GIT J club endoscopy dec 2014.
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Several randomized controlled trials and meta-analyses demonstrate that rectally administered nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce the risk of post-endoscopic retrograde cholangiopancreatography (PEP) by around 50% and also decrease the severity of PEP in both high-risk and average-risk patients. The European Society of Gastrointestinal Endoscopy recommends rectal NSAIDs as a grade A recommendation for nearly all ERCP patients to help prevent PEP. While rectal NSAID use has increased in clinical practice, some healthcare providers and patients are uncomfortable with the rectal administration method.
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This document summarizes key aspects of anaesthesia for elective neurosurgery. It discusses the importance of maintaining optimal cerebral perfusion pressure and oxygenation. While volatile agents remain popular, studies have found propofol and sevoflurane to be suitable options. Propofol may help reduce intracranial pressure and cerebral blood volume compared to other agents. Awake craniotomy techniques are gaining popularity for removal of brain lesions near eloquent areas to allow for neurological monitoring during the procedure. Advances in minimally invasive techniques continue to offer benefits like reduced trauma and faster recovery times.
Austria 1652011
The document discusses the role of clinical pharmacists in pediatric oncology in Egypt. It describes the clinical pharmacy program that has been implemented across several hospitals in Egypt. The program provides comprehensive pharmaceutical services including IV preparation, dispensing, patient education and monitoring. Statistics on pharmacy activities and services provided are presented. The challenges faced and the positive impact of clinical pharmacy services on outcomes such as mortality, costs and medication errors are highlighted.
Contrast Simulation Study material 20150509.ppt
This document provides guidelines for contrast reactions and their management from the American College of Radiology (ACR). It discusses various types of intravenous contrast media and their risks. Adverse reactions can range from mild to severe/life-threatening and include contrast-induced nephrotoxicity and nephrogenic systemic fibrosis. The document outlines Boston Medical Center's premedication regime using steroids and antihistamines to reduce reaction risk. It also provides guidance on assessing and treating acute contrast reactions according to their severity per ACR guidelines.
Acute+kidney+injury+ +final+version+(08+march+2011)+
This document provides clinical practice guidelines for acute kidney injury (AKI) from the UK Renal Association. It summarizes the definition and staging systems for AKI from ADQI, AKIN and KDIGO to standardize classification. AKI has significant prevalence in hospitalized patients and poor outcomes, with mortality ranging from 10-80% depending on severity and presence of multiorgan failure. Prevention and early recognition of AKI is important. The guidelines cover areas like assessment, prevention, management, renal replacement therapy modalities and prescriptions, and timing of treatment. Improving education of healthcare professionals about AKI is emphasized.
Ponv
Postoperative nausea and vomiting (PONV) is a common issue, affecting approximately 35% of patients. It can decrease patient satisfaction and potentially increase recovery time. Several risk factors are identified, including female sex, history of motion sickness, nonsmoking status, and opioid use. Guidelines recommend stratifying patients into low, moderate, and high risk to guide appropriate prophylaxis and treatment. Common prophylactic medications include 5-HT3 antagonists, dexamethasone, droperidol, and anticholinergics. For high risk patients, combination therapy is more effective than single agents. Treatment focuses on 5-HT3 antagonists like ondansetron if prophylaxis fails. Multimodal prevent
REMS
The document summarizes the history and requirements of Risk Evaluation and Mitigation Strategy (REMS) programs mandated by the FDA for certain drugs. It focuses on the use of erythropoiesis-stimulating agents (ESAs) in cancer patients. Several meta-analyses found ESAs increased risks of thrombosis, mortality, and decreased survival. The FDA Oncologic Drugs Advisory Committee reviewed these findings and required boxed warnings be added to ESAs about increased risks. The committee later recommended limiting ESA use to palliative patients only after receiving informed consent due to further trials showing adverse outcomes. As of 2010, over 150 drugs had FDA-mandated REMS programs including required medication guides for almost all drugs.
