"‏من المحتمل أنه استجاب منذ اللّحظة الأولى، لكنّه يدبّر الأمر ..

فأبشر😍
#منقول

🛑Neonatal and SSRIs and SNRIs drugs

✅Neonatal complications associated with in utero exposure to SSRIs and SNRIs during the third trimester include the poor neonatal adaptation syndrome, which includes agitation and restlessness, irritability and continuous crying, insomnia or somnolence, poor feeding, vomiting, diarrhea, hypoglycemia, hypothermia, respiratory distress, altered muscle tone, hyperreflexia, jitteriness, shivering, tremors, and very rarely, seizures.
✅ Symptoms of poor neonatal adaptation syndrome are generally mild, self-limited, and rarely last longer than two weeks.

#Uptodate2024

🛑 valproate (Valopric acide)

✅Conversion to monotherapy from valproate adjunctive therapy:  Dosage reduction of the concomitant antiseizure drug may begin when valproate therapy is initiated or 1 to 2 weeks following valproate initiation.
✅Concomitant antiseizure drug withdrawal may be variable,
✅one suggested strategy is tapering the concomitant antiseizure drug over 8 weeks (eg, by ~25% every 2 weeks)

#Uptodate2024

🛑بالعربي كذا لو مريض كان ماشي على اي دواء من ادوية الصرع مثل carbamazepine وكنت بحاجه الى التحويل إلى دواء Valopric acide لأي سبب مثل عشان التحكم بالنوبات ...او الاعراض الجانبيه ...الخ

✅في هذه الحاله عشان اتجنب الاعراض الانسحابية للدواء قد ابدا انقص من جرعه الدواء الاول بعد اسبوع إلى اسبوعين من البداء بدواء valopric acide ,او هناك استراتيجية اخرى هي خفض جرعه الدواء الاول خلال 8 اسابيع بحيث ننقص جرعه الدواء بمقدار 25% لكل اسبوعين

🛑Use of steroids for cellulitis

✅Steroids are not routine standard of care
✅ Prednisone 40 mg by mouth once daily for 7 days may be considered in non-diabetic patients with cellulitis and multiple SIRS criteria

#ACCP

Approved Antibacterial Therapy for Infectious Diarrhea by Pathogen

SIRS criteria
Systemic  inflammatory response syndrome

مرجع منشور
Approved Antibacterial Therapy for Infectious Diarrhea by Pathogen19

الفيديو شوي مسرع ع شان الحجم تقدروا تأخروا في التسريع

https://t.me/clinical_Notes

ع شان نكتشف مرض السكر مبكرا ضروري نعمل
Screening
طيب منهم الي مفروض نعمل لهم ومتى نعمل لهم؟
Screening should be considered for
1⃣ Overweight/obese adults with one or more of the following risk factors:
🔻First-degree relative with diabetes
🔻High-risk race/ethnicity
(e.g.African American, Latino, Native American, Asian American, Pacific Islander)
🔻History of CVD
🔻Hypertension (BP ≥130/90 mmHg or on antihypertensive therapy)
🔻HDL <35 mg/dL and/or triglycerides >250 mg/dL
🔻Polycystic ovary syndrome
🔻Physical inactivity
🔻Clinical conditions associated with insulin resistance (e.g. severe obesity, acanthosis nigricans)
2⃣ Patients with prediabetes (A1C 5.7-6.4%) should be screened annually.
3⃣ Patients with a history of gestational diabetes should be screened every 3 years.
4⃣ For all other patients, screening for diabetes should begin at an age of 35 years and be repeated at least every 3 years (if results are normal).
5⃣Certain medications (e.g., glucocorticoids, statins, thiazide diuretics) may increase the risk for developing type 2 diabetes. It is reasonable to consider screening patients receiving these medications for prediabetes and diabetes.
6⃣Patients prescribed second-generation antipsychotic medication should be screened for prediabetes and diabetes at baseline, 12-16 weeks after initiation (sooner, if indicated), and then annually thereafter.
7⃣Patients with HIV should be screened for prediabetes and diabetes at baseline (prior to antiretroviral therapy) and when switching antiretroviral therapy (ART). Screening should repeat 3-6 months after initiating or switching ART. If results are normal, screening should continue annually.


In these patients, FPG is the recommended screening method.Unless otherwise specified, FPG, 2-HR PG following 75 gram oral glucose tolerance test or A1C can be used as appropriate screening methods.

🛑Surgery with spinal or epidural anaesthesia and anticoagulants

✅Epidural or spinal anaesthesia should not be initiated or removed unless the INR is ≤1.4 and there is no appreciable heparin effect.
✅Avoid insertion or withdrawal of an epidural catheter within 12 hours of 40mg enoxaparin or within 24 hours of a therapeutic (1mg/kg) dose of LMWH.
✅Avoid heparin administration (SC or IV) for 4 hours after removal of an epidural

#NUH guidelines

انا كمان حافظ ل بيبتك السر بس مالحقتش اقوله 😂🌚🌚🌚

Teratogenic risk profiles of antiseizure medications

#remember
🛑 Acute migraine treatment
✅ adjunctive dexamethasone at a dose of 4 mg IV to reduce migraine recurrence.
#Uptodate2024

#remember
✅Gabapentin should be taken at least two hours after the use of antacids since concurrent administration decreases its bioavailability.

🛑 Lamotrigine and cardiovascular disease

✅Due to its pro-arrhythmic potential, lamotrigine should be avoided in patients who have cardiac conduction disorders (eg, second- or third-degree heart block), ventricular arrhythmias, or cardiac disease or abnormality (eg, myocardial ischemia, heart failure, structural heart disease, Brugada syndrome or other sodium channelopathies)

#Uptodate2024

🛑Glucocorticoid and osteoporosis

✅For all patients receiving any dose of chronic glucocorticoid therapy or initiating glucocorticoids with an anticipated duration of ≥3 months, we suggest calcium and vitamin D supplementation (Grade 2B).
✅Most adults require 1000 to 1200 mg of elemental calcium daily, total diet plus supplement, and 800 international units of vitamin D daily


✅glucocorticoids (any dose equivalent to prednisone ≥2.5 mg/day with an anticipated duration of >3 months

#Uptodate2024

🛑Fever in the intensive care unit (ICU

●Fevers between 38.3°C (101°F) and 38.8°C (101.8°F) may be infectious or noninfectious. The differential diagnosis is longest in this range.

●Fevers between 38.9°C (102°F) and 41°C (105.8°F) can be assumed to be infectious.

●Fevers ≥41.1°C (106°F) are usually noninfectious. Examples include drug fever, transfusion reactions, adrenal insufficiency, thyroid storm, neuroleptic malignant syndrome, heat stroke, and malignant hyperthermia. 

#Uptodate2024