June 30, 2010

U.S. court rejects Pfizer’s appeal on drug test in Nigeria

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Firm barred from releasing N50b to victims

AN appeal by Pfizer at the United States (U.S.) Supreme Court challenging the decision of a U.S. Court of Appeal that it can be sued for illegally testing an antibiotic drug, Trovan, in Nigeria in 1996 failed yesterday.

The U.S. Supreme Court refused to consider Pfizer Inc.’s case brought before it last year, after the court had asked the U.S. government to wade into the matter through the office of the U.S. Solicitor-General.

Besides, the Abuja Division of Federal High Court yesterday ordered Pfizer to put on hold the ongoing disbursement of about N50 billion compensation to victims of its 1996 clinical trial of the Trovan vaccine in Kano State.

The court also directed that the DNA test being conducted by the Health Care Meningitis Trust Fund Ltd to determine the real victims of the controversial Trovan vaccine test be halted.

A federal trial judge in New York threw out the lawsuits in 2005, ruling that international law didn’t provide a basis for the plaintiffs to sue Pfizer in U.S. courts for the alleged clinical-trial violations. But a divided second U.S. Circuit Court of Appeals revived the lawsuits last year, deciding that the plaintiffs could proceed with the case.

The Supreme Court, without comment, yesterday simply let the Appeal Court’s ruling stand. On occasions, the U.S. Supreme Court does adopt the practice of simply ignoring a case after accepting written arguments from both sides. And by ignoring the case, the U.S. highest court allows the pending decision to stand, like the previous ruling in this case made by the Appeal Court.

Last November, the U.S. Supreme Court asked the Obama administration through its Solicitor-General, Elena Kagan to file an opinion in the case to enable it to determine what to do with the case. Kagan herself is now being considered by the U.S. Senate to become a U.S. Supreme Court.

The Nigerian respondents in the case led by Rabi Abdullahi had earlier through their New York-based lawyer Arthur Miller submitted a brief to the Supreme Court, opposing Pfizer’s appeal against the U.S. Court of Appeal that ruled in favour of the Nigerians.

After the court of first instance, U.S. District Court in New York, ruled in favour of Pfizer, the Appeal Court reversed the decision. According to the Second U.S. Circuit Court of Appeals in New York, “the norm prohibiting non-consensual medical experimentation on human subjects has become firmly embedded and has secured universal acceptance in the comity of nations.”

The Nigerian respondents had sued Pfizer for the illegal testing of Trovan on children in Kano. The district court in New York presided over by Mr. J. Pauley dismissed the case for lack of jurisdiction, adding that international law didn’t provide a basis for the Nigerians to sue the company in U.S. courts for the alleged clinical-trial violations.

But the Nigerians with the backing of some New York-based civil right lawyers proceeded to the Appeal Court, where in January this year, through a majority but divided 2-1 decision ruled that the Nigerians could indeed sue and set aside the decision of the lower court, rescinding it and remanding the case back to the lower court for continued hearing.

Dissatisfied, Pfizer took the matter to the American apex court in July. In the appeal, Pfizer got two additional amicus briefs, to support its case, arguing that the Appeal Court in its judgment was legislating, and usurping the powers of the U.S. Congress.

United States (U.S.) district courts are the equivalent of Nigeria’s state or federal high courts.
Therefore, the Nigerian respondents submitted that the Appeal Court decision didn’t conflict with other U.S. circuits regarding the questions Pfizer raised in its petition.

In their brief filed before the Supreme Court, the Nigerians said: “The highly unusual and discrete facts of this case make any decision rendered of limited precedent value, as it will turn on the assessment of factual allegations particular to this case and the pleading of a claim that present circumstances not likely to be repeated.”

They said Pfizer was not arguing that consent was not required, “but instead attempts to characterise its misconduct as mere technical failure in obtaining consent,” adding that “such mis-characterisation obscures Pfizer’s violations of basic human rights principles governing that conduct, with or without the presence of state action.”

