Opthea’s Post

Ophthopedia Update:Real world efficacy and durability of faricimab in patients with neovascular AMD (nAMD) who had sub-optimal response to prior anti-VEGF therapy: Eye, Published online: 04 July 2024; doi:10.1038/s41433-024-03218-7Real world efficacy and durability of faricimab in patients with neovascular AMD (nAMD) who had sub-optimal response to prior anti-VEGF therapy #Ophthalmology #Eye #Ophthotwitter

Ophthopedia Update:Bacillary Layer Detachment in Neovascular Age-related Macular Degeneration From a Phase 3 Clinical Trial: To evaluate the incidence of bacillary layer detachment in patients with neovascular age-related macular degeneration (nAMD) and their response to anti–vascular endothelial growth factor (VEGF) therapy #Ophthalmology #Retina #Ophthotwitter

🔬 Case for Personalized Medicine in the Management of ASD Repair 🔬 I recently had the opportunity to work on interesting case involving an 18-year-old female who was born with an ASD (Atrial Septal Defect) heart condition. The patient's cardiologist recommended an ASD repair procedure to address the condition. Following the surgery, the cardiologist devised a treatment plan that involved prescribing Plavix 75 mg once a day, along with baby aspirin, for a duration of 6 months to prevent clotting. During my involvement in the case, I recommended the use of pharmacogenomics (PGx) testing and explained the significance of the boxed warning on the FDA label associated with Plavix. This warning highlights the importance of considering genetic factors that can impact the effectiveness of the medication. When the results of the PGx testing came back, it was revealed that the patient was a poor metabolizer for the CYP2C19 enzyme, which is responsible for activating Plavix. As Plavix is an inactive drug that needs to be metabolized by CYP2C19 to become effective, being a poor metabolizer can result in lower systemic active metabolite concentration, leading to a lower antiplatelet response and potentially higher cardiovascular risk for the patient. In light of this information, the patient's doctor decided to explore alternative platelet P2Y12 inhibitors that would not be affected by CYP2C19 metabolism. This personalized approach, guided by the PGx results, helped the patient avoid potential medication failure and mitigate the higher cardiovascular risk associated with her genetic profile. This case exemplifies the power of pharmacogenomics in tailoring treatment plans to individual patients. By considering genetic factors, healthcare providers can make more informed decisions, optimize medication choices, and ultimately enhance patient outcomes. #PersonalizedMedicine #Pharmacogenomics #ASDRepair #PatientCare

You may have seen a recent article about management of knee osteoarthritis with orthobiologics and corticosteroid (Mautner et al., Nat Med 2023 Nov 2. doi: 10.1038/s41591-023-02632-w. Epub ahead of print). At first glance a superb study; randomized controlled trial with 480 patients. The first sentence in the abstract sets the tone: "Various types of cellular injection have become a popular and costly treatment option for patients with knee osteoarthritis despite a paucity of literature establishing relative efficacy to each other or corticosteroid injections [CSI]." Here's the authors' main conclusion from their study (last sentence of the abstract): "In summary, this study shows that at 1 year post injection, there was no superior orthobiologic as compared to CSI for knee osteoarthritis." This publication once again demonstrates how important it is to read the entire paper critically and not just the abstract. You can find an in-depth analysis here; please give it your own thoughts: https://lnkd.in/eXCJSnUE

Discussed consult during Lawton rounds for a rare, perplexing clinical entity referred to as diffuse cerebral proliferative angiopathy while at The BNI with Jeff Ehresman Redi Rahmani and Michael T. Lawton. We (including my home comrade Brian Lien of UCI School of Medicine) put together a review on this pathology which is essentially a diffuse arteriovenous malformation that does not possess a distinct nidus, quite unlike an AVM. As it is entirely non focal, this cerebrovascular anomaly can encompass an entire lobe or even span the entire cerebral hemisphere (or bilateral hemispheres). Medical management of symptoms (e.g., AEDs for seizures) is the most that can be done for many of these patients. Surgical resection is not an option as it is for classic AVMs. Treating it as if it were pediatric Moyamoya has worked - but in only a handful of reported cases.

🧠 SetPoint Medical’s neuroimmune modulation platform gets FDA breakthrough device status in MS SetPoint Medical has received breakthrough device designation from the US Food and Drug Administration (FDA) for its neuroimmune modulation platform to treat relapsing-remitting multiple sclerosis (RRMS). The investigational platform technology is said to precisely stimulate the vagus nerve to activate innate anti-inflammatory and immune-restorative pathways for the treatment of inflammation-mediated autoimmune diseases. During an outpatient surgery, SetPoint Medical’s integrated and miniaturised neurostimulation device is put on the vagus nerve via a small incision on the left side of the neck. Using a preprogrammed schedule, the device is set up to automatically administer therapy by stimulating the vagus nerve once a day. This triggers the inflammatory response for a systemic immune-restorative impact. The breakthrough status was granted based on data which showed that SetPoint Medical’s therapeutic approach can possibly lessen demyelination and boost remyelination. Read more online: https://lnkd.in/eRYvkeu2 📰 Follow Medical Device Developments to receive the latest medical device news daily and to subscribe to our weekly newsletter #MedicalDeviceDevelopments

