مازلنا مع آخر guidelines في علاج جرثومة المعده
ثاني الخطوط العلاجية

العلاج الثلاثي مع rifbutan
مضاد حيوي
عبارة عن
اومبيرازول او ايزموبرازول 40 مجم كبسولة كل 8ساعات
مع
Rifbutan 50mg
كبسولة كل 8ساعات
مع
اموكسيل 1جم ك كل 12ساعة

يتواجد في الاسواق في كبسولات
Talicia
الجرعة 4 كبسول كل 8 ساعات
12كبسولة يوميا لمدة اسبوعين

مازلنا مع آخر guidelines في علاج جرثومة المعده
ثالث الخطوط العلاجية

مجموعة العلاج الثلاثي المحتوي علي vonprazan لمدة 14 يوم
عبارة عن

Clarithromycin 500
كبسول كل 12ساعة
مع

اموكسيسلين 1 ك جم كل 12ساعة
أو 500 مجم 2ك كل 12ساعة
مع

Vonprazan 20mg
قرص كل 12ساعة
في الدول العربيه يؤخذ كل نوع لوحدة
في الخارج
متوفر كل الانواع في عقار واحد اسمة voquenza كما في الصورة

#Antithrombotic_therapy in
patients with obesity

1.No dose adjustment is required for antiplatelet medications in patients with vs. without obesity.

2.In patients who have indication for chronic oral anticoagulation therapy and have undergone bariatric surgery, it is reasonable to prefer VKAs over DOACs.

3.In patients receiving warfarin and a GLP-1 RA, the INR should be carefully monitored.

4.It is reasonable to avoid edoxaban and dabigatran for prevention or treatment of VTE in patients with a BMI >40 kg/mor body weight > 120 kg.

#ESC_2024

💉💉💉952
10 mmol of IV or 20 mmol of ORAL potassium usually raises SERUM potassium by only 0.1 mmol/L.

#Hyperkalemic_ECG

✍The earliest ECG changes of hyperkalemia are peaking of the T waves and shortening of QT interval
- PR interval is prolonged
-loss of P waves
- widening of the QRS complex is seen with "sine- wave pattern
- asystole.


#Pseudohyperkalemia is an in vitro phenomenon caused by the
1-mechanical release of potassium
from cells during phlebotomy or specimen processing
2-marked leukocytosis and thrombocytosis.

#In_patients with pseudohyperkalemia, the plasma potassium concentration is normal.

#DON'T_BE_TRICKED
Significant hyperkalemia associated with a normal ECG suggests pseudohyperkalemia.

#تعال_استفيد

#Hypokalaemia_ECG

😊 U have no Pot and #no_T, but a long #PR and a long #QT

#Chemotherapy_Heart_failure

✍ Doxorubicin: dose-related HF (irreversible)

✍Trastuzumab: non-dose-related HF (reversible)

#تعال_استفيد

#LTOT_in_COPD

#long_term_oxygen_therapy
✍Patients who receive LTOT should breathe supplementary oxygen for at least 15 hours
a day as this reduce mortality.
Oxygen concentrators are used to provide a fixed supply for LTOT.

#Assess patients if any of the following:
🔸 very severe airflow obstruction (FEV1 < 30% predicted).
🔸 Assessment should be 'considered' for patients with severe airflow obstruction (FEV1 30-49% predicted)
🔸 cyanosis
🔸 polycythaemia
🔸 peripheral oedema
🔸 raised jugular venous pressure
🔸 oxygen saturations less than or equal to 92% on room air

#Assessment is done by measuring arterial blood gases on 2 occasions at least 3 weeks apart in patients with stable COPD on optimal management.

#Offer_LTOT_to :
✍patients with a pO2 of < 55 mm Hg (7.3kpa) or SaO2 less than 88% with or without hypercapnia
or
✍to those with a pO2 of 55 - 60 mm Hg (7.3-8kpa) or SaO2 less than 88% with one of the following:
✔secondary polycythaemia
✔nocturnal hypoxaemia
✔peripheral oedema
✔pulmonary hypertension 

#Goals
Oxygen should be administered by nasal cannula or face mask, at 1 to 2 L/min, which provides 24% to 28% oxygen to #Improve PaO2 >60 mm Hg or SaO2 to 88% to 92%.
#N.B :
✍Improving oxygenation above 92% is not helpful and in patients with chronic hypercarbic respiratory failure hypoxemia can worsen V/Q matching and precipitate worsening hypercarbia.

