggestive of Carotid dissection until proved other wise

🌸🌸36-Mitral valve prolapse should diagnosed only in Parasternal long axis view not apical 4chamber view

🌸🌸37-Drop out of the interatrial septum in Apical 4 chamber is not suggestive of ASD except after confirmation with colour flow across and further assessment in subcostal view

🌸🌸38-Dynamic LVOT obstruction with significant LVOT gradient could be seen in elderly dehydrated tachycardiac patients(especially if hypertensive withLVH and small LV cavity(
After rehydration and control of HR
The gradient across the LVOT disappear

🌸🌸39-Verapamil increase the digitalis toxicity and it is better to combine Diltiazem rather than verapamil with digitalis

🌸🌸40-Digoxin toxicity can occur inspite of normal digoxin level
And can be diagnosed only based on clinical basis and ECG

🌸🌸41-ACE inhibitors can be considered for all patients with CAD if no contraindictions

🌸🌸42-In patients with CHF and there is contraindiction for ACE inhibitors, you can give instead:Hydralazine (Arteriolar dilator) with isosorbide dinitrate(venodilator)

🌸🌸43-Spironolactone should be given for patients with resistant hypertension as it act as aldosterone antagonist

🌸🌸44-Spironolactone should be given for patients with right sided HF (congestive hepatomegaly and Ascites ) as one of the mechanisms of fluid retention in these patients is failure of the liver to metabolise the aldosterone , so we give anti aldosterone

🌸🌸45-Enoxaparin should not be given for pregnant women with prosthesis without monitoring of antifactor X level

🌸🌸46-Lidocaine and phenytoin are the antiarrhythmic drugs of choice in patients with ventricular arrhythmia secondary to digitalis toxicity

🌸🌸47-Causes of Bidirectional VT are CPVT and digitalis toxicity

🌸🌸48-Spodick's sign in ECG:
is downsloping TP segment in lead II can help to differentiate pericarditis from other causes of ST elevation

🌸🌸49-Dewinter Sign in ECG: is hyperacute T waves with upsloping ST depression in anterior precordial leads ; indicative of acute proximal LAD occlusion and considered as STEMI equivalent

🌸🌸50-The Safest drugs that can be given for patients with pericarditis and ACS are Ibuprofen (as it increases Coronary blood flow) or high dose acetyl salicylic acid

🌸🌸51-As regard second degree heart block, there is a distinct subtype called 2:1AV block
Can be either Mobitz type I or type II
If it improves with atropine and narrow complex, most probably it is type I
If it worsen with atropine or wide complex , most probably it is type II

🌸🌸52-Reciprocal ST depression in I and AVL may preceed frank ST elevation in Inferior MI

🌸🌸53-To diagnose MI in paced rhythm with LBBB morphology, we apply sgarbossa criteria

🌸🌸54-Anteroseptal STEMI and isolated RV infarction both can causing ST elevation from V1-V3
But the difference is
If the ST elevation is maximum in V1 and decreases gradually to V3 ,then it is RV infarction
If the ST elevation is gradually increasing towards V3 , then it is anteroseptal MI

🌸🌸55-To differentiate Course AF from Atrial flutter with variable block,
You should notice that the flutter waves are identically the same morphology, so if the atrial activity waves are different, then it is course AF

🌸🌸56-In Echocardiography, we assess pericardial effusion in diastole (as regards measurement)

🌸🌸57-In patient with Interatrial septal aneurysm, you should exclude PFO

🌸🌸58-Central venous pressure is a poor indicator of volume status and we should IVC collapsibility index better

🌸🌸59-In assessment of Aortic prosthesis, Dimensionless velocity index is a useful tool
(LVOT VTI/Aortic VTI) if this ratio is Lee than 0.25 it denote significant stenosis

🌸🌸60-In assessment of mitral prosthesis , MV VTI/LVOT VTI
If this ratio more than 2.5
It denote significant stenosis

#تعال_استفيد

*🚨 Latest ACS Guideline Released!*

*👉 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for Acute Coronary Syndromes*

Key Updates 🏥

✅ DAPT for ACS – Ticagrelor/prasugrel preferred over clopidogrel for PCI patients.

✅ Radial access for PCI – Reduces bleeding & vascular complications.

✅ Complete revascularisation – Recommended for STEMI & NSTEMI.

✅ Cardiogenic shock – Select use of microaxial flow pumps.

✅ Lipid management – High-intensity statins + ezetimibe for LDL ≥70 mg/dL.

✅ Diabetes & ACS – SGLT-2 inhibitors/GLP-1 RAs recommended.

✅ Cardiac rehab – Prioritised, including home-based programs.

📢 Stay updated with the latest evidence!

https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000001309?download=true

قال رسول الله ﷺ : "من نام وفي يده غمر فعرض له عارض فلا يلومن إلا نفسه " ما معنى غمر ؟
👇👇👇
https://tatwwiraldhat.blogspot.com/2025/03/blog-post_2.html