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jacobi August 24, 2017August 25, 2017Education, TidbitsEducation, GI, neuro

Weekly Tidbits 8/26-27

Hepatorenal Syndrome ATACH-II trial: What is the optimal blood pressure control for ICH patients? Status Epilepticus Lung Cancer Immunology Therapy: Anti-PD-1 Antibodies Acetaminophen Hepatotoxicity Hepatorenal Syndrome Type 1 HRS is characterized by rapid and progressive renal impairment and is most commonly precipitated by spontaneous bacterial peritonitis (SBP). Type 1 HRS occurs in approximately 25% of patients with SBP, despite rapid resolution of the infection with antibiotics. Without treatment, the median survival of patients with type 1 HRS is < 2 … Continue reading “Weekly Tidbits 8/26-27”

jacobi August 10, 2017August 10, 2017AsideEducation, TidbitsEducation, ID, malaria

Malaria Prophylaxis

Falciparum Ovale Vivax Malarie Age of RBCs infected All Young Young Old Size of cell NL Big Big NL % of Parasitemia >5% <5% <5% <5% Liver stage no yes yes no Common prophylaxis drugs (eg, chloroquine, mefloquine and doxycycline) target blood stage of parasite (blood schizonticides). Malaria with liver stage (Ovale, Vivax) should treated with tissue schizoticides (eg, atovaquone/proguanil). If one person travel to chloroquine-resistant P falciparum (Sub-Saharan Africa, Southern & Southeast Asia), prophylaxis with Atorvaquone-proguanil, Doxycycline, … Continue reading “Malaria Prophylaxis”

jacobi August 3, 2017AsideTidbits, Weekend CoverageEducation, neuro

Neurological emergency

Hydrocephalus: if you see hydrocephalus in a patient with consistent severe headaches, this could be a sign of impending herniation. Patient will need emergent relief of intracranial pressure. Botulism: Rapidly progressive paralysis with blurry vision, sluggish pupils and diplopia. This condition is caused by an irreversible toxin and the antitoxin should be given as soon as possible, so needs high clinical suspicion. The diagnosis is by injecting patient’s serum in mice to see if it causes paralysis (takes a … Continue reading “Neurological emergency”

jacobi August 3, 2017August 9, 2017Tidbits, Weekend CoverageEducation, hyponatremia, renal

hyponatremia

Pathophysiology: Hyponatremia means excess of body water compared to total body sodium and potassium. Also likely to involve ADH (vasopressin), the hormone involved in water balance. Total osmolality: concentration of all solutes in a given weight of water (mOsm/kg) regardless of whether or not osmoles move across biological membranes Effective osmolality: number of osmoles that contribute to water movement between intracellular and extracellular compartments Most hyponatremia is from low effective osmolality (hypo-osmotic/hypotonic hyponatremia), but occasionally, hyponatremia occurs in isotonic … Continue reading “hyponatremia”

jacobi August 3, 2017August 3, 2017ImageTidbits, Weekend CoverageID, sepsis, toxoplasmosis, weekly image

weekly image 0803

39M from DR, h/o AIDS (CD4 = 40, VL 250k) not on HAART, p/w AMS, also have decreased ambulation/appetite/speaking/ambulation for 2 wks Vitals: 98.3/55/18 BP: 100/60 What is the differential diagnosis ? What to do for this patient ? From NEJM Teaching Topics | February 23, 2012 Q. What neoplastic processes are part of the differential diagnosis of a peripherally enhancing brain lesion? The differential diagnosis of a peripherally … Continue reading “weekly image 0803”

jacobi August 3, 2017August 12, 2017ImageEducation, Tidbitspulmonary, tuberculosis, weekend coverage, weekly image

Jacobi Weekly Image 0805-0806

24M from Albania no PMH, move to US * 2 years, present with cough * 2 months, right post upper back pain, night sweats, poor appetite for months Found to have RLL cavity 6.5 x 5 x 6 cm with scattered nodular, tree and bud capacities What is the differential diagnosis ?

jacobi August 3, 2017Tidbitscardiology, Education, neuro, syncope

Syncope

1: Reflex syncope Neuro-cardiogenic (vaso-vagal), carotid sinus syndrome, situational (micturition) 2: Cardiogenic Arrhythmias – Tachyarrhythmia: WPW (especially with Afib), Brugada, Long QT syndrome, – Bradyarrhythmia: Second degree AV Block Mobitz II, Third degree AV block, Sick sinus syndrome – Structural heart disease (HOCM, LVOT obstruction, Aortic stenosis, Intracardiac tumor: Myxoma 3: Orthostatic

jacobi July 24, 2017July 24, 2017AsideTidbitsAfib, anticoagulation, cardiology, DVT, Education, Pulm/CCM

NOACs

Antidote: Dabigatran = Idarucizumab (Praxabind) Idarucizumab for Dabigatran Reversal N Engl J Med 2015; 373:511-520 Factor Xa (Apixaban, Rivaroxaban) are POTENTIALLY reversible by Andexanet alfa (study was done in healthy human subjects, Andexanet reverses effect while infusion is running but rebounds on completion, further data will be available later) ANNEXA-4 trial N Engl J Med 2016;375:1131-41. Aripazine (PER977) is a medication currently on trial and can potentially reverse Factor Xa, dabigatran AND heparin, LMWH Use of PER977 to Reverse the Anticoagulant Effect of Edoxaban N Engl J … Continue reading “NOACs”

jacobi July 20, 2017AsideTidbitsbrugada, cardiology, sudden death

Brugada syndrome

Brugada Syndrome is an ECG abnormality with a high incidence of sudden death in patients with structurally normal hearts. It is due to a mutation in the cardiac sodium channel gene. This is often referred to as a sodium channelopathy. The 3 common types: TYPE I VERY SCARY – refer to arrhythmia team for ICD!

jacobi July 20, 2017AsideTidbitsEducation, Pulm/CCM, sepsis, shock

Pressors

Highlights from Sepsis surviving Campaign 2016: Base on ProCESS, ProMISe and ARISE trials, all 3 trials confirmed that there was no survival benefit of EGDT compared to usual resuscitation. However, in all three studies patients had early antibiotics, >30ml/kg of IVF prior to randomization. We need therefore to keep in mind that the practice has changed. Source control: empiric broad-spectrum therapy Abx to cover all likely pathogens within 1hr Initial resuscitation: 30ml/kg of IV crystalloid fluid in first 3 hours … Continue reading “Pressors”