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https://0daymusic.org/Shared by: Albert Einstein
In patients with suspicion of contained appendiceal inflammation, based on a palpable mass or long duration of symptoms, the diagnosis should be confirmed by imaging techniques, especially CT scan. The patient should receive primary nonsurgical treatment with antibiotics and abscess drainage as needed. After successful nonsurgical treatment, no interval appendectomy is indicated in some cases, but the patient should be informed about the risk of recurrence especially in the presence of appendicolith. The risk of missing another underlying condition (cancer or CD) is low, but motivates a follow-up with a colon examination and/or a CT scan or US, especially in patients above the age of 40 years.
For the dyslipidemic patient, how do we differentiate between the statins; ie, when should one be used preferentially over the other? Are there significant clinical differences among them?
As a class, the statins are remarkably safe and their use in patients who need LDL lowering for atheroprevention has a very high benefit/risk ratio. But because they are most commonly used in older patients with complicated health histories, and because of heightened public concerns, we must always remember to address several safety issues when prescribing statins. Although there is increasing impetus toward more and more aggressive lipid-lowering therapy, we need to keep the following always in mind:
1. Safety, cost, and efficacy considerations often point to:
-Use of lower doses of a given statin and/or
-Use of safer statins such as fluvastatin and pravastatin; and
-Use of other agents (ezetimibe, niacin, fibrates, and/or sequestrants) in combination with statins for greater LDL-lowering and/or other lipid benefits
2. When starting statins, patients must always be informed of potential safety risks, and any symptoms or signs of adverse effects must be taken seriously and handled properly.
The beneficial role of statins in primary and secondary prevention of coronary heart disease has resulted in their frequent use in clinical practice. However, safety concerns, especially regarding hepatotoxicity, have driven multiple trials, which have demonstrated the low incidence of statin-related hepatic adverse effects. The most commonly reported hepatic adverse effect is the phenomenon known as transaminitis, in which liver enzyme levels are elevated in the absence of proven hepatotoxicity. This class effect is usually asymptomatic, reversible, and dose-related. However, the increasing incidence of chronic liver diseases, including nonalcoholic fatty liver disease and hepatitis C, has created a new challenge when initiating statin treatment in patients with high cardiovascular risk. These diseases result in abnormally high liver biochemistry values, discouraging statin use by clinicians, fostering treatment discontinuation, and leaving a large number of at-risk patients untreated. A PubMed/MEDLINE search of the literature regarding statin safety (January 1, 1994-December 31, 2008) was performed, using the following search terms: statin safety, statin-related hepatotoxicity, and chronic liver disease and statin use, as well as the specific names of different statins and different liver diseases. Relevant clinical trials, review articles, panel discussions, and guideline recommendations were selected. This review supports the use of statin treatment in patients with high cardiovascular risk whose elevated aminotransferase levels have no clinical relevance or are attributable to known stable chronic liver conditions. For each patient, the decision should be based on an individual assessment of risks and benefits.Shared by: Albert Einstein
The following are key points to remember from this Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease (PAD)Shared by: Albert Einstein
3 minute explanation of Ethereum by inventor Vitalik Buterin.
Ethereum is a platform that makes it possible for any developer to write and distribute next-generation decentralized applications.
Borrowing the concept of distributed consensus and cryptographic proof that makes cryptocurrencies such as Bitcoin so effective in trustless payments, Ethereum extends the use of these technologies to trustless agreements. This allows developers to easily build innovative new products on a censorship and collusion-resistant foundation.
What is Ethereum and decentralised applications?Shared by: Albert Einstein
What is the blockchain? If you don't know, you should; if you do, chances are you still need some clarification on how it actually works. Don Tapscott is here to help, demystifying this world-changing, trust-building technology which, he says, represents nothing less than the second generation of the internet and holds the potential to transform money, business, government and society.Shared by: Albert Einstein