And sodium thiosulfate can be an additional therapeutic option

😴 Procedural Sedation - #RxShorts 💉 Procedural sedation is patient-specific depending on procedure, in addition to degree of pain and anxiety. 📑 Pharmacokinetics and pharmacodynamics makes certain agents preferable in specific cases. 📋 Indications for procedural sedation include need for imaging in MRI, lumbar punctures, abscess drainage, and joint or bone reductions. Here’s some procedural sedation deposits for the drug bank; midazolam, etomidate, and methohexital. These agents are considered cardiovascular neutral. Midazolam has a slow onset, etomidate isn’t suitable for bone reductions due to myoclanus, and methohexital has minimal amnestic properties compared to others on the table. As a rapid acting barbituate, methohexital is a great option for cardioversions. Website: www.pharmwyze.com Shop: www.pharmwyze.com/shop Social Links: https://lnkd.in/gDieXyz9 DrugQueryInbox Request: https://lnkd.in/gzEWM7A3 Streaming Platforms: https://lnkd.in/gXp643UM Patreon: https://lnkd.in/gRuFrt6z Paypal Donation: https://lnkd.in/gdMcixdh PHARMWYZE SITREP Newsletter: https://lnkd.in/gsD4VgvG Not medical advice. Educational purposes only. No relationships to report. #MedicalInsights #ClinicalPearls #MedicalEducation #MedicineToday #pharmacist #pharmwyze #pharmfax #criticalcare #emergencymedicine #studentpharmacist #nursingstudent #medicalstudent #pharmacy #medicine #nursing #meded #shorts #rxshorts #medigram #medshed #foamed #emrx #pharmacology #pharmacokinetics #cardiology #antibiotics #neurology

⭕ I left out some details in my previous post about reticulocytes because of limited space, and they might be confusing. 𝗢𝗻𝗲 𝗸𝗲𝘆 𝗽𝗼𝗶𝗻𝘁 𝗶𝘀 𝘄𝗵𝘆 𝗶𝘁'𝘀 𝘀𝗼 𝗶𝗺𝗽𝗼𝗿𝘁𝗮𝗻𝘁 𝘁𝗼 𝗴𝗲𝘁 𝗮𝗻 𝗮𝗰𝗰𝘂𝗿𝗮𝘁𝗲 𝗰𝗼𝘂𝗻𝘁 𝗼𝗳 𝗿𝗲𝘁𝗶𝗰𝘂𝗹𝗼𝗰𝘆𝘁𝗲𝘀 𝗶𝗻 𝗰𝗮𝘀𝗲𝘀 𝗼𝗳 𝗮𝗻𝗲𝗺𝗶𝗮. I have included a picture where I explain everything in more detail. I have shown this with two examples: one where the person has normal red blood cells and reticulocyte count, and another has anemia. In the second case, suppose hematocrit (HCT) is 22.5 and hemoglobin (Hb) is 7, but their reticulocyte count is normal. 𝗣𝗹𝗲𝗮𝘀𝗲 𝗰𝗼𝗺𝗺𝗲𝗻𝘁 𝗯𝗲𝗹𝗼𝘄 𝗼𝗻 𝘁𝗵𝗲 𝗿𝗲𝗮𝘀𝗼𝗻 𝗳𝗼𝗿 𝘁𝗵𝗶𝘀 𝘁𝘆𝗽𝗲 𝗼𝗳 𝗮𝗻𝗲𝗺𝗶𝗮. 𝗔𝗻𝗼𝘁𝗵𝗲𝗿 𝘁𝗵𝗶𝗻𝗴 𝘁𝗵𝗮𝘁 𝗰𝗮𝗻 𝗯𝗲 𝗰𝗼𝗻𝗳𝘂𝘀𝗶𝗻𝗴 𝗶𝘀 𝘄𝗵𝘆 𝘄𝗲 𝘂𝘀𝗲 𝗺𝗮𝘁𝘂𝗿𝗮𝘁𝗶𝗼𝗻 𝘁𝗶𝗺𝗲 𝘁𝗼 𝗮𝗱𝗷𝘂𝘀𝘁 𝘁𝗵𝗲 𝗰𝗼𝘂𝗻𝘁. The reason is that normally, reticulocytes live for about a day in peripheral blood at normal HCT. But in anemia, they can live longer, which can make it harder to figure out the right count, even though your bone marrow is trying to respond. This is why we consider how long they have been maturing. HCT %                                                                 Maturation Time in Days 45                                                                                     1 35                                                                                   1.5 25                                                                                    2 15                                                                                   2.5 #Reticulocytes #AnemiaAwareness #Hematology #MedicalEducation #HealthcareProfessionals #BloodDisorders #MedicalResearch #ClinicalCases #Hematocrit #Hemoglobin #BoneMarrowResponse

Calcinosis cutis affects 40% of SSc pts w/ significant morbidity. Assoc w/ Long Dz duration, vascular dysfunction, & osteoporosis. Dx by radiography. Surgical treatment is most effective therapy, but no medical therapies have proven efficacy in RCTs