The respondents also alleged “that Pfizer, despite knowing that Trovan had the potential to cause serious side effects in children, rushed at the opportunity to test them on children struck ill by a sudden bacterial meningitis epidemic in Northern Nigeria in 1996.”

They recalled that Pfizer occupied two wards of the Kano Infectious Diseases Hospital (IDH), a public hospital, to conduct the Trovan experiment and that these facilities were handed over to Pfizer by the Nigerian government.

The respondents added that at the time of the Trovan testing, the Nobel Prize winning body Medecins Sans Frontieres (MSF), also on location during the epidemic, deemed the same “facilities unfit for its own treatment efforts.”

Describing Pfizer’s lack of attention to appropriate consent as appalling, the Nigerians noted that the drug outfit “failed to inform families either that the treatment offered was experimental, or that MSF offered a non-experimental treatment recommended by the World Health Organisation. Moreover, no representative of Pfizer offered or read any informed consent document to respondents.”

They, therefore, submitted to the U.S. Supreme Court that “Pfizer’s misconduct represents a gross violation of international legal norms prohibiting nonconsensual medical experimentation. These norms have been universal and well-defined since, at the latest, the years following World War II.”

Continuing, the respondents stated that “although arguably no specific treaty makes Pfizer’s misconduct actionable, seminal international human rights documents as well as internationally accepted codes governing the practice of medicine and medical experimentation specifically make clear that the norm applies to private actors. Pfizer does not, and cannot, argue that it is not bound by the norm and is free to conduct nonconsensual medical experimentation anywhere at any time.”

In essence, the two groups of Nigerian families have been arguing for a while now in U.S. courts that Pfizer violated international law when it tested the experimental drug Trovan on 200 Nigerian children during a bacterial-meningitis outbreak. The Nigerian plaintiffs alleged that Pfizer conducted the clinical trial without proper consent from the children’s guardians and didn’t disclose the experimental nature of the study or the serious risks involved.

The clinical trial caused the deaths of 11 children and left others blind, deaf, paralyzed or brain-damaged, the plaintiffs alleged.

Pfizer said its Trovan study, conducted in the Nigerian state of Kano, took place with the approval of the Nigerian government and the consent of the children’s parents. The drug maker said any deaths were the result of illness, not of the clinical trial.

In 1998, the U.S. Food and Drug Administration approved Trovan for adult use only, and its usage has since been restricted to only emergency care. The drug was banned in the European Union.

The case, Pfizer v. Abdullahi, has caught international attention as Pfizer has been fighting to terminate it with as much legal muzzle. But now, the case will proceed back to the lower court where if successful heavy damages may be imposed on Pfizer in addition to those which Pfizer has already suffered in Nigeria.

Delivering his ruling on an oral application for a preservative order sought by Etigwe Uwa (SAN) on behalf of 192 victims, Justice Gabriel Kolawole of the Abuja Division of Federal High Court yesterday held that the order became necessary to prevent the case of the plaintiffs from destruction.

The court held that should the compensation be effected during the pendency of the case, the 192 victims might be left in the cold and unprotected in the deal.

Justice Kolawole held that victims have rights to justice and that nothing would be lost by all the defendants in the fresh suit upon the new order.

The action of the court was prompted by the refusal of some defendants to make undertaking that they would not take any action on the disputed money and the test while the case subsists.

Similarly, the court also took judicial notice of the failure of the defendants to file their response in respect of the case since May 26, 2010 when the court ordered them to do so.

The defendants are the Healthcare Meningitis Trust Fund Ltd, the Attorney General of Kano State, Pfizer Incorporated, Pfizer Specialties Ltd, David Odiwo, the Attorney General of the Federation and Corporate Affairs Commission (CAC).

About 200 victims were registered in 1996 some of who were said to have either lost their lives or suffered permanent disability when the alleged drug was administered on them to protect them against the meningitis infection.

However, upon agreement for compensation for the victims in place of further court actions, the figures of victims rose to 597.

