#remember
🛑In the setting of STEMI, 
✅dopamine is recommended in hypotensive patients with clinical evidence of shock
✅ dobutamine is recommended in hypotensive patients without clinical evidence of shock


✅Low doses of dopamine may decrease arterial pressure due to redistribution of blood flow.


✅Dopamine in medium-to-high doses should be reserved for hypotensive patients for whom an increase in arterial pressure is considered a priority.

#UpTodate2023
#Salah

#remember
✅Aminoglycosides are generally used in combination with a beta-lactam and should NOT be used as a single agent for infections other than those of the lower urinary tract.
✅When using an aminoglycoside as part of therapy for an infection with a high risk of P. aeruginosa, we favor tobramycin over gentamicin as it has greater intrinsic antipseudomonal activity; however, it may not be widely available.
#UpTodate2023

#remember

🛑 treatment of Pseudomonas aeruginosa infections in adults


✅Among the carbapenems, we favor meropenem or doripenem over imipenem, which has a higher propensity to induce resistance during treatment. For severe infection (eg, septic shock)
✅ imipenem can be given up to a dose of 1 g every 8 hours. 

#UpTodate2023
#Salah

🛑ادويه يجب تجنبها في مريض migraine with aura اذا كان المريض لديه history ل Stroke او TIA او cardiovascular disease
●Triptans
●Ergotamine derivatives
●Serotonin antagonists (eg, pizotifen and methysergide)

لأنها تزيد من حصول cerebral ischemia

#UpTodate2023
#Salah

#remember
✅We suggest that beta blockers should not be used as initial therapy for migraine prophylaxis in patients over age 60 years and in patients who smoke.
#UpTodate2023
#Salah

🛑paroxetine in pregnant women

✅Accumulated evidence would suggest there is not an increased risk, although some data is conflicting and there are study limitations Case-control, cohort, and meta-analysis of these studies, have not been consistent with their findings. In the studies that found an increased risk of malformations (congenital and/or cardiac) with paroxetine use, the risk was 2-fold or less.

✅One study suggested the risk of congenital & cardiac malformations is dose-dependent, with doses >25mg/day. If starting an antidepressant in a woman of childbearing potential or who is pregnant-consider selecting an antidepressant other than paroxetine, unless the patient has responded to paroxetine in the past &/or has failed other agents.

✅If a pregnant woman is stabilized on paroxetine you may continue paroxetine, especially if the patient has previously failed other antidepressants. Decreasing the dose may help reduce potential risks. Switching to another antidepressant in the first trimester is a option, but switching medications may result in relapse.


✅بالمختصر كذا في حاله احتجت دواء مضاد للاكتئاب للمراه المخطط للحمل او في مرحلة الحمل يفضل تجنب دواء paroxetine

✅ممكن نستمر او نستخدم دواء paroxetine في المرأه الحامل لو كان حالتها  استقرت  على دواء  paroxetine وفشل باقيه الادويه ،ممكن نخفض جرعه paroxetine أثناء مرحلة الحمل أيضا لتقليل من potential risk


#Rexfill
#Salah

🛑صحيح بأن المرأه تكون أقل اصابه بأمراض القلب من الرجل ولكن في حاله حصولها تكون مضاعفتها تكون أكثر فمثلا

✅النساء اكثر من الرجال في حصول cardiogenic shock بعد STEMI
✅Women receiving fibrinolysis have a higher rate of mortality and morbidity compared with men  These differences are primarily due to worse baseline characteristics, such as older age and significantly higher rates of diabetes mellitus, hypertension, and prior heart failure


✅Women undergoing primary PCI have had higher rates of in-hospital and longer-term mortality than men in both retrospective observational studies 
#UpTodate2023

#remember
✅ Avoid  Fosfomycin if suspected pyelonephritis or complicated UTI.

✅Avoid  Nitrofurantoin suspected pyelonephritis or prostatitis

#Rexfill
#Salah

التحديثات المضافه في
  2024 ADA guideline include the following
1اولا ضروري أميز بين السكر النوع الأول والثاني
ضروري نعمل
Standardized islet autoantibody testing
عندما يكون هناك اعراض او علامات ع وجود سكر نوع اول
مثل ايش  ؟ 👇🏼
unintentional weight loss, diagnosis at younger age, presence of ketoacidosis)
أيضآ
الذي اعمارهم
≥8 years old with stage 2 type 1 diabetes
إستخدام ال
teplizumab should be considered to help delay the onset symptomatic
2 ضروري نعمل screening للذي يستخدم
👇🏼
Glucocorticoids
Statins
Thiazide diuretics
Second-generation antipsychotics
Antiretroviral medications (in patients with HIV)

