Monthly Archives: April 2012


It may be worth starting metformin immediately on diagnosis of DM, without waiting to see whether dietary treatment works. One study found that starting metformin within three months of diagnosis was associated wtih a reduced rate of monotherapy failure a … Continue reading

Posted in Alternative medicine, BMJ, Cardiovascular, Credits 2012, Dementia, Diabetes, HRT, Migraine, Paediatrics | Leave a comment

Ottawa rules

I could probably recite the ankle rules in my sleep, but found the following clarification of details helpful: ‘Malleolus’ includes the lower 6 cm (posterior edge or tip) ‘Weight-bearing’ means ability to walk four steps both immediately and in the … Continue reading

Posted in BMJ, Ligaments, Orthopaedics | Leave a comment

Neuropathic pain

I’ve often wondered how long to persevere with medication for neuropathic pain before giving up on it. The advice from this article was two to eight weeks, with at least one or two weeks at maximum tolerated dosage.  It’s also … Continue reading

Posted in BMJ, Credits 2012, Medication, Neuropathy, Pain control | Leave a comment

Antimuscarinics for overactive bladder

As I would have expected, main SEs are dry mouth and constipation.  There is some evidence that solifenacin, extended release oxybutinin, and extended release tolterodine are more effective than the other drugs and that fesoterodine may be the most effective.  … Continue reading

Posted in BMJ, Incontinence, Medication, Urology | Leave a comment

Cluster headache

Cluster headaches are one of a group of trigeminal autonomic cephalalgias, also including SUNCT and paroxysmal hemicrania.  Diagnostic criteria are: At least 5 attacks Attacks of severe unilateral orbital, supraorbital, or temporal pain, lasting between 15 minutes and 3 hours … Continue reading

Posted in BMJ, Credits 2012, Impact, Neurology | Leave a comment


Presents with weakness in the large muscles that spares the small muscles. About a third of patients have a rash (dermatomyositis) – the one I always remember is the blue-purple discolouration on the eyelids, but it can also prseent as … Continue reading

Posted in Credits 2012, Rheumatology | Leave a comment

Benzodiazepine withdrawal

Symptoms can begin within 24 hours for short-acting benzos, or several days for longer-acting. They reach their maximum intensity between 3 and 14 days, but can continue for up to six weeks, and some people report symptoms for as long … Continue reading

Posted in Credits 2012, Medication | Leave a comment