Podcast appearances and mentions of Marc S Sabatine

Episode 58: Transaminitis.  Elevated aminotransferases can be caused by intrahepatic and extrahepatic causes, Dr Martinez and Dr Civelli explain the workup of transaminitis, distribution of Chantix was stopped by Pfizer, smoking cessation updates Introduction: Smoking Cessation UpdatesBy Hector Arreaza, MD, Valeri Civelli, and Yosbel Martinez, MD On June 25, 2021, Pfizer stopped distribution of some badges of Chantix(r) after high levels of the carcinogen N-nitroso-di-methyl-amine (NDMA) were found in some lots of the pills. “Pfizer told Reuters the distribution pause was ordered out of abundance of caution while further testing is conducted.”The FDA approved Varenicline in 2006, and there is evidence that Chantix is the most effective anti-smoking medication.USPSTF Grade A recommendations:1. All adults should be asked about their tobacco use. Then, if determined to be smokers or tobacco users, advise them to quit, and provide behavioral interventions and FDA-approved medications for cessation. This applies to all adults who are not pregnant and use tobacco.2. All pregnant patients should be asked about their tobacco use, advised to quit using tobacco, and offer behavioral interventions for cessation. USPSTF Grade I (I stands for “I don't know”):1. The USPSTF does not endorse or discourages the use of pharmacotherapy for smoking cessation in pregnant patients because there is insufficient evidence.2. E-cigarettes have insufficient evidence to be recommended as an effective way to stop smoking in adults. This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home.___________________________Transaminitis. By Yosbel Martinez, MDTransaminitis (Also known as Elevated Aminotransferases). “itis” normally means inflammation in medical terms, and for that reason transaminitis is not etymologically correct, but it's easy to use and everyone understands what it means. What are aminotransferases?Aminotransferases are intracellular enzymes are sensitive indicator of liver cell injury (necrosis vs inflammation) ALT (alanine aminotransferase) more specific measure of liver injury because AST (aspartate aminotransferase) also found in striate muscle, heart, brain, kidney and Red and white blood cells.-There is poor correlation between degree of liver cell damage and level of aminotransferases. General Approach of Chronic Transaminitis Chronic > 6 months (Often asymptomatic patient)Initial evaluation for most common liver conditions.-Drugs (herbal or recreational drugs) or medications (acetaminophen, INH, amiodarone, statins)-Hepatitis A, B, C-Alcohol Hepatitis AST/ALT ratio above 2:1-Fatty Liver AST/ALT < 1, RUQ Ultrasound- Hemochromatosis Iron/TIBC > 45% Hereditary hemochromatosis is an autosomal recessive disorder that disrupts the body's regulation of iron. It is the most common genetic disease in whites. Men have a higher risk of iron-overload disease compared with women. Hemochromatosis symptoms are absent in the early stages. If present, symptoms may include weakness, lethargy, arthralgias, and impotence. Later manifestations include arthralgias, osteoporosis, cirrhosis, hepatocellular cancer, cardiomyopathy, dysrhythmia, diabetes mellitus, and hypogonadism. Diagnosis requires confirmation of increased serum ferritin levels and transferrin saturation, with or without symptoms. Treatment of hereditary hemochromatosis requires phlebotomy, and the frequency is guided by serial measurements of serum ferritin levels and transferrin saturation. Dietary modification is generally unnecessary. Screen: Testing should be performed in first-degree relatives of patients with classical HFE-related hemochromatosis, those with evidence of active liver disease, and patients with abnormal iron study results. Screening for hepatocellular carcinoma is reserved for those with hereditary hemochromatosis and cirrhosis. Statins: Statins are very important in prevention of treatment of cardiovascular disease. They are safe.“The risk of hepatic injury caused by statins is estimated to be about 1 percent, similar to that of patients taking a placebo.”Patients with transaminase levels no more than three times the upper limit of normal can continue taking statins; often the elevations will resolve spontaneously. Coexisting elevations of transaminase levels from nonalcoholic fatty liver disease and stable hepatitis B and C viral infections are not contraindications to statin use Dosing: Hepatic Impairment: AdultContraindicated in active liver disease or in patients with unexplained persistent elevations of serum transaminases. Further evaluations to Determine likely source-Hepatic source (less common liver conditions)-Autoimmune Hepatitis (women, SPEP, ANA, ASMA)-Wilson disease (ceruloplasmin, slip lamp exam for Kayser- Fleischer rings)-Alfa 1- antitrypsin deficiency (emphysema out of proportion, obtain AA-1 level)-Other viral Hepatitis D, E, CMV, EBV, HSV,VZV. Non-Hepatic source.-Muscle disorder (CK, aldolase)-Thyroid disease (FT4, TSH)-Celiac/IBD (IgA anti-tissue transglutaminase, Calprotectin,CRP, P-ANCA, MRCP/ERCP.-Adrenal insufficiency (8 am cortisol level and plasma ACTH)-Anorexia nervosa (Psychiatric evaluation, BMI, electrolytes and Echo or TTE) Final step of evaluation.Liver biopsy (for diagnostic, staging and grading of liver disease)Now we conclude our episode number 58 “Transaminitis”. Dr Martinez and Dr Civelli explained what to do when we find elevated aminotransferases. Remember you can have intra-hepatic and extra-hepatic causes. If you cannot determine what's causing transaminitis, you may need to ask for a liver biopsy.  Even without trying, every night you go to bed being a little wiser.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Yosbel Martinez, and Valerie Civelli. Audio edition: Suraj Amrutia. See you next week!_____________________References:Pfizer Halts Distribution of Stop-Smoking Pill Chantix, WebMD, webmd.com, accessed on Jul 6, 2021. https://www.webmd.com/smoking-cessation/news/20210625/chantix-distribution-halted-pfizer. Tobacco Smoking Cessation in Adults, Including Pregnant Persons: Interventions, United States Preventive Services Taskforce, uspreventiveservicestaskforce.org, accessed on Jul 6, 2021. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/tobacco-use-in-adults-and-pregnant-women-counseling-and-interventions Uworld Boards Family Medicine Qbank.Harrison's Manual of Medicine 20th Edition.Pocket Medicine 7th Edition by Marc S. Sabatine.      

Following the Evidence: LDL-C as a Path to Reducing Cardiovascular Events—How Low Do We Go?

Following the Evidence: LDL-C as a Path to Reducing Cardiovascular Events—How Low Do We Go?

Following the Evidence: LDL-C as a Path to Reducing Cardiovascular Events—How Low Do We Go?

Following the Evidence: LDL-C as a Path to Reducing Cardiovascular Events—How Low Do We Go?

Following the Evidence: LDL-C as a Path to Reducing Cardiovascular Events—How Low Do We Go?

Following the Evidence: LDL-C as a Path to Reducing Cardiovascular Events—How Low Do We Go?

Following the Evidence: LDL-C as a Path to Reducing Cardiovascular Events—How Low Do We Go?

Following the Evidence: LDL-C as a Path to Reducing Cardiovascular Events—How Low Do We Go?

Following the Evidence: LDL-C as a Path to Reducing Cardiovascular Events—How Low Do We Go?

Following the Evidence: LDL-C as a Path to Reducing Cardiovascular Events—How Low Do We Go?

Interview with Marc S. Sabatine, MD, MPH, author of Efficacy and Safety of Further Lowering of Low-Density Lipoprotein Cholesterol in Patients Starting With Very Low Levels: A Meta-analysis

Interview with Marc S. Sabatine, MD, MPH, author of Efficacy and Safety of Further Lowering of Low-Density Lipoprotein Cholesterol in Patients Starting With Very Low Levels: A Meta-analysis