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Pancreas Pancreatic Insufficiency

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Pancreas Friday, November 2, 2018 1:12 PM Pancreatic insufficiency Tuesday, August 18, 2015 07:47 The gold standard is quantification of the coefficient of fat absorption (CFA); this requires patients to maintain a strict 5-day diet containing 100 g of fat/day and collection of all faeces produced over the last 3 days for faecal fat quantification.” Despite most patients with CP and [EPI] having vitamin D deficiency, it is not a useful marker of [EPI] due to the high prevalence of this deficiency in the general population, at least in northern countries,” and “[p]lasma proteins may also be useful for the diagnosis of [EPI], with evidence suggesting that lower RBP is a marker for [EPI], at least in patients with CP.”. Retinol binding protein [EPI] may have a deficiency in a particular parameter, any nutritional evaluation for [EPI] should comprise multiple nutritional markers, and include at least circulating levels of fat soluble vitamins (preferably vitamin E), prealbumin, RBP, zinc and magnesium.” Neurology Friday, November 2, 2018 1:15 PM Concussion test Wednesday, February 14, 2018 3:44 PM The Brain Trauma Indicator measures levels of two proteins — ubiquitin C-terminal hydrolase and glial fibrillary acidic protein — that are released from the brain into blood and measured within 12 hours of head injury. Resistant asthma Friday, January 26, 2018 4:45 PM LFT hepatitis or cholestasis Tuesday, February 6, 2018 9:21 PM R ratio is ALT/ULN ALT divided by alk phos /ULN alk phos More than 5 hepatitis, less than 2 cholestasis and 2-5 mixed For example, examination of the local reference laboratory ranges for ALT used by the Nonalcoholic Steatohepatitis (NASH) Clinical Research Network demonstrated significant differences (range, 35-79 IU/L for men and 31-55 IU/L for women).[7] These wide ranges appeared to be due to the different reference populations used by each laboratory to establish the normal range; inclusion of data from these disparate local populations may not have taken such variables as body mass index into consideration.[2,7] The authors of this guideline cite several studies that have proposed a standardized ULN for ALT based on prospectively acquired data using various methodologies.[2] They conclude that a normal ALT level in prospectively studied populations without identifiable risk factors for liver disease ranges from 29 to 33 IU/L for males and from 19 to 25 IU/L for females. They recommend that levels above this range should trigger an assessment. The authors emphasize that using a significantly lower ULN for ALT will have implications by defining many more patients as having abnormal ALT levels.[2] Appropriate, age-specific ALT threshold values have also been established for the diagnosis of liver disease in children. Schwimmer and colleagues[8]reported sex-specific, biology-based, pediatric thresholds. The Screening ALT for Elevation in Today's Youth (SAFETY) study collected observational data from acute care children's hospitals, the NHANES (1999-2006), overweight children with and without nonalcoholic fatty liver disease (NAFLD), and children with chronic hepatitis. The 95th percentile ALT levels in pediatric NHANES participants who were of healthy weight, metabolically normal, and free of liver disease were 25.8 U/L for boys and 22.1 U/L for girls. https://livertox.nlm.nih.gov Asymptomatic IBD Tuesday, February 6, 2018 9:37 PM Most recently, a 2017 retrospective analysis of more than 31,000 screening colonoscopies performed in Spain after positive fecal immunochemical testing (FIT) during 2009-2014 reported new incidental IBD diagnoses in 0.35% of asymptomatic screened individuals. Fructan food Friday, January 26, 2018 4:43 PM <<Foods high in Fructan.docx>> Types of Diabetes Friday, March 2, 2018 8:37 AM SAID - Severe autoimmune diabetes, usually GAD positive SIDD - Severe insulin deficient diabetes, GAD neg SIRD - Severe insulin resistant diabetes , benefit most by metform, elevated HOMA2-IR index MORD- mild obesity related diabetes, MARD- mild age related diabetes Published in Lancet Diabetes and endocrinology Liquid biopsy Friday, March 2, 2018 8:40 AM New blood test developed by Hopkins CancerSEEK - it detects certain proteins and circulating tumor DNA ctDNA. Detects multiple types of cancers in the blood. Details being worked out. Keep an eye on it Veno occlusive disease medication Friday, January 26, 2018 4:43 PM LDL Thursday, June 22, 2017 10:17 PM FOURIER AND ODYSSEY TRIAL T2D 4 class of meds Sunday, June 25, 2017 4:26 PM Two types of incretin. GIP & GLP1 GLP 1 stimulates insulin release and inhibits glucagon GLP1 agonist, first found in gila lizard monster saliva can be human / Synthetic. Byetta or victoza Liraglutide) GLP 1 is destroyed by DPP 4 dipeptidyl peptidase. There are currently 4 DPP 4 antagonist. Linagliptin sitagliptin can be used in cardiac patients Metformin SGTL drugs Dapagliflozin increases hb by acting on hepcidin Insulin Starting dose of insulin - 0. 