Cannabidiol (CBD) — what we know and what we don’t
Cannabidiol (CBD) has been recently covered in the media, and you may have even seen it as an add-in booster to your post-workout smoothie or morning coffee. What exactly is CBD? Why is it suddenly so popular?
How is cannabidiol different from marijuana?
CBD stands for cannabidiol. It is the second most prevalent of the active ingredients of cannabis (marijuana). While CBD is an essential component of medical marijuana, it also is derived directly from the hemp plant, which is a cousin of the marijuana plant. While CDB is a component of marijuana (one of hundreds), CBD by itself, does not cause a “high.” According to a...
Source: Harvard Health Blog - August 24, 2018 Category: Consumer Health News Authors: Peter Grinspoon, MD Tags: Drugs and Supplements Health Marijuana Source Type: blogs
MKSAP: 77-year-old woman with frequently fluctuating INRs
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 77-year-old woman is evaluated for frequently fluctuating INRs (<1.8 to >3.5) while taking warfarin therapy. She has undergone INR testing every 1 to 2 weeks and frequent warfarin dose adjustments. She reports a consistent dietary intake. Medical history is notable only for recurrent deep venous thrombosis. She takes no other medications.
On physical examination, vital signs are normal, as is the remainder of the examination.
Which of the following is the most appropriate next step in management?
A. Dail...
Source: Kevin, M.D. - Medical Weblog - August 18, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Oncology/Hematology Source Type: blogs
Changing the treatment plan when covering for another doctor
I was a little taken aback when Dr. C. changed my patient from warfarin to one of the novel anticoagulants. And one I seldom use, at that.
I have only worked with her for about three years, and we seem to come from the same mold: seasoned family docs with a penchant for teaching and patient empowerment. I had not imagined she would step in and completely change my treatment plan when she was just covering for one day.
As far as which is safer, warfarin with variable therapeutic effect and fluctuating INRs or novel anticoagulants, which have hardly been studied at all in patients on dialysis, you won’t see test results th...
Source: Kevin, M.D. - Medical Weblog - August 8, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/a-country-doctor" rel="tag" > A Country Doctor, MD < /a > Tags: Physician Cardiology Medications Source Type: blogs
Forskolin: another natural compound goes on my list of myeloma killers
Yesterday I came across a 2015 study that really caught my attention. A group of Norwegian researchers has discovered that the combination of dexamethasone with a natural compound called forskolin kills multiple myeloma cells.
They tested forskolin with other conventional myeloma drugs, too: bortezomib (Velcade), cyclophosphamide, doxorubicin, and melphalan.
And by itself.
Results in a nutshell: dead myeloma cells.
Excerpt from the abstract: “Our findings support a potential role of forskolin in combination with current conventional agents in the treatment of MM.”
The researchers believe that forskolin mi...
Source: Margaret's Corner - August 1, 2018 Category: Cancer & Oncology Authors: Margaret Tags: Blogroll forskolin myeloma Source Type: blogs
No Scientific Proof That Multivitamins Promote Heart Health
https://www.medscape.com/viewarticle/899130No Scientific Proof That Multivitamins Promote Heart HealthTaking multivitamin/mineral (MVM) supplements does not prevent myocardial infarction, stroke, or death from a cardiovascular cause, according to a comprehensive meta-analytic review of relevant research." The take-home message is simple: there is no scientific evidence that MVM supplements promote cardiovascular health. We hope that our paper helps to settle the controversy on MVM use for CVD prevention, " lead author Joonseok Kim, MD, University of Alabama at Birmingham, toldtheheart.org | Medscape Cardiology.The study wa...
Source: Dr Portnay - July 25, 2018 Category: Cardiology Authors: Dr Portnay Source Type: blogs
How dangerous are NSAIDs in patients with AF?
One of the most commonly asked questions in the office is the treatment of arthritis pain. This comes up because of the concern over taking NSAIDs (non steroidal anti-inflammatory drugs) in patients who are on anticoagulants (such as warfarin, or dabigatran, rivaroxaban, apixaban).
My views on this matter have changed.
But first, I want to mention a study published in JACC that addressed the issue of NSAID use in pts with AF who take an anticoagulant.
This was a sub-analysis of the RELY trial, which pitted dabigatran vs warfarin. Remember, in the original RELY trial, the 150mg dose of dabigatran did better than warfarin at...
Source: Dr John M - July 13, 2018 Category: Cardiology Authors: Dr John Source Type: blogs
‘Rats! I’m High’
A 24-year-old man presented with uncontrollable epistaxis. He said he had been bleeding "a ton" from his nose continuously for four hours. He denied recent trauma, and explained that this epistaxis was sudden onset. He had no past medical history, and denied previous episodes of excessive bleeding. An examination demonstrated no signs of trauma and was unremarkable aside from the epistaxis. His nostrils revealed no obvious bleeding vessels for cauterization. His social history was remarkable for occasional drinking, marijuana use, and recent use of synthetic marijuana.His vital signs were a heart rate of 85 bp...
