• Natural potassium intake for hypertension

    Hi everyone, this is more of an open question and reflexion.

    After a few exchanges with patients, it has come to my attention again a 2013 study titled “Effect of increased potassium intake on cardiovascular risk and disease factors: a systematic review and meta-analyzes”. Here the link:

    https://www.ncbi.nlm.nih.gov/pubmed/23558164

    While our ancestors’ arguably included in their eating habits about a daily potassium intake of 200ml, present day societies to my knowledge are seeing a surge in hypokalemia cases. This deficiency could be due to the massification of processed foods, with people tending to go for the chocolate bar over the fruit. I have come across a wave of new studies on the role of potassium in lowering blood pressure values. Potassium is hence an effective component in the prevention and treatment of hypertension. Stroke, kidney failure, cardiovascular risks .... We all know the dramatic consequences from these conditions but I think we often underestimate how this awareness is not necessarily still widespread amongst patients. Hypertensive subjects who are more comfortable coping and living their everyday lives with their hypertension tend to abandon their treatment but are also more likely to change their diets, if given specific “hacks” of what to eat. If they are advised to consume more potassium with clear food examples, there is a good chance that they prefer to follow this rather than following their (pharmacological) treatment. I guess potassium intake in this way, has an insidious effect on high blood pressure and it does not overwhelm patients too much. So do not hesitate to “prescribe” and encourage patients to eat a banana or a fruit of their choice more frequently and on a daily basis!

    Whats your experience with this? Should we at least keep our patients informed on fruits and vegetables as a form of prevention and solution to certain conditions? Have you found this to be effective in cases where treatment compliance fails or is intermittent? Has this been effective in their control readings for their pathologies.

    Thanks all for any reflections!

    Anna

  • Question on Allergic Asthma Treatment

    Dear colleagues,

    I have been treating a 28-year-old patient, male, with severe allergic asthma for a while. The patient has many food allergies, plus allergic reaction to dust mites, mold and almost all types of pollen. It is almost impossible for him to avoid allergens. Even with long-acting beta-adrenoceptor agonist (LABA) or glucocorticoid therapy, severe asthma attacks are common, and day-to-day life is severely disrupted.

    I am studying the possibility of prescribing Omalizumab, a monoclonal antibody targeted at immunoglobulin E. However, I have no experience with this treatment and am at the moment somewhat reserved. I read that this treatment poses a risk of developing malignant tumors and that the drug could cause anaphylactic adverse reactions. Treatment costs are also of concern.

    Are you in favor of prescribing this medicine?

    Thanks for your help.

  • Cortisol and empathy

    In February 2014, the journal "Neuropsychopharmacology" published results from a research conducted at the Charité University Hospital in Berlin about cortisol’s capacity to influence feelings of compassion.

    We know that cortisol activates the mineralocorticoid and glucocorticoid receptors in the brain. For the study, the participants' mineralocorticoid receptors were stimulated with fludrocortisone. Stimulated participants reacted with significantly more empathy than the control group. 

    The pharmacological effect of feeling more compassion could be used for the treatment of psychiatric disorders. My questions to colleagues is, which pathologies do you believe may be relevant from a therapeutic perspective for the application of cortisol treatment given this finding?+

    Could people in non-pathological or asymptomatic mental health also benefit from this potential?

    Thanks for any opinions. Here's the link to the article in question

    https://www.nature.com/articles/npp201436

  • Aortic disease

    Hi am looking for a scientific article that addresses the topic of aortic disease, in particular references for thoracic/thoracic abdominal aneurysms are greatly appreciated. Especially articles that address these subjects with in-depth focus on its development and studies based on ultrasound methods.

    Thank you for your help.

  • Morbid obesity patient

    Hi, I’m a general practitioner and need an opinion on one of my patients.

    She is a 55-year-old morbidly obese female, with a BMI of 42 in need of bariatric care. The patient has already undergone LAGB with a therapeutic failure event 10 years ago. Her dietary history includes multiple regimes and the patient has had several cycles of weight loss and gain. Comorbidities include hypertension and type 2 diabetes (insulin independent), both treated and evolving within normal values.

    My question to colleagues is if this patient would benefit from a new bariatric surgery intervention despite the previous incidence of LAGB failure? If so, what type could she have as the best option? Or would any of you recommend a trial of psychological treatment associated with dietary management before a surgical intervention?

    Thank you in advance for your comments!

    Yours sincerely, AP

  • Tramadol side effect management

    Dear Colleagues, 

    Could any of you provide feedback on your experience with Tramadol ODs? In particular, instances of management with naloxone, and without association to alcohol intake. 

    best regards, 

    B

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