PACES Digest

Question of the day ‼️

A 65-year-old man presents to the Gastroenterology Clinic after presenting to his General Practitioner with a 1 year history of tiredness. He has no previous medical history and takes no regular medication. He denies weight loss or a change in bowel habits. He has a varied diet, including red meat. There is nothing to find on examination.

Which of the following investigations should be performed next?

A. Urinalysis
B. Oesophago-gastro-duodenoscopy
C. Colonoscopy
D. Iron studies
E. Capsule endoscopy

Every answer is very welcome and highly appreciated 💛
Answer will be uploaded tomorrow.

Hope you all enjoy learning with PACES Digest 💛

Different GLP1 agonists တွေရဲ့ MOA, HbA1C reduction %, Weight loss %, CVD benefit စတာတွေ comparison လုပ်ထားတဲ့ table share ပေးလိုက်ပါတယ်

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Cardiovascular famous trials တွေ ရဲ့ paper & summary တွေကို ဖတ်ချင်ကြသူတွေအတွက် Telegram links တွေပါ

page မှာ link တန်းမပေါ်လို့ telegram link ကနေ ဝင်ကြည့်ပါ

https://t.me/pacesdigest/654

🔥 Landmark SGLT2 Inhibitor Trials

🔴 CV Outcome Trials (T2D)

• EMPA-REG OUTCOME (2015) – Empagliflozin

• CANVAS Program (2017) – Canagliflozin

• DECLARE–TIMI 58 (2019) – Dapagliflozin

• VERTIS-CV (2020) – Ertugliflozin

🔵 Heart Failure Trials

🫀 HFrEF

• DAPA-HF (2019) – Dapagliflozin

• EMPEROR-Reduced (2020) – Empagliflozin

🫀 HFpEF/HFmrEF

• EMPEROR-Preserved (2021) – Empagliflozin

• DELIVER (2022) – Dapagliflozin

⚡Acute/WHF

• EMPA-RESPONSE-AHF Trial (2020) – Empagliflozin (2020)

• SOLOIST-WHF Trial (2020) – Sotagliflozin

• EMPAG-HF Trial (2022) – Empagliflozin)

• EMPULSE Trial (2023) – Empagliflozin)

🔴 Acute MI

• EMMY Trial (2022)
• DAPA-MI Trial (2024)
• EMPACT-MI Trial (2024)

🟢 Chronic Kidney Disease (CKD) Trials

• CREDENCE (2019) – Canagliflozin (T2D + CKD)

• DAPA-CKD (2020) – Dapagliflozin (with/without diabetes)

• EMPA-KIDNEY (2023) – Empagliflozin (broader CKD population)

🟡 Special / Overlap Trial

• SCORED (2021) – Sotagliflozin (T2D + CKD, CV outcomes focus)

Hope you all enjoy learning with PACES Digest 💛

မနေ့က မေးခွန်းရဲ့ အဖြေပါ

ဒီမှာ mechanism ၂ မျိုး နဲ့ ရှင်းပြပါမယ်

Glucocorticoids can inhibit prolactin release from anterior pituitary directly. (first photo)
အဲ့တော့ glucocorticoid deficiency ဖြစ်တဲ့ Addison disease မှာ inhibitory effect မရှိတော့ Prolactin ပိုထွက်ပါမယ်

နောက်တစ်ခုကတော့ Glucocorticoids inhibit TRH relaease (second photo)
Glucocorticoid deficiency မှာ TRH ပိုထွက်ပါမယ်
ပထမပုံကို ပြန်ကြည့်ပါ TRH stimulates Prolactin.

What does prolactin do?
GnRH release ကို inhibit လုပ်လို့ FSH, LH ကျ Estrogen ကျပြီး amnerrhoea ဖြစ်ရတာပါ

So အဖြေမှန်က E. Prolactin ပါ

Hope you all enjoy learning with PACES Digest 💛

A 19-year-old woman presents with nausea, vomiting and dehydration. She has been unwell for some weeks and passed out while shopping and was brought to hospital by ambulance. The only other past history of note is that her periods stopped a few months ago.
On examination, her blood pressure is 110/80 mmHg lying down and drops to 90/60 mmHg on standing; her pulse is 90 bpm and regular. Her body mass index (BMI) is 19 kg/m2 and her skin looks quite tanned. Other examination is unremarkable.

She is diagnosed with Addison's disease.
Change in which hormone is likely to be responsible for her amenorrhoea?

