Santa attending an interview in Software Company.
Manager: Do U know MS Office?
Santa: If U give me the address I will go there sir.
Funny clinical notes (Dr. Minakshi)
Patient had waffles for breakfast and anorexia for lunch.
Evidence Based Practice
The administration of a rabies immune globulin is generally recommended in conjunction with the first dose of the rabies vaccine, particularly in cases of severe bites. Drugs 1998 Nov.;56(5):801 809.
Mistake: A 60 year old patient with osteoarthritis developed GI bleed after NSAID
Reaction: Oh my god! Why was he give NSAID as a routine
Make sure that elderly patients with pain are prescribed NSAIDs sparingly.
Dr Good Dr Bad
Situation: A patient with chronic anemia needed blood
Dr Bad: Give whole blood transfusion
Dr Good: Give pack cells
Lesson: In chronic anemia, packed red cell transfusion is the treatment of choice, as the hemoglobin level can be raised without overloading the circulation.
Health tip (Dr Prachi Garg)
Athlete's foot is a fungal infection, usually causing itching and redness between the toes. It's commonly contracted in locker rooms and other moist, warm areas where fungi like to grow.
1. Topical antifungal creams, sprays or ointments.
2. Oral antifungal drugs.
3. Fungicidal chemicals may work, but may not penetrate deeply enough into the skin.
4. Washing the feet thoroughly and frequently, being sure to carefully dry between the toes.
5. Keeping feet dry with a powder inside shoes and socks.
Diabetes 2009 revisited
DPP4 inhibitors and pancreatitis:
There have been 88 post marketing case reports of acute pancreatitis in patients using Sitagliptin. Pancreatitis should be considered in all patients with persistent severe abdominal pain (with or without nausea) on sitagliptin alone or with metformin and the drug should be discontinued in such patients. http://www.fda.gov/Drugs/DrugSafety/
Twice daily NPH as good as single daily glargine
In a five year trial in over 1000 patients with type 2 diabetes previously treated with oral hypoglycemic agents, insulin, or both, there was no difference in the risk of retinopathy progression (defined as an increase in three steps or more on the early treatment of diabetic retinopathy study scale) in patients randomly assigned to twice daily NPH versus once daily glargine [Diabetologia 2009; 52:1778.]
Glargine not linked to cancers
Does insulin analogs is linked to cancer the results are conflicting. Until more data are available, there is insufficient evidence to make a recommendation against glargine. [Diabetologia 2009; 52:1732.]
Mediterranean diet good for the diabetes
In a four year trial of a low carbohydrate Mediterranean tyle diet (=50 percent complex carbohydrates, > 30 percent mono and polyunsaturated fat) versus a low fat (<30 percent) diet in 215 overweight patients with newly diagnosed type 2 diabetes, patients randomly assigned to the Mediterranean diet were significantly less likely to require anti hyperglycemic drugs (44 versus 70 percent) [Ann Intern Med 2009; 151:306.]
Saxagliptin, a new DPP IV inhibitor
Saxagliptin, a new DPP IV inhibitor that reduces hemoglobin A1C by approximately 0.5 percentage points, can be used as initial pharmacologic therapy for the treatment of type 2 diabetes or as a second agent in those who do not respond to a single agent, such as a sulfonylurea, metformin, a thiazolidinedione [Diabetes Care 2009; 32:1649.]