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Guidelines, multiple specialists, and the science versus the art of medicine
My 80-year-old patient presented with symptoms and signs of kidney failure. I hospitalized him and asked for the assistance of a kidney specialist. We notified his heart specialist as a courtesy. A complicated evaluation led to a diagnosis of an unusual vasculitis with the patient’s immune system attacking his kidney as if it was a foreign toxic invader. Treatment, post kidney biopsy, involved administering large doses of corticosteroids followed by a chemotherapy agent called Cytoxan. Six days later it was clear that dialysis was required at least until the patient’s kidneys responded to the therapy and began working ...
Source: Kevin, M.D. - Medical Weblog - July 16, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/steven-reznick" rel="tag" > Steven Reznick, MD < /a > Tags: Physician Cardiology Hospital-Based Medicine Source Type: blogs

Teva Releases First Breath Activated Asthma Inhaler in U.S.
Traditional corticosteroid inhalers for management of asthma symptoms require patients to squeeze and inhale in a coordinated maneuver. This is surprisingly difficult for many patients who end up receiving sub-optimal treatment. Teva Pharmaceutical, ...
Source: Medgadget - February 12, 2018 Category: Medical Devices Authors: Editors Tags: Cardiology Medicine Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 8
This study found that though it is often associated with coronary artery disease (CAD), it can also occur in those without significant CAD. It was not specifically associated with disease of right coronary artery disease. This cardioinhibitory response may be a manifestation of the Bezold-Jarisch reflex. Bezold-Jarisch reflex inhibits sympathetic activity (sympathetic withdrawal) and increases parasympathetic activity, resulting in bradycardia, which may be associated with vasodilatation, nausea and hypotension. Bezold-Jarisch has been described in the setting of inferior wall infarction and coronary angiography. Origin...
Source: Cardiophile MD - January 26, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ Cardiology X-ray Featured Source Type: blogs

Praluent, the Next Expensive "Game Changer," Blockbuster," "New Hope," - But Not Yet Shown to Benefit Patients
ConclusionsThe NEJM study was accompanied by an editorial by Stone and Lloyd-Jones(2) which documented that drugs previously shown to lower cholesterol were never proved to do any good for patients, and concluded,it would be premature to endorse these drugs for widespread use before the ongoing randomized trials, appropriately powered for primary end-point analysis and safety assessment, are available. After an FDA advisory committee recommended approval of aliromucab and another PCSK9 inhibitor in June, 2015, John Mandrola entitled a Medscape article,Dear FDA: Resist the Urge on PCSK9 DrugsHis reasons included lack o...
Source: Health Care Renewal - August 5, 2015 Category: Health Management Tags: aliromucab evidence-based medicine health care prices manipulating clinical research PCSK9 inhibitor Praluent Regeneron Sanofi-Aventis Source Type: blogs

Research and Reviews in the Fastlane 077
This article sheds some light on the issue. In this study of ICU patients in Australia and New Zealand, the standard SIRS criteria missed 1 in 8 patients who went on to severe sepsis. These results call into question the reliability of the SIRS criteria.Recommended by: Anand SwaminathanThe R&R iconoclastic sneak peek icon keyThe list of contributorsThe R&R ARCHIVER&R Hall of famer You simply MUST READ this!R&R Hot stuff! Everyone’s going to be talking about thisR&R Landmark paper A paper that made a differenceR&R Game Changer? Might change your clinical practiceR&R Eureka! Revolutionary i...
Source: Life in the Fast Lane - April 2, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology Emergency Medicine Haematology Immunology Infectious Disease Intensive Care R&R in the FASTLANE critical care Education literature recommendations research and reviews Source Type: blogs