Attempts by the Trust Board in charge of the fund to conduct DNA test to determine the real victims were opposed by the new victims on the ground that they could not trust the conduct of any test now especially 14 years after some fluids for tests were removed from their bodies.

Justice Kolawole while ordering that the case be preserved in the interest of justice adjourned hearing till July 20, 2010.

He ordered that all necessary papers must be filed and exchanged by the parties in the suit seven days to the adjourned date to prevent unnecessary delay.

FROM LAOLU AKANDE (NEW YORK), LEMMY UGHEGBE (ABUJA) AND ADAMU ABUH (KANO)

June 27, 2010

Stem cell therapy complication seen in kidney disease

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A NEW complication has been seen in a patient with kidney disease who received stem cell therapy, scientists have warned. Stem cells were injected into the kidney, but the patient suffered tissue damage and died from an infection.

The Canadian and Thai researchers said the findings published in the Journal of the American Society of Nephrology showed caution was needed.

Experts said there was a gap between research and treatment. Many scientists hope stem cell therapy can be used to treat a wide range of diseases.

It has been shown that it is possible to reprogram adult stem cells, taken from bone marrow, to become a range of specific cell types - including kidney cells.

And animal studies have indicated that injecting stem cells directly into organs, including the kidney, is safe. The patient in this case had been treated by a private clinic.

Researchers from Chulalongkorn University in Bangkok, Thailand, and Paul Scott Thorner, from the University of Toronto, were involved in removing and analysing the kidney.

They found that the patient had not benefited at all from the treatment, but had actually developed tissue damage called angiomyeloproliferative lesions at the injection sites. These were found to be clusters of blood vessels and bone marrow cells.

Dr. Duangpen Thirabanjasak, from Chulalongkorn University, who led the research, said: “This type of lesion has never been described before in patients, and we believe that this is either formed directly by the stem cells that were injected or that the stem cells caused these masses to form.”

And she warned that, because they had not been seen before, no one knew how the lesions might have developed over time.

The authors conclude that their findings should serve as a warning to clinical investigators that the development of blood vessel and bone marrow masses may be a possible complication of stem cell therapy.

And they said more work was needed to identify why the masses formed, and how this could be avoided.
Writing in the journal, Andras Nagy, of Toronto’s Mount Sinai Hospital, and Susan Quaggin, of the University of Toronto, said caution was needed over stem cell therapies - especially if they were being offered by unregulated private clinics.

They added: “Premature enthusiasm and protocols that are not fully vetted are dangerous and result in negative publicity for the field of stem cell research, and more importantly, may result in disastrous outcomes with no benefit to the patient.

“Although there is promise, a large gap still exists between scientific knowledge and clinical translation for safe and effective stem cell-based therapies.

MRCP 2 Question 5

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A mother is concerned about her overweight 6 year old son who appears to be constantly tired during the day. She has noticed that her son has loud snoring and mouth breathing which causes the child to awaken frequently, often coughing and gasping for breath.

Appropriate management should include:

a) No medical treatment required
b) refer to an ENT specialist
c) Cromoglycate inhalers
d) inhaled low dose corticosteroids
e) Single dose 1 ml 0.5% salbutamol




ANSWER
The correct answer is B

Explanation

It is essential to refer these children to an ENT specialist to assess for adenoid and tonsillar hypertrophy.

Obstructive sleep apnea occurs during deep levels of sleep, is associated with snoring and mouth breathing, and causes the child to awaken frequently, often coughing and gasping for breath. This cycle may recur continuously during the night, robbing the child of necessary REM sleep due to intermittent airway obstruction.

Children with OSA are often drowsy during the day and they and their families suffer emotionally as well as physically. The most important piece of information that will uncover an association between allergy and OSA is the child's weight, as up to 17% of obese children experience OSA.

Additional questions to pursue include the presence of snoring and mouth breathing during the night, as well as frequent nocturnal crying, awakening, coughing, and gasping for breath.

