Thursday, December 24, 2020

The three O's of GI bleeding : Overt, obscure, and occult

GI bleeding can be classified into three O's: Overt, obscure, and occult! Can you define these terms?

If not, I'll help you out

Sunday, December 20, 2020

Pediatrics | Pulmonary & Critical Care | CK Uworld

The BNT162b2 Covid-19 Vaccine: Pfizer-BioNTech Vaccine


The BNT162b2 mRNA Covid-19 vaccine, popularly known as the Pfizer vaccine is the first Covid-19 vaccine to receive authorization for use in the general public. The first jab was given to a 90-year old lady in the UK on December 8, 2020; a monumental event that brought hope to billions of people all across the globe. In this article, I will discuss this vaccine’s clinical trial and potential future implications.


How does it act?

The BNT162B2 is a lipid nanoparticle-formulated, nucleoside-modified mRNA that encodes the SARS-CoV-2 full-length spike protein, modified by two proline mutations to lock it in the prefusion conformation. This means that this is an mRNA that has been modified to resist disintegration by nucleases and that translates into the SARS-CoV-2 spike protein. However, this spike protein has also been modified to lock it into its pre-fusion conformation; so that it doesn’t fuse with the target cell’s plasma membrane and remain exposed to immunogenic stimulation.


Who is it for?

This primarily depends on the characteristics of the population included in the vaccine’s clinical trial. This trial randomised 43,458 persons from six countries: USA, Argentina, Brazil, South Africa, Germany, and Turkey. More than three-fourth of the study population (76.7%) belonged to the USA. Moving on to the representation of race or ethnicity in the study population - 82.9% were white, 27.9% were Hispanic, while African Americans, Asians, and Native Americans comprised 9.2%, 4.2%, and 0.5% of the study group. Males and females were almost equally included. The age range is from 16 years to 89 years in the intervention group. This trial did not evaluate the efficacy of the vaccine in children, adolescents, and pregnant women.  


Is it effective?

Define effective; it depends on the trial’s efficacy end points. The primary endpoint was the efficacy of the vaccine to prevent Covid-19 infection 7 days after the second dose in participants who had no serologic (antigen and antibodies) or virologic (RT-PCR) evidence of SARS-CoV-2 infection up to 7 days after the second dose; the second primary endpoint was to prevent infection in those with and without evidence of prior infection. Confirmed Covid-19 was defined as – the presence of at least one symptom (fever, new or worsened cough, new or worsened dyspnoea, chills, new or worsened muscle pain, new loss of taste or smell, sore throat, diarrhoea or vomiting combined with a positive RT-PCR test within 4 days).    



Efficacy End Point


BNT162b2 Group


Placebo Group

Vaccine efficacy, % (95% credible interval)

Covid-19 Cases


Covid-19 Cases


1st Primary






2nd Primary






 This trial showed that a two-dose regimen of BNT162b2 (30 micrograms per dose, given 21 days apart) was 95% effective in preventing symptomatic Covid-19 infection 7 days after its course. The efficacy was 52% after the first dose, and 91% in the first 7 days after the second dose.

However, the trial results did not show the efficacy in preventing asymptomatic infection. We don’t know if this vaccine can safeguard against transmissible asymptomatic infection; therefore, people who have taken the vaccine should not stop wearing masks for the sake of the people around them.


Is it safe?

The vaccine group reported more local reactions, such as pain, redness, and swelling at the injection site than the placebo group. In general, these were mild-to-moderate in severity and resolved within 1-2 days. The systemic adverse effects were also reported more in the intervention group, especially in the younger population (16 to 55 years of age), and more after the second dose. These included – fever (11%), fatigue (51%), headache (39%), chills (23%), muscle pain (29%), joint pain (19%), and 38% of the vaccine group needed to use antipyretic medication. These were generally mild and resolved within 1-2 days. Two deaths happened in the vaccine group, one from arteriosclerosis, and one from cardiac arrest. These deaths weren’t related to the vaccine or Covid-19. The investigators plan to continue the surveillance for adverse events for further 2 years.  


This study has importance beyond the efficacy of the BNT162b2 vaccine candidate. It demonstrates the utility of RNA-based vaccines, its speed of development, and its promising efficacy in preventing infectious diseases. The success of this clinical trial immensely improves our preparedness for a future pandemic.


Polack, FP, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. New England Journal of Medicine. Dec 10, 2020. 10.1056/NEJMoa2034577. C4591001 Clinical Trial group


Thursday, December 17, 2020

All mnemonics for how to determine axis deviation of EKG

Hello Everybody! 

Before reading this post I would like to suggest please see both the videos of How to determine axis deviation in real scenarios... Then come back here for summary & some extra mnemonics. 

Hope it’ll definitely helps you!

How to remember numbers...? 

“Isoelectric Method” 

You are in front of me ... as arrows in the image..... 
I is perpendicular to avF ..
II  to avL 
III to  avR .....

So finally I & you are the leads 😂. 
Thank you..!! 
-Dr. Drashtant!

Wednesday, December 16, 2020

Tips on creating a Rank Order List (point system) for residency and fellowship

Types of Left Ventricular Hypertrophy (LVH)

 Types of Left Ventricular Hypertrophy (LVH)

LVH = increase in the mass of the left ventricle (LV)

Caused due to:
1. enlargement of the muscle cells
2. extracellular fibrosis

Concentric LVH 
- occurs in response to pressure overload
- examples: aortic stenosis or hypertension
- associated with: reduced cavity size

Eccentric hypertrophy
- occurs in response to volume overload
 -examples: aortic or mitral regurgitation
- associated with: dilation

LVH is also classified based on the cause
Due to primary condition (hypertrophic cardiomyopathy)
Secondary to pathology (hypertension, myocardial infarction, and valvular heart disease)

That's all!