A. Aldosterone
B. Cortisol
C. 17a-OH progesterone
D. Dehydro-epiandrosterone
E. Prolactin

Every answer is very welcome and highly appreciated. 💛
Answer will be uploaded tomorrow.

Hope you all enjoy learning with PACES Digest. 💛

💥 Why Hyponatremia occurs in hypoadrenalism?

မနေ့က မေးခွန်းရဲ့ အဖြေပါ

✔️ Depletional & Dilutional Hyponatremia 2 မျိုးလုံးရနိုင်ပါတယ်

📌 No 1.
- အားလုံးသိထားကြသလိုပဲ Hypoadrenalism မှာ Aldosterone ထုတ်တာနဲတယ် (Aldosterone function က distal renal tubule မှာ Na ပြန်စုပ် H/K ထုတ်တာ)
- Aldosterone နဲတော့ Na ပြန်မစုပ်နိုင်တော့ Hyponatremia ရတယ် (Na loss in tubule & urine မို့ Depletional Hyponatremia)

📌 No 2.
- နောက်တစ်ချက်က Cortisol ရဲ့ Function
- Normally, cortisol inhibits ADH release (ADH က Collecting duct မှာ Auaporin 2 channel က နေတစ်ဆင့် water ပြန်စုပ်တာ), ADH နဲသွားတော့ (Antidiuresis နဲတော့) Diuresis ဖြစ်မယ် = Cortisol causes Free water clearance in normal circumstances.
- Hypoadrenalism မှာ Cortisol နဲလို့ ADH ကို inhibit မလုပ်နိုင်တော့ Antidiuresis effect နဲ့ water retention ရပြီး Dilutional Hyponatremia ရတယ်

📌 No 3.
- No 1 Aldosterone နဲလို့ Hypotension, Hypovolaemia ရရင် Carotid barorecptors တွေ activate ဖြစ်ပြီး ADH ပိုထွက်, Hypovolaemia ကို compensate လုပ်ဖို့ Aquaporin 2 channel တွေ Upregulate ဖြစ်ပြီး ရေပိုစုပ်
Dilutional Hyponatremia ရစေပြန်ရော

📌 No 4.
Hypotension, Hyponatremia ရတဲ့အခါ Renal haemodynamics (Na transporters) တွေ အပြောင်းအလဲဖြစ်ပြီး ရေပိုစုပ်တော့ Dilutional Hyponatremia ထပ်ရတယ်

📌 No 5.
နောက်ဆုံးအချက်က CRH ကလဲ ADH release ကို အားပေးတယ်. Cortisol နဲတော့ positive feedback နဲ့ CRH ပိုထွက်, So increases ADH release causing Dilutional Hyponatremia again.

Hope you all enjoy learning with PACES Digest 💛

Questions time⁉️

💥 Why does hyponatremia occur in Hypoadrenalism?
Explain possible mechanisms.

Answers will be uploaded tomorrow.

Every answer is very welcome & highly appreciated 💛

Antidotes for Anticoagulation Reversal NEJM 2026

NEJM ရဲ့ မနေ့ကမှ release လုပ်ထားတဲ့ journal ကို share ပေးလိုက်ပါတယ်
Clinical မှာ အသုံးဝင်တဲ့ topic မို့ ဖတ်ကြည့်ကြပါအုံး

Download link >> https://drive.google.com/file/d/1iUxjhUhDa4EMVbNNmfGFCY1OtWWJHAjI/view?usp=drivesdk

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💥 𝐕𝐢𝐝𝐞𝐨𝐬 𝐜𝐨𝐦𝐩𝐢𝐥𝐚𝐭𝐢𝐨𝐧𝐬 💥

Page မှာ တင်ဖူးသမျှ Video compilation update ကို system တခုချင်းစီ ခွဲပြီး ပြန်စု​ပေးလိုက်ပါတယ်

Total 112 videos ရှိပါတယ်

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Heart sounds https://www.facebook.com/share/v/1BaJTC469V/?mibextid=wwXIfr

Understanding cardiac murmur https://fb.watch/gNAV1bbLdK/?mibextid=1DJ7Ir

Causes of Hypertension https://fb.watch/mSxJuEd0OC/?mibextid=HSR2mg

Heart failure https://fb.watch/gNAPSua6Y9/?mibextid=1DJ7Ir

Cyanotic congenital heart disease https://www.facebook.com/share/r/USqg3FiECoZJ3bVv/?mibextid=VMBKnz