Once the association is made, it is essential to refer these children to an ENT specialist to assess for adenoid and tonsillar hypertrophy, which may further cloud the diagnostic picture.

MRCP 2 Question 4

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A 65 year old smoker with a three month history of a dry cough develops bilateral pleural effusions. Thoracocentesis reveals a pleural effusion with a Lactic Acid Dehydrogenase level which is is less than 50% of the serum Lactic Acid Dehydrogenase level.

This suggests that:

a) the patient is probably diabetic
b) the patient is likely to have an empyema
c) the protein content of the effusion is likely to be above 4 g/dl
d) the specific gravity of the fluid is likely to be less than 1.02
e) the patient is likely to have a bronchogenic neoplasm




ANSWER
The correct answer is D


Explanation

A Pleural fluid LDH-to-serum LDH ratio <0.6 is suggestive of a transudate.
1. Laboratory differentiation.
§ Specific gravity. Under 1.016 is suggestive of a transudate.
§ Protein. Less than 3 g/dl is suggestive of a transudate.
§ Pleural fluid protein-to-serum protein ratio. <0.5 is suggestive of a transudate.
§ Pleural fluid LDH-to-serum LDH ratio. <0.6 is suggestive of a transudate.

The pleural fluid level is not useful in the differential diagnosis of exudative pleural effusion.

Nevertheless, it is recommended that a pleural fluid LDH level be measured every time a diagnostic thoracentesis is performed, since the level of LDH in the pleural fluid is a good indicator of the degree of inflammation in the pleural space.

If the pleural fluid LDH level increases with serial thoracentesis, the degree of inflammation is worsening and one should be more aggressive in pursuing the diagnosis

MRCP 2 Question 3

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Cytogenetic abnormalities are a known side effect of several cytotoxic drugs.

Which of the following cytotoxic drugs is most likely to lead to endometrial cancer ?

a) tamoxifen
b) 5-fluorouracil
c) taxoids
d) cyclopentenyl cytosine
e) trastuzumab



ANSWER
The correct answer is A

Explanation

Long term use of tamoxifen has been associated with an increase in endometrial cancer.

MRCP 2 Question 2

No comments:
Examine the diagram below carefully. Then choose the most correct answer from the choices below:


a) acute extradural hematoma
b) sub-acute acute extradural hematoma
c) acute subarachnoid hematoma
d) subacute subdural hematoma
e) acute subdural hematoma



ANSWER
The correct answer is D

Explanation

Subdural hematomas which become symptomatic between 3 days and 3 weeks after initial injury are considered subacute.

Compared to the normal brain parenchyma, subacute subdural hematomas appear isodense to low density. These collections may be subtle, especially if they are bilateral.

Medial displacement of the gray-white matter interface is an important finding to identify.

MRCP 1 Question 6

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In the mechanism of action of antibiotics, the mechanism of action of Tetracyclines:

a) Inhibits protein synthesis by binding to a subunit of the bacterial ribosome
b) blocks cross-linking of the cell wall structure
c) inhibits enzymes needed in the biosynthesis of folic acid
d) inhibits bacterial DNA gyrase
e) inhibits DNA-dependent RNA polymerase



ANSWER
The correct answer is A

Explanation

Tetracyclines: Inhibit protein synthesis by binding to the subunit of the bacterial ribosome (30S subunit).

MRCP 1 Question 5

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A patient with allergic rhinitis develops acute urticaria. This is best relieved by
a) Antigen avoidance
b) combination of H1 and H2 antagonists
c) Antihistamine-decongestant preparation
d) Topical adrenergic agonist
e) oral adrenergic agonist




ANSWER
The correct answer is B

Explanation

For the treatment of acute urticaria, the combination of H1 and H2 antagonists is more effective than the H1 antagonist alone.

But for the treatment of pruritus from acute allergic reactions, the H1 antagonist is more effective than the H2 antagonist, and the combination offers no additional benefit.