1 to 0.2 U /kg/day. If hba1c more than 8 0.2-0.3 u/Kg /day Most events of hypoglycemia with NPH AND Morning BS variability Most stable in that regard is insulin degludec and insulin glargine U300 ( more than 24 hour half life). Adjust dose every 4-5 days based on BS with 20 % increase Intermediate stability insulin glargine U100, insulin detemir. Adjust ever 2-3 days with 20% dose change Insulin is atherogenic but glargine shown NOT to increase cardiovascular mortality NPH to other insulin conversion is 80% dose Target Hba1c 6-8. Tighter control leads to higher risk of hypoglycemia which increases cathecholamines and higher chance of cardiovascular mortality CHF nsaid mineralocorticoid receptor antagonist Thursday, September 3, 2015 21:43 LONDON -- The investigational non-steroidal mineralcorticoid receptor antagonist finerenone worked as well as eplerenone (Inspra) with a possible mortality advantage over the older drug in heart failure, the phase II ARTS-HF trial suggested. Reductions in NT-proBNP of more than 30% from baseline to day 90, the study's primary endpoint, occurred in 37.2% of eplerenone-treated patients compared with 30.9% to 38.8% of finerenone-treated patients across doses tested (P not significant), Gerasimos Filippatos, MD, of Athens University Hospital Attikon in Greece, and colleagues found. Nausea medicine Thursday, September 3, 2015 21:45 The U.S. Food and Drug Administration approved Tesaro Inc's oral drug rolapitant (Varubi) for treatment for chemotherapy-induced nausea and vomiting in adults, the company said on Wednesday. ORBIT bleeding risk Friday, September 11, 2015 23:16 ESD Solutions Saturday, September 12, 2015 16:17 Voluven hydroxyl ethyl starch Glycerin solution - 10 % glycerol plus 5 % fructose mixed in normal saline - indigo carmine Methyl cellulose - hydroxyl propyl methyl cellulose You can take solid indigo carmine and make solution Methylene blue is ok. 5 drops in 250 cc bag Coaggraaper with soft coag. Ovesco clip Sergey : 6% hetastarch in 0.9% saline with 1-2 cc methylene blue Saturday, September 12, 2015 16:53 [email protected] HCV type 3 Monday, September 14, 2015 23:21 DM Type 1 prevention Monday, September 14, 2015 23:22 Adrenal adenoma Tuesday, September 15, 2015 4:54 PM The recommended workup for an adrenal incidentaloma is Hormonal evaluation . The evaluation in apparently asymptomatic patients has been debated. Even in asymptomatic patients, the European Network for the Study of Adrenal Tumors (ENSAT) recommends performing the following tests to determine the secretory activity of the tumor: fasting blood glucose, serum potassium, cortisol, corticotropin (ACTH), 24-hour urinary free cortisol, fasting serum cortisol at 8 AM following a 1 mg dose of dexamethasone at bedtime, adrenal androgens (dehydroepiandrosterone- sulfate [DHEA-S], androstenedione, testosterone, 17-OH progesterone), and serum estradiol in men and postmenopausal women [76]. Adrenal carcinomas are typically inefficient steroid producers, but they secrete excessive amounts of adrenal steroid precursors due to decreased expression of several steroidogenic enzymes (which also results in diminished cortisol production). Even in patients with adrenal carcinomas who presumably did not produce excess steroids, more sensitive methods such as gas chromatography/mass spectrometry identify increased urinary metabolites of several steroids and precursors of androgens (pregnenediol, pregnenetriol, androsterone, etiocholanolone) or glucocorticoids (17-hydroxyproesterone, tetrahydro- 11-deoxycortisol, cortisol, 6-hydroxy-cortisol, tetrahydrocortisol, and a-cortol); this is different from cortisol secreting adenomas which produce cortisol, but little androgens [77]. Low serum aldosterone concentrations, but normal or high serum or urinary concentrations of aldosterone precursors (ie, deoxycorticosterone, 18-hydroxydeoxycorticosterone, corticosterone, and 18-hydroxycorticosterone, tetrahydro-11-deoxycorticosterone (THDOC), and 5 alpha-THDOC) are found in most adrenal carcinomas, but not in adrenal adenomas [77,78]. The European Network for the Study of Adrenal Tumors (ENSAT) also recommends that plasma metanephrines or urinary metanephrines and catecholamines be obtained in all patients to exclude pheochromocytoma, and that plasma aldosterone and renin be obtained in patients with hypertension and/or hypokalemia (see "Establishing the cause of Cushing's syndrome" and "Adrenal hyperandrogenism" and "Pathophysiology and clinical features of primary aldosteronism" and "The adrenal incidentaloma"). Hormonal evaluation may help in establishing
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