Indications of long‐term oxygen therapy

Hi!

I was discussing the indications of long‐term oxygen therapy with a friend today...

Long‐term continuous oxygen therapy, ideally for ≥18 h/day is indicated when:

1. Daytime partial arterial oxygen concentration (PaO2) is ≤ 55 mm Hg at rest or a pulse oxygen saturation (SpO2) less than or equal to 88 percent.

2. Daytime PaO2 is 56–59 mm Hg and there is evidence for hypoxic organ damage (right heart failure, pulmonary hypertension or polycythaemia)

Fact of the day: AHN in old age

Hi!

Fact: New neurons proliferate as we age, in both physiologically and pathologically aging brains, even in the ninth decade of life.

Authors' diary: Battling jealousy

Hi!

I read comment on YouTube recently, "There are people who don't even share their notes and there are people like you who help others with their work..."

I know that feeling. It stems from a number of negative emotions. One of them is jealousy or envy - The intolerance in seeing someone else succeed more than you.

Treatment resistant depression notes

Hi! Quick notes for a friend :)

Treatment resistant depression: Major depressive episodes that do not respond satisfactorily to at least two trials of antidepressant monotherapy.



Things to consider:
Assess adherence
Identify comorbidities
Reassess diagnosis

Treatment strategies:
Augmentation (adding a treatment)
Switching treatment

Important Mnemonics for Oral hypoglycaemic drugs in Diabetes

Hello everyone .. 

I make mnemonics for some important side effects of oral hypoglycemic drugs. 

You must know that because you may prescribe it for 1 out of 11 adults in whole population the of world….!!

Side effects of Oral hypoglycaemic drugs along with it's class & mechanism of action 

#Mnemonic 1

Big Men ForminG Poor Diabetic neuropathy ( D/Dx B12 Deficiency ➡️ confirmed by doing  B12 LAB test.)

Biguanide = Metformin 

Inhibit mGPD 

It causes Vitamin B12 Deficiency & Lactic Acidosis (LA) 

#Mnemonic 2 

1st Key to SUccess is Lord "Ram"

1st Gen SUlfonylureas

Closes K+ Channel 

Ram = Disulfiram like reaction….

#Mnemonic 3 

Paragliding makes your heart failed or maybe a fracture or bladder injury 

Para = PPAR Y

Gliding = Glitazone activates it...

#Mnemonic 4

"Rosy red Blood don't reach to heart (MI) but goes into Pee = Red Pi ( Pee = Urine in Bladder Cancer )

MI (rosiglitazone) 

Bladder cancer (pioglitazone)

#Mnemonic 5

“Change your Daily Personal Passivity (DPP) otherwise your heart fails” 

DPP  = DPP-4 inhibitors 

#Mnemonic 6

“Candid Status is Very Good in Love Test”

SGLT-2 inhibitors can cause Vulvovaginal Candidiasis 

Drugs category & their Suffix 

Pramlintide = Amylin Analogue 

1st gen Sulfonylureas = “Amide”

2nd gen Sulfonylureas = “Ride” & “Zide”

Meglitinides = “Nide”

DPP-4 Inhibitors = “Gliptin”

Glitazones / thiazolidinediones = “Zone”

SGLT -2 Inhibitors = “Flozin”

#Mnemonic 7

Alpha glucosidase inhibitors = "Please Side your Car & Pay Toll"

Acarbose & Miglitol 

#Clinical Pearls 

Weight neutral = DPP 4 & Alpha Glucosidase inhibitors 

SGLT2 inhibitors & GLP-1 = Used in CVD

( Cardiovascular diseases) patients

In case of Renal failure you can only give 2 type of drugs orally = DPP 4 inhibitors & Glitazones 

Injectables can be given in renal failure.

3 times / day dosing = Pramlintide , Alpha Glucosidase inhibitors & Glinide 

Regular Insulin ( Short acting ) is preferred for 

DKA ( IV)

Hyperklaemia (Add Glucose)

Stress Hyperglycemia

Thank you :)

- Dr. Drashtant Prajapati

Therapeutics in Sickle Cell Anemia

Apart from Hydroxyurea, Analgesics and vasodilators like phosphodiesterase inhibitors, certain tantalizing novel drugs have been approved for Sickle cell anemia.... Let's take a closer look at them.

(1) Voxelotor (HbS polymerization inhibitor) binds covalently to N-terminal valine of alpha chain of HbS (around 30% of HbS in individual cell) stabilizing it's oxygenated form and causing left ward shift of dissociation curve without impairing oxygen delivery to tissues.

