Constipation associated with CKD 11-Nov-2016

10% of patients with constipation can develop chronic kidney disease

Non gluten sensitivity 17-Oct-2016

A newly discovered protein called amylase trypsin inhibitor may be responsible for NCGS symptoms 

HCV assoc.with nasopharyngeal and oropharynx cance 06-Jul-2016

Risk association with HCV cancer includes liver cancer, non hodgkins Lymphoma, nasopharyngeal cancer and oropharyngeal cancer (MD anderson study)

Risk of alkaseltzer - GI bleed 01-Jul-2016

Risk of bleeding is higher in alkaseltzer seltzer Risk factors include: Age 60 or older A history of stomach ulcers or bleeding problems Taking a blood thinner or steroid medication Taking an NSAID Drinking three or more alcoholic beverages a day

Epclusa aporoved for hepatitis C 30-Jun-2016

this is the first pan genotypic medication for HCV.  EPCLUSA

MS : fatigue assoc with sluggish bowel 16-Jun-2016

A small study based on 3 different types of questionaire found that multiple sclerosis patients had a higher incidence of fatigue if they had sluggish bowel habits

Ulcer prevention on ASA-PPI , H2 block no effect 15-Jun-2016

Ulcer prevention on ASA - H2 blocker 12% effective versus PPI 8% effective and neither was statistically different.

Normal BMI for asians is 2.5% less ! 14-Jun-2016

This is true for all aspects of obesity.

Obesity table
Morbidly ObeseMore than 40More than 37.5


Sleep apnea 01-Jun-2016

Sleep apnea. One third of patients with insomnia have obstructive sleep apnea (OSA),[8] which is caused by upper-airway collapse during sleep that leads to repeated breathing stoppages throughout the night. If a patient has OSA, their insomnia may be refractory to both nonmedication and medication treatment options. Once OSA is formally diagnosed with polysomnography and treated, the associated insomnia symptoms often completely resolve.

In addition to insomnia, there are also long-term risks associated with untreated OSA. These include an association with long-term cardiovascular and cerebrovascular disease.[5]

The STOP BANG Inventory[9] can help you quickly establish whether your patient is at high risk for OSA and would benefit from polysomnography. If they have five or more of the following factors, they are considered at high risk:


  • Snoring
  • Tiredness
  • Observed that you stop breathing
  • History of high blood pressure


  • Body mass index > 35 kg/m2
  • Age older than 50 years
  • Neck circumference > 40 cm (15.75 in)
  • Gender: male

Although polysomnography is not part of the standard workup of insomnia, it is warranted in specific cases, such as when sleep apnea or another sleep disorder is suspected or if the insomnia remains refractory to treatment.[2]


Insomnia 01-Jun-2016

Common medications than can cause insomnia include anticonvulsants, beta-blockers, antipsychotics, antidepressants, and nonsteroidal anti-inflammatory drugs.[12] A timeline may be useful to determine whether the initiation of a new medication, or a change in dose, correlates with worsening of insomnia.


Qnexa - Is there hope? 12-Apr-2011

Qnexa, an investigational drug, for weight loss showed promise. In one study published in Lancet, it helped patients lose 22 pounds, lowered their blood pressure and cholesterol. The drug was denied by FDA in October 2010 - they asked for additional studies.

C Diff 06-Apr-2011

C diff is an infection that occurs when the normal bowel bacteria is killed. This gives an opportunity to other toxic bacteria like C diff to grow. Currently we use flagyl (metronidazole) or vancomycin or Rifaximin. However, there is a relapse meaning repeated infection of C diff because those antibiotics stil kill the normal flora. A new medication will hopefully come out soon - it is called Fidaxomicin (Dificid) which is better in preventing relapses and works better

NEW PPI WARNING! 03-Mar-2011

The latest update on PPI (Protonix, Nexium, Aciphex, Prilosec, Prevacid, Dexalant) is that long term use (defined as more than 1 year use) is associated with low Magnesium level. This low magnesium level can be associated with a higher chance of cardiac rhythym problems. All patients on long term PPI use, especially if they take a diuretic or digoxin should get their Magnesium level checked. Please call my office or your primary care

Capsule Crawler 30-Oct-2010

In the United Kingdom, they are working on a capsule endoscopy that has "legs" and can be controlled with a remote!

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