WHAT IS NEW IN MEDICINE TODAY? Bangladesh Academy of Family Physicians organizes continuing medical education (CME) program last Friday of each month during 9AM to 12 noon. Part of this CME program is a 15-20 minutes presentation on "What is new in medicine today?" This presentation is prepared and presented exclusively by me. To prepare this presentation I need to go through number of journals, recently released guidelines etc., collect specific information regarding newest researches and present.

3. Nephrolithiasis-new ACP guideline
Nov 4, 2014
Dietary and Pharmacologic Management to
Prevent Recurrent Nephrolithiasis in
Adults: A Clinical Practice Guideline From
the American College of Physicians
Ref: Ann Intern Med. 2014;161(9):659-667. doi:10.7326/M13-
2908

5. No:1
Increased fluid intake spread throughout the day to achieve
at least 2 L of urine per day to prevent recurrent
nephrolithiasis
No:2
Pharmacologic monotherapy with a thiazide diuretic or
allopurinol to prevent recurrent nephrolithiasis in
patients with active disease in which increased fluid
intake fails to reduce the formation of stones
No:3
Patients should also be encouraged to avoid colas, which
are acidified with phosphoric acid. The recommendation
does not apply to fruit-flavored soft drinks, which are
often acidified with citric acid

6. Co-trimoxazole & SCD
Co-trimoxazole and sudden death in patients
receiving inhibitors of renin-angiotensin
system: population based study
Ref: Co-trimoxazole and sudden death in patients receiving inhibitors of renin-
angiotensin system: population based study . BMJ 2014;349:g6196 , October 30,
2014

7. - Study in Ontario, Canada
- From 1 April 1994 to 1 January
2012
- Age >66yrs. On either ACEI or
ARB
- 3 in 1000 patients died from SCD in
7 to 14 days of starting co-
trimoxazole

8. Cause of death
Severe hyperkalemia

9. High risk for coronary artery disease
(CAD) in metabolic syndrome
Low serum bilirubin

10. Low serum bilirubin (≤ 0.32mg/dl) should be
counted as risk factor for coronary artery
disease in patients with metabolic syndrome
Ref: Effect of Low Serum Total Bilirubin Levels (</=0.32 mg/dl)
on Risk of Coronary Artery Disease in Patients With Metabolic Syndrome.
Am J Cardiol. 2014 Sep 16.

11. Metformin in hypothyroidism
Ref: Metformin and low levels of thyroid-stimulating
hormone in patients with type 2 diabetes mellitus.
CMAJ October 21, 2014

12. Patients treated by levothyroxine for
hypothyroidism, concomitant use of
metformin leads to 55% increased risk of
low TSH level
Concomitant use of metformin and
levothyroxine requires frequent follow up of
thyroid hormones and dose adjustment

13. November 15 – 19 2014
American Heart Association
Scientific Session Chicago
2014

14. IMPROVE-IT (IMProved Reduction of
Outcomes: Vytorin Efficacy International
Trial)
N = 18000
Duration = 7-yrs

15. Statin along with ezetimibe leads to
greatest LDL lowering efficacy in
comparison to statin alone.

16. How low LDL should be?
As low as possible