New malaria infection discovery boosts vaccine hope

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DISCOVERY of a key red cell molecule used by the malaria parasite gives renewed hope for an effective vaccine in the future, according to an international team of researchers.

Plasmodium falciparum, a blood parasite that causes malaria by invading and multiplying in the red blood cells, kills one to two million people annually.

“How the parasite invades red blood cells is not completely understood,” said Dr. Jose A. Stoute, senior investigator and team leader, Department of Medicine, Division of Infectious Diseases and Epidemiology, Penn State College of Medicine.

“For many years it has been known that proteins called glycophorins are used by the parasite to gain entry into the red cell.”

Because infection can take place without glycophorins, researchers suspected that another protein is also involved. The identity of this protein remained a mystery for 20 years and it was named the “X” receptor.

A team of researchers now reports in PLoS Pathogens, the identity of this protein as the complement receptor 1 (CR1), also known to help protect red cells from attack by the immune system. CR1 has been suspected of having other roles in the development of malaria complications.

The team was able to demonstrate that this protein is important in the invasion of red cells by using several laboratory strains of malaria as well as strains obtained from Kenya.

June 25, 2010

MRCP 2 Question 1

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A fifty-five year old with chronic cardiac failure is on treatment with digoxin and the a loop diuretic.

This combination is likely to cause digoxin toxicity by the following reason:

a) this combination increases the half-life of digoxin
b) diuretics decrease potassium levels
c) frusemide and digoxin interact to form a poisonous compound
d) digoxin is a competitive inhibitor of frusemide
e) the above statement is wrong, loop diuretics are not a recognised cause of increased digoxin toxicity



ANSWER
The correct answer is B

Explanation

Loop and thiazide diuretics decrease potassium and magnesium levels, predisposing patients taking both a diuretic and digoxin to an increased risk of digoxin toxicity.

Also, amphotericin B (Fungizone), an antifungal, has an additive potassium-lowering effect when given with a thiazide or loop diuretic.

Thiazides may increase the blood levels of lithium.

Bile acid sequestrants cholestyramine (Questran) and colestipol (Colestid) decrease the absorption of thiazide diuretics when given concomitantly, while nonsteroidal anti-inflammatory drugs such as indomethacin (Indocin) may decrease the therapeutic effects of both the loop and thiazide diuretics.

June 23, 2010

MRCP 1 Question 4

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A random controlled trial of acute asthma treatment was performed in the emergency department wherein patients were discharged with oral corticosteroids plus either budesonide (an inhaled corticosteroid) or placebo.

The main outcome event was relapse, defined as an unscheduled visit for worsening asthma symptoms within 21 days of discharge.

Of the 100 patients randomized to budesonide, 25 relapsed. Conversely, 50 of the 94 patients randomized to placebo relapsed.

What is the relative reduction in 21-day relapse from asthma in the treated patients ?

a) 7.5%
b) 12.5%
c) 17.5%
d) 25%
e) 50%




ANSWER
The correct answer is E

Explanation

The relative risk reduction (RRR) is a quantification of how much the treatment reduces the risk of the outcome relative to the baseline outcome event rate. Wherein the baseline risk of an outcome event is the event rate in the control group defined by C/(C + D), the RRR is the difference in outcome event rates between the control and treatment groups divided by the outcome event rate in the control group.

The relative risk reduction = (0.50 - 0.25) / 0.50 = 0.50

we convert these numbers to percent by simply multiplying by 100 to arrive at
The relative risk reduction = 50%

MRCP 1 Question 3

No comments:
A patient develops syncope on head turning.

The physician decides to perform carotid massage and is giving instructions to his senior registrar on how to perform the carotid massage.

Which of the following is a valid instruction for carotid massage in this patient:

a) Start with carotid sinus on left side
b) Never massage both carotids simultaneously
c) A Carotid Bruit is a definite contraindication
d) patient should be sitting up for the procedure
e) Patient should stand for 5 minutes prior to massage



ANSWER
The correct answer is B

Explanation

June 21, 2010

Cervical Pap Smear Tests Should Start at Age 21

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Young women should have their first Pap test no sooner than age 21, regardless of when they become sexually active, say new guidelines from the American College of Obstetricians and Gynecologists. Earlier screening for cervical cancer may lead to unnecessary and possibly harmful treatments for an increasingly rare cancer, according to ACOG, the leading U.S. professional organization for obstetricians and gynecologists.