COA https://www.facebook.com/share/r/c7iNJrgAymLM83jT/?mibextid=VMBKnz

Mitral stenosis findings https://www.facebook.com/share/r/GPpr5cXd6HMPcjNz/?mibextid=VMBKnz

Aortic stenosis findings https://www.facebook.com/share/v/1GLytqAuaX/?mibextid=wwXIfr

HOCM https://www.facebook.com/share/v/1Ur7ovm6aL/?mibextid=wwXIfr

IE https://www.facebook.com/share/v/1Gq61F1vHo/?mibextid=wwXIfr

Supravalvular AS https://www.facebook.com/share/v/1K9ZC3bHLJ/?mibextid=wwXIfr

Effects of position/ respiration on murmur https://www.facebook.com/share/v/1aVSAHokFc/?mibextid=wwXIfr

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Myasthenia gravis https://www.facebook.com/share/v/14NBsKTbd7R/?mibextid=wwXIfr

Alzheimer’s disease https://fb.watch/gNANycNOq2/?mibextid=1DJ7Ir

Migraine https://fb.watch/gNAIuqcYL-/?mibextid=1DJ7Ir

Migraine vs Cluster headache vs Chronic paroxysmal hemicrania https://www.facebook.com/share/v/1gTGoWB82c/?mibextid=wwXIfr

Flaccid paraparesis https://www.facebook.com/share/v/17h3JLEz8E/?mibextid=wwXIfr

Lateral gaze palsy, INO & One and A half $ https://fb.watch/gNAEJBv4Hp/?mibextid=1DJ7Ir

Conus vs Cauda https://fb.watch/iC5VCNYsrG/?mibextid=tejx2t

UMNL Vs LMNL Facial palsy https://fb.watch/iC5WZG9yNb/?mibextid=tejx2t

Hydrocephalus https://www.facebook.com/share/r/QijwhfK9ZadCwt25/?mibextid=VMBKnz

RAPD https://www.facebook.com/share/v/18qSgG7coy/?mibextid=wwXIfr

MND https://www.facebook.com/share/v/18eGYvN747/?mibextid=wwXIfr

Approach to Ptosis and Myasthenia gravis https://fb.watch/gNAR7ND9ZI/?mibextid=1DJ7Ir

Brain imaging introduction https://fb.watch/gNADdI9cRX/?mibextid=1DJ7Ir

Understanding Rennie and Weber test https://fb.watch/gNAOGqVz9N/?mibextid=1DJ7Ir

Nystagmus made easy https://fb.watch/gNAJtlnxvc/?mibextid=1DJ7Ir

Aphasia types https://fb.watch/mSxUkjRE_P/?mibextid=HSR2mg

Understanding sleep cycle https://fb.watch/gNATuAyVUv/?mibextid=1DJ7Ir

Parkinson medications MOA https://www.facebook.com/share/v/1J3J14tSr3/?mibextid=wwXIfr

Median nerve lesions https://www.facebook.com/share/v/1brnejYuzx/?mibextid=wwXIfr

Spastic paraparesis https://www.facebook.com/share/v/18hdAoiMm4/?mibextid=wwXIfr

🌟 ℝ𝕖𝕤𝕡𝕚𝕣𝕒𝕥𝕚𝕠𝕟

Asthma Pathophysiology & Updated treatment https://www.facebook.com/share/v/17S6HgY1Nm/?mibextid=wwXIfr

COPD Pathophysiology & Updated treatment https://www.facebook.com/share/v/17a4s9tpVD/?mibextid=wwXIfr

TB treatment https://fb.watch/gNASoICMmX/?mibextid=1DJ7Ir

Obstructive sleep apnoea https://fb.watch/mSxWSc_lHM/?mibextid=HSR2mg

Pneumothorax treatment https://fb.watch/mSxNYEQlkA/?mibextid=HSR2mg

Bronchiectasis https://fb.watch/mSxPEQlPSf/?mibextid=HSR2mg

Lung fibrosis https://www.facebook.com/share/r/LTmoN8b1VKS2F2fz/?mibextid=VMBKnz

DVT/ PE risk factors https://fb.watch/mSxYj36ND1/?mibextid=HSR2mg

Cystic fibrosis https://fb.watch/mT9Ve-H_oR/?mibextid=K8Wfd2

Diffusion capacity https://www.facebook.com/share/v/14rtMxQdcW/?mibextid=wwXIfr

Pleural effusion https://www.facebook.com/share/v/1HWgVtH9Ds/?mibextid=wwXIfr

Aspergillus infections https://www.facebook.com/share/v/1Eb12PeEJm/?mibextid=wwXIfr

