A Man with a Rash on palms

1-A morbilliform (also called maculopapular) drug eruption is the most common drug hypersensitivity reaction. It usually occurs 1 to 2 weeks after exposure to a new drug.Morbilliform drug eruptions tend to occur in a symmetric distribution and often spread in a centrifugal manner, starting on the trunk and spreading out to the arms and legs.
2- Hand, foot, and mouth disease coxsackievirus infection, and fever and sore throat painless, nonpruritic, macular, and maculopapular or vesicular lesions on the hands and feet The oral lesions are characterized by macules that progress to painful vesicles and finally ulcers.
3-Measles is a morbilliform rash, and lesions usually appear on the head and neck before spreading to the torso and the rest of the body. It is accompanied by fever, cough, coryza, and conjunctivitis.
4-Covid-19 causes a wide variety of cutaneous manifestations, including maculopapular and papulovesicular rashes,
5- Patients with subacute bacterial endocarditis can present with petechiae and splinter hemorrhages or with Janeway lesions (erythematous macules on the palms and soles) or Osler nodes (tender, violaceous nodules on the fingers and toes). These characteristics are the result of microvascular occlusion that is either acute or subacute in nature.
6- syphilis
7-Scaling rash on the palms psoriasis

By prof. Dr mohamed salem

Low platelets & anticoagulation in AF

ITP has been reported to be associated with AF .

Guidelines do not provide clear guidance for anticoagulation in these patients.

Anticoagulation in patients with ITP and AF is a clinical challenge because it is usually contraindicated when the platelet count is less than 50,000.

Rules;

1)  a low platelet count does not protect from thrombosis;

2) in general, thrombotic complications are more dangerous than bleeding complications
. A reduced-dose direct oral anticoagulant (rivaroxaban 15 mg once daily, or apixaban 2.5 mg bid) is effective and safe with mild thrombocytopenia (platelet count between 50,000 and 100,000/µL).

left atrial appendage occlusion using the Watchman device could be a safe and effective means of preventing stroke in AF patients with thrombocytopenia

By Prof. Dr. Mohamed Salem

لكثره تشخيص القولون العصبي اخطات في تشخيص امراض قولون اخري لها علاج مختلف واليكم خبرتي وارجو ان تتدبروها
functional bowel disease is a great mimic. In patients with chronic diarrhea, we perform the following:
1.  CBC , S.albumin.
2.  -Fecal calprotectin or fecal lactoferrin
3.  -Stool testing for giardia by ELISA giardia antigen.
4.  -Serologic testing for celiac disease
5.  -CRP levels and ESR
6.  Stool studies

  If fecal calprotectin and fecal lactoferrin are normal, a diagnosis of 'Inflammatory bowel disease' IBD is unlikely. If fecal calprotectin or fecal lactoferrin levels are above the reference range, we proceed with ileocolonoscopy and biopsy to confirm the diagnosis of IBD.

   Microscopic colitis is characterized by chronic, non-bloody, watery diarrhea. Studies that have evaluated fecal calprotectin excretion as a marker of active microscopic colitis have been conflicting.

The use of calprotectin to exclude or monitor microscopic colitis is not recommended.

We perform colonoscopy with separate sampling of the right and left colon. The endoscopic appearance of the colon is typically normal. The diagnosis of microscopic colitis is established by biopsy of the colonic mucosa demonstrating characteristic histologic changes.

  Patients with diarrhea-predominant irritable bowel syndrome (IBS) may present with chronic diarrhea similar to patients with microscopic colitis]. However, IBS is predominantly characterized by recurrent chronic abdominal pain and normal mucosal histology.

  – Patients with celiac disease may have similar symptoms of chronic diarrhea but can be distinguished by serologic testing and small bowel biopsy.

  Stool studies should include routine stool cultures (Salmonella, Shigella, Campylobacter, Yersinia and Escherichia coli ),]. Microscopy for ova and parasites (three samples) and a Giardia stool antigen test.,

I usually start Rifaximin 550mg twice/D+ Nitazoxanide 500mg twice
+ Tinidazole 1 tab once daily to cover amoeba,giardia, cryptosporidium and bacteria.

Secret;
Bloody diarrhea think of;
1.  Ulcerative colitis
2.  Ischemic colitis
3.  Amoebic colitis
4.  And most important irritable bowel syndrome with associated piles

By Prof. Dr. Mohamed salem

Christmas tree sign on ECG

Bidirectional VT may due to sever digoxin toxicity

? remember

✅ Elevated serum or plasma CRP is an independent predictor of atherosclerosis among apparently healthy men and women.

✅ Among apparently healthy men, the plasma concentration of CRP predicts the long-term risk of a first myocardial infarction, ischemic stroke, hypertension, peripheral artery disease, sudden cardiac death, and total mortality

UpTodate2023

Causes of Lower lobes fibroses (#RASCO)

1⃣ rheumatoid arthritis
2⃣ asbestosis
3⃣ scleroderma
4⃣ cryptogenic fibrosing alveolitis
5⃣ other (drugs, e.g. busulphan, bleomycin, nitrofurantoin, hydralazine, methotrexate, amiodarone)

Causes of upper lobe fibroses

1⃣ silicosis (progressive massive fibrosis)
2⃣ sarcoidosis
3⃣ coal workers’
4⃣ pneumoconiosis (progressive massive fibrosis)
5⃣ histiocytosis
6⃣ ankylosing spondylitis
7⃣ allergic bronchopulmonary aspergillosis
8⃣ radiation
9⃣ tuberculosis