Journal Round Up – Q1 2020

a) Diabetes
 Deprescribing
 HbA1c < 7% is not for everyone particularly the elderly – worse outcomes if less than this –
conflicting cohort studies from UK
 Chose one medication at a time to reduce and gradually wean
b) MJA – Jan / Feb March 2020 - coverage of this Journal being reconsidered
 Lifetime cancer risks for most common cancers are overestimated by AIHW
 Routine testing for Mycoplasma genitalium is not recommended unless symptomatic, has had contact
with infected person or will have vaginal surgery soon
 Migraine
 Dx per ID: > 3 months, need two out of 1) N/V 2) Photophobia 3) incapacitated for at least 1 day
 Triggers for imaging
 thunderclap; novel, persistent; progressive symptoms; neuro signs; changes with increase ICP
pressure maneouvres; other Dx likely (neuralgia, cluster, etc); systemic signs ?oither cause e.g.
infections, mets
 Stop the opioids
 Address lifestyle factors
 Trial of acute and preventative measures
 Acute – advise patients not to “chase every headache”
 NSAIDs: Naproxen (menstrual link – best); diclofenac – supps can work well
 Triptans: Sumatriptan (intransal) / oral rizatriptan good in nausea ++); not if CVD history
 Antiemetics: metoclopramide / prochloperazine – can add ondansetron
 Preventative (selected) – aim to reduce not completely prevent
 TCA: nortriptyline up to 1mg / kg
 BB: propanolol up to 80mg BD
 Candesartan: check EUC before and after
 Serotonin antagonist: pizotifen 1-4mg nocte – wt gain and drowsiness -> 3rd line but effective
 Antiepileptics: topiramate (50-100mg BD: cognitive AE, glaucoma); Valproate (500mg BD:
older pt)
 Nutraceuticals: Riboflavin 400mg daily – yellow urine – some good efficacy data
 Dengue vaccine – CYD – TDV
 Tetravalent, 0, 1 and 6 months
 Special access scheme only – currently not recommended to primary prevention; Only if
seropositive and planning to live / travel frequently to second strain area
 Gluten free diets for non-coeliacs – nil effect – FODMAP may be more appropriate
 Choosing 2nd line T2DM medications after metformin
 SGLT2: if CVD, CKD, heart failure. NB also reduce SBP 2-3mmHg. NB warn and monitor for
DKA.
 GLP1: if CVD
 DPPIVi
 Skin biopsies
 Rash / SCC / BCC: 3mm punch
 Pigmented lesions: excisional with margin
 Punch >2mm will need a suture
 Paracetamol overdose – complicated time / dose / MR vs IR related nomogram: use online resources if
encountered
c) AJGP Jan / Feb March 2020
 Overuse injuries in athletes
 Achilles / patellar tendinopathy
 Educate, low impact upservised exercise programme. Stretching / NSIADs don’t change
outcomes; may be some role for PRP; may take 4m to resolve if so -> sports physician
 ITB syndrome


Topic: cephalexin dosing

 UTI: 500mg BD for 5 days
 All other uses: QID