From the Archives

At long last-this week's Arch Int Med contains articles of good clinical relevance.About hyponatremia being predictive of mortality in CHF, effect of pneumovax on severity of CAP, a meta-analysis of trials on dual blockade of the RAAS system on CHF.
My interpretations : Hyponatremia in CHF is hypoosmolal with increased TBW- this in turn reflects the severity of heart failure. So the result is expected...you are just calling a spade a spade. Whats new about that?
Why should pneumovax affect severity of CAP? Well assuming they are referring to typical CAP, the three most commonest organisms are pneumococcus, Hemophilus and Moraxella in that order. So if you have protected against pneumococcus you have the relatively less virulent two to deal with. Big deal then!!But if it were atypical pneumonia I think I do not have an explanation entirely. Again the polysaccharide vaccine is not a very good immunogen, memory T cell response in the aged would not be that good with the current policy of one shot at >65 years( which I have never understood)Also most folks receiving pneumovax before that age have specific conditions that predispose to pneumonia occurrence.And pathogens in them might not be the same as in healthy people.So....what gives?I don't know.

I used to think- give a CHF patient Alsikiren plus beta blocker plus ACEI plus ARBs plus Aldactone...khallas. Absolut paralysis.Mother of block nanas. But I think there are problems we have to deal with here. I do not know the prognosis of medical nephrectomy...have seen it just once in a nephrotic we put on ACEIs. But the KDOQI recommends close follow up in a diabetic CRF put on ACEIs, as beyond a few weeks things level of, and the prognosis is actually good.I wonder why someone does not take this up as a thesis topic- multiple RAAS blockade in CHF and prognosis of renal disease if any.

Jhakaas !!! Mast vaatla.Tumhala kaay vatla?