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Posts Tagged ‘General practice’

Disorders of lipid metabolism

Posted by iskanbasal on March 27, 2009

Or disorders of lipoprotein metabolism. I studied for this subject some chapters from important textbooks of medicine:

1. Chapter 350 from the Harrison’s principles of internal medicine. Clinically is the most comprehensive on the subject, either the description of  diseases of lipid metabolism or the approach to treatment.

2. Chapter 217 from Cecil medicine. Same as the above particularly when telling the physiopathology and the role of nuclear factors such as the PPARalpha, PPAR?, and PPARd in the regulation of lipids in the human body.

3. Chapter 21 “hyperlipidemias” from the Lippincott’s illustrated reviews: pharmacology 4th ed. a good rapid and concise review on the drugs used here.

4. Chapter 5 Tests of lipid metabolism from the Wallach interpretation of diagnostic tests. Excellent tables on this subject from the Adult Treatment Panel III guidelines.

One of the most useful paragraphs on the subject is that where the Harrison’s describes the diagnostic process. Now I should consider the lab results and divide them in categories. The critical first step in managing a lipid disorder is to determine the class or classes of lipoproteins that are increased or decreased in the patient. I might have Lab results showing only increased levels of tryglicerides or only increased levels of LDL-cholesterol and think about the differential diagnosis in each situation. But the most common error in the diagnosis and treatment of lipid disorders occurs in patients with a mixed hyperlipidemia without chylomicronemia. This occurs with increased levels of both cholesterol and tryglyceride which may indicate TypeIII (increased IDL levels) or Type IIb( increased LDL and VLDL) or TypeIV ( increased VLDL levels). Analysis of lab tests is very important to distinguish between the different situations. I also considered the secondary causes of lipid disorders: obesity, Diabetes mellitus, thyroid diseases, renal diseases, liver disorders, alcohol, and endocrine disorders but particularly the role of hyperlipidemia as a major risk for Coronary heart disease. Actually the tests of lipid metabolism ( my initial interest in this subject) has two important objectives:

1. to assess risk of atherosclerosis, especially Coronary heart disease

2. to classify hyperlipidemias.

I reviewed all the other risk factors for coronary heart disease(CHD) and understood the importance in calculating the atherogenic risk in a general practice setting. What I’m doing is to try to build the good and necessary clinical knowledge (CK) that one needs.

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Posted in Cardiology, Lab | Tagged: , , , | Leave a Comment »

Primary Prevention Of Atherosclerotic Heart Disease: New Data from the AHA

Posted by iskanbasal on March 12, 2009

Thanks to KevinMd where I got information about reachMd radio. Actually it is a good educational site, there are many prog to follow and I just finished my first act of listening to an interesting program on the primary prevention of atherosclerotic heart disease and got a CME 0.25 credit. As only a medical student I only wanted to listen and develop a little my english and also get new important information directed to general practice. The clinical researcher discussed in this activity the results of a trial  in which patients with a normal level of cholesterol= 130mg/dL but with high levels of C reactive protein called CRP (which is considered an important risk factor for CAD) took a statin to prevent the occurence of cardiac events. The trial resulted in a 44% reduction in cardiovascular events and was stopped early because the benefits were very evident.   

Primary Prevention Of Atherosclerotic Heart Disease: New Data from the AHA

Listen here.

Posted in Cardiology | Tagged: , , , | Leave a Comment »

Risks of proton-pump inhibitors: what every doctor should know

Posted by iskanbasal on February 2, 2009

This is an interesting editorial introduces an article on the Medical Journal of Australia:

Risks of proton-pump inhibitors: what every doctor should know


“A low level of gastric acid promotes the growth of swallowed and enteric flora in the proximal gut, and these bacteria may be aspirated during episodes of physiological reflux. In this issue of the Journal, Roughead and colleagues assess the risk of pneumonia in Australian veterans taking PPIs”

The article is here.

MJA 2009; 190 (3): 109-110

The bottom line is that no drug is completely safe, and this applies to acid suppression therapy. Fortunately, the risks, if causal, seem small, although preventive strategies are largely unavailable and identifying those at particularly high risk of serious side effects (eg, based on pharmacogenomics to individualise therapy) is not yet an established strategy. However, it is prudent and best practice to warn patients about the potential serious (albeit rare) side effects of PPIs, to prescribe the lowest possible dose of PPI (when indicated) for as short a time as possible, and to consider alternative management options if these are available.

Posted in Drugs | Tagged: , , , | Leave a Comment »

Students whose behaviour causes concern: Case history

Posted by iskanbasal on January 2, 2009

I found this article from the British medical journal interesting as it concerns either medical student or medical professionals.

“What should you do when you see a fellow student behaving inappropriately? After a group of students wrote to the BMJ about their experience during an elective, we sought the opinions of an ethicist (doi:10.1136/bmj.a2882), a dean (doi:10.1136/bmj.a2884), a GMC representative (doi:10.1136/bmj.a2876), and a lecturer from an African university (doi:10.1136/bmj.a2875)”.

Posted in Medical education, Medstudent | Tagged: , , | Leave a Comment »

Hypertension, December issue of “In The Clinic”

Posted by iskanbasal on December 16, 2008

Annals of internal medicine has this very interesting and educational section directed to the physician in practice: “In The Clinics”. Since the beginning of 2007 they have published many important monthly issues. Each is accompanied with important tool kit that take the reader to many added resources:

“In the Clinic is a monthly feature in Annals of Internal Medicine introduced in January 2007 that focuses on practical management of patients with common clinical conditions. It offers evidence-based answers to frequently asked questions about screening, prevention, diagnosis, therapy, and patient education and provides physicians with tools to improve the quality of care.

The foundation for In the Clinic is the evidence-based clinical guidance in the American College of Physicians’ electronic point-of care decision-making resource, PIER (Physicians Information and Education Resource). In developing In the Clinic, Annals editors draw upon other ACP knowledge products, such as MKSAP (Medical Knowledge Self-Assessment Program), as well as outside resources, including practice guidelines and quality-of-care measures. In the Clinic integrates this material on broad topics in a relatively brief, easy-to-read format with an emphasis on practical measures that can be readily integrated into practice.”

This month’s issue is about HYPERTENSION.

Posted in Clinical Practice, General practice | Tagged: , , | Leave a Comment »

Iron and human disease

Posted by iskanbasal on September 18, 2008

doi:10.1371/journal.pbio.0000079

The above link to an interested primer on the importance of iron in human metabolism and disease

“How Mammals Acquire and Distribute Iron Needed for Oxygen-Based Metabolism”.

A link to the primer.

Posted in General practice, internal medicine | Tagged: , , | Leave a Comment »

 
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