بسم الله الحمد لله

What can I say, busy two weeks since the last OLM and more interesting things keep happening in the medical world.

Most eye catching: Forgive and reduce your BP, watchout for hand grab rails in bathrooms they are infested!

FORGIVE & REDUCE YOUR BLOOD PRESSURE: Rude interruptions increase your BP (surprise, surprise!) but apologise to a woman and her BP will go down rapidly but apologise to a man to keep it high (strange).
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24-04-2010


GLP1 v DPP4: Does that sound like two strange football teams in cyberspace? Well its injectable Liraglutide v oral Sitagliptin giving a greater HbA1c reduction 1.5% v 0.9% – what they did not mention is that the FDA were a bit concerned about the Thyroid tumours produced in rats by GLP1 agonists [http://www.drugdevelopment-technology.com/projects/liraglutide/]
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24-04-2010


SITAGLIPTIN AND DIABETES: Nice review in short: 100mg qd as add on to ODA and/or Insulin anything, add if hypos are a problem with SUs, -1% HbA1c is how good it is, can cause acute pancreatitits, Chochrane x11 RCT reviews noted increased risk of URTI and UTIs (strange if you ask me).
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24-04-2010


STATINS & HAIR LOSS: Possible but rare cse report territory – Simvastatin the most implicated.
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24-04-2010


STATINS & MEMORY LOSS: Case report territory, it has happened and with rechallenge testing so bear it mind (if you can remember); Nice MHRA summary case reports to date.
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24-04-2010


H1N1 RECENT FINDINGS: The line of note for me was: ‘Nonpharmacological public health interventions for containment and mitigation have been relatively ineffective in limiting the rapid, global spread of this pathogen.’
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24-04-2010


ROOM CLEANING: What is best? 10% Bleach + Hydrogen peroxide vapour (good but not stat sig), UV very good (bed sides rails, toilet seats even cleared BUT grab rails in bathroom not cleared though, these are called High Touch Surfaces, cleaning is best if supervised educating cleaners not good enough.
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24-04-2010


ANTI-DEPRESSANTS AND SUICIDE RISK IN ADOLESCENTS: In short all SSRIs & TCAs are equal(ly) bad or not so depending on whether you believe they increase suicide risk or not (Cohort study x9y, No 20,906, 266 suicidal attempts 3 completed over 12 months, British columbia residents)
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24-04-2010


CARBS: Bad for women’s hearts but not men (Cohort study, FU 7.9y, No 47749. questionnaire based) Carbs high v low quartlie gave a RR 2.0 for CHD in women but not men – worse with High GI RR 2.24 and men not affected.
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24-04-2010


EXERCISE AND INJURY: Bad: Soccer, team sports, racket sports, martial arts, running – Good: Walking, swimming, gardening.
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24-04-2010

INFLUENZA VACCINE – ONCE STARTED DON’T STOP? Overall, both the sickest individuals (as measured by a risk score that predicted future medical costs) and those most likely to die during the upcoming year were the least likely to be vaccinated. Further, patterns of vaccination were telling: For older patients (age, ≥75) who had been vaccinated consistently in previous years, not receiving the vaccine was associated strongly with a higher probability of death within 1 year; among those who had not been vaccinated in previous years, receiving the vaccine was associated with a higher probability of death within 1 year. Presumably, changes in individuals’ vaccination habits were responses to worsening overall health.
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24-04-2010


LT4 & ORLISTAT: Potentially reduced LT4 absorption so give 4 hours apart.
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24-04-2010


HYPERGRANULATION TISSUE & SILVER NITRATE: Works in practice, apply by rubbing days1-4 while protecting normal skin.
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24-04-2010


PE PERIPHERAL ONES ARE DIFFICULT : Peripheral emboli can be difficult to catch: 70 f, non-smoker, recent onset SOB, Pulse 96: D-Dier raised & PE on CT.
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24-04-2010


MALE URETHRITIS: Test for N Gonorrhoeae & Chalmidya [C], Empiric Rx is Azithromycin 1g OTO or Dox 100mg bid x7d + Cefixime 400mg/Ceftriaxone 125mg IM [C]; ‘expedited partner Rx’ i.e. Rx for partner without seeing; Not working? Urine culture for N Gon & chlam & Atypicals (Mycoplasma Genitalium & Ureaplasma spp. Rx2=Azithro 500mg qd x5d OR Dox 100mg bid x7d + Metro (2g OTO). Think Trichomonas, HSV & test for HIV Hep B/C
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13-04-2010


PSCYHIATRISTS YOUNG v OLD: Older ones don’t use DSM IV as much as younger ones, overall 25% don’t (Survery No. 291 Psyches).
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13-04-2010


COPPER & BALANCE: Case report on Copper dificiency showing up with poor balance and falls – B12 deficiency symptoms may be due to Copper deficiency.
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13-04-2010


ULTRALONG INSULINS – 3 times a week – under trial – watch this space.
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13-04-2010


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