Soccer Practice May Significantly Reduce Blood Pressure in Inactive People

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Soccer practice may significantly reduce blood pressure in inactive people"- ScienceDaily
A research experiment on inactive men with high blood pressure published in ScienceDaily on Feb. 17, 2010 shows that just 3 months of soccer practise twice a week causes a significant fall in blood pressure, resting pulse rate, and percentage of body fat, and is more effective than the doctor's usual advice on healthy diet and exercise.

Other parallel experiments on both women and men further demonstrates that a regular game of soccer affects numerous cardiovascular risk factors such as maximal oxygen uptake, heart function, elasticity of the vascular system, blood pressure, cholesterol and fat mass far more than e.g. strength training and just as much if not more than running.

Each of the experiments was controlled randomized studies where the soccer groups were compared to other exercise groups and inactive controls.

The soccer experiments are part of a large-scale research project on soccer and health carried out at the University of Copenhagen, four Danish University Hospitals, the Swiss Federal Institute of Technology and the Schulthess Clinic in Zurich.

Project Leader and Associate Professor at the University of Copenhagen Peter Krustrup recaps the results: "Our research shows that soccer is a versatile and intense form of exercise that provides a positive effect on cardiovascular risk factors in a large group of untrained adult men and women," and continues: "Based on the results, soccer can be recommended as part of the treatment for high blood pressure and as broad-spectred prevention of cardiovascular diseases."

Small games, big gains

When untrained children, teens, adults and older people play soccer, their pulse rate remains high and they perform multiple intense actions like sprints, turns, kicks and tackles. "Our analyses also showed that the pulse rate and activity profile is the same in small-sided games where only 4, 6, 8 or 14 people play.

In other words, it is very easy to obtain a combination of cardio and strength training with soccer," concludes Krustrup

Research partner Lars Juel Andersen from the Clinic of Sport Cardiology at Gentofte Hospital, Denmark, believes that the results are good news for the millions of people worldwide, suffering from high blood pressure: "It is well known that physical inactivity is a substantial risk factor in developing cardiovascular diseases in itself, but it is new that a pleasurable team sport like soccer is effective in treating high blood pressure."

Furthermore, associate professor Peter Riis Hansen from Gentofte Hospital suggests that football may have other favourable effects on the vascular system, namely a reduction of arterial stiffness, which has been associated with improved cardiovascular outcomes.

University of Copenhagen (2010, February 17). "Soccer practice may significantly reduce blood pressure in inactive people". ScienceDaily

Tiny chip could diagnose disease

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Researchers have demonstrated a tiny chip based on silicon that could be used to diagnose dozens of diseases.

A tiny drop of blood is drawn through the chip, where disease markers are caught and show up under light.

The device uses the tendency of a fluid to travel through small channels under its own force, instead of using pumps.

The design is simpler, requires less blood be taken, and works more quickly than existing "lab on a chip" designs, the team report in Lab on a Chip.

It has a flexible design so that it could be used for a wide range of diagnostics.

Much research in recent years has focused on the chemical and medical possibilities of so-called microfluidic devices at the heart of lab-on-a-chip designs.

These microfluidics contain between dozens and thousands of tiny channels through which fluids can flow, and as micro-manufacturing methods have advanced, so has the potential complexity of microfluidics.

Now, scientists at IBM's research labs in Zurich have developed a cheap lab-on-a-chip that has the potential to diagnose dozens of diseases.


Bind and shine


The device relies on an array of antibody molecules that are designed to latch on to the protein-based molecular markers of disease in blood.

The antibodies are chemically connected to molecules that emit light of a specific colour when illuminated - but only when they have bound to the disease markers.