Pediatrics | Male Reproductive System | CK Uworld

Tuesday, December 15, 2020

J-1 visa: Statement of Need and surety bond for Indian International Medical Graduates (IMGs)

Histoplasmosis mnemonic

Histoplasmosis mnemonic

Bubonic plague mnemonic

Bubonic plague mnemonic 

COVID-19 Vaccine Development

The worldwide magnitude of the COVID-19 pandemic is ineffable; it is unsurprisingly compared to the Spanish flu pandemic, which ravaged the world during the First World War (adding fuel to the fire!). One of the pandemic's various positive impacts has been the unprecedented research collaboration and data sharing across the world. Such singular efforts made it possible to cut down the usual time to achieve an approved vaccine from 10+ years to less than a year.

To put things into perspective, it took 60 years from the time of the first polio outbreak to developing its vaccine; in the case of Ebola, it took 15 years. Vaccine candidates for SARS-CoV-1 and MERS did not receive the necessary impetus to advance into fruition. However, with SARS-CoV-2, the situation is very different. Global initiatives such as ACTIV (Accelerating COVID-19 Therapeutic Interventions and Vaccines), a public-private partnership comprising of bigwigs like CDC, FDA, EMA (European Medicines Agency), and numerous leading biopharmaceutical enterprises. Another project on a similar scale is Operation Warp Speed, which has invited comparison to the infamous Manhattan Project.

What is an "ideal" COVID-19 vaccine? There are three criteria from the immunological perspective: 1) It induces a robust humoral immune response that produces long-lasting neutralizing antibodies against SARS-CoV-2 antigens, 2) It generates a strong cell-mediated immunity that includes the production of memory T cells, 3) It should be free of any serious local or systemic adverse effects. Considering the logistics of vaccinating the entire world, there are three more criteria: 1) It should be easy to administer, preferably in one or two doses, 2) It should be easy to produce on a large-scale, 3) Its storage should be uncomplicated, ideally possible at room temperature.

 Source: Front. Pharmacol., 19 June 2020 |

Let us discuss the vaccines that are currently in development. We all have heard about a few of them in the news and social media, namely, Pfizer, Moderna, Covaxin, Astra Zeneca, and so on. There are, impressively, 125+ SARS-CoV-2 vaccines in development globally. Broadly, there are six platforms currently being utilized for vaccine development –

1.   DNA

2.   mRNA (examples – Moderna, Pfizer)

3.   Protein (Subunit vaccines)

4.   Viral vector – replicating/non-replicating (examples - Oxford/Astra Zeneca, Johnson & Johnson)

5.   Live attenuated virus

6.   Inactivated virus

Almost all of the above models have targeted the spike glycoprotein, which is present on the surface of SARS-CoV-2, to interfere with the viral entry into a cell.

This article is an oversimplified summary of the vaccine development process. I haven't covered the vaccine platforms, molecular targets, and vaccine candidates in detail. With the advent of vaccine administration, whether it's Pfizer's or any other, there will be a massive surge in vaccine-related information. There will be challenges at every step, from distribution to underdeveloped areas of the world to alleviate the concerns of the skeptical anti-vaxxers. Let us hope that these vaccines start the end of the pandemic.


J-1 visa: Statement of need (SON) attestation from Indian Consulate

Saturday, December 12, 2020

About the Pfizer BioNTech COVID-19 Vaccine trial

Important things we know about the Pfizer BioNTech COVID-19 Vaccine

• From roughly 44000 participants, vaccine and placebo were administered 1:1 ratio, the vaccine participants demonstrated 95% efficacy in preventing COVID-19 in those without prior infection 7 days or more after the second dose.

• Partial protection from the vaccine candidate appeared as early as 12 days after the first dose.

• The vaccine has shown consistent results in people of different ages, races, BMI, and with various co-morbid conditions.

Emoticon game: Acute Liver Failure answers

If you haven't tried the emoticon game, check it out here:

The answers are posted below.

Emoticon game: Causes of Acute Liver Failure

Pediatrics Allergy & Immunology UWorld Step 2 CK


COVID-19 and the increased risk of Parkinson's disease


Currently posted in psychiatry, I was reading articles on Parkinson's disease and came through this important finding in context with the coronavirus disease.

Friday, December 11, 2020

Cosmetic surgery and Nontuberculous Mycobacterial infections

There has been an increase in plastic surgery tourism because some countries offer cheap cosmetic surgery. Common surgical procedures sought are breast augmentation surgery, liposuction, eyelid surgery, facelift, labiaplasties, and gluteal lift procedures. [1]

Conus medullaris syndrome vs. Cauda equina syndrome

Both of these are orthopedic/neurosurgical emergencies! But in general, CM syndrome is more severe than CE syndrome.

Here's a comparison between the two...

Guidelines for management of gout by ACR 2020


Long time..

Urate-lowering therapy indications and important guidelines for management of gout, as updated by ACR in 2020:

Monday, December 7, 2020

Saturday, December 5, 2020

Mechanical ventilation

Terms you need to know

1.       PaO2: Oxygen saturation in arterial blood  (N = 80-100)

2.       PaCO2: Carbon Dioxide saturation in arterial blood (N = 35 – 45)

3.       FiO2: Fraction of inhaled O2 (N = 21% i.e. the fraction of O2 in atmosphere air which we inhale)

4.       PEEP: Positive End Expiratory Pressure – The pressure needed at the end of expiration to keep the alveoli open.

5.       RR: Respiratory rate (N = 12-16)

6.       TV: Tidal Volume (N = 6-8 ml/kg = approx. 500 ml)