Wednesday, December 2, 2015
At 6 months, improvements in field cancerization and levels of cyclobutane pyrimidine dimers were significantly greater for the sunscreen-plus-enzymes group compared with sunscreen-only patients. … »»
Sunday, December 6, 2015
Fluoroquinolone labeling currently has warnings about the risks for tendonitis, tendon rupture, central nervous system effects, peripheral neuropathy, myasthenia gravis exacerbation, QT prolongation and Torsades de Pointes, phototoxicity, and hypersensitivity.
Wednesday, November 25, 2015
The cancers that Dr Rehm refers to include those of the oral cavity, pharynx, larynx, esophagus, breast, colon, rectum, gallbladder, and liver. It is also considered probable that alcohol increases the risk for pancreas cancer, although the evidence is inconclusive.
Recent evidence suggests that melanoma, as well as cancers of the stomach, lung, and prostate, may be associated with alcohol consumption, although only with high levels of consumption and to a moderate excess risk. There are also differences of opinion on whether liver cancer should be considered an alcohol-related cancer and whether the risk for colorectal cancer is increased in both sexes or only in men.
Tuesday, September 15, 2015
The recommended workup for an adrenal incidentaloma is
Hormonal evaluation . The evaluation in apparently asymptomatic patients has been debated. Even in asymptomatic patients, the European Network for the Study of Adrenal Tumors (ENSAT) recommends performing the following tests to determine the secretory activity of the tumor: fasting blood glucose, serum potassium, cortisol, corticotropin (ACTH), 24-hour urinary free cortisol, fasting serum cortisol at 8 AM following a 1 mg dose of dexamethasone at bedtime, adrenal androgens (dehydroepiandrosterone-sulfate [DHEA-S], androstenedione, testosterone, 17-OH progesterone), and serum estradiol in men and postmenopausal women .
Adrenal carcinomas are typically inefficient steroid producers, but they secrete excessive amounts of adrenal steroid precursors due to decreased expression of several steroidogenic enzymes (which also results in diminished cortisol production). Even in patients with adrenal carcinomas who presumably did not produce excess steroids, more sensitive methods such as gas chromatography/mass spectrometry identify increased urinary metabolites of several steroids and precursors of androgens (pregnenediol, pregnenetriol, androsterone, etiocholanolone) or glucocorticoids (17-hydroxyproesterone, tetrahydro-11-deoxycortisol, cortisol, 6-hydroxy-cortisol, tetrahydrocortisol, and a-cortol); this is different from cortisol secreting adenomas which produce cortisol, but little androgens . Low serum aldosterone concentrations, but normal or high serum or urinary concentrations of aldosterone precursors (ie, deoxycorticosterone, 18-hydroxydeoxycorticosterone, corticosterone, and 18-hydroxycorticosterone, tetrahydro-11-deoxycorticosterone (THDOC), and 5 alpha-THDOC) are found in most adrenal carcinomas, but not in adrenal adenomas [77,78].
The European Network for the Study of Adrenal Tumors (ENSAT) also recommends that plasma metanephrines or urinary metanephrines and catecholamines be obtained in all patients to exclude pheochromocytoma, and that plasma aldosterone and renin be obtained in patients with hypertension and/or hypokalemia (see “Establishing the cause of Cushing’s syndrome” and “Adrenal hyperandrogenism” and “Pathophysiology and clinical features of primary aldosteronism” and “The adrenal incidentaloma”). Hormonal evaluation may help in establishing the adrenal origin of the tumor and provide tumor markers that can be useful during follow-up to estimate the presence of residual tumor or tumor recurrence after surgery.
Potassium sparing drug
Wednesday, October 21, 2015
The approval of patiromer for oral suspension (Veltassa, Relypsa) comes after the phase-2 AMETHYST-DN study showed that daily administration of the potassium-binding agent safely controlled hyperkalemia over 1 year in patients with type-2 diabetes and hypertension with or without heart failure (HF). They had entered with mild-to-moderate hyperkalemia secondary to treatment with renin-angiotensin-aldosterone system (RAAS)-inhibiting drugs.
Thursday, November 5, 2015
Make room, cholesterol. A new disease marker is entering the medical lexicon: suPAR, or soluble urokinase-type plasminogen activator receptor. A study in the New England Journal of Medicine shows that suPAR, a circulating protein measured by a simple blood test, can reliably predict a person’s chances of developing chronic kidney disease as much as five years before this common killer starts causing damage.
The New England Journal of Medicine article appears in Online First, November 5, 2015 to coincide with the American Society of Nephrology’s Kidney Week meeting. It will also appear in the printed issue of the journal on November 12.
Saturday, November 21, 2015
Tedizolid phosphate is a second-generation oxazolidinone antibiotic that offers enhanced antimicrobial potency and low rates of bacterial resistance.[13-15] Available in both IV and oral forms, tedizolid exhibits bacteriostatic activity by binding the 50S subunit of the bacterial ribosome, resulting in inhibition of bacterial protein synthesis.[11,13-15] The recommended dosage is 200 mg once daily for 6 days,[6,7,14,16] which may offer increased convenience and compliance when compared to twice daily linezolid.
New Antibiotics in the Management of Acute Bacterial Skin and Skin Structure Infections
GLYCOPEPTIDE THERAPEUTICS – DALBAVANCIN AND ORITAVANCIN
Dalbavancin is a long-acting IV semisynthetic lipoglycopeptide antibiotic with bactericidal activity against gram-positive cocci, including MRSA.[6-10] It is the first US FDA approved drug for adults with ABSSSIs that requires only 2 IV doses administered 1 week apart: the first dose is 1000 mg IV infused over 30 minutes, followed 1 week later by the second dose of 500 mg IV.[6-10]
Saturday, November 21, 2015
THE RIGHT WAY OF ADMINISTERING BLOOD PRODUCTS (?)
[ from “THE CLINICAL — USE OF BLOOD: HAND BOOK , World Health Organization & Blood Transfusion Safety , GENEVA ]
✔️Prefer a larger cannula: A doubling of the diameter of the cannula increases the flow rate of most fluids by a factor of 16.
✔️In case of Whole blood, red cells, plasma and cryoprecipitate
>Use a new, sterile blood administration set containing an integral 170–200 micron filter
>Change the set at least 12-hourly during blood component infusion
>In a very warm climate, change the set more frequently and usually after every four units of blood, if given within a 12-hour period
✔In case of Platelet concentrates
>Use a fresh blood administration set or platelet transfusion set, primed with saline.
>There is no evidence that warming blood is beneficial to the patient when infusion is slow.
>At infusion rates greater than 100 ml/minute, cold blood may be a contributing factor in cardiac arrest. However, keeping the patient warm is probably more important than warming the infused blood.
>Warmed blood is most commonly required in: Large volume rapid transfusions:
-Adults: greater than 50 ml/kg/hour -Children: greater than 15 ml/kg/hour
Exchange transfusion in infants Patients with clinically significant cold agglutinins.
>Blood SHOULD ONLY BE WARMED in a blood warmer. Blood warmers should have a visible thermometer and an audible warning alarm and should be properly maintained.
>Blood should never be warmed in a bowl of hot water as this could lead to haemolysis of the red cells which could be life-threatening.
✔️Severe reactions most commonly present during the first 15 minutes of a transfusion. All patients and, in particular, unconscious patients should be monitored during this period and for the first 15 minutes of each subsequent unit.
✔️The transfusion of each unit of the blood or blood component should be completed within four hours of the pack being punctured. If a unit is not completed within four hours, discontinue its use and dispose of the remainder through the clinical waste system.