#note
Platelet Aggregation
Increased by ADP, 5HT, TXA2, thrombin, α2agonists
Decreased by PGI2, cAMP, ASA, clopidogrel, GP IIb/IIIa blockers
@clinical_Notes

https://t.me/clinical_Notes

#Note
Hyperphosphatemia in the setting of normal kidney function: think excessive intake,
cellular breakdown, or hypoparathyroidism.👌
#salah

🛑Management of LDL-C to reduce cardiovascular risk in nondialysis CKD patients


🛑Statin for secondary prevention
if A patient has established atherosclerotic CVD (prior history of coronary, cerebrovascular, or peripheral arterial disease)


🛑Statin for primary prevention 


⛔️Option A

✅All patients with GFR <60 mL/min

✅Patients with CKD and GFR ≥60 mL/min and age ≥50 years

or

✅Patients with CKD and GFR ≥60mL/min and other CVD risk factors (eg, diabetes, hypertension, smoking, low HDL-C, high Lp(a), etc

⛔️Option B*:

✅Statin if predicted 10-year absolute risk of having a major CVD event is 7.5 to 10% or higher

✅Statin might be offered if risk is between 5 and 7.5%

✅No statin if risk is below 5%



#Note
✅Option A and Option B reflect differing opinions among UpToDate authors and editors about criteria for initiating statin therapy in patients with nondialysis CKD

#UpTodate2023
#salah

🛑 pregnancy and level T3 and T4

✅in normal pregnancy  (T3) and T4 levels show a slight increase with suppressed (TSH)  in the first trimester due to the partial thyroid-stimulating action of human chorionic gonadotrophin (beta-HCG)
✅ Free T3 and T4 remains within normal ranges

✅pregnancy increase   thyroxine-binding globulin (TBG) and increase  total thyroxine but does not affect the free thyroxine level

✅TSH may be mildly suppressed in up to 13.5% of pregnancies during the first trimester, and 4.5% of women in the second trimester, and this is considered a normal variant.
✅HCG levels will fall in second and third trimester

#Note and Note

🛑What antimicrobial prophylaxis should he receive before starting chemotherapy with fludarabine?

✅ Co-trimoxazole

✅ there is a significantly higher risk of patients developing Pneumocystis jirovecii pneumonia while on treatment.
✅ Use of prophylactic co-trimoxazole (Septrin) has dramatically reduced the frequency of this severe opportunistic infection in these patients

. ✅ Co-trimoxazole should be continued after chemotherapy until the CD4 counts exceeds 200 cells/mm3 (0.2 ×109/L).

#note and Note

#remember

✅The combination of anaemia and jaundice should always suggest haemolytic anaemia until proved otherwise

#Note and Note

#remember
✅Salmonella osteomyelitis is seen in patients with sickle cell anaemia
#NOTe and Note

🛑Glycosuria in pregnancy

✅The most likely
mechanism of glycosuria in pregnant woman Reduced renal reabsorption
✅patients with persistent glycosuria should be investigated with a glucose tolerance test at around 24 weeks
#Note and Note

🛑Thyroxine in pregnancy
✅During pregnancy, the average thyroxine requirements typically increase by 25-50 mcg.
#Note

#remember
✅Patients on long term corticosteroids should have their doses during intercurrent illness
✅بالعربي كذا الشخص الذي ماشي على ادوية corticosteroids بشكل مزمن يحتاجون إلى رفع الجرعة بحدود الضعف عند حدوث نوبه حاده من اي مرض مثل العدوى أو ارتفاع درجة الحرارة

#Note and Note

🛑A Fasting glucose of one patient is = 7.7 mmol/l, but his HA1c is = 31 mmol/mol (5.0%).Which would explain the discrepancy between the HbA1c and fasting glucose levels?

✅Sickle-cell anaemia
#note and note