Tripod position mnemonic

Hi everyone!

Short mnemonic is here..

“Tripod TONE is forwarding air into the Lungs” 

Mnemonic | Major risk factors for Ventilator associated pneumonia | Step2 CK

 

Mnemonic for an opioid intoxication | Step 2 CK

Mnemonic for LAB evaluations for SSRI overdose

Hii! 

Short mnemonic!

Isolated SSRI overdose = Asx / mild CNS Depression 

If symptomatic SSRI overdose with altered mental status & abnormal physical findings. 

Then Check for “ECG” 

Mnemonic = ECG! 

E  = ECG ( As Citalopram & Escitalopram can cause QT prolongation ) 

MOST IMPORTANT 

C = Coingestants (Ethanol , Benzodiazepines, Acetaminophen )& biCarbonate Levels ( assess for Metabolic acidosis ) 

G = Glucose levels ( rule out hypoglycemia as a cause of altered mental status) 

Mnemonic for Caustic Esophageal injury

Hi everyone! 

Here is a short mnemonic! 

ACidic Substance = Coagulation Necrosis ( Protein denaturation) - 

results in Eschar - prevents further acid penetration & thereby severe injury.

ALakaline Substance = Liquefactive Necrosis (Cell membrane dissolution) - deeper penetration results in more severe injuries. 

1st step = Serial CXR & abdominal x-ray to identify perforation

If no perforation or respiratory distress then Upper GI endoscopy within 24 hours to assess severity for esophageal damage. 

Thank you! 

The Moderna Vaccine: End of Pandemic?

 

The Moderna (mRNA-1273) SARS-CoV-2 vaccine is the second vaccine to receive emergency use authorisation (EUA) by the FDA. Like the Pfizer vaccine, it is also a lipid nanoparticle encapsulated mRNA vaccine, and therefore has the same mechanism of action. Please read about the brief mechanism from the Pfizer vaccine article: https://www.medicowesome.com/2020/12/the-bnt162b2-covid-19-vaccine-pfizer.html I will try to avoid big numbers and statistics in this article. 

Both Moderna and Pfizer vaccines start protecting their recipients 10 days after the first dose, with maximum protection two weeks after the second dose. They both have efficacy ranging from 94-95% in protecting against symptomatic Covid-19. However, studies haven't yet evaluated their role in preventing asymptomatic Covid-19, a substantial missing link. 

Can Covid-19 vaccines mitigate the pandemic? 

People picture vaccines as a way back to normalcy, as before the pandemic; unless these mRNA vaccines' role in controlling asymptomatic SARS-CoV-2 infection is studied, normalcy is out of our reach. The other issues concerning the above question are -

1. Since the phase 3 studies of these vaccines are relatively 'young', we don't have sufficient knowledge about the nature and duration of immunological protection. Animal studies have shown that neutralizing antibodies confer protection and CD4 and CD8 T cells also amplify the immunological response. We don't know how long will the neutralizing antibodies last in our plasma after receiving the vaccine. 

2. With both these vaccines, there is an inevitable study flaw. Vaccine recipients faced more systemic adverse events, such as fever, fatigue, headache, myalgia than the placebo group. These symptoms can also occur with Covid-19. Therefore, it is not unlikely that vaccine recipients could have designated their symptoms to the 'shot', and hesitated to refer themselves to be tested for Covid-19.

3. The third issue is quite popular in the daily news. What if the virus mutates and renders itself 'immune' to the vaccine? Some new strains have come up worldwide, and expectedly, the diaspora has started panicking. People need answers quickly while science takes time. So we cannot rule out the possibility that the virus devises a way to escape from the vaccine-induced immunological response. 

4. Vaccine-associated enhanced disease (VAED). Earlier preclinical studies with SARS and MERS have demonstrated that low-level neutralizing antibodies in the plasma can trigger a severe form of the disease. Both the Moderna and Pfizer vaccines are 100% effective in protecting against severe Covid-19, notwithstanding this fact, the regulatory authorities should monitor these and other vaccine candidates for this adverse event. 

5. Anti-Vaxxers! The anti-vaccine sentiment is appalling, and there have been 'anti-vaccine' protests in many parts of the world, including the US, Germany, Poland, and others. There are numerous fake news and misinformation in social media platforms that misguide people and tarnish their perspective about the vaccines. And this phenomenon has even affected the medical professionals. The healthcare authorities have an onerous task to incite confidence in the general public and safeguard them from misinformation. 

Safety

The adverse effect profile of both the vaccines is similar, with the most common being local injection-site reactions. Systemic side effects are more common in the vaccine group and comprise mainly of fatigue and headache. Bell's palsy occurred in three (out of 15,210) vaccine recipients within 28 days of administration. This anecdotal risk would be studied in the planned two-year follow-up. 

Being a physician in the Indian subcontinent, there are various reasons to mistrust this vaccine. Both the mRNA vaccines have been studied primarily in the US population (mainly whites), and we don't have any data on its long-term effects. Recently, I have come across various tweets and posts in my social media feed with the headline - " Doctors and nurses are declining the vaccine." I am unaware of these posts' credibility; however, this isn't false in my experience. Well for what it's worth, we haven't seen a whole lot of polio, diphtheria or smallpox recently. 

Thanks for reading!

-VM

 

 

Perspective: My ideology and philosophy about medicine

 

 

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

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	N	Covid-19 Cases	N
1st Primary	8	18,198	162	18,325	95(90.3-97.6)
2nd Primary	9	19,965	169	20,172	94.6(89.9-97.3

 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.

Reference:

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

-Vinayak

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! 

https://youtu.be/306jxLzyyag

https://youtu.be/7FHNmM-V2c0

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!

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!

-IkaN