"There are devices that have been developed in microfluidics to do analysis of proteins, but most of them use active pumping and electrical components," said Luc Gervais, a co-author on the study.

"They're very complex systems; this makes them less easy to use by non-trained personnel - and it makes them a lot more expensive to manufacture," Dr Gervais told BBC News.

Instead, the new device exploits capillary action, the tendency of fluids to climb through narrow channels - the same phenomenon that drives water into a sponge placed on a wet surface.

The speed with which blood is drawn through the chip can be controlled by the design of the micro-channels on the device. Those channels can be designed with incredible precision on a silicon chip - something with which IBM has significant experience.

The microchannel-patterned chip is then sealed with a special polymer called polydimethylsiloxane, to which the "detector" antibodies easily bond.

Different antibodies can be placed in a number of distinct channels, making it possible to diagnose a range of different diseases simultaneously.

From BBC News; read more...

MRCP 1 Question 2

No comments:
Hospitalized immunocompromised patients are at risk for pneumonias.

Which of the following would represent such a nosocomial pneumonia.

a) P carinii
b) Nocardia spp
c) M avium-intracellulare
d) Pseudomonas aeruginosa
e) Staphylococcus aureus




ANSWERS
The correct answer is D

Explanation

Hospitalized immunocompromised patients are at risk for nosocomial pneumonias, half of which are caused by anaerobic gram-negative bacilli, including:
  • Pseudomonas aeruginosa,

  • Enterobacter species,

  • Klebsiella species,

  • Escherichia coli, and

  • Acinetobacter specie

MRCP 1 Question 1

No comments:
A 38 year old farmer is seen with severe headache and fever. He has a history of a ten day cough with bloody sputum and showed consolidation on a chest x-ray for which he was given erythromycin by his physician. Physical examination was unremarkable except for bilateral inspiratory crackles and a lumbar puncture was performed. This demonstrated a highly pleomorphic coccobacillii with gram-negative cell wall.

These features are characteristic of:
a) Streptococcus pneumoniae
b) Bacteroides fragilis
c) Coxiella burnetii
d) Escherichia coli
e) Haemophilus influenzae



ANSWER
The correct answer is C

Explanation

Coxiella burnetii, the etiologic agent of Q fever, is a highly pleomorphic coccobacillus with a gram-negative cell wall.

There are three presentations of Q fever : atypical pneumonia, rapidly progressive pneumonia, and pneumonia as an incidental finding in a patient with a febrile illness. This last presentation is probably the most common form of Q fever pneumonia.

In Q fever due to Coxiella burnetii the physical examination of the chest is often unremarkable. The most common physical finding is inspiratory crackles. Patients with rapidly progressive pneumonia usually have the physical signs of pulmonary consolidation.

About 5% of patients have splenomegaly. Fever and severe headache suggest central nervous system infection, and lumbar puncture is often performed.

The rapidly progressive form of Q fever pneumonia mimics legionnaires' disease and the pneumonic form of tularemia, and indeed, all the causes of rapidly progressive pneumonia enter the differential diagnosis.

June 20, 2010

Drug for Sexual Desire Disorder Opposed by Panel

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A federal advisory panel on Friday unanimously voted against recommending approving a drug to treat female sexual desire disorder, but it encouraged the company to continue its research.

That vote by the panel, an adviser to the Food and Drug Administration, followed an F.D.A. staff report earlier this week that also recommended against approval. Such advisory votes do not always influence the F.D.A.’s final decision on a drug, but often they do.

June 19, 2010

Benefits and risks of childhood vaccination

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Children generally do not have their immunity developed to its full potential, so vaccines are a safe and effective way to ensure their immunity against a number of potentially serious diseases.

At birth, babies have a certain amount of natural protection against disease in the form of antibodies from their mothers, but this protection does not last past the first year of life. Young children, therefore, are at risk for a number of diseases which can prove to be serious, or even fatal.

