Bismillah, alhamdulillah:

It s quite nice to read a review of what was important in 2010 and perhaps one day I will construct a table which show how my knowledge and thoughts have changed with the passage of time. Here are the highlights from 2010 edited highlights from Medscape:

Topics: Ca supplements increase heart attack risk by 30%, PSA – why?, Don’t leave your LABA alone, Quinine & platelets, bisphosphonates cause fractures, FDA & Rosiglitazone – the love story, Tramadol & suicidal ideation

Calcium supplementation: Increases heart attack risk by 30% according to meta analysis reported in the BMJ. Touché from the skeptics of calcium supplementation to the guideline sticklers.

PSA: The American Cancer Society (ACS) has updated its prostate cancer screening guideline, last published in 2001 – and guess what?  There is no significant change.  In summary: PSA >4 : refer, 2.5-4: have a good chat before referring,  <2.5 ask yourself why you started this ball rolling.

Drug Warnings:

Quinine for leg cramps possible life-threatening hematologic adverse effects – whihc means: From 2005-8 : 38 events (thromocytopenia, HUS), 2 deaths.  But out of how many patients taking quinine – not stated! How many die from antibiotic misuse? Is someone developing a new treatment for leg cramps?

Long-acting beta agonists don’t use them on their own for asthma. But still okay on their own for COPD. I remember when the drug reps kept pushing LABAs down everyone’s throats – but basic pathophysiology did not give its nod as LABAs did not deal with the underlying inflammation!

Simvastatin 80-mg dose of simvastatin is associated with an increased risk for myopathy, including rhabdomyolysis – surprise, surprise!

Tramadol: avoid in the suicidal and addiciton prone. Most of my patients on Tramadol are elderly and don’t fit into this suicidal and drug addicted profile – phew!

Bisphosphonates can cause atypical femur fractures – according to Dr Kehoe look out for the following:  tell-tale dull, aching pain in the thigh or groin. Most patients on bisphosphonates who sustain a complete atypical femur fracture experience this pain weeks or months beforehand. The pain may be related to a partial fracture, such as a stress fracture”. – I have a feeling there are a few more chapters still to be written in the bisphophonate story. I am still prescribing them, but can you imagine giving someone the once a year version (Zoledronic Acid) and then telling them we have now got new data … but we can’t get that out of your system for the next 5 half-lives!

Rosiglitazone was allowed to remain available under a stringent restricted-access program, despite adverse cardiovascular effects – amazing what a bit of persuasion can do – the Europeans have sent Rosiglitazone on its final exit. But the FDA have put it on a restricted access program – seems very difficult to get in the US – but what is the effect of this decision by the FDA in the rest of the FDA-following world? The take home message will be it is still FDA approved!

Well I got this far in between patients, still have another 14 news items to scan. Watch out for part 2.


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