#للتذكير
✅ارتفاع الصفائح (thermbocytosis) لايعني بان المريض يعاني من نقص الأسبرين 😂

🛑key causes of thrombocytosis
✅اهم اسباب ارتفاع الصفائح

✅️Do not automatically discontinue diuretics in patients with gout, especially when needed to manage edema.
✅️Consider an alternative antihypertensive (e.g., an ACE inhibitor/ARB or dihydropyridine CCB) if it can effectively and affordably control blood pressure without increasing uric acid.
✅️Treat diuretic-induced gout with urate-lowering therapy when indicated.
✅️Do not treat asymptomatic hyperuricemia caused by diuretics routinely.

#UPTODATE2026

🛑pregnancy and hyperthyroidism

✅Women diagnosed with overt hyperthyroidism during the first 16 weeks of pregnancy should take propylthiouracil
(PTU)

✅ Women diagnosed with overt hyperthyroidism after 16 weeks should take methimazole

#Uptodate2026

🛑propylthiouracil (PTU) and hepatotoxicity

✅most cases of hepatotoxicity occur within the first 90 days of treatment.
#Uptodate2026

🛑 diabetes and schizophrenia

✅The prevalence of type 2 diabetes mellitus is approximately two to three times greater in individuals with schizophrenia than in the general population

#Uptodate2026

🛑Prevention and Management of Antipsychotic-Associated Weight Gain and Obesity

✅Key Points Summary

Prepared by: Salah Aldeen Mansour – Clinical Pharmacy

Source: UpToDate® – Prevention and Management of Antipsychotic-Associated Weight Gain and Obesity

🛑 Drug Interaction Alert: Valproate + Topiramate
⚠️ Why should we avoid combining Topiramate with Valproate?
💊 The answer: Increased risk of hyperammonemia.
🔬 Mechanism: Both valproate and topiramate can contribute to the development of hyperammonemia. Their combination may increase the risk of elevated blood ammonia levels, which can lead to hyperammonemic encephalopathy.
🧠 Clinical manifestations may include: 🔹 Altered mental status or confusion
🔹 Lethargy and excessive drowsiness
🔹 Vomiting
🔹 Cognitive changes
🔹 In severe cases, encephalopathy or reduced consciousness
📌 Clinical Pearl: The combination of valproate and topiramate is associated with an increased risk of hyperammonemia, sometimes even when liver function tests are normal.
✅ Clinical Recommendation: Avoid this combination when possible, particularly in patients at increased risk. If concomitant use is necessary, monitor for symptoms of hyperammonemia and evaluate ammonia levels when clinically indicated.
🚨 Important: Unexplained lethargy, vomiting, or altered mental status in a patient receiving this combination should raise suspicion for hyperammonemic encephalopathy.
📚 Source: Valproate and topiramate prescribing information; UpToDate — Drug-induced hyperammonemia and valproate-associated hyperammonemic encephalopathy.
✍️ By Salah Aldeen Mansour (Clinical Pharmacy)

🚨 التقرير الطبي لحالة برشلونة بعد رباعية باريس سان جيرمان! 🏥⚽️

🩺 Diagnosis: Acute Parisian Syndrome 🇫🇷😂

📋 Clinical presentation:

- Tachycardia ❤️‍🔥
- Acute psychological trauma 🧠
- Severe defensive failure 🛡️💔
- Multiple episodes of Ball Possession Without Clinical Benefit 😂

💉 Treatment plan:

1. Immediate administration of 4 doses of Paracetamol 💊
2. Strict bed rest for 90 minutes ⏳
3. Avoid watching match replays for at least 72 hours 📺🚫
4. Psychological consultation with the defensive line 🧠😂

⚠️ Prognosis: Guarded!

📌 Final diagnosis: Four-goal shock with no effective antidote! 😂💉

الطبيب المعالج: د. باريس سان جيرمان 🩺🇫🇷
الحالة: تحت المراقبة حتى إشعار آخر! 🤣🤣

🛑GERD and H.pylori relationship

🛑fluid management in adults with acute diarrhea
#Uptodate2026