The DASH Diet Benefits

The DASH diet, which stands for Dietary Approaches to Stop Hypertension, is a dietary pattern that is designed to help lower blood pressure and reduce the risk of heart disease. 

The DASH diet emphasizes the consumption of whole foods, such as fruits, vegetables, whole grains, lean proteins, and low-fat dairy products, while limiting the intake of processed and high-fat foods.

The DASH diet is high in fiber, potassium, magnesium, and calcium, all of which have been shown to have beneficial effects on blood pressure. It also emphasizes the reduction of sodium intake, which is an important factor in controlling blood pressure.

The DASH diet is a flexible and balanced eating plan that can be adapted to meet the needs and preferences of individuals. It has been recommended by many health organizations, including the American Heart Association, as a heart-healthy dietary pattern.

Sure! Here are some additional details about the DASH diet:

- The DASH diet was developed by the National Heart, Lung, and Blood Institute (NHLBI) in the United States as a way to help people lower their blood pressure without medication.

- The diet emphasizes the consumption of fruits, vegetables, whole grains, lean proteins, and low-fat dairy products. It also includes nuts and seeds, and limits the consumption of red meat, sweets, and sugary beverages.

- The DASH diet is high in nutrients such as fiber, potassium, magnesium, and calcium, which have been shown to have beneficial effects on blood pressure.

- The diet also emphasizes the reduction of sodium intake, which is an important factor in controlling blood pressure. The NHLBI recommends limiting sodium intake to 2,300 milligrams per day, or 1,500 milligrams per day for those with high blood pressure.

- The DASH diet is a flexible eating plan that can be adapted to meet the needs and preferences of individuals. It can be tailored to various calorie levels, and can accommodate different cultural and dietary preferences.

- Studies have shown that the DASH diet can help lower blood pressure in people with hypertension, and can also reduce the risk of developing heart disease, stroke, and other chronic conditions.

- The DASH diet is often recommended as part of a comprehensive approach to managing hypertension and reducing the risk of heart disease, along with regular exercise, stress management, and other lifestyle modifications.

Overall, the DASH diet is a balanced and nutritious dietary pattern that emphasizes whole, nutrient-rich foods and can help improve cardiovascular health.

Novel oral anticoagulants(NOACs)

1-Other names:

Direct oral anticoagulant(DOACs), non vitamin K antagonist oral anticoagulant(NOACs)

2-Either Direct thrombin inhibitors (dabigatran), anti factorX (Rivaroxaban, apixaban, edoxaban)

Are Contraindicated as follow

3-Contraindicated in Pregnancy and lactation

4-Contraindicated in Mechanical prosthesis and Mitral stenosis (Mitral valve area 1.5 cm2 or less)

5-Contraindicated in the first three months after mitral valve repair or tricuspid valve repair

And contraindicated in the first 3 months after Implantation of mitral or tricuspid tissue valve

6-Contraindicated in liver cirrhosis, Child C

Main points to be considered:

7-The approved one in Chronic kidney disease or dialysis is Apixaban

8-Antidote for dabigatran is Idarucizumab, antidote for Anti Factor X (mainly Rivaroxaban) is andexanet alfa,

you can give 4 factors prothrombin complex concentrate for NOCAs related Bleeding

9-When you switch from Warfarin to NOACs, start NOACs when INR is 2. 5 or less

10-When switch from NOACs to warfarin, give both till INR reach 2 for two consecutive readings

11-As a general rule, NOACs are stopped 2 days before surgery (except for dabigatran in patients with CKD,

will need longer interval)

12-As a general rule, you can restore NOACs 3 days after surgery

13-As a general rule, the risk of GIT Bleeding with NOACs is more than Warfarin except Apixaban 5mg twice or

dabigatran 110 mg twice which have a comparable GIT Bleeding risk similar to Warfarin

14-PTT can be prolonged with dabigatran, and dabigatran is the only one that be be cleared with

dialysis in case of toxicity

15-As a general rule, NOACs are at least as effective as Warfarin and they are more safe as regard Bleeding risk

