medical conditions

Paget's disease: excessive osteoclastic-mixed osteoclastic-osteoblastic activity. ? a/w paramyxovirus eleated ALP with normal Ca, Po4, aminotransferase. Elderly patient, bone scan. Abnormal bone architecture. normal PTH <1% osteosarcoma.

Treatment: bisphosphonates (risderonic, alendronic, pamidronic acids), calcitonin , vitamin D, exercise.

Osteoporosis: normal calcium, phosphate, variable ALP, PTH unaffected, decreased bone mass.

abnormal PTH: osteomalacia/rickets, osteitis fibrosa cystica

Gullain Barre: AIDP acute INFLAMMATORY demyelinating polyneuropathy. ascending paralysis, autonomic dysfunction. CSF: elevated protein (10-1000mg/dL) , no increased cell count. intubation if VC 20ml/kg NIF <-25cmH20, more than 30% decrease in either VC of NIF within 24 hours

diagnosis: nerve conduction studies

Treatment: IVIG/ plasmapheresis, supportive care.

antidepressants

TCA
Tetracyclic antidepressant (NaSSA, noradrenergic and selective serotoninergic antidepressant) - mirtazapine (remeron)-15mg helps sleep,3omg doesn't. helps with appetite.
mirtazepine can interact with warfarin - less arrhythmias than TCAs

SSRI: escitalopram, fluoxetine, fluvoxamine, sertraline
(inhibits reuptake of serotonin, increase serotonin concentration)

SNRI: Venlafaxine (effexor), duloxetine (cymbalta)

tramadol -interaction with warfarin

reduction of 2,3 DPG concentration is minimised/reduced by

addition of

-TRUE phosphate, glucose, adenosine

-FALSE mannitol, pyruvate

PDPH

PDPH

http://www.acep.org/content.aspx?id=32526

frontal headache that can become generalised, can radiate to interscapular region
visual changes, cranial nerve palsy, tinnitus, photophobia
worsened by movements that increase ICP (coughing,sneezing)
worse on sitting up
Gutshe sign: firm manual p on abdomen: temporary relieve

increased risk:
female, pregnancy, pre existing headache,

small gauge, higher number- a/w less headache and hearing loss
size of needle, placement of tip, orientation of bevel (longitudinal orientation- lower risk)

cutting : quincke
pencil: whitacre, sprotte, -lower incidence of PDPH
pencil point: more trauma, more inflammation, promote healing?
- but need operator expertise

cutting 36% (22G Quincke), 3-25% (25G Quincke), whitacre 3%- randomised trial
16G tuohy 70%

operator experience and amt of fluid used-not significant\
lying supine/bedrest-not shown to be effective


MANAGEMENT:

DIFFERENTIALS:
cerebral venous sinus thrombosis,
migraine,
caffeine withdrawal

ENIGMA I

2050 patients,
non cardiac surgery >2 hrs with or without nitrous

followed up max 5.7 years (median 3.5)
primary end point= survival

a/w long term AMI risk but not death or stroke

need further RCT

PICO

What is the PICO method?
PICO is a method of putting together a search strategy that allows you to take a more evidence based approach to your literature searching when you are searching bibliographic databases like Medline (OVID), PubMed and Embase.
PICO stands for:
Patient/Population Who or What?
Intervention How?
Comparison What is the main alternative? (If appropriate)
Outcome What are you trying to accomplish, measure, improve, effect?