Ards goals
The document provides a review of therapeutic strategies for acute lung injury and acute respiratory distress syndrome (ARDS) based on published evidence and guidelines. It summarizes definitions of severe ARDS, initial evaluation and interventions including low tidal volume ventilation and conservative fluid management. Further strategies discussed include recruitment maneuvers, high positive end-expiratory pressure, prone positioning, high-frequency oscillatory ventilation, inhaled nitric oxide, glucocorticoids, and extracorporeal life support. Recommendations are provided for each strategy based on risks, benefits, and evidence from clinical trials.
2015 ESC Guidelines on Infective Endocarditis ppt. by Dr Abhishek Rathore MD
The document summarizes guidelines for the management of infective endocarditis (IE). It recommends an endocarditis team approach in a reference center for complicated IE cases. It emphasizes the importance of early diagnosis, antibiotic therapy, and consideration of early surgery. It also discusses new recommendations for specific IE situations, antibiotic prophylaxis, surgical management, and the roles of imaging and multidisciplinary care in IE management.
escpe1-191229130329.pptx
This document provides an overview of the key changes and recommendations in the 2019 guidelines for pulmonary embolism (PE). Some of the major updates include: revised criteria for diagnosing PE using D-dimer tests and imaging; a new definition of high-risk PE and assessment of severity; and preference for non-vitamin K antagonist oral anticoagulants as first-line treatment in eligible patients. The guidelines also provide new algorithms for diagnosing and managing PE in pregnancy and long-term follow-up care after PE.
2019 ESC guidelines on pulmonary embolism
The document provides an overview of the updates in the 2019 guidelines for pulmonary embolism (PE) diagnosis and treatment. Key changes include adjusted D-dimer cut-off values based on age and probability; revised algorithms for diagnosing high-risk PE and assessing severity; recommending non-vitamin K antagonist oral anticoagulants as first-line treatment for eligible patients; classifying recurrence risk factors and extending treatment duration indications; and proposing a comprehensive post-PE patient follow-up algorithm. The guidelines aim to improve PE risk stratification, optimize acute care, determine chronic anticoagulation regimens, and ensure long-term management and surveillance for complications.
MCO 2011 - Slide 19 - M. Aapro - Spotlight session - EORTC G-CSF Guidelines -...
MCO 2011 - Slide 19 - M. Aapro - Spotlight session - EORTC G-CSF Guidelines -...European School of Oncology
The document summarizes updates to EORTC guidelines for the use of granulocyte colony-stimulating factor (G-CSF) to prevent febrile neutropenia from chemotherapy. The 2010 guidelines included 6 recommendations. Key changes were incorporating new risk assessment models and data on pegylated G-CSF and biosimilars. The guidelines emphasize using G-CSF prophylactically based on individual patient and treatment risk factors rather than reactively once neutropenia occurs. Suboptimal G-CSF use is associated with worse outcomes.Peritoneal Dialysis
Peritoneal dialysis is a way to remove waste products from your blood when your kidneys can no longer do the job adequately.
A cleansing fluid flows through a tube (catheter) into part of your abdomen and filters waste products from your blood. After a prescribed period of time, the fluid with filtered waste products flows out of your abdomen and is discarded.
Peritoneal dialysis differs from hemodialysis, a more commonly used blood-filtering procedure. With peritoneal dialysis, you can give yourself treatments at home, at work or while traveling.
Peritoneal Dialysis
Peritoneal dialysis is a way to remove waste products from your blood when your kidneys can no longer do the job adequately.
A cleansing fluid flows through a tube (catheter) into part of your abdomen and filters waste products from your blood. After a prescribed period of time, the fluid with filtered waste products flows out of your abdomen and is discarded.
Peritoneal dialysis differs from hemodialysis, a more commonly used blood-filtering procedure. With peritoneal dialysis, you can give yourself treatments at home, at work or while traveling.
