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Nem Nov 08


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Presentation at CME program organized by Bangladesh Academy of Family Physicians (BAFP) in November 2008

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Nem Nov 08

  1. 1. W H A T I S N E W I N M E D I C I N E ?
  2. 2. DR. G. C. DHAR. NOVEMBER 2008
  3. 3. T H I N K A B O U T F L U R O Q U I N O L O N E S !
  4. 4. . FDA “BLACK BOX” WARNING TO FLUROQUINOLONES <ul><li>From November 1997 through December 2007, there have been 407 reported cases of tendon rupture and 341 cases of tendinitis in patients using fluoroquinolones. </li></ul><ul><li>Actual number may be much higher. </li></ul>
  5. 5. FDA “BLACK BOX” WARNING TO FLUROQUINOLONES <ul><li>Most common rupture was of the Achilles tendon. </li></ul><ul><li>High Risk Patients: </li></ul><ul><li>Patients over 60 years of age. </li></ul><ul><li>-Patients who had received kidney, heart, or lung transplants </li></ul><ul><li>-Patients taking steroid treatment. </li></ul>
  6. 6. FDA “BLACK BOX” WARNING TO FLUROQUINOLONES <ul><li>PRACTICE SUGGESTION: </li></ul><ul><li>In case of tendon pain, drug must be stopped. </li></ul><ul><li>The warnings apply to tablets, capsules, and injectable formulations for systemic use. </li></ul><ul><li>not to ophthalmic or otic formulations </li></ul>
  7. 7. FDA “BLACK BOX” WARNING TO FLUROQUINOLONES REF: Published 15 July 2008, doi:10.1136/bmj.a816
  8. 8. Azithromycin eye drop <ul><li>Topical therapy with azithromycin 1.5% administered only twice daily for 3 days effectively eradicates most pathogenic bacteria associated with bacterial conjunctivitis. </li></ul><ul><li>This new anti-infective product has the advantage of a short treatment course which could lead to an improvement in patient compliance. </li></ul>
  9. 9. Azithromycin eye drop <ul><li>Ref: PMID: 18988154 [PubMed - in process] </li></ul><ul><li>Eur J Ophthalmol. 2008 Nov-Dec;18(6):858-68. </li></ul>
  11. 11. Sleep duration and CV Risk in HTN <ul><li>Short sleep duration (<7.5 hrs) is an independent predictor of Cardiovascular events in patients with hypertension. </li></ul><ul><li>Physicians should inquire about sleep duration in the risk assessment of patients with hypertension. </li></ul><ul><li>Ref: Arch Intern Med. 2008;168(20):2225-2231. </li></ul>
  13. 13. R A A S
  14. 14. NEW ANTI-HYPERTENSIVE! <ul><li>Aliskiren approved by FDA in March 2007. </li></ul><ul><li>Highly effective in Diabetic Nephropathy. </li></ul><ul><li>When used along with Losartan, ACR is decreased by >50% in comparison to Losartan alone. </li></ul><ul><li>Available in 150mg & 300mg in tablet form. </li></ul><ul><li>Ref: N Engl J Med 2008 6;358(23):2433-46 </li></ul>
  15. 15. hs-CRP ?
  16. 16. A Simple Blood Test hs-CRP <ul><li>High level of hs-CRP is a useful marker for cardiovascular disease and predict heart attack and stroke. </li></ul><ul><li>Lowering hs-CRP irrespective of other cardiovascular markers e.g. dyslipidemia effectively reduces risk of cardiovascular outcomes. </li></ul><ul><li>Ref: NIH (14 th November 2008) </li></ul>
  17. 17. M I X E D D Y S L I P I D E M I A ? H O W T O M A N A G E ?
  18. 18. Total Cholesterol: 289mg/dl. HDL-C: 32mg/dl LDL-C: 209mg/dl TG: 386mg/dl.
  19. 19. MIXED DYSLIPIDEMIA <ul><li>Long-term fenofibric acid + statin combination therapy is generally well tolerated and resulted in comprehensive and sustained improvements in multiple lipid parameters in adults with mixed dyslipidemia. </li></ul><ul><li>Ref:Journal of Clinical Lipidology; 14 Nov 2008. </li></ul>
  21. 21. Statins Reduce Death Risks from Pneumonia
  22. 22. Statin and prognosis of pneumonia <ul><li>Eight year long study in Denmark on adult population hospitalized due to pneumonia, a significant reduction in death rate found in patients who were under prior statin therapy. </li></ul><ul><li>Ref: Arch Intern Med (Oct 2008) 168: 2081-2087. </li></ul>
  23. 23. Statin in infection <ul><li>Statins have diverse immunomodulatory and antiinflammatory properties independent of their lipid-lowering ability. </li></ul><ul><li>Statins offer good prognosis along with antibiotics in patients suffering from sepsis specially in patients with diabetes mellitus, those with malignancy, and those receiving steroid. </li></ul>d.
  24. 24. Statin in infection <ul><li>Researches now under way to use statin along with antibiotics in acute and persistent infection. </li></ul><ul><li>How statins act on infection? </li></ul><ul><li>Statins reduce G-protein mediated inflammation and infection. </li></ul><ul><li>Ref: Br J Anaesth. 2008 Jun;100(6):862. No abstract available. </li></ul><ul><li>PMID: 18483119 [PubMed - indexed for MEDLINE]. </li></ul>
  25. 25. P H O T O Q U I Z
  26. 26. 29 year old man came to you for employment physical examination. <ul><li>BMI: 39kg/M2 </li></ul><ul><li>FBG: 177mg/dl </li></ul><ul><li>Lipid Profile: TC: 154mg/dl; HDL-C: 31mg/dl; LDL-C: 69mg/dl; TG: 271mg/dl. </li></ul>
  27. 29. W H A T I S Y O U R D I A G N O S I S ?
  28. 30. skin findings reveal acanthosis nigricans, a sign of insulin resistance syndrome. Dx: Type 2 DM with dyslipidemia .
  29. 31. T H A N K S !