16-The risk of Hemorrhagic stroke or cerebral hemorrhage is low with all NOCAs when compared to Warfarin

17-The only 2 NOCAs that showed superiority over warfarin in stroke risk reduction are:

apixaban 5 mg twice and Dabigatran 150mg twice

Other NOACs have a comparable stroke risk reduction VS. Warfarin

18-Dabigatran is associated with reduction of vascular mortality, Apixaban is associated with

reduction of all cause mortality,

edoxaban is associated with reduction of Cardiovascular mortality

19-Rivaroxaban should be given with meal

20-Highest renal excretion with dabigatran, lowest renal excretion with apixaban

21-Trials of NOACs with P2 Y12 inhibitors

-Redual PCI(dabigatran)

-Pioneer AF(Rivaroxaban) 

-Augustus(apixaban)

-Entrust(Edoxaban) (ongoing)

Trials of NOACs in AFib

-Rely (dabigatran)

-Rocket(Rivaroxaban)

-Aristotle (Apixaban)

-Engage (Edoxaban)

Trials of NOACs in venous thromboembolism

-Recover(Dabigatran)

-Einstein(Rivaroxaban)

-Amplify(Apixaban)

22-No need for concomitant treatment with parenteral anticoagulant upon starting with apixaban or

Rivaroxaban in treatment of Venous thromboembolism

Instead, you can give apixaban 10mg twice for 1 week then 5 mg twice daily thereafter

And Rivaroxaban 15mg twice daily for 3 weeks then 20mg once daily thereafter

Apixaban 5 mg in Egypt

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Breakthrough in PCI

Protected PCI with Impella 2.5 reduces adverse events, with a 29% reduction in MACCE at 90 days

A Protected PCI is an Impella-supported procedure that maintains a patient’s hemodynamic stability, allowing you to do a more complete revascularization in a single session.

The Impella 2.5 is a temporary (≤ 6 hours) ventricular support device indicated for use during:

1-High risk PCI performed in urgent or

 2-Elective hemodynamically stable patients with severe coronary artery disease and 3-Depressed left ventricular ejection fraction, when a heart team, including a cardiac surgeon, has determined high risk PCI is the appropriate therapeutic option. Use of the Impella 2.5 in these patients may prevent hemodynamic instability that may occur during planned temporary coronary occlusions and may reduce peri- and post-procedural adverse events.

Impella is the only hemodynamic support device proven safe and effective at reducing adverse events in elective and urgent high risk PCI patients

The FDA indication for high risk PCI is defined as the combination of complex coronary artery disease (3VD or ULM), hemodynamic compromise (LVEF <=35%) and patient comorbidities.