Thesis_PhD_Improving medication safety in the elderly
The document discusses medication safety issues for elderly patients, noting that physiological changes with aging increase their risk of adverse drug reactions and interactions from polypharmacy. Polypharmacy, defined as using multiple medications, is common in elderly patients due to multiple chronic conditions but can increase problems with adherence and side effects. Improving medication safety for elderly patients requires addressing polypharmacy issues through individualized treatment reviews that consider life expectancy, treatment goals and targets.
Effetti a lungo termine dell'associazione a dose fissa di latanoprost e timol...
This prospective study observed 2339 patients with glaucoma or ocular hypertension who were switched to latanoprost/timolol fixed combination therapy for at least 18 months. The primary reasons for switching were inadequate intraocular pressure (IOP) reduction and desire for once-daily dosing. IOP was effectively reduced and maintained over 24 months. Optic disc and visual field assessments showed stability. Physicians rated the fixed combination as effective, well-tolerated, and that patients were compliant with the treatment regimen.
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Prof. a. el sebaeii.fluid management in patients with aki
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Anaesthesia for elective neurosurgery journal (zuhura)
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Acute+kidney+injury+ +final+version+(08+march+2011)+
Acute+kidney+injury+ +final+version+(08+march+2011)+
2015 ESC Guidelines on Infective Endocarditis ppt. by Dr Abhishek Rathore MD
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Git j club fiber in git20
Dietary fiber from whole foods like grains, legumes, vegetables, and fruits has demonstrated benefits for gastrointestinal (GIT) health. Isolated and extracted fibers also show promising regulatory effects on the gut and microbiome. However, fibers have varying physicochemical properties depending on their origin and processing that influence their functional characteristics and clinical applications. More research is needed, including well-designed randomized controlled trials, to determine which fiber sources, characteristics, doses and durations optimize GIT health benefits and manage gastrointestinal disorders. Combining fibers with different physiological effects may be a promising therapeutic strategy.
Med j club mm covid20
- Coronaviruses typically cause common colds but SARS-CoV and MERS-CoV can cause pneumonia, respiratory failure, and death. A novel coronavirus, SARS-CoV-2, emerged in Wuhan, China in late 2019 and caused a global pandemic.
- SARS-CoV-2 spreads mainly through respiratory droplets when people cough, sneeze or talk within 6 feet of each other. Asymptomatic and pre-symptomatic people are highly infectious.
- COVID-19 symptoms range from mild to critical illness. The elderly and those with pre-existing conditions are at higher risk for severe disease. Diagnosis involves PCR testing of respiratory samples.
GIT J Club IBD- sexual dysfunction20.
- Sexual dysfunction and infertility are more prevalent in men with IBD compared to the general population.
- Depression is the most consistent negative predictive factor of sexual function among men with IBD.
- Sulfasalazine can reversibly reduce male fertility, so it is recommended to discontinue 3-4 months prior to conception. Most other IBD medications do not significantly impact fertility.
- Men with IBD have an increased risk of prostate cancer and prostate cancer screening guidelines for higher risk patients should be followed.
GIT J Club IBD- pregnancy2020
The document summarizes a consensus clinical care pathway for women with inflammatory bowel disease (IBD) who are considering pregnancy or are pregnant. The pathway was created by an expert multidisciplinary team representing multiple societies to provide standardized, evidence-based recommendations for gastroenterology and obstetric providers to ensure healthy pregnancies for women with IBD. It addresses the lack of consistent advice available previously by compiling available data on therapeutic options for IBD that have increased over the last 15 years and putting them into an easily accessible format for clinical practice.
Med 5th geriatrics20
This document provides an overview of geriatrics and common issues in caring for elderly patients. It discusses how biological age is more important than chronological age in clinical decision making. Frailty and disability are also addressed. Common geriatric problems like falls, delirium, incontinence and adverse drug reactions are examined in terms of presentation, evaluation, and management strategies. The importance of a comprehensive assessment, considering multiple comorbidities and functional status, is emphasized in developing treatment plans for elderly patients.
