mcatmemoranda2

Point-of-Care Glucose Targets (ADA/AACE)

Fasting/preprandial glucose: 80–130 mg/dL (ADA); <110 mg/dL (AACE) [2][5]

Forms of acute target organ damage that qualify include:

Brain: Hypertensive encephalopathy, posterior reversible encephalopathy syndrome (PRES), intracranial hemorrhage (ICH), acute ischemic stroke

Heart: Acute heart failure/pulmonary edema, acute coronary syndrome, acute decompensated heart failure

Large vessels: Acute aortic syndrome (aortic dissection, penetrating aortic ulcer)

Kidneys: Acute kidney injury

Microvasculature: Retinal hemorrhage, papilledema

The distinction from severe hypertension without target organ damage (previously termed "hypertensive urgency") is critical — patients with severe hypertension but no evidence of acute target organ damage should not receive aggressive BP lowering or parenteral antihypertensive therapy. Reinstitution or intensification of oral antihypertensive medications, preferably in the outpatient setting, is recommended for these patients. [1]

Management recommendations per the 2025 ACC/AHA guidelines: [1]

ICU admission is recommended for continuous BP monitoring and consideration of parenteral therapy.

For compelling conditions (e.g., acute aortic dissection), SBP should be reduced to <140 mm Hg for most conditions and <120 mm Hg in aortic dissection during the first hour.

For emergencies without a compelling condition, SBP should be reduced by no more than 25% within the first hour, then to <160/100 mm Hg within 2–6 hours, and cautiously to 130–140 mm Hg over the next 24–48 hours.

There is no viral load threshold required to initiate hepatitis C treatment — current guidelines recommend treating all patients with detectable HCV RNA, regardless of viral load level. [1-3] The decision to treat is based on the presence of chronic (or acute) HCV infection confirmed by a positive HCV RNA test, not on a specific viral load cutoff.

"Treat All" Approach

Both the AASLD-IDSA (2023) and the WHO/ACP guidelines endorse a universal treatment strategy for all individuals with chronic HCV infection. [1-3] The only exceptions are patients with a life expectancy of less than 1 year due to non-liver-related conditions or those whose liver disease is not remediable by DAA therapy or transplantation. [2] Treatment should be expedited in patients with significant fibrosis (METAVIR F2–F4), extrahepatic manifestations, or high-risk populations. [2]

Where Viral Load Does Matter: Treatment Duration

While viral load does not determine whether to treat, it can influence the duration of certain regimens:

Ledipasvir/sofosbuvir for genotype 1: treatment-naive, noncirrhotic patients with HCV RNA <6 million IU/mL may be eligible for a shortened 8-week course (vs. 12 weeks). [2][4]

Elbasvir/grazoprevir for genotype 1a or 4: this regimen is recommended only when HCV RNA is <800,000 IU/mL. [2]

They need documentation that patient has used phentermine or Contrave or phentermine/topiramate (Qsymia). As well as documentation of continued diet and exercise, of 150 minutes exercise weekly and 1200-1800 calories daily. If patient has not lost 5% of body weight after these measures have been taken, then they will be approved for an injectable GLP-1.

Phentermine is contraindicated because the pt has a hx of substance use disorder. So we applied to get a PA for Zepbound again and they approved it:

This is a website you can use to check your surgeon's certification. It's important to ensure that your surgeon is certified in plastic surgery if you are going for plastic surgery because at some commercial cosmetic procedure places like Sono Bello, they have doctors who are not certified in that specialty who are doing procedures like liposuction. A doctor who trained in orthopedic surgery for example could learn how to do liposuction and do it well, but the best results are likelier with someone who has completed a plastic surgery fellowship and is certified by the American Board of Medical Specialties. I'm planning on going for liposuction and my doctor is board certified with more than a decade of experience. So it's reassuring, but I still worry about it a bit.

1 mcg = 40 IU

The recommended daily allowance (RDA) of vitamin D for most adults aged 1 to 70 is 600 IU (15 mcg), increasing to 800 IU (20 mcg) for adults over 70. The safe upper limit for daily intake is 4,000 IU.

Osteopenia:

For adults with osteopenia, the general recommendation is 600 to 2,000 IU of Vitamin D daily, often paired with 1,000–1,200 mg of calcium, to maintain bone health and prevent further density loss. Those over 70, with limited sun exposure, or with a diagnosed deficiency may require higher doses, typically in the range of 800–2,000 IU.

Osteoporosis treatment:

Check calcium, vitamin D, and Cr. Correct low calcium and vitamin D before starting alendronate.

Prior to starting pharmacotherapy for osteoporosis, confirm the diagnosis and review the following serum tests usually performed as part of the evaluation of osteoporosis:

●Calcium

●Creatinine

●25-hydroxyvitamin D

Correct underlying vitamin D deficit, if needed, with repeat measurement of 25-hydroxyvitamin D in approximately eight weeks

Refer patients with eGFR <30 to 35 mL/min per 1.73 m2 to a clinician with experience in treating chronic kidney disease-mineral bone disorder.

Most women – For the initial treatment of osteoporosis in most postmenopausal women, we suggest oral bisphosphonates. We prefer these agents based on efficacy, cost, and long-term safety data. Oral bisphosphonates are contraindicated in those with esophageal disorders (eg, esophageal stricture) or known malabsorption (eg, Roux-en-Y gastric bypass).

We typically prefer alendronate, although risedronate is a reasonable alternative.

Very high fracture risk – Examples of very high fracture risk may include:

●T-score of ≤-3.0 even in the absence of fractures

●T-score of ≤-2.5 plus a fragility fracture

●Severe or multiple fragility fractures

The pt will get a text message about it. According to what people who have done this have said:

with chronic liver disease is important for assessment of prognosis and for evidence of disease progression. The diagnosis of cirrhosis is important to initiate screening for varices and liver cancer. A FibroScan can be used as a noninvasive

alternative to a liver biopsy to help guide the physician in therapeutic decisions but is not able to stage liver fibrosis or diagnose the cause of liver injury in the same way as a liver biopsy. A liver biopsy may still be recommended after a FibroScan

if clinically indicated.

Liver stiffness can be falsely elevated by inflammation in the liver, hepatic congestion from heart failure or pulmonary hypertension, jaundice, and transient portal flow changes induced by food intake within 3 hours prior to the test. FibroScan should