The top-prescribed and Top-selling prescription drugs in the United States

Table 1. Top 100 Drugs by Monthly Prescription
Rank	Drug (Brand Name)	Total Prescriptions to June 2014
1	Synthroid	22,664,826
2	Crestor	22,557,735
3	Nexium	18,656,464
4	Ventolin HFA	17,556,646
5	Advair Diskus	15,003,169
6	Diovan	11,401,503
7	Lantus Solostar	10,154,739
8	Cymbalta	10,065,788
9	Vyvanse	10,019,178
10	Lyrica	9,684,884
11	Spiriva Handihaler	9,518,849
12	Lantus	9,358,961
13	Celebrex	8,815,391
14	Abilify	8,777,842
15	Januvia	8,758,309
16	Namenda	7,640,319
17	Viagra	7,584,152
18	Cialis	7,555,933
19	Zetia	7,411,629
20	Nasonex	7,304,210
21	Suboxone	7,011,882
22	Symbicort	6,948,403
23	Bystolic	6,722,578
24	Flovent HFA	5,623,533
25	Oxycontin	5,559,330
26	Levemir	5,554,827
27	Xarelto	5,014,364
28	Nuvaring	5,011,966
29	Dexilant	4,866,178
30	Thyroid	4,834,481
31	Benicar	4,725,628
32	Voltaren Gel	4,709,766
33	Proventil HFA	4,494,004
34	Tamiflu	4,149,835
35	Novolog	4,044,310
36	Novolog Flexpen	4,006,690
37	Premarin	3,984,357
38	Vesicare	3,873,046
39	Humalog	3,858,256
40	Benicar HCT	3,633,026
41	Lumigan	3,283,060
42	Afluria	3,242,605
43	Lo Loestrin Fe	3,154,488
44	Janumet	3,089,749
45	Ortho-Tri-Cy Lo 28	3,053,738
46	Toprol-XL	3,044,003
47	Pristiq	3,023,546
48	Combivent Respimat	2,994,490
49	Vytorin	2,988,460
50	Travatan Z	2,919,358
51	Focalin XR	2,866,278
52	Pataday	2,757,094
53	Humalog Kwikpen	2,626,530
54	Lunesta	2,590,519
55	Avodart	2,527,583
56	Pradaxa	2,442,678
57	Seroquel XR	2,405,130
58	Strattera	2,387,756
59	Minastrin 24 Fe	2,353,282
60	Evista	2,232,555
61	Chantix	2,151,879
62	Zostavax	2,145,562
63	Humira	1,923,427
64	Victoza 3-Pak	1,902,995
65	Exelon	1,877,942
66	Exforge	1,838,730
67	Combigan	1,821,491
68	Dulera	1,790,677
69	Onglyza	1,784,018
70	Welchol	1,778,218
71	Premarin Vaginal	1,718,405
72	Enbrel	1,627,480
73	Xopenex HFA	1,588,895
74	Ranexa	1,567,961
75	Truvada	1,532,734
76	Alphagan P	1,503,194
77	Viibryd	1,447,730
78	Tradjenta	1,443,791
79	Effient	1,434,572
80	Azor	1,433,045
81	Norvir	1,384,306
82	Actonel	1,339,615
83	Namenda XR	1,319,963
84	Amitiza	1,309,980
85	Aggrenox	1,286,826
86	Lotemax	1,276,480
87	Patanol	1,274,050
88	Levitra	1,273,311
89	Advair HFA	1,272,551
90	Uloric	1,244,536
91	Detrol La	1,225,506
92	Asmanex Twisthaler	1,219,112
93	Lipitor	1,212,376
94	Atripla	1,183,636
95	Prempro Low Dose	1,162,513
96	Latuda	1,123,396
97	Novolog Flxpen Mix 70/30	1,119,855
98	Invokana	1,106,268
99	Epiduo	1,103,330
100	Humulin N	1,071,673

The Four Major Statin Groups

The four major primary- and secondary-prevention patient groups who should be treated with statins were identified on the basis of randomized, controlled clinical trials showing that the benefit of treatment outweighed the risk of adverse events. The four treatment groups include:

·         Individuals with clinical atherosclerotic cardiovascular disease.

·         Individuals with LDL-cholesterol levels >190 mg/dL, such as those with familial hypercholesterolemia.

·         Individuals with diabetes aged 40 to 75 years old with LDL-cholesterol levels between 70 and 189 mg/dL and without evidence of atherosclerotic cardiovascular disease.

·         Individuals without evidence of cardiovascular disease or diabetes but who have LDL-cholesterol levels between 70 and 189 mg/dL and a 10-year risk of atherosclerotic cardiovascular disease>7.5%.

Stroke Family Caregivers Happiest when Helping Their Relevant

People taking care of a family member who's had a stroke are happier when they maintain control of their own lives and continue to enjoy their interests and hobbies,

 according to new Canadian research.

"In the caregiving field, a lot of the studies have focused on more negative outcomes, like burden or depression and things like that, but when you actually speak with family caregivers they say, 'You know, it's not all that bad,'.

"There are some very good aspects to helping your family member and providing care, so we wanted to do a study that tried to emphasize some of the positive things and then try to understand what the factors that contributed to caregivers really being happy in the caregiving role are,"