ARZT

31/03/2025

Dark circles under the eyes can be categorized into four main types, each with distinct causes and characteristics :

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1️⃣ Pigmented Dark Circles 🟤
- Cause: Excess melanin production leading to hyperpigmentation.
- Appearance: Brown or black discoloration under the eyes.
- Triggers: Genetics, sun exposure, inflammation, or melasma.
- Treatment:
- Use of depigmenting agents like Vitamin C or Kojic Acid.
- Sunscreen to prevent further pigmentation.
- Chemical peels or laser therapy for stubborn cases.

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2️⃣ Vascular Dark Circles 🔵
- Cause: Visible blood vessels under thin skin or dilated veins.
- Appearance: Blue, purple, or pink hues under the eyes.
- Triggers: Poor blood circulation, lack of sleep, or allergies.
- Treatment:
- Cold compresses to reduce swelling and improve circulation.
- Retinoid creams to thicken the skin over time.
- Laser treatments to target visible veins.

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3️⃣ Structural Dark Circles 🕳️
- Cause: Shadows caused by hollowness or deep tear troughs.
- Appearance: Dark shadows under the eyes, often due to aging or genetics.
- Triggers: Fat loss, bone structure, or aging.
- Treatment:
- Dermal fillers to restore volume.
- Fat grafting for a more permanent solution.
- Proper lighting and makeup techniques to minimize shadow effects.

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4️⃣ Mixed-Type Dark Circles:
- Cause: Combination of pigmentation, vascular issues, and structural shadows.
- Appearance: A mix of brown, blue, or shadowy tones.
- Triggers: Multiple overlapping factors like genetics, lifestyle, and aging.
- Treatment:
- A tailored approach addressing all contributing factors.
- Combination therapies like topical creams, fillers, and laser treatments.
- Lifestyle changes, including better sleep and hydration.

16/12/2024

عن الفضيل ابن عياض أن رجلاً سأله فقال: يا أبا علي متى يبلغ الرجل غايته من حب الله تعالى؟ فقال له الفضيل: إذا كان عطاؤه ومنعه إياك عندك سواء، فقد بلغت الغاية من حبه.

14/12/2024

The European Medicines Agency (EMA) has allowed Eli Lilly to update the product label of its weight-loss drug *Mounjaro (tirzepatide)* to indicate its benefits in treating *obstructive sleep apnea (OSA)* without requiring a separate approval.

Here are the key details:

1.Existing Approval: Mounjaro is already approved for weight management in patients with obesity and type 2 diabetes. The EMA determined that its benefits for treating OSA are covered under this existing approval.

2.Clinical Data: Lilly submitted data from two clinical studies involving 469 adults with moderate to severe OSA and obesity.
These studies showed that Mounjaro reduced the frequency of irregular breathing by up to 63%.

3.Overlap of Conditions: The EMA highlighted that OSA and obesity often overlap, with about 58% of people with moderate to severe OSA having excess weight. Therefore, weight reduction can improve OSA symptoms.

4.Updated Product Information: The EMA will include data on Mounjaro's effects on OSA in its product information for healthcare professionals.

5.Global Impact: Obstructive sleep apnea affects roughly 1 billion people globally, and common treatments include CPAP machines, surgery, and weight loss.

Lilly is also seeking approval for Mounjaro's use in treating OSA in the U.S. This expanded use could provide additional benefits for patients with obesity and OSA.

06/12/2024

*Recent Medical News and Updates (Continued)*
*FDA Grants Accelerated Approval to Bizengri (zenocutuzumab-zbco)*
- Approved for NRG1+ pancreatic adenocarcinoma and NRG1+ non–small cell lung cancer.

*FDA Approves Yesintek (ustekinumab-kfce)*
- Approved as a biosimilar to Stelara.

*FDA Approves Rapiblyk (landiolol)*
- Approved for atrial fibrillation and atrial flutter in critical care settings.

*FDA Approves Imkeldi (imatinib)*
- Approved for the treatment of certain forms of leukemia and other cancers.

*Recent Drug Applications*

*Govorestat*
- Applied Therapeutics received a complete response letter from the FDA for classic galactosemia treatment.

*STS101*
- Satsuma Pharmaceuticals' resubmission accepted by the FDA for acute migraine treatment.

*DCCR (Diazoxide Choline)*
- Soleno Therapeutics' review period extended by the FDA for Prader-Willi syndrome.

*Plozasiran*
- Arrowhead Pharmaceuticals submitted a new drug application for familial chylomicronemia syndrome treatment.

