كيف تفرق؟
فشل القلب غالبًا:
Orthopnea (يزيد إذا نام)
PND
زيادة وزن واحتباس سوائل
Crackles بالرئة
أما PE:
ضيق نفس جاه فجأه
الم صدر يزيد مع النفس
Tachycardia
يكون عنده شي ممكن يساهم فيه
مثل سفر او عمليه قريبه
او دواء معين مثل OCP
مريض عنده Heart failure، جاء الطوارئ بضيق نفس.
والـ BNP مرتفع.
قبل لا تبدأ معه Diuretics وتقول انه
decombensated HF
فيه تشخيص واحد لو كان السبب ممكن يغيّر الخطة كلها👇
Intraop TEE - patient transferred immediately to cardiac surgery after procedure-related perforation of NCC during transseptal puncture for pulmonary vein isolation in a patient with AFib #echofirst
Voriconazole,CRP and Sepsis.
*A sharp rise in C-reactive protein (CRP) during sepsis causes voriconazole levels to spike because systemic inflammation downregulates the liver enzymes responsible for clearing the drug.
*When the body experiences severe inflammation, the release of pro-inflammatory cytokines (such as IL-6) suppresses the activity of hepatic cytochrome P450 enzymes—primarily CYP2C19 and to a lesser extent CYP3A4.
*Because voriconazole is heavily dependent on these enzymes for metabolism, the drug's hepatic clearance can drop by up to 50%.
*Consequently, the drug accumulates in the bloodstream, leading to potentially toxic, supra-therapeutic levels.
*Because voriconazole has a narrow therapeutic window, this drug-inflammation interaction can lead to severe adverse effects (e.g., hepatotoxicity, neurotoxicity, or visual disturbances) if dosages are not appropriately adjusted.
https://t.co/5tAuOxeHUt
Immunohistochemically, positive for CD20, CD30, BCL-2, and EBV-encoded small RNA, but negative for CD3, CD5, CD4, CD21, CD23, ICOS, BCL-6, and PD1.
What is the diagnosis?
DLBCL=diffuse large B-cell lymphoma
TCL=T-cell lymphoma
FCL=follicle centre lymphoma
3/3
A skin biopsy showed a lymphocytic infiltration without vasculitis in the dermis and subcutaneous tissue, with medium-to-large-sized atypical cells with eosinophilic cytoplasm.
2/3
🧠Quiz Time!
An 83-year-old woman with stage IV angioimmunoblastic T-cell lymphoma developed a painful and pruritic rash on her face, chest, and back after 4 cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone).
1/3