GIT 4th abd wall pain
Here are the answers to the CME questions:
1. b
2. e
3. a
4. b
5. d
6. b
7. Inguinal hernias
8. E
GIT 4th endoscopy indications20
Upper and lower GI endoscopies have diagnostic, therapeutic, and screening indications. For upper endoscopy, common diagnostic indications include dyspepsia in patients over age 60 or with red flags, upper GI bleeding, and dysphagia. Therapeutic uses include treatment of bleeding, removal of foreign bodies, dilation of strictures, and stenting. Screening is done for portal hypertension, Barrett's esophagus, eosinophilic esophagitis, and cancers. Lower endoscopy indications involve diagnostic evaluation of bleeding, abdominal pain, diarrhea, and screening of average-risk adults over 50 and high-risk groups. Therapeutic colonoscopy is used for polypectomy, bleeding treatment, and stricture dilation
GIT J Club from UEG Week 2018.
Dr. Hiwa Abubakir and Dr. Mohamed Alshekhani discuss the management of nonvariceal gastrointestinal bleeding. They recommend endoscopy within 24 hours, or earlier for high-risk patients, to identify and treat the bleeding source. A variety of endoscopic tools can be used for hemostasis, including injection of adrenaline combined with clips, bands, electrocautery, or laser coagulation. Newer tools like over-the-scope clips are best for high-risk or recurrent bleeders. Doppler probes help ensure complete vessel occlusion. Additional prothrombotic agents or interventions may be needed in some cases.
Med j club dm antithrombosis19
The document discusses antithrombotic strategies for patients with diabetes who are at risk of cardiovascular events. It proposes strategies for primary prevention, stable coronary artery disease, acute coronary syndromes, ischemic stroke, peripheral artery disease, atrial fibrillation, and venous thromboembolism. More aggressive antithrombotic therapies are associated with greater reduction in recurrent cardiovascular events for patients with diabetes. However, these strategies must be weighed against the risk of bleeding. Further clinical trials are still needed to better understand optimal antithrombotic treatment for cardiovascular patients with diabetes.
Git 4th GC18.
1) Gastric carcinoma is the third leading cause of cancer death worldwide, with highest incidence in East Asia and parts of South America.
2) Risk factors include H. pylori infection, smoking, diet high in salted/preserved foods, and family history of gastric cancer.
3) Early detection through endoscopy in dyspeptic patients over 50 years old or with red flags can improve outcomes, as resection allows for potential cure in early gastric cancer confined to mucosa or submucosa.
GIT J Club IBS NEJM17.
This document summarizes guidelines for the diagnosis and management of irritable bowel syndrome (IBS). It defines IBS and its subtypes based on the Rome IV criteria. It recommends diagnosing IBS based on symptoms in the absence of alarm features or abnormal test results. Limited testing like fecal calprotectin can help distinguish IBS from inflammatory bowel disease. Treatment involves dietary changes, probiotics, antispasmodics, antidepressants, and targeted therapies depending on IBS subtype and predominant symptoms. For refractory cases, a multidisciplinary approach including psychological support may help manage persistent symptoms.
GIT 4th indication for upper GI endoscopy.
Upper gastrointestinal endoscopy has diagnostic, therapeutic, and screening indications. Diagnostically, it is used to detect diseases causing dyspepsia like gastric cancer, investigate upper GI bleeding, diagnose dysphagia, remove foreign bodies, assess GERD, detect esophageal varices, and diagnose celiac disease. Therapeutically, it treats upper GI bleeding, removes foreign bodies, dilates strictures, treats achalasia, places stents, treats GERD, eradicates Barrett's esophagus, inserts feeding tubes, and performs bariatric procedures. Screening indications include detecting Barrett's esophagus, portal hypertension, and cancers of the esophagus and stomach in high-risk patients
GIT Cholestatic AI HBD 17
The document discusses various autoimmune and cholestatic liver diseases including primary biliary cholangitis, primary sclerosing cholangitis, and intrahepatic cholestasis of pregnancy. It provides details on the epidemiology, clinical features, diagnosis, and management of these conditions. It also includes several multiple choice questions to test understanding of topics covered in the document.
GiIT 4th CRC 2017.
