Controversies over Infective Endocarditis Prophylaxis and the need for National Guidelines

Infective endocarditis (IE) is a relatively rare but invariably fatal disease if left untreated. Over decades, individuals with certain congenital or acquired heart defects were given antibiotic prophylaxis before certain procedures to prevent IE. However, controversies on this regimen have begun to grow since 2002 and in 2007-2008, three major international health organizations, the American Heart Association (AHA), the European Society for Cardiology (ESC), and the National Institute for Health and Clinical Excellence (NICE), UK published have their revised guidelines where AHA and ESC markedly shortened the list of indications for IE prophylaxis and NICE abandoned the concept of IE prophylaxis altogether. This has literally divided not only the medical practitioners around the world but practitioners within countries who used to follow either AHA, ESC or NHS guidelines in absence of their own national guidelines. This chaotic situation has also affected the medical teaching in those countries because of contradictory teaching from teachers having different views and belongingness on this issue. Even follow up review five years after the introduction of revised guidelines has failed to resolve the controversies and it deems un resolvable in near future. In such circumstances, every country needs to have own guideline for uniform medical teaching and practice

Menopausal hormone therapy and risk of venous thromboembolism: the story so far

Menopausal hormone therapy (MHT) is known to increase the risk of venous thromboembolism (VTE), which includes deep vein thrombosis, pulmonary embolism, and less frequently cerebral vein thrombosis, but the absolute risk for a given patient is very low. After starting MHT, the risk of VTE seems to be at its highest, declining to the non-HRT user baseline level of risk after stopping. Whether estrogen-only or estrogen-progestin HRT combination is linked to a similar risk of VTE is unclear from the available evidence. The aim of this study is to evaluate the risks of developing VTE in relation to different types as well as different modes of administration of MHT through a database search including PubMed, MEDLINE, Google Scholar, Cochrane Library, and others in order to provide the women carers with the up-to-date and evidence-based guidelines and recommendations while counseling the post-menopausal women enquiring on use of hormonal therapies either to alleviate the menopausal symptoms or to prevent the longterm sequelae of estrogen deficiency

An uncommon side effect from the ‘king of fruit’: A case report on life-threatening hyperkalaemia after eating durian fruit

Hyperkalaemia is a condition of excess potassium level that occurs as a result of increased intake, or reduced renal clearance, or both. In a severe condition, hyperkalaemia is a medical emergency that can be life-threatening especially if recognised late and left untreated. There are many causes of hyperkalaemia. However, eating durian fruit in the background of impaired kidney function is a very rare occurrence. In this article, we report a case of an elderly lady who presented with a life threatening hyperkalaemia as a result of eating large amount of durian fruit while having multiple diarrhoeal episodes due to acute gastroenteritis that led to acute kidney injury. She was successfully treated and was discharged well. The objective of this case report is to share the rare cause of a life-threatening hyperkalaemia where prompt diagnosis and treatment initiation are crucial to prevent mortality

Psychiatry illnesses in Pregnancy: A Literature review

Background: Women of reproductive age frequently suffer from psychiatric disorders. The risk of developing anxiety, bipolar, and depressive disorders is especially significant during the perinatal period. Objectives: This article aims to identify and discuss the different psychiatric conditions that might affect pregnant women and update the mother’s carers about the recent and updated bidirectional relationship between psychiatric disease and adverse pregnancy outcomes, As well as the most updates in diagnostic and management strategies. Methods: A thorough analysis of the literature was conducted using database searches in EMBASE, Science Direct, Google Scholar, Scopus, and PubMed to obtain the objectives and aim of the study. Results: The presence of maternal mental illness during pregnancy has been linked to preterm delivery, newborn hypoglycemia, poor neurodevelopmental outcomes, and disturbed attachment. Placental anomalies, small-for-gestational-age foetuses, foetal discomfort, and stillbirth are among more undesirable perinatal outcomes