McNeil Consumer Healthcare Over-the-Counter Infants’ and Children’s Products: Recall

McNeil Consumer Healthcare Over-the-Counter Infants’ and Children’s Products: Recall

Cervical Cancer Prevention Vaccine - Good or Bad?

There has been a lot of controversy behind the new Gardasil vaccine in adoloscent girls and now boys. The pharmaceutical company is recommending this vaccine to be given to girls between age 9-26 yrs of age. They claim that this vaccine prevents from some strains of HPV virus that cause cervical cancer. Well, what about the other strains? There are more than 150 different strains of this vaccine and Garadsil prevents only from the strains types 6, 11, 16 and 18. What about other high risk strains? And , I agree that 16 and 18 are responsible for 70% of cancers but what about the rest 30%? The vaccine is full of side effects and about 6% of the reported side effects were serious and included 32 reports of death. Medically important serious events included the following:Death, Anaphylactic reaction, Deep vein thrombosis, Guillain-Barre Syndrome, Hypersensitivity, Transverse myelitis (inflammation across the width of the spinal cord), Inflammation of the pancreas, Blood clot in the lung, Convulsion, Hives, Autoimmune disorder.

Now, the choice is yours..
Feel free to post comments on the vaccine on my blog.

Virtual tour of a beautiful house on sale...Must see!

http://tour.circlepix.com/tour.htm?id=721513

Home Selling Tips:

1) Stage your home: Make it appealing to the buyer.
2) Remove the clutter: Let the buyer have the feeling of openness.
3) Put more plants indoor as well as outdoors: Plants give a fresh look to your house.
4) Replace all bad and old light fixtures: There should be lot of light in the house.
5) Clean the windows and doors: Open them to give a bigger look to your hoom.
6) Clean the carpet: Get all the stains removed.
7) Take off personal pictures: Depersonalization removes all the biases that teh buyer might have.
8) Burn some candles with nice fragrances: Nice smell makes a good impact.
9) Set the closets: Stack up all the clothes and toys. You don't want buyer to open the closet and have things falling on him.
10) Paint the house in neutral colors: You don't want the buyer to remember your house as "that yellow house".

DIABETES

Diabetes type II is one of the most common conditions that is seen in Family practice. Here are some simple tips to manage diabetes.

Diagnosing Criteria:
1) FBS> or equal to 126 on two occasions
2) Random blood sugar > or equal to 200 with symptoms ( Polyuria, polydipsia, polyphagia)
3) 2 hrs PP blood sugar > or equal to 200

Etiology:
Genetic factors, obesity, drug induced (antipsychotics, HIV meds)

Risk Factors:
Family history (1st degree relatives), gestational diabetes, obesity, ethnicity (AA, Latino, native American, Asian American), BP > 140/90, HDL <35mg/dl>250mg/dl, metabolic syndrome, PCOS.

Symptoms:
polyuria, poluydipsia, polyphagia, weight los, weakness, fatigue, frequest infections.

Tests:
1) FBS
2) 2 hr PP if FBS between 100-125
3) HgA1c - though not used for diagnosing

Management:

Pnemonic: GLUCOSEBAD
G: Glycemic control. Goal FBS <130, PP <180, before meals <140. Goal HgA1C <7%
L: Lipids. Goal LDL <100, if CVD present then goal LDL <70. Statins are now considered in
every patient >40 if one or more CVD risk factors are present.
U: Urine microalbumin urea. Goal urine albumin/Serum creatine ratio is < 30ug/mg. If
abnormal, start ACEI'S even if BP is normal.
C: Cigarette smoking. Pts should be counseled to stop smoking.
O: Opthalmology. Pts need dilated eye exam yearly to rule out retinopathy
S: Sexual problems. Pt's sexual problems should be addressed at every visit. If males are
experiencing erectile dysfunction, consider Sildenafil.
E: Comprehensive foot exam needed yearly and monofilament test at evry visit. If abnormal test
or absent pedal pulses, refer to vascular surgery. If neuropathy, consider medications
(Gabapentin).
B: Goal BP <130/80. ACEI's are recommended if no contraindications.
A: ASA use. Every pt >40 yrs of age should be on ASA
D: Dental exam evry 6 monthly.

Medications:
Sulfonylureas: Glyburide Glipizide, Glimeperide
Thiazolidinediones : Rosiglitazone, Pioglitazones
Biguanides: Metformin
Meglitines: Nateglinide (starlix), Repaglinide (prandin)
Alpha glucosidase inhibitors: Acarbose
DDP-4 Inhibitor: Sitagliptin (Januvia)
GLP-1 mimetic: Exanatide (Byetta)
Amylinomimetic: Pramlintide (Symlin)
Insulin: Rapid acting (lispro, aspart), Short acting (Regular), Intermediate acting ( NPH),
Long acting ( Lantus, Detemir)

Start with Metformin, if not controlled add SFU or TZD's or DDP4i. can give upto 3 group of medications. If still not controlled, add insulin. Stop SFU's, dec dose of TZD's.

INSULIN: Starting dose in outpatient is 0.2 units/kg/day. If patient already on insulin then start with 0.5 units/kg/day. Keep increasing 3 units every 3 rd day till blood sugars at at goal.

Method: Start with either 1)Basal insulin (long acting) plus bolus (rapid acting) OR
2) NPH + Regular in 70/30 mixture or 50/50 mixture.