- Screening and surveillance are recommended for CRC starting at age 50 to detect and remove precancerous polyps through colonoscopy.
Git j club colonoscopy mistakes.
1. The document outlines 19 potential mistakes that can occur during colonoscopy procedures. These include doing colonoscopies without proper indications or patient evaluation, failing to adequately prepare the colon, misdiagnosing conditions like ulcerative colitis or hemorrhoids, not performing important parts of the exam like ileal intubation or biopsies, and not adhering to quality standards. Addressing these issues can help improve safety, accuracy of diagnoses, and overall quality of colonoscopy.
GIT 4th ibd 2017
This document provides an overview of inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease. It discusses risk factors, clinical manifestations, diagnostic testing, and treatment approaches. The main points are:
- IBD is characterized by idiopathic inflammation of the gastrointestinal tract. The two main types are ulcerative colitis and Crohn's disease.
- Genetic and environmental factors contribute to risk. Smoking increases risk for Crohn's but decreases risk for ulcerative colitis.
- Symptoms vary based on disease location but may include abdominal pain, diarrhea, bleeding, weight loss, and nutritional deficiencies. Extraintestinal manifestations are more common with Crohn's.
GIT 4th IBS 2017
This document provides information on irritable bowel syndrome (IBS), including its definition, diagnostic criteria, subtypes, differential diagnosis, evaluation, and management approaches. Some key points:
- IBS is a common functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits. It affects 10-15% of the population.
- Diagnosis is based on fulfilling the Rome symptom criteria, with subtyping based on predominant stool pattern. Additional testing is usually not needed in absence of alarm features.
- Treatment involves reassurance, dietary modifications, antispasmodics, laxatives/antidiarrheals based on subtype, and tricyclic antidepressants/SSRIs for refractory cases.
Ppi seminar hiwa.
This document discusses the classical and long-term indications for PPI use, including GERD, Barrett's esophagus, use with NSAIDs, use with anti-platelets, and non-ulcer dyspepsia. For GERD, guidelines recommend daily PPI for erosive esophagitis but intermittent PPI courses may be sufficient for many patients. For Barrett's esophagus, the absolute cancer risk reduction with daily PPI is low. For NSAID and anti-platelet users at high risk of bleeding, the benefits of daily PPI are well documented. Intermittent PPI courses are often sufficient for non-ulcer dyspepsia, though some patients may require long-
Ppi symposium araz.
This document discusses potential long-term side effects of PPI use including increased risk of dementia, chronic kidney disease, and fractures. It notes that the evidence for associations between PPI use and these conditions is not conclusive. The document advises using the lowest effective dose of PPIs for indicated conditions and avoiding long-term daily use when possible. It also stresses the importance of only prescribing PPIs for appropriate indications and discontinuing them when no clear benefit exists.
Ppi symposium muhsin
The document summarizes short-term side effects of PPIs (proton pump inhibitors), which are generally well tolerated. The most common side effects are headache, diarrhea, abdominal pain and nausea. Diarrhea appears to be related to acid suppression and the overall incidence is less than 5%, though it may be dosage and age related. PPIs are considered safe for short-term use and have similar safety profiles to H2 blockers. PPIs should be used cautiously in patients with liver disease.
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GIT J club endoscopy dec 2014.
- 33. Eight RCTs &several meta-analyses demonstrated that rectal (NSAIDs) reduce the risk of (PEP) by about 50%. Rectal indomethacin/ diclofenac also reduce the severity of PEP, effective in both high& average-risk cases It is grade A recommendation by the European Society of GIE for almost all patients undergoing ERCP. Although the uptake in clinical practice has been rapid & widespread, there does appear to be some apprehension surrounding the rectal mode of administration.
- 34. Rectal administration is unappealing to some healthcare providers &may be undesirable to certain patients. NSAID suppositories are not available on many hospitals, challenging to obtain& marginally more expensive than their parenteral counterparts. Based on available RCT data, only rectal indomethacin or diclofenac should be prescribed for PEP prevention, as recommended by existing guidelines