Medical Concepts

MANAGEMENT FOR H.PYLORI ERADICATION It is known that H.pylori infection is associated with over 90% of duodenal ulcers and 80% of Gastric Ulcers. Antibiotics alone or acid-suppressing agents alone, do not eradicate H.pylori . Both therapies act synergistically as growth of the organism occurs at elevated pH and antibiotics efficacy is enhanced during growth. Additionally, increasing intragastric pH may enhance antibiotic absorption. High eradication rates are achieved by a short course of Triple Therapy consisting of:            1 .PPI                                         2. Clarithromycin                         3. Amoxicillin/Metronidazole          in a twice recommended simultaneous regimen. First-Line Therapy :  European Guidelines recommended 1 week of therapy, whereas the US Guidelines recommend 10-14 days of therapy and achieve 7-9% better eradication rates.     OCA : Omeprazole(20mg), Clarithromycin (500mg) and Amoxicillin (1g)                                         

SITUATIONS REQUIRING HOSPITALIZED CARE The NICE-SUGAR (Intensive versus conventional glucose in critically ill patients) trial compared intensive (81-108 mg/dL) with conventional glucose control using IV Insulin in 6104 intensive care unit patients. At 90 days, intensively controlled patients had an increased absolute risk of death of 2.6%. Significantly, more hypoglycemia was observed in intensively controlled group. Recommendations: Current recommendations call for critically ill patients to be started on IV Insulin therapy at a threshold of 180mg/dL. A goal range of 140-180mg/dL is recommended for majority of patients. More stringent goals may be considered for selected critically ill patients, but only if hypoglycemia can be avoided. Scheduled SC insulin regimens with basal, nutritional and correction components are recommended for patients who are not critically ill. Goals of less than 140mg/dL for fasting glucose and less than 180mg/dL for random glucose are recommended for non-

  TREATMENT OF CONCOMINANT CONDITIONS RELATED TO DIABETES MELLITUS Coronary Heart Disease Dyslipidemia Hypertension HIV and AIDS Antipsychotic Therapy Hypoglycemia Diabetic Ketoacidosis (DKA) Hyperosmolar Hyperglycemic state Retinopathy Neuropathy Foot Ulcers  TREATMENT OF LONG-TERM COMPLICATIONS 1. Retinopathy 2. Neuropathy 3.Microablumiuria 4. Foot Ulcers 9.RETINOPATHY Diabetic retinopathy is the leading cause of blindness in adults 20-74 years of age in the United States. Pathophysiology: Diabetic retinopathy occurs when the microvasculature that supplies blood to the retina becomes damaged. This damage permits leakage of blood components through the vessel walls. Etiology: The risk of retinopathy is increased in patients with longstanding DM, chronic hyperglycemia, hypertension and nephropathy. Glaucoma, cataracts and eye disorders are more frequent in pt. with DM. Treatment: The AD recommends that patients with DM receive a dilated eye examination annually by an ophthalmologist or

  TREATMENT OF CONCOMINANT CONDITIONS RELATED TO DIABETES MELLITUS Coronary Heart Disease Dyslipidemia Hypertension HIV and AIDS Antipsychotic Therapy Hypoglycemia Diabetic Ketoacidosis (DKA) Hyperosmolar Hyperglycemic state Retinopathy Neuropathy Foot Ulcers  The Acute Complications Include: Hypoglycemia DKA Hyperosmolar Hyperglycemic state 6. HYPOGLYCEMIA  "Hypoglycemia or low blood sugar can be defined clinically as a blood glucose level of less than 50mg/dL". Signs: Individuals with DM can experience symptoms of hypoglycemia at varying blood glucose levels. Patients who have regular blood glucose levels as high as 300-400mg/dL may experience symptoms of hypoglycemia when blood glucose levels are lowered to the middle to upper mg/dL range. Most people whose blood glucose levels are controlled adequately may experience symptoms when levels fall below 70mg/dL. Symptoms: Shakiness Sweating Fatigue Hunger Headaches Confusion *Patients experiencing symptoms of hypoglycemia shou

  TREATMENT OF CONCOMINANT CONDITIONS RELATED TO DIABETES MELLITUS Coronary Heart Disease Dyslipidemia Hypertension HIV and AIDS Antipsychotic Therapy Hypoglycemia Diabetic Ketoacidosis (DKA) Hyperosmolar Hyperglycemic state Retinopathy Neuropathy Foot Ulcers  3.HYPERTENSION Uncontrolled blood pressure plays a major role in the development of macrovascular events as well as microvascular complications, including retinopathy and nephropathy in patients with Diabetes Mellitus. Medications: There are several other principles regarding the treatment of hypertension in Diabetes patients. Angiotensin-converting enzyme (ACE) inhibitors or Angiotensin II receptor Blockers are recommended as initial therapy because of their beneficial effects on renal function. Combination therapy with ACE Inhibitor and Dihydropyridine calcium channel blockers has shown to reduce cardiovascular morbidity and mortality versus those receiving ACE Inhibitor therapy combined with Thiazide Diuretic. However, th