Antihypertensives

Very often we come across this situation ! MUST the patient be Fasting for a Lipid profile ? The answer, certainly depends upon what we want to measure. ! Surprised. ? Need not be! Let me explain ! Eating raises plasma triglycerides but only has a minimal impact on total cholesterol or HDL-C or apo-B. But LDL-C is a calculated number that depends on the level of plasma triglycerides and therefore requires a Fasting specimen. Yes , the patient must be Fasting if we want LDL-C. A Fasting sample is needed for the classical lipid profile ( total cholesterol, triglycerides, HDL-C and LDL-C ) because the treatment goals and proven benefits of treatment are targeted at LDL-C. But the patient need not fast if we want total cholesterol, HDL-C, non- HDL-C, or apo-B. Total cholesterol and HDL-C are the only Measurements we need to know to determine non- HDL-C. And non HDL-C includes All of the Cholesterol in all of the potentially atherogenic lipoproteins containing apo-B ( any lingering Chylomicron remnants, VLDL-C, IDL-C, LDL-C and Lp (a) ). Non HDL-C is useful Measure to consider when the triglycerides are in the range of 200 - 499 , but then cannot be calculated when the triglycerides exceed 500.

48/Male Presented with Severe Chest pain Since 1 Hr with Mild Dyspnoea and Left Arm Radiating Pain. History of Smoker and Stopped Alcohol 5 Year Back Pulse: 86 /min Spo2: 95% on RA BP: 140/80 Attached ECG

Patient 46 year old male came with this... pain * 1 month Pus discharge * 1 month Ulcer over lower leg * 1 month Rx?

27 year old female presented with infertility and amenorrhea. She has undergone a pelvic ultrasound scan. Images are shown below.

70 yrs male h/o sudden falled on ground 1 day back while walking, followed by weakness of lt upper and lower limbs bp was 260/120 pr 100/mt conscious after m20%,epsolin,lasix, antibiotics,methylcobalamin,neurocetam, aspirin,rosuavas,depin now well please suggest ur valuable opinions