Pulmonary hypertension drugs MOA https://www.facebook.com/share/v/1JD8ZpkAny/?mibextid=wwXIfr

🌟 ℍ𝕖𝕞𝕒𝕥𝕠𝕝𝕠𝕘𝕪

Hemolysis https://www.facebook.com/share/v/15x6ZkKGR2/?mibextid=wwXIfr

Causes of Anemia https://www.facebook.com/share/v/16k6q2Ti7B/?mibextid=wwXIfr

Typical vs Atypical HUS https://fb.watch/kC_uchufm6/?mibextid=l2pjGR

TTP https://www.facebook.com/share/r/Jpd43DYgmc8YBtcq/?mibextid=VMBKnz

PNH https://fb.watch/iC5Z0HQkm3/?mibextid=tejx2t

B12 deficiency A https://www.facebook.com/share/r/ZskgY5TSHnn7gXtn/?mibextid=VMBKnz

Folate deficiency A https://www.facebook.com/share/r/Z6YtMbpD5jMbQBPY/?mibextid=VMBKnz

IDA https://www.facebook.com/share/v/17w5xVvHtS/?mibextid=wwXIfr

Hemophilia https://www.facebook.com/share/v/1ZGfMQ9TnN/?mibextid=wwXIfr

G6PD deficiency https://www.facebook.com/share/v/1F2TMshiZL/?mibextid=wwXIfr

Sideroblastic anemia https://www.facebook.com/share/v/1E4Zh2kiAU/?mibextid=wwXIfr

vWD https://www.facebook.com/share/v/18oU3cUCRc/?mibextid=wwXIfr

🌟 ℕ𝕖𝕡𝕙𝕣𝕠𝕝𝕠𝕘𝕪

UTI https://fb.watch/gNAMsreMSb/?mibextid=1DJ7Ir

Nephrotic $ Pathophysiology https://www.facebook.com/share/v/17Wgw2iMxK/?mibextid=wwXIfr

Causes of Nephrolithiasis https://www.facebook.com/share/v/17aUEM43qf/?mibextid=wwXIfr

BPH Pathophysiology & Medical treatment https://www.facebook.com/share/v/1SSqntbSYU/?mibextid=wwXIfr

PCKD https://fb.watch/mSxSYQn-jd/?mibextid=HSR2mg

Alport $ https://fb.watch/iC5MJC1UXQ/?mibextid=tejx2t

Dialysis disequilibrium https://www.facebook.com/share/r/JYv3j6frA9VPZEgi/?mibextid=VMBKnz

Nephrotic $ https://www.facebook.com/share/r/Qf4ogGBY9197hKk2/?mibextid=VMBKnz

CKD Stages https://fb.watch/mSxQ-qHmL4/?mibextid=HSR2mg

🌟 ℝ𝕙𝕖𝕦𝕞𝕒𝕥𝕠𝕝𝕠𝕘𝕪

Risk factors for Osteoporosis https://fb.watch/mSxK-TT5xA/?mibextid=HSR2mg

Causes of Osteomalacia https://fb.watch/mSxMJGgm6Z/?mibextid=HSR2mg

Gout https://www.facebook.com/share/v/1Ds3h28DxL/?mibextid=wwXIfr

Bone remodeling https://www.facebook.com/share/r/sgjdvo6jVzQdjDvz/?mibextid=VMBKnz

RA https://www.facebook.com/share/v/17rVBGbweQ/?mibextid=wwXIfr

🌟 𝔼𝕟𝕕𝕠𝕔𝕣𝕚𝕟𝕠𝕝𝕠𝕘𝕪

DI https://www.facebook.com/share/r/fx1D5DekKqVhfjHQ/?mibextid=VMBKnz

Insulin physiology https://www.facebook.com/share/r/isFBdm5kBg5CAq6k/?mibextid=VMBKnz

Cushing investigations https://www.facebook.com/share/r/7aucfJNE3Mhcj6Dd/?mibextid=VMBKnz

Functions of Thyroid hormones https://www.facebook.com/share/v/1CupjwrmdF/?mibextid=wwXIfr