*Reproxalap*
- Aldeyra Therapeutics' new drug application accepted for dry eye disease treatment.

*Tamibarotene*
- Syros Pharmaceuticals announced topline data from a Phase 3 trial for higher-risk myelodysplastic syndrome.

*Sacituzumab Tirumotecan (sac-TMT)*
- Granted Breakthrough Therapy Designation for specific non-small cell lung cancer patients.

*LP-184*
- Lantern Pharma's investigational drug received the second fast track designation for triple-negative breast cancer.

*Anaphylm (epinephrine)*
- Aquestive Therapeutics received positive FDA feedback for sublingual film for anaphylaxis treatment.

05/11/2024

Staying away from foot odor begins with proper hygiene: washing the feet regularly, drying them thoroughly, and keeping the toenails short and clean. Even the shoes and socks one wears can make a difference in fighting off foot odor. Diabetic patients should take special care of their feet. Making foot care a part of a regular hygiene routine is one key to waving off the bad odor. Home treatments are usually easy and effective.

18/06/2024

Orlistat is reversible inhibitor of gastric and pancreatic lipases, thus inhibiting absorption of dietary fats by 30%.
And also it inhibits fat soluble vitamins like vitamin K which is mainly playing a key role in helping the blood clot

So, Orlistat has Drug-Drug interaction (Category C) with vitamin K antagonist(Warfarin) and may enhance the anticoagulant effect of Warfarin and increase its bleeding risk. This interaction may need close monitoring by INR/Prothrombin time

A single case report describes a warfarin-stable patient who experienced an increase INR 18 days after the addition of orlistat to his regimen. Subsequent doses were held and then restarted at a reduced warfarin dosage to maintain an acceptable INR.
In contrast, the pharmacokinetics of racemic warfarin (30 mg single oral dose) were essentially unaltered in 12 healthy participants when administered on the day 11 of a 16-day course of orlistat (120 mg 3 times/day).2 No changes in INR were detected. Serum concentrations of vitamin K and its epoxide were also unaltered.
Prescribing information for orlistat states that patients who are on chronic stable doses of warfarin who are prescribed orlistat should be monitored closely for changes in coagulation parameters due to the possible decrease in vitamin K absorption.3 The prescribing information for phenindione also states that orlistat may decrease vitamin K absorption and enhance the effects of vitamin K antagonists.
The mechanism of this potential interaction has not been fully investigated. Although the pharmacokinetics of warfarin appear unchanged by orlistat, dietary adjustments (eg, lower fat meals) and potential reductions in the absorption of fat-soluble vitamins (vitamin K in particular), may lead to increased warfarin effects and an increased
Finally :
According to these data, from my experience I think we can use Non Vitamin K antagonist anticoagulants (NOACs) Like apixaban And According to The patient Clinical Case .

18/06/2024

Some medications need to be taken after food, others on an empty stomach, but did you know that certain medications are recommended to be taken with a specific minimum number of calories?

💊Ziprasidone is recommended to be administered with at least 500 calories for optimal absorption. Administration with food increases absorption twofold.

💊Lurasidone is recommended to be administered with at least 350 calories. Food substantially increases absorption; it increases AUC ~2-fold and Cmax ~3-fold.

03/06/2024

⛔️DRUG-DRUG Interaction: ⛔️

1. PDE-5 INHIBITORS AND NITRATES :

• PDE-5 Inhibitors (Sildenafil, Tadalafil) are used for erectile dysfunction.
• Nitrates (Nitroglycerin) is used as an anti-anginal.
SO Both medications cause blood vessels to dilate, which can cause severe hypotension .

2. NSAID’S AND WARFARIN :

• NSAID's increase the risk of bleeding .
• Warfarin: is an anti-coagulant that increases the risk of bleeding too.
SO Together, they REALLY increase the risk of bleeding!

3. SPIRNOLACTONE AND POTASSIUM CHLORIDE :

• Spironolactone (Potassium-sparing diuretic) holds onto potassium in the body If taken with a potassium supplement, the patient can experience severe hyperkalemia and dysrhythmias!

4. LITHIUM AND DIURETICS :

• Lithium (Mood stabilizer): is a cation similar to sodium and acts similar to sodium!
• Diuretics: get rid of fluids and can also get rid of sodium (which is a salt)
So If salt is giving with diuretics, lithium will take the place of "missing sodium" in our body and reach toxic
levels!