1) Divide total daily dose (TDD) of insulin into half. Give half as long acting at night and half as rapid acting given with each meal (this half is divided into 3)

2) For 70/30, give 2/3rd in am and 1/3rd in pm. For am give 2/3rd of NPH and 1/3rd regular. For pm give 1/2 of NPH, 1/2 regular. OR 60% of 70/30 in am and 40% in pm.
Am dose: TDD x 0.4 NPH and TDD x 0.2 regular
PM dose: TDD x 0.2 NPH, TDD x 0.2 regular

Actions of medications:
SFU's, TZD's, Metformin, insulin: Peak is 2,4,8, none hrs
Duration of action is 4,8,12,24 hrs

Tip: For every 30 mg increase in blood sugar, HgA1C inc by 1%.

Tips For USMLE Step 2

First of all I would like to tell you all that I found this exam easier than the first one. This exam is more clinical than Step 1.
As I mentioned in Step 1 also, use logic more than common sense while answering the questions .
This exam is not very difficult and does not involve memorizing things. The examiner tries to change the language of the question in such a way that the test taker gets confused. But, If you know the conceps well and also what he is trying to ask, you can easily get it right. The question stem is very long and time is less, but don't panic, concentrate on the relevant things. They might give you a lot of irrelevant information about that particular case e.g. Lab Values, X-rays, EKG's etc. Don't get scared, these are given probably to make the question complicated. They are just testing your basic clinical knowledge. So, try to think what diagnosis you can make out of that given findings. Read the whole question carefully, especially the last line and the key words like What, How etc. While reading the question, you will think "O' I know the answer" but sometimes its not the right answer. Read what the examiner is asking.Try to look for "Best Possible" answer rather than "The Right Answer". Try to think the case as a real one even if it doesn't sound real. Use logic and then answer. Also, there will be some buzz words in inverted comas("), dont get distracted by them. Sometimes they are not important at all.
I read Kaplan notes for theory and practiced Usmleworld questions. I think they really helped me to approach the questions. I also read Crush Step 2 in the end to review the whole syllabus. I also referred to CMDT for my queries. I scored very well in Step 2 (234/95). I think the most important thing on this exam is to use logic and practice a lot of questions. Also NBME exam 3 weeks before the real exam helps to assess yourself about your preparation.

Websites:
a) For Usmle world-- www.usmleworld.com. You will have to buy these questions.
b) For NBME---www.nbme.org

Tips for USMLE Step 1 Preparation

Ok! So here is what I think is required to prepare for USMLE.

First of all always think that it is a do-able exam. Do not get nervous, keep your cool and attack.The most important thing to do is to stay focussed. Study whatever material you feel is good. If you think you want to read only Kaplan notes, thats fine, but know the concepts well. The basic thing in this exam is how to approach the questions. The examiner is asking you simple stuff but in a complicated way. So you should know, what he is trying to ask. Use logic. He will give you many irrelevant things. You need to focus only on things that are asked. Also, time restraint makes it difficult to finish the exam. But,try to practice many questions, beforehand, with time. Also, concentrate on topics that are important e.g Pathology, Pharmacology, Immunology, Phychiatry and Genetics. Subjects like Anatomy and Microbiology are not that important. Don't waste time in memorizing each and every bacteria in Microbiology. Try to learn them in a tabulated form (given at the end of the Kaplan notes). This will help you to remember them well. Also, in Anatomy, Embryology is important. So, try to first read FIRST AID for Anatomy and then the notes.

Step 1: I think kaplan notes are very good for step 1 preparation.In addition to that, First Aid step 1 is also very useful. I also read BRS for psychiatry and statistics. It has very good explanations and also many questions to practice. I did Kaplan Q-book and also Q-bank to practice questions. I did un-timed tests initially but then switched to timed-tests later. It really helped me to get used to the time limit. Also, put your queries on the USMLE forums and people will help you. When you are near the exam (3 weeks before the actual exam), buy NBME exam. This exam is similar to the real exam and helps you to judge yourself in your preparation. You can do un-timed exam first and after one week, try doing the timed one. This will help you to gauge your preparation and also helps you to decide if you want to postpone your exam. Don't panic if you do not score well, try to think where you can improve. One day before the exam, try to stay relaxed. Talk to your loved ones, eat well and most importantly, sleep well.

Some important websites:
www.nbme.org---To buy NBME exam.

USMLE forums
www.prep4usmle.com.
www.studentdoctor.com
www.usmle.net

Technorati Tag: USMLE Step 1 Residency

USMLE Information

USMLE- United States Medical Licence Examination. This is an exam taken by Doctors to get licence and practice in the USA. Anyone who wish to work in the states as a Doctor has to take this exam, whether he is an American Medical graduate (AMG) or a Foreign Medical Graduate (FMG or IMG). Although,I had done my post graduation from India, I had to take these tests to get into residency in the USA. So, no matter what degree you have from your own country, you have to do reisdency again in the USA. USMLE has three steps-Step 1, Step 2 CK (Clinical Knowledge) & CS (Clinical Skills) and Step 3. you can take either Step 1 first or Step 2 first. I started with Step 1. It tests your basic knowledge in subjects like Anatomy, Physiology, Biochemistry, Pharmacology, Pathology and Ethics. Its a do-able exam. The second step tests your clinical knowledge in subjects like Medicine, Surgery, Pediatrics, Ob/GYN, Psychiatry and Ethics. Easier than Step 1. Both the exams are computer based exams and 8 hour long. They have 7 blocks with 46 questions each. You have to finish each block in one hour.Step 2 CS tests your clinical skills and for FMG's ,they test your english speaking skills. If you need any kind of visa, you have to take step 3 before residency, otherwise you can take it anytime during your residency. This was the basic idea of USMLE.

I will share my experiences and some tips on how to prepare for these exams in my next post.