Amiodarone and thyroid dysfunction
Brief Review Amiodarone is one of the most widely used anti arrhythmic drug. It is well known that amiodarone can induce both hypothyroidism and hyperthyroidism due to the iodine content of the drug. 200 milligrams of amiodarone daily would deliver twenty to forty times the usual daily iodine intake. Amiodarone reduces 5-deiodinase activity and thereby the monodeiodination of T4 to T3. There is decreased generation of T3 and reduced clearance of rT3 (reverse T3), which accumulates. Destructive thyroiditis is due to the direct toxic effect of amiodarone and its metabolite on the thyroid follicular cells.1 It has been menti...
Source: Cardiophile MD - December 21, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs

Cardiology MCQ: Hypothermia for post op arrhythmia
Hypothermia for post op arrhythmia is used in case of: a) Complete heart block b) Atrial fibrillation c) Junctional ectopic tachycardia d) None of the above Correct answer: c) Junctional ectopic tachycardia Hypothermia for post op arrhythmia is used in case of junctional ectopic tachycardia (JET). JET is a unique postoperative arrhythmia, especially seen in children after surgery for congenital heart disease and it is often difficult to treat. It is likely to recur after cardioversion as it is due to enhanced automaticity. Sedation and cooling (hypothermia) are helpful. Postoperative cardiac arrhythmias are a major cause o...
Source: Cardiophile MD - November 23, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance ECG / Electrophysiology Source Type: blogs

Research and Reviews in the Fastlane 051
Welcome to the 51st edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature. This edition contains 10 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check out...
Source: Life in the Fast Lane - October 6, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Cardiology Education Emergency Medicine Gastroenterology Infectious Disease Intensive Care Pre-hospital / Retrieval Respiratory Resuscitation critical care literature R&R in the FASTLANE recommendations Research an Source Type: blogs

Pulmonary edema due to beta agonist used as tocolytic
Beta agonist given as a tocolytic to prevent premature labour can rarely (thought to be one in four hundred) cause pulmonary edema. Pulmonary edema with use of beta agonist as tocolytic can occur with both oral and intravenous therapy and may occur within twenty four hours of discontinuation of therapy. Mechanism of pulmonary edema with beta agonist used as tocolytic seems to be unique to the pregnant state as even large doses of beta agonists in non pregnant females with asthma seldom produce pulmonary edema. Hypervolemia of pregnancy and excess fluid given during infusion of tocolytic have been implicated in the pathogen...
Source: Cardiophile MD - July 26, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology ADH anti-diuretic hormone Pulmonary edema due to beta agonist renin-angiotensin system Source Type: blogs

How Manipulated Clinical Evidence Could Distort Guidelines - the Case of Statins for Primary Prevention
This study excluded many patient for whom the statins were not contraindicated or warned against: uncontrolled hypertension; type 1 or type 2 diabetes mellitus on insulin or with a HgBA1C at least 10%; and body weight more than 50% "desirable limit for height."  (Based on the official contraindications and warnings for commonly used statins, e.g., see contraindications for Lipitor here, active liver disease, pregnancy for likely to become pregnant, nursing mothers, hypersensitivity to the medicine; and warnings: use of cyclosprine or strong CYP3A4 inhibitors, uncontrolled hypothyroidism, renal impairment.)  Thus ...
Source: Health Care Renewal - December 3, 2013 Category: Health Medicine and Bioethics Commentators Tags: American College of Cardiology American Heart Association clinical trials conflicts of interest evidence-based medicine guidelines manipulating clinical research review articles Source Type: blogs

Breakthroughs in Research and Clinical Practice Helping Patients
Pharmaceutical and medical device companies make significant breakthroughs in research to develop innovative treatments and technologies that have prolonged the lives of millions of Americans and made millions more live healthier, pain free lives.  Consequently, several recent articles have underscored the critical contributions such companies and their products have had on in several disease areas including Crohn’s disease, hypertension, and cholesterol.  Crohn’s Disease  A recent article from Med Page Today reported that “Patients with treatment-refractory Crohn's disease obtained long-term improvement when tr...
Source: Policy and Medicine - January 11, 2013 Category: Health Medicine and Bioethics Commentators Authors: Thomas Sullivan Source Type: blogs