Source: The Tox Cave - July 2, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
The Evidence Crisis: Causal Inference – Don ’ t be a chicken (Part 3)
By ANISH KOKA
Part 1
Part 2
Physicians have been making up numbers longer than people have been guessing weights at carnivals. How much does this statin lower the chances of a heart attack? How long do I have to live if I don’t get the aortic valve surgery?
In clinics across the land confident answers emerge from doctors in white coats. Most of the answers are guesses based on whatever evidence about the matter exists applied to the patient sitting in the room. The trouble is that the evidence base used to be the provenance of experts and anecdotes that have in the past concluded leeches were good for pneumonia...
Source: The Health Care Blog - June 29, 2018 Category: Consumer Health News Authors: anish_koka Tags: Uncategorized Source Type: blogs
Life as a doctor is selfless and selfish at the same time
It was 5:45 in the morning on a Monday after a full weekend of call. Thoroughly exhausted, I shuffled into the elevator and was met by the stench of stale clothing mixed with cigarette smoke. A painfully thin teenager exited, looking lost. I allowed him to wander out, grateful to be spared his odor. I was apathetic, overtaken by a weariness I vowed as a medical student never to have.
Morning rounds passed without incident. All our CABG patients were more or less stable. I collected each patient’s overnight events, vital signs, laboratory values, daily chest X-ray, EKG, fluid balance and wound status. With my attending’...
Source: Kevin, M.D. - Medical Weblog - June 20, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/farah-karipineni" rel="tag" > Farah Karipineni, MD < /a > Tags: Physician Cardiology Hospital-Based Medicine Surgery Source Type: blogs
Roche Unveils Blood Coagulation Checker with Bluetooth Features
Roche has announced that next month it will be releasing a new device for patients to test their own blood coagulation parameters, the CoaguChek Vantus. The device, which looks like a cellular phone from a few years ago, has Bluetooth connectivity built-in, which lets it dump its INR readings to the patient’s smartphone and then automatically to the clinicians working with the patient.
The idea was to reduce visits to the clinic while making things easier to keep track of for patients on warfarin. If setup and used correctly, the device alleviates any manual tracking of coagulation readings. “As healthcare sys...
Source: Medgadget - June 13, 2018 Category: Medical Devices Authors: Editors Tags: Cardiology Medicine Source Type: blogs
Patient with Paced Rhythm in Severe Cardiomyopathy Presents with SOB due to Acute Decompensated Heart Failure
This is a middle-aged male with h/o with a history ofheart failure with severely reducedejection fraction due to dilated ischemic cardiomyopathy (EF 5-10%), probably with some component of non-ischemic cardiomyopathy, with h/o CABG, who is status post ICD placement (and previous appropriate shocks for VT) and biventricular pacer ( " cardiac resynchronization therapy " ), who is on amiodarone for VT suppression, and has h/o LV thrombus and is on chronicanticoagulation with warfarin.He presented forparoxysmal nocturnal dyspnea that didn ' t resolve with use of his home prn diuretics. He was hyp...
Source: Dr. Smith's ECG Blog - June 9, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
A Tale of 2 FDAs
By ANISH KOKA
Frances Oldham Kelsey by all accounts was not mean to have a consequential life. She was born in Canada in 1914, at a time women were meant to be seen and not heard. Nonetheless, an affinity for science eventually lead to a masters in pharmacology from the prestigious McGill University. Her first real break came after she was accepted for PhD level work in the pharmacology lab of a professor at the University of Chicago. An esteemed professor was starting a pharmacology lab and needed assistants, and the man from Canada seemed to have a perfect resume to fit. That’s right, I said man. France...
Source: The Health Care Blog - June 4, 2018 Category: Consumer Health News Authors: anish_koka Tags: Uncategorized Source Type: blogs
Antiphospholipid Syndrome
Antiphospholipid Syndrome (APS) important in vascular medicine as well as obstetrics. In obstetrics, it is important because it can cause fetal loss, intrauterine growth retardation and severe preeclampsia. In vascular medicine it is important because it can cause thrombotic events which could be arterial, venous or microvascular [1]. It can also be accompanied by moderate thrombocytopenia [2]. Thrombotic events involving multiple organs may be termed catastrophic Antiphospholipid Syndrome [3].
APS is an autoimmune disease with antibodies directed against beta2 glycoprotein I. This leads to suppression of tissue factor p...
Source: Cardiophile MD - May 27, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology anti beta2 glycoprotein I antibodies anti cardiolipin antibodies lupus anticoagulant Source Type: blogs
Factors enhancing risk of limb loss after revascularization
are:
Infra inguinal bypass using prosthetic material
Bypass below the knee
Use of sub optimal conduit
Poor arterial runoff
Extensive lesion
When these risk factors are noted, anti thrombotic therapy can be intensified by adding either rivaroxaban or warfarin to aspirin. Another option is to give dual antiplatelet therapy. While intensifying therapy, risk of limb loss should be weighed against the potential bleeding risk in each individual. Triple therapy with two antiplatelet agents and one anticoagulant is better avoided in view of high bleeding risk.
The post Factors enhancing risk of limb loss after revascularization...
Source: Cardiophile MD - May 26, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Peripheral Interventions Source Type: blogs
