New Revision Course and Biscuits

We can now officially announce that our MRCPCH part II revision course is up and running. Those of you preparing for the exam can benefit from our database of 500 questions, all relevant to the current syllabus and based on Case History, Data Interpretation and Photographic Material questions.

Check out our MRCPCH part II Question of the Day if you would like to see what the questions are like.

And if you would like to sign up to the course we have a special introductory price of £40 for 2 months, £60 for 4 months. Come over to OnExamination.com to become a member.

In other news we have been mentioned in this month's Medical Student Newspaper. We have been recommended as one of the, strangely biscuit themed, 'Custard Cream of the Crop Sites on the Web'. Thanks to the writers of Medical Student Newspaper for that!

Labs news is working

Medical news articles are now bubbling to the top of the listings quite easily. The programmers have been fiddling with the algorithms to keep the listings responsive to new articles but also maintain popular articles at the top.

Diploma Course approved

Had the Programme Approval Panel for the Postgraduate Diabetes Diploma with Cardiff University today which went well. We were only left with 2 conditions and 7 recommendations which are largely to do with clarifying in writing what we intend to do with certain aspects of the course.

Looks like the course will be ready for January or February 2007.

Would like to link in the diabetes news from labs.onexamination.com. It would be a useful resource for students on the course.

Quiet time

Had a quiet time with the blogging since I've moved efforts on maintaining the medical news stories to labs.onexamination.com where the developers at OnExamination.com have created a community news system. There are quite a few keen users already following a general invitation to all current and past users of the O/E revision website.

So what to do with this journal now?

Maybe I'll just make it up as I go along.

How To Eat To Prevent Or Treat Diabetes - ADA Releases First Food Guidelines Tailored To Medical Categories

How To Eat To Prevent Or Treat Diabetes - ADA Releases First Food Guidelines Tailored To Medical Categories: "Whether you're trying to prevent diabetes, better manage your disease or slow complications from developing, the American Diabetes Association (ADA) has developed specific guidelines to help you choose the right meal plan to get you to your goals. Published in the September issue of Diabetes Care, the ADA's revised medical nutrition therapy recommendations update statements published in 2002 and 2004 using the most recent scientific data available. [click link for full article]"

Sitagliptin Phase III trials results announced at ADA

Newly released Phase III studies presented on 10th June 2006 at the American Diabetes Association (ADA) 66th Annual Scientific Sessions demonstrated that JANUVIA (sitagliptin phosphate), Merck and Co., Inc.'s investigational oral, once-daily medicine for type 2 diabetes, significantly reduced blood glucose levels when used as monotherapy or as an add-on treatment to two commonly used therapies (metformin or pioglitazone). Additionally, treatment with JANUVIA improved some measures of beta cell function.

Sitagliptin is DPP-4 inhibitor.

Side effects were low with coryzal symptoms, diarrhoea, headach and joint pain being reported slightly more than placebo.

It's effect on HbA1c is greater for higher starting levels of HbA1c. In three monotherapy studies in patients with mildly to moderately elevated A1C levels (mean baseline A1C levels ranged from 7.5% to 8.1%), JANUVIA 100 mg once daily (the proposed registration dose) showed significant mean placebo-subtracted reductions in A1C ranging from 0.60% to 1.05% (1.20% to 1.50% in patients with higher baseline A1C >9%; patients were to be enrolled in the studies with a baseline A1C <6.5% and >10%). In patients in the lowest pre-defined stratum (baseline A1C <8%), the mean placebo-subtracted A1C reductions ranged from 0.44% to 0.57%.

"The data for JANUVIA presented today showed significant glucose-lowering effects across a range of patients with type 2 diabetes, especially in those with more elevated baseline A1C levels. In these studies, a low rate of hypoglycemia was observed and JANUVIA was generally weight neutral," said Edward S. Horton, M.D., vice president of the Joslin Diabetes Center in Boston and head of its clinical research division.

3 days of amoxycillin as good as 8 in community acquired pneumonia

Discontinuing amoxicillin treatment after three days is not inferior to discontinuing it after eight days in adults admitted to hospital with mild to moderate-severe community acquired pneumonia who substantially improved after an initial three days' treatment.

BMJ 2006;332:1355

Researchers from the Netherlands sought to compare the effectiveness of discontinuing treatment with amoxicillin after three days or eight days in adults admitted to hospital with mild to moderate-severe community acquired pneumonia who substantially improved after an initial three days' treatment.

A randomised, double blind, placebo controlled non-inferiority trial was set up in nine secondary and tertiary care hospitals in the Netherlands. Adults with mild to moderate-severe community acquired pneumonia (pneumonia severity index score ≤ 110) who had substantially improved after three days' treatment with intravenous amoxicillin were randomly assigned to oral amoxicillin (n = 63) or placebo (n = 56) three times daily for five days.

Baseline characteristics were comparable, with the exception of symptom severity, which was worse in the three day treatment group. In the three day and eight day treatment groups the clinical success rate at day 10 was 93% for both (difference 0.1%, 95% confidence interval - 9% to 10%) and at day 28 was 90% compared with 88% (difference 2.0%, - 9% to 15%). Both groups had similar resolution of symptoms. Radiological success rates were 86% compared with 83% at day 10 (difference 3%, - 10% to 16%) and 86% compared with 79% at day 28 (difference 6%, - 7% to 20%). Six patients (11%) in the placebo group and 13 patients (21%) in the active treatment group reported adverse events (P = 0.1).