Fortunately, most countries offer access, ofttimes free access, to various vaccines and vaccination programs that can immunize their children against immunizable diseases like polio, measles, mumps, tuberculosis, whooping cough, diphtheria and many others.

The concept of vaccination / immunization

Simply put, vaccination (or immunization) means the inoculation of a person or animal with a vaccine to produce immunity to a disease. It is a form of preventive, as against curative, medicine with the primary aim of protecting individuals and communities from infectious diseases by preparing their body to fight against future infections. Thus, life and huge sums of money are saved.

It is based on the presumption that once you have had a disease, you are unlikely to contract it again i.e. the body has to be exposed to infection once for the immune system to recognize it. This may be true of many diseases like varicella and smallpox, but definitely not so of some others.

How vaccination works

Injections, oral drops or scratches on the skin introduce dead, weakened, or purified components of disease-producing microorganisms or toxins into the body, stimulating production of antibodies and antitoxins. Thereafter, when the body becomes exposed to that infection, the immune system "recognizes" it, and produce antibodies or antitoxins to destroy that infection.

Childhood immunization thus helps the child's immune system build up resistance to disease by enabling it store information about how to respond and produce particular antibodies, if the child is exposed to that same microorganism in the future.

Benefits and risks of childhood vaccination

It is worth emphasizing that the advantages and benefits of vaccinating a child far outweighs the disadvantages and risks. The popular argument is that there is no reason to suffer from a disease if there is a safe and effective way to prevent it.

The diseases that vaccines fight are serious, and ofttimes life-threatening. Diseases like polio, diphtheria, measles, and whooping cough can lead to paralysis, pneumonia, choking, brain damage, heart problems, and even death in children who are not protected.

Many children have minor and temporary reactions like pain or some swelling at the point of injection if the vaccine is injected, while others may develop a mild fever. Only very rarely and with some vaccines would permanent damage or other serious side effects like severe allergic reactions, with or without fatal consequences, occur.

Precautions before vaccinations

Just like every other thing in life, precautions should be taken before vaccinating your child. Make sure s/he is in good health before taking her for a shot and report any side effects to the doctor immediately. Remember that the advantages of immunization far outweigh its drawbacks. It is thanks to immunization that a disease like small pox has been eradicated.

June 18, 2010

Symptoms of Male Menopause Identified

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SYMPTOMS OF MALE MENOPAUSE

In the June 17, 2010 edition of WebMD Health News as written by Katrina Woznicki, and reviewed by Laura J. Martin (MD); the headlines screamed and the issue of menopause in men was discussed: Decreased Sex Drive and Fatigue Are Among Symptoms of Late-Onset Hypogonadism.

Food and Drug Administration Readies for Fight Over 'Female Viagra'

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CRITICS SAY FLIBANSERIN, AN ANTIDEPRESSANT, HAS LIMITED EFFECTIVENESS AND MEDICALIZES WOMEN'S SEXUALITY

A German drug company is ready to market a pill for premenopausal women who are distressed by low sexual desire, and is prepared to fight for Food and Drug Administration approval at a hearing Friday.

June 13, 2010

Novartis Multiple Sclerosis Pill Gilenia Wins Advisory Panel Approval

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MULTIPLE SCLEROSIS: FIRST ORAL PILL TO BE APPROVED SOON

This is nothing short of great news within the medical community in the United States in particular, but worldwide in general, as the first oral pill designed to treat multiple sclerosis is on its way to final approval from the United States FDA.

Bronchial Asthma and Cardiac Asthma -- The Differences Between Them

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BRONCHIAL AND CARDIAC ASTHMA - THE DIFFERENCES

Of these two - bronchial asthma and cardiac asthma, the former is more common. The term ‘bronchial’ is used to differentiate it from what doctors sometimes call ‘cardiac’ asthma, which is not true asthma but breathing difficulties caused by heart failure. Although the two conditions have similar symptoms, including shortness of breath and wheezing (a whistling sound in the chest), they have quite different causes.