3 مراقبه التراكمي A1c
مرتين في السنه اذا كان مستقر
او اربع مرات في السنه اذا كان معرض للنخفاض او الارتفاع او كان طفل
4
Insulin analogs (or inhaled insulin) over human insulins to minimize the risk for hypoglycemia in most adults with T1DM
5
patients with T2DM and documented heart failure (preserved or reduced ejection fraction)
هذا المريض ضروري ياخذ
SGLT2i or SGLT1/2i (e.g., empagliflozin) with proven heart failure benefit
6
نبداء بدوائين لضغط اذا كان
hypertension Office-based BP ≥150/90 mmHg
بينما كان السابق
previously ≥160/100 mmHg)
7
use on non-statin therapies for primary and secondary prevention of ASCVD in patients with statin intolerance
اذا كان هناك مشكله من ال statin ونريد نستخدم ك
primary prevention use 👇🏼
bempedoic acid
to reduce the risk for cardiovascular events

secondary prevention👇🏼

  use of a PCSK9 inhibitor monoclonal antibody, bempedoic acid or inclisiran
#massoud

الكل ينزل منشور عن أفضل شي حصل في 2023 وانا اقول لا شي يضاهي جمال ماحصل في يوم السابع من أكتوبر المجيد 🤩🤩🤩

لاحول ولاقوه الا بالله سيناريو انتقام احداث ميونيخ بدا من قبل الصهاينة ال ك لاب
الرحمة والخلود للقيادي صالح العا روري

انتشر التدخين الالكتروني (Vipe) وبعد أن كان بديل مؤقت للمساعدة على إقلاع التدخين، أصبح وسيلة جذب للتدخين خاصة الشباب🤥
هل ترى أن تدخين ال Vipeآمن كليًا، وأنه بديل جيد للإقلاع عن التدخين، أم غير هذا؟🤔
⬅️لنصل جميعًا لإجابة عملنا دراسة ومحتاجين كل شخص منكم -سواء دخن ولو مرة واحدة vipe أو لم يدخن- يعبي الاستبيان وباذن الله هذه الدراسة تعطي نتيجة علمية مفيدة للناس لاحقًا ويكون لنا جميعًا أجر المساهمة في نفع الناس بأبسط شي نقدر عليه! ✨
(ومن ناحية الخصوصية فاستبيانات قوقل لا تنقل أي بيانات شخصية، حتى الايميل لا يصل) سرية تامة فيرجى الإجابة بمصداقية تامة ودقة قدر الإمكان🙏🏻
💫أي شخص حتى ولو ما دخن، ممكن يساهم بتعبئة الاستبيان -مشكورًا- لأن دراستنا مبنية على المقارنة بين من يتعرض للدخان 🚬 حسب نوعه ومن لا يتعرض له مطلقًا.
https://docs.google.com/forms/d/e/1FAIpQLSfDRGNNMYCqUdy3Fq5PHC-c9Uo_ECfuGV3hPgu5N0OTHWxfOQ/viewform?usp=pp_url&entry.57421275=14122141DC31c657456345324

#remember
🛑Albendazole
✅Absorption of albendazole is enhanced by taking it with fatty meals
✅ Albendazole should be taken with fatty foods for treatment of invasive systemic parasitic infections
✅it should be taken with no food (eg, on an empty stomach) for treatment of intraluminal parasitic infections with no systemic involvement
#UpTodate2024

#remember
✅azithromycin extended-release suspension should be taken on an empty stomach.
✅ clarithromycin extended-release tablets should be administered with food.
#UpTodate2024

لاخير فينا ان نسينا
#غزة

صوره معبره

#remember
🛑Factors may give false positive higher HbA1C level
✅Higher than actual level of HbA1C can be seen in people with a longer red blood cell lifespan, such as with Vitamin B12 or folate deficiency.
#critical-care-pearl2018

🛑Why is initiation of warfarin always recommended with Heparin/LMW Heparins, particularly at higher doses?

✅ Warfarinization (start of warfarin) initially and temporarily may cause clotting. This is because warfarin causes a drop in protein C levels during the initial 36 hours, and since the level of protein C and protein S are also dependent on vitamin K activity, lowered levels of S can lead to a lower rate of activity in protein C, for which it is the co-factor. This leads to a prothrombotic state.
✅ For this very reason, when warfarin is given at a dose greater than 5 mg/day, it is advisable to co-administer heparin.

✅دواء ينصح بتجنبة أثناء نوبه Thyroid storm وهو دواء الأسبرين ،ماهي العلاقه


✅Rationale: Aspirin is a universal medicine on most patient's medication list particularly in patients with stroke, cardiac or vascular history.  Aspirin should be held and avoided in thyroid storm to prevent decrease in protein binding which subsequently could result in increases in free T3 and T4 levels.  Aspirin, as a matter of fact, is known to precipitate thyroid storm.
#critical-care-pearl2018