#تعال_استفيد

STEMI in paced rhythm or LBBB:

Sgarbossa Criteria

1. Concordant ST elevation ≥ 1mm in a lead with a positive QRS (5pts)

2. ST depression ≥ 1 mm in V1, V2 or V3 (3pts)

3. Discordant ST elevation ≥ 5 mm in a lead with a negative QRS (2pts)

≥3points = 98% specific for ACS

#تعال_استفيد

#DOACs and Surgery/Procedures

*Minor (cath,derm,dental,eye): do not stop DOACs

*Moderate (Gallbladder,hernia, hysterectomy, hand/foot surgery): Stop ONE day in advance. Resume ONE day after

*High Bleed risk (joint replace, aortic, kidney): Hold TWO days in advance, Restart 2 after

#تعال_استفيد

أتعرف على مواصفات الرقية الشرعية الصحيحة :
https://tatwwiraldhat.blogspot.com/2024/09/arkehalshraih.html

#Cardiology_Notes

✍️Two key elements are associated with a successful transition to home following hospitalization for heart failure:
👉follow-up phone call within 2 to 3 days of discharge and
👉an office visit within 7 to 14 days of hospital discharge .

✍️In patients with atrial fibrillation, rivaroxaban is noninferior to warfarin in the prevention of stroke or systemic embolism and is associated with less intracranial and fatal bleeding.

✍️Premature ventricular contractions (PVCs) without high-risk features (syncope, family history of premature sudden cardiac death, structural heart disease) are managed with reassurance , treatment is reserved for bothersome symptoms or frequent PVCs.

#MKSAP_19
#تعال_استفيد

#Mitral_stenosis (MS)_anticoagulation is indicated in the following scenarios:

✍️ Atrial Fibrillation (AF): Since MS increases the risk of atrial fibrillation, which in turn increases the risk of thromboembolism, anticoagulation is essential.


✍️History of Thromboembolism: If a patient with MS has had a previous thromboembolic event (e.g., stroke), anticoagulation is recommended.

✍️Left Atrial Thrombus: If imaging shows a thrombus in the left atrium, anticoagulation is indicated.

✍️Severe Mitral Stenosis with Large Left Atrium: A large left atrium (generally ≥ 5.5 cm) increases the risk of clot formation, and anticoagulation may be indicated even if AF is not present.



#note :
👉Only warfarin use as anticoagulant in patient with moderate and sever MS with previous indication .

هذا البوست موجة لكل اطباء الجهاز الهضمي في مصر والوطن العربي

🗒️2024 ECCO
Guidelines on Therapeutics in Crohn’s Disease: Medical Treatment

1️⃣ 5-ASA is not recommended🚫for the induction or maintenance therapy in CD➡️consistent lack of evidence.

2️⃣ Budesonide is recommended for inducing clinical remission in patients with active, mild-to-moderate CD limited to the ileum / ascending colon

👉Additionally, systemic corticosteroids are suggested for induction therapy in patients with active, moderate-to-severe CD

3️⃣Thiopurine monotherapy is not recommended for induction therapy in CD, but it can be considered for maintenance

4️⃣Parenteral
methotrexate
is suggested for both induction and maintenance therapy in moderate-to-
severe CD

5️⃣ Infliximab➡️induction and maintenance for mod/sev active CD
👉Use combination with thiopurine during the induction and continue 6–12 months

Patients who achieve long-term remission with this combination ➡️de-escalation to infliximab monotherapy and withdrawal of thiopurines

6️⃣ Adalimumab is recommended as both induction and maintenance therapy for patients with moderate-to-severe CD

👉For those bionaïve, Adalimumab monotherapy 💪is preferred over combination therapy with thiopurines during induction and maintenance.

7️⃣Certolizumab
is suggested for both induction and maintenance therapy in moderate-to-severe CD.

🎱 There is insufficient evidence to recommend proactive therapeutic drug monitoring over reactive monitoring or standard care for anti-TNF agents
🔥Controversy here

!9️⃣Ustekinumab is recommended for both induction and maintenance therapy in moderate-to-severe CD

🔟Adalimumab and ustekinumab 🆚 are suggested to be equally effective🟰 for both induction and maintenance therapy in biologic-naïve patients with moderate-to-
severe CD


#منقول
#تعال_استفيد

#Low_Voltage_ECG :
✍️Definition:
The QRS is said to be low voltage when:
👉The amplitudes of all the QRS complexes in the limb leads are < 5 mm; OR
👉The amplitudes of all the QRS complexes in the precordial leads are < 10 mm
✍️Mechanisms
Low voltage is produced by…
The “damping” effect of increased layers of fluid, fat or air between the heart and the recording electrode.
Loss of viable myocardium.
Diffuse infiltration or myxoedematous involvement of the heart.

✍️Causes
Specific causes of low voltage include:
👉Fluid: Pericardial effusion; Pleural effusion
👉Fat: Obesity
👉Air: Emphysema; Pneumothorax
👉Infiltrative / Connective Tissue Disorders: Myxoedema; infiltrative myocardial diseases — i.e. restrictive cardiomyopathy due to amyloidosis, sarcoidosis, haemochromatosis; constrictive pericarditis; and scleroderma.
👉Loss of viable myocardium: Previous massive MI; end-stage dilated cardiomyopathy

✍️Most important cause:
Massive pericardial effusion with triad of:
Low voltage
Tachycardia
Electrical alternans
Patients with this triad need to be immediately assessed for clinical or echocardiographic evidence of tamponade


#ECG_note
#تعال_استفيد

#ESGE_guidelines on the management of lower GI bleeding 🩸