General medicine

Clinically, the distinction between a hepatocellular and a cholestatic reaction is indicated by
the R value, the ratio of alanine aminotransferase (ALT) to alkaline phosphatase (ALP) values, both expressed as multiples of the upper limit of
normal.
*R value of >5.0 : Hepatocellular injury,
*R

Glucocorticoid Pulse Therapy:

Leprosy:
After rifampin, the most bactericidal agents against M. leprae in mice and patients appear to be minocycline, clarithromycin, and ofloxacin.

Goiter is defined, somewhat arbitrarily, as a lateral lobe with a volume greater than the thumb of the individual being examined. On ultrasound, total thyroid volume exceeding 30 mL is considered abnormal.

Pathophysiology of adrenal insufficiency.

Most heart failure in DM is due to epicardial coronary disease.
In obesity : Rapid clearance of ANP by adipose tissue causes fluid retention.

Important practical information:
Determining the intrinsic heart rate (IHR) may distinguish SA node dysfunction from slow heart rates that result from high vagal tone. The normal IHR after administration of 0.2 mg/kg propranolol and 0.04 mg/kg atropine is 117.2 − (0.53 × age) in beats/min; a low IHR is indicative of SA disease.

Very important and practical information regarding Alcoholic Liver Disease.

Mechanism of action of Hydroxychloroquine in brief in Rheumatic diseases.

CCB's and beta blockers in IHD:

1)Verapamil ordinarily should not be combined with beta blockers because of the combined adverse effects on heart rate and contractility.

2)Diltiazem can be combined with beta blockers in patients with normal ventricular function and no conduction disturbances.

3) Amlodipine (Decreases blood pressure)and beta blockers(Decreases the heart rate and contractility) have complementary actions on coronary blood supply and myocardial oxygen demands.

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Azathioprine in myasthenia Gravis:

**An initial dose of 50 mg/d is given for about a week to test for these side effects. If this dose is tolerated, it is increased gradually to about 2–3 mg/kg of total body weight, or until the white blood count falls to 3000–4000/μL.

**The beneficial effect of azathioprine can take a year or more to become evident. Approximately 10–15% of patients are unable to tolerate azathioprine because of idiosyncratic reactions consisting of flulike symptoms of fever and malaise, bone marrow suppression, or abnormalities of liver function.