5. LANOXIN (DIGOXIN) AND AMIODARONE :

• Digoxin :is a cardiac glycoside that improves the force of contraction to make meaningful beats
• Amiodarone: is an anti-arrhythmic and may affect how much digoxin is absorbed in the bloodstream Together, this may cause digoxin toxicity!

6. ATORVASTATIN AND AMIODARONE :

• Amiodarone (Anti-arrhythmic) : is used to irregular heartbeats like A-fib
• Atorvastatin (Statins): is given to reduce cholesterol levels
Amiodarone will increase the level or effect of Atorvastatin by P-glycoprotein (MDR1) efflux transporter.

7. MAOI'S AND OTHER ANTIDEPRESSANTS :

Stop MAOIs for at least 2 weeks before taking other antidepressants. It can cause
serotonin syndrome which has UPPER-type symptoms (agitation, muscle twitching, fever, seizures)

8. BENZODIAZEPINES AND OPIOIDS

• Alprazolam and Percocet (Oxycodone Acetaminophen) produce sedative effects

03/06/2024

Clinical Practice guidelines:
The American Diabetes Association diagnostic criteria for DKA are the presence of

✔️ hyperglycemia with blood glucose greater than 13.9 mmol/L (250 mg/dL)

✔️ arterial pH less than 👉or equal to 7.3

✔️ serum bicarbonate less than or equal to 18 mmol/L (mEq/L)

✔️ blood anion gap greater than 10 mmol/L (mEq/L)

😘✅ and positive serum or urine ketone on a semi-quantitative test.

✔️ However, they did not define a specific cutoff level for blood ketone concentration.

according to the statement of the American Association of Clinical Endocrinology (AACE) and the American College of Endocrinology (ACE), DKA is diagnosed with

🔶 arterial pH less than 7.3

🔶 beta-hydroxybutyrate greater than or equal to 3.8 mmol/L (39 mg/dL)

🔶 anion gap greater than 10 mmol/L (mEq/L)

🔶 and hyperglycemia greater than 13.9 mmol/L (250 mg/dL) or lower glycemia in specific cases.

From their statement, there was no specific cut-off for serum bicarbonate level.

® In the UK, the diagnostic criteria consist of blood glucose greater than 11 mmol/L (200 mg/dL) or known diabetes,

venous bicarbonate less than 15 mmol/L (mEq/L)

and for venous pH less than 7.3, and blood ketone greater than 3 mmolfL (31 mg/dL) or ketonuria more than 2+.

the diagnosis of DKA in patients taking SGLT-2 inhibitors is confirmed using arterial pH and serum beta-hydroxybutyrate levels. 👆👆👆👆❤️

management of DKA is aimed to achieve the following metabolic targets:

✔️ Decrease in blood glucose by 3.0 mmol/Ljhour (54 mg/dLjhour)

✅ and blood ketone concentration by 0.5 mmol/Ljhour (5 mg/dL/hour)

✔️an increase of venous bicarbonate by 3.0 mmol/L/hour (mEq/L/hour)

✅ and lastly maintaining potassium concentration between 4.0- 5.0 mmol/L (mEq/L).

✅ Available protocols rely on 3 major arms:

✔️ intravenous hydration
✔️ insulin therapy
✔️ and electrolytes balance.

06/04/2024

06/04/2024

✅ Wegovy (semaglutide):

🔶 Another new indication for Wegovy?

🔶 Novo Nordisk’s blockbuster GLP-1 drug improved symptoms and physical function in a trial of patients with:

✔️ obesity
✔️diabetes
✔️and heart failure with preserved ejection fraction.

✅ This comes after Novo reported positive results last year in a similar HFpEF trial, but in patients😳👉 who didn't have diabetes.

✅ With the data from these two new trials, Novo is now seeking regulatory approval for a new indication for Wegovy in HFpEF.

🛜 The drug is quickly amassing data that shows its benefits beyond weight loss.

🛜 It just last month 👉got FDA clearance for the use of preventing cardiovascular complications.

11/03/2024

Cola-containing drinks (CCDs) are enjoyed by millions worldwide. However, recent research has shown that CCDs can interact with certain drugs, leading to potentially toxic effects.

The study found that CCDs' acidity and caffeine content can potentiate interactions with different drugs, affecting drug absorption, metabolism, and renal excretion.

For instance, the consumption of CCDs has been shown to serum concentrations of MTX, clozapine, carbamazepine, phenytoin, and ibuprofen, while serum levels of lithium and warfarin.

Reference:

https://lnkd.in/eGM9vGeV