Causes of Hypothyroidism https://www.facebook.com/share/v/16Q9ovhDCH/?mibextid=wwXIfr

Causes of Hyperaldosteronism https://www.facebook.com/share/v/175hbnAFN8/?mibextid=wwXIfr

Causes of Hypoadrenalism https://www.facebook.com/share/v/16RikAsC3G/?mibextid=wwXIfr

Cause of Hyperprolactinemia https://www.facebook.com/share/v/1AEpx4mREv/?mibextid=wwXIfr

Congenital Adrenal Hyperplasia https://www.facebook.com/share/r/VYy289p4rip1wGfb/?mibextid=VMBKnz

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Ascites https://www.facebook.com/share/r/QmQtTZneBm4yBNh1/?mibextid=VMBKnz

HCV treatment interruption https://www.facebook.com/share/v/15Bsvud4ML/?mibextid=wwXIfr

PU Sites https://www.facebook.com/share/v/12G4RNPnCNr/?mibextid=wwXIfr

Heyde’s syndrome https://www.facebook.com/share/v/14N6asmEw5F/?mibextid=wwXIfr

Portal hypertension causes https://www.facebook.com/share/v/1E7cBJDm3b/?mibextid=wwXIfr

🌟 𝕀𝕟𝕗𝕖𝕔𝕥𝕚𝕠𝕟𝕤

Malaria 1 https://fb.watch/gNAC9DA2E4/?mibextid=1DJ7Ir

Malaria 2 https://fb.watch/gNAv4cT6dy/?mibextid=1DJ7Ir

Trypanosomiasis https://www.facebook.com/share/v/1HRXFwk5pw/?mibextid=wwXIfr

Ge***al ulcers https://www.facebook.com/share/v/1A2VU21dVX/?mibextid=wwXIfr

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Paracetamol overdose https://fb.watch/gNAB7FjjPT/

Organophosphate poisoning https://fb.watch/iC5SqzmaG9/?mibextid=tejx2t

MOA of Anti-platelets https://fb.watch/gNAmDywSAu/?mibextid=1DJ7Ir

MOA of Anticoagulants https://fb.watch/gNAjGlKl9P/?mibextid=1DJ7Ir

MOA of Thrombolytics https://fb.watch/gNAy0OZsLK/?mibextid=1DJ7Ir

Adrenergic Receptors https://www.facebook.com/share/r/PA8jSHXnTUx1xxTv/?mibextid=VMBKnz

Antihypertensives MOA https://www.facebook.com/share/v/1EUwooh3Pq/?mibextid=wwXIfr

🌟 𝕄ℝℂℙ

Format and mark distribution https://fb.watch/gNAt4OPeof/?mibextid=1DJ7Ir

How to collect scores in PACES https://fb.watch/gNArV9GD3U/?mibextid=1DJ7Ir

Communication scenarios https://fb.watch/gNAlaPZeRL/?mibextid=1DJ7Ir

History format https://fb.watch/gNAHg9HiZ-/?mibextid=1DJ7Ir

AI as Surrogate https://www.facebook.com/share/v/1JtpFpcAaz/?mibextid=wwXIfr

🌟 𝔼ℂ𝔾

ECG Terminology https://fb.watch/gNAoYlM_Wc/?mibextid=1DJ7Ir

ECG Axis calculation https://fb.watch/gNAqWLAoyG/?mibextid=1DJ7Ir

SVT https://fb.watch/gNAnQegi9V/?mibextid=1DJ7Ir

🌟 𝕄𝕚𝕤𝕔𝕖𝕝𝕝𝕒𝕟𝕖𝕠𝕦𝕤

Clubbing https://fb.watch/gNAx40gtkx/?mibextid=1DJ7Ir

Hereditary Angioedema https://fb.watch/iC5QpqurzI/?mibextid=tejx2t

Personality disorders https://fb.watch/kC_vUQi7Lu/?mibextid=l2pjGR

Hypercalcemia https://www.facebook.com/share/r/o9wfbRmuJXQds5qx/?mibextid=VMBKnz

ABG Interpretation https://www.facebook.com/share/v/17jJsp4LEZ/?mibextid=wwXIfr

Primary immune deficiency https://fb.watch/gNAKsZNA6x/?mibextid=1DJ7Ir

Are you a drinker? https://fb.watch/gNAu6jaIa6/?mibextid=1DJ7Ir

AI Study tips https://www.facebook.com/share/v/16LWhYZPs2/?mibextid=wwXIfr

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