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Nem Dec 09


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Presentation at CME program organized by Bangladesh Academy of Family Physicians (BAFP) in December 2009

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Nem Dec 09

  1. 2. DR. G. C. DHAR. MD, DTM&H, MCFP (Canada) N E W I N M E D I C I N E ?
  2. 3. N O : 1
  3. 5. When to prescribe low dose aspirin in HTN? <ul><li>After breakfast? </li></ul><ul><li>After lunch? </li></ul><ul><li>After dinner? </li></ul>
  4. 6. Associated with significant reduction in blood pressure Aspirin used after dinner is
  5. 7. No effect on blood pressure When used with breakfast
  6. 8. Low dose aspirin in hypertension <ul><li>Research shows: </li></ul><ul><li>24 hours plasma renin level and urinary excretion of cortisol, dopamine and norepinephrine is greatly reduced when aspirin used at night, but no such action found when aspirin used in the morning. </li></ul><ul><li>Ref: Hypertension. 2009 Nov;54(5):1136-42. Epub 2009 Oct 5. </li></ul>
  7. 9. N O : 2
  8. 10. Urinary incontinence in post-menopausal women
  9. 11. Post-menopausal urinary incontinence. Estrogen deficiency is one of the reasons of
  10. 12. Prescription of estrogen / HRT May be considered BUT HOW?
  11. 13. HRT <ul><li>As systemic therapy should not be used as it can do the situation worse. </li></ul><ul><li>Local vaginal cream 0.5gm oestriol once daily for 2-3 weeks and then twice weekly for 3-4 months can completely cure the situation. </li></ul><ul><li>Should not be used if the patient is diabetic , or suffer from any form of cardiovascular disease or cancer . </li></ul>
  12. 14. Stop HRT immediately if patient <ul><li>Develops jaundice </li></ul><ul><li>Sudden increase of blood pressure. </li></ul><ul><li>New attack of migraine. </li></ul><ul><li>Ref: Cochrane Database Syst Rev. 2009 Oct 7;(4):CD001405. </li></ul>
  13. 15. N O : 3
  14. 18. How long to continue dual- anti-platelet therapy after PCI with DES <ul><li>More than 12 months up to 24 months. </li></ul><ul><li>WHY? </li></ul><ul><li>Risk of stent thrombosis after DES (sirolimus, paclitaxel) starts after 12 months due to growth of neointima (scar tissue) </li></ul><ul><li>Ref: amjcard. Nov 2009. </li></ul>
  15. 19. N O : 4
  16. 20. B A C T E R I A
  17. 21. C O - T R I M O X A Z O L E
  18. 22. Co-trimoxazole may induce severe hypoglycemia <ul><li>Be careful to prescribe co-trimoxazole in patients under anti-diabetic agents </li></ul><ul><li>Or </li></ul><ul><li>In non diabetic patients with renal impairment. </li></ul><ul><li>Co-trimoxazol leads to hypoglycemia due to its SU like effect. </li></ul>
  19. 23. Before prescription of co-trimoxazole <ul><li>For non diabetics, check for renal impairment, if found, avoid it. </li></ul><ul><li>Do not prescribe co-trimoxazole in diabetics under anti-diabetic agents. </li></ul><ul><li>Ref:The Lancet Infectious Diseases, Volume 6, Issue 3 , Pages 178 - 182, March 2006. </li></ul>
  20. 24. N O : 5
  21. 25. C O R T I C O S T E R O I D S A n t i-T N F M T X
  22. 27. HB status should be checked before starting of therapy <ul><li>WHY? </li></ul><ul><li>Reactivation of HBV can occur during therapy and may be fatal. </li></ul><ul><li>If found positive prophylactic antiviral therapy should be started before starting chemotherapy, immunosuppressive or long term corticosteroids and should be continued at least 6 months after completion of therapy. </li></ul>