Consistently reduces hemolysis and viscosity with in 2 weeks of administration... FIRST EVER therapy targeting core defect.

Benign vs Malignant pulmonary calcifications mnemonic

A nice mnemonic to differentiate benign and malignant pulmonary calcifications is:

Malignant calcifications are ***SuPER bad*** :P
S: Spiculated
P: Punctate
E: Eccentric
R: Reticular

I use those 3 starts (***) to remind me of punctate.(vs the other P of Popcorn in the benign lesions)

Bening ones are the rest:
Popcorn, laminated, concentric and diffuse homogeneous

-Murad

NB: these calcification types suggest benign vs malignant lesions and are not diagnostic per se.

Check the other amazing mnemonic by Drashtant in the comments section below  :)

Inferior wall MI treatment mnemonic

Inferior wall MI is different than other MIs . It is associated with sinus bradycardias and AV block.

Lower back pain notes

Hello!

Here are my quick and dirty notes on Low back pain (LBP) mostly seen in ambulatory medicine! I will not be going into evidence-based medicine (EBM) physical examination (PE) findings but I have put a quick note for conditions you can test on PE so you can look them up.

Hepatorenal Syndrome: An Overview

Hello good folks! Let's discuss HepatoRenal Syndrome (HRS) in brief.

Cirrhosis + Ascites + Renal Failure = HRS, after excluding other causes of kidney damage.

How common is HRS?
1 in 10 patients of advanced cirrhosis or acute liver failure develop HRS.

How does HRS happen?
Abnormal haemodynamics, that's how. Pathogen, faulty immune system and mesenteric angiogenesis result in splanchnic and systemic vasodilation but renal vasoconstriction. Other factors maybe contributory.

Types and management
Type 1: Rapidly progressive, median survival about 2 weeks. Haemodialysis may be required.

Type 2: Slowly progressive, median survival about 6 months. Transjugular Intrahepatic Portosystemic Shunt (TIPS) maybe required.

Liver and/or kidney transplant maybe considered for both types.



Thanks for reading.
- Ashish Singh.

Dihydropyridine vs non-Dihydropyridine CCBs mnemonic

Dihydropyridine vs non-Dihydropyridine CCBs were always a struggle to me because they are both CCBs but at the same time they have some differences.

I hope that the following mnemonic will help in reminding you which one is Dihydro and which one is not :D :

The mnemonic (remember DIE HARD movie and Bruce Willis)

I am a DIe Hard FAN

DIHydropyridine CCBs:
FAN
F- felodipine
A- amlodipine
N- nicardipine

So non-Dihydropyridine CCBs are Verapamil and Dilitazem.

The original FAN mnemonic was posted here:
http://woanchyi818.blogspot.com/2015/03/calcium-channel-blockers-ccbs.html

good luck :)

Murad

Topical vs Oral antifungal mnemonic

Hey my friends, a common question in qbanks is when to use topical vs oral antifungals in Tinea infections.
Well, you can use the following mnemonic:

Tinea CAPitis => Imagine a CAP covering your head/scalp so you need a systemic treatment => Oral treatment (eg: Terbinafine) to reach it.
Scientifically, the systemic/oral treatment is needed to reach the hair shaft.

Tinea Corporis: Since Tinea Capitis is the oral one, Tinea Corporis is the topical one :)


Murad :)

Classification and causes of hyponatremia mnemonics + notes

Hi!

Classification and causes of hyponatremia mnemonics + notes:

1. Hyponatremia with low osmolality :

     (i) reduced effective blood volume

              (A) increased ECF volume -

                               - Edematous kidney (nephrotic syndrome)

                               - Cirrhosis of liver

                               - Failure of heart

              (B) REduced ECF volume -

                                - Renal loss of Na ( Diuretics, Ketonuria, Addison's disease)

                                - Extrarenal loss of Na ( sweating, diarrhea, vomiting, peritonitis, pancreatitis)

    (ii) Normal/ increased EBV

                - Inadequate ADH syndrome

                - Constant thirst

                - Renal failure (chronic)

2. Hyponatremia with raised osmolality :

( H & M)

- Hyperglycemia 

- Mannitol administration 

Note -

- Hyponatremia per se does not produce any significant clinical features. The low osmolality that it causes is responsible for various features.

- Slow correction of hypotonicity produces gradual rise in osmolality without any significant risk. But rapid correction of hyponatremia produces loss of brain water resulting in brain damage!

- The rate of correction should be around 0.6 mEq/L/hr. In severely symptomatic patients, total correction in a day should not exceed 8-10 mEq/L/hr.

That's all

Hope it helps

- Jaskunwar Singh