Hello! 👋
Welcome to The Ward Round 001 - I hope over the next couple of years every week, I can provide you with news, entertainment and learning in the world of medicine, health and performance. I have created this as it was always something I wanted to read myself so join me on the journey and let me know your thoughts.
The Admission 🏥
Your weekly medical news.
Along with a pizza you can now order a doctor through UberEats in Lisbon, Portugal
Guinea worm disease which once infected millions of people is close to eradication
Heart disease risks soar after COVID - even with a mild case
BBC report that one quarter of rivers tested had unsafe levels of pharmaceutical compounds
The Journal Club 📚
Your weekly paper that may or may not change your practice
Alkaline Urine in the Emergency Department Predicts Nitrofurantoin Resistance.
Finally. A use for the urine dipstick.
Notably, when urine pH is greater than 8 UTIs are more often than not caused by urease producing bacteria (hence making the urine more alkaline and producing resistance to nitrofurantoin)
From above article.
Alkaline Urine in the Emergency Department Predicts Nitrofurantoin Resistance. J Emerg Med. 2022 Jan 6:S0736-4679(21)00763-0. doi: 10.1016/j.jemermed.2021.10.022. Epub ahead of print.
The Dispensary 💊 - 001 Nitrofurantoin
Each week we will deep-dive into the development and interesting facts of a widely-used medication.
Speaking of nitrofurantoin. It is the focus of this week’s Dispensary.
Image credit: drugbank.ca
Nitrofurantoin is nitrofuran antibiotic used to treat uncomplicated urinary tract infections. It has become widely used as the first-line antibiotic due to increasing resistant to the other well-known antibiotic, trimethoprim.
Also known as brand name Macrobid (a clue in the name to the dosing interval, BID as in twice daily)
It was approved by the FDA all the way back in 1953.
Nitrofurantoin is converted by bacterial nitroreductases to electrophilic intermediates which inhibit the citric acid cycle as well as synthesis of DNA, RNA, and protein. Essentially it works on different targets leading to reduced antibiotic resistance.
Bit of weird one but nitrofurantoin is essentially useless for anything else but urinary tract infections. 60-75% undergoes first pass metabolism and the remainder concentrates in renal and urinary tissues.
Key Facts
Taking with food increases the absorption and duration of therapeutic concentrations of nitrofurantoin in urine.
Avoid in eGFR < 45ml/min/1.73m2 - This leads to sub-therapeutic levels in the urinary tract and can increase risk of drug levels in plasma.
Can cause brown urine, pulmonary fibrosis and should be definetly avoided in infants and pregnant women during labour or delivery due to increased risk of haemolytic anaemias.
As always more information can be found in the Summary of Product Characteristics (SmPC) or the British National Formulary (BNF)
The Ear 👂
Podcasts to enjoy and listen this week.
The Break Room 🍴
A weekly link, picture or article that’ll give you some more ammo in those small pockets of time in healthcare.
The Humerus 🦴
This week’s best medical memes and #medtwitter debacle.
A certain medtwitter med reg caused all sorts of bother saying he doesn’t make tea.
Love to know the weirdest/most inappropriate non-clinical job you’ve done.
The Physio Room 🚴♀️
I love sports in particular sports and exercise medicine. Weekly discussion on the biggest sports medicine topics.
This week 15-year old Russian olympic figure skater Kamila Vaileva tested positive for trimetazidine. A banned substance.
However she is being cleared to continue to compete at the Winter Olympics after the Court of Arbitration for Sport (CAS) determined that no provisional suspension should be imposed.
She describes that a mix-up with her grandfather’s medication caused this issue.
However, this drug has a mechanism much like meldonium - both of which are not even commonly prescribed in Europe. The suspected benefit lies in it being a metabolic modulator which helps to inhibit breakdown of fatty acids helping to preserve energy metabolism and intracellular ATP which in theory helps with being able to train harder, longer, recover faster, and improve endurance
Note russian tennis ace Maria Sharapova was previously given a long ban from tennis due to testing positive with meldonium.
The Prescription 💉
Weekly supplement or health advice you can use to improve health, performance, energy and vitality.
Try taking 1000mg of EPA (Omega-3 fish oil) each day to help against fighting depression. I have found it personally hard to get this much EPA in normal Omega-3 supplements but Amazon has a few good brands.
Link to study: https://www.tandfonline.com/doi/abs/10.1080/07315724.2009.10719785
The Antidote 🌞
The Antidote to a tough week.
The Scottish Higlands, courtesy of _hannesbecker https://instagram.com/hannes_becker/
Have a great rest of the week,
See you next Wednesday.