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  Ofloxacin for traumatic TM perforation
Posted by: dbrosnahan - 07-30-2016, 03:09 AM - Forum: General Discussion - No Replies


The effect of ofloxacin otic drops on the regeneration of human traumatic tympanic membrane perforations. These studies show positive results. A retrospective study of patients with traumatic tympanic membrane perforation greater than one quarter the size of the membrane found that topical application of either epidermal growth factor (EGF) or ofloxacin otic drops reduced healing time over that associated with observation.  Healing with EGF and ofloxacin otic drops took a mean 12.6 and 12.9 days, respectively, compared with 35.7 days for observation. 

The first study says that the "closure rate" was not significantly different between the observation and treatment groups but the "closure time" was significantly decreased.  I'm going to have to read this paper more to understand "closure rate. The second study makes the point that they think the decreased closure time is due only to the "moist environment" resulting from the frequent use of ear drops.

1. Jian-Yang, Zi-Han-Lou, Yahui-Fu, Zheng-Cai-Lou. A retrospective study of EGF and ofloxacin drops in the healing of human large traumatic eardrum perforation. Am J Otolaryngol. 2016 Mar 22.
2. Lou Z, Lou Z, Tang Y, Xiao J. The effect of ofloxacin otic drops on the regeneration of human traumatic tympanic membrane perforations. Clin Otolaryngol. 2015 Oct 14.

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  Provera BID
Posted by: dbrosnahan - 07-28-2016, 09:41 AM - Forum: General Discussion - No Replies

Menorrhagia (heavy menstrual bleeding) in the ED is usually treated with Provera 10 mg Daily x 10 days. However, many Gynecologists are recommending 10 mg BID. If vaginal bleeding is excessive in the ED, IV Premarin 25 mg x 1 can be given with good results.

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  "Do you want to go to jail or the ED?"
Posted by: dbrosnahan - 07-27-2016, 03:32 AM - Forum: General Discussion - No Replies

Often police will respond to a complaint for public intoxication or domestic violence in the setting of alcohol and drug intoxication and offer the patient the option of going to jail or the ED.  I'm not sure what kind of choice this is.  I think rehab is the best for the patient, but rehab doesn't work if the patient is fully invested.  For the police, I am sure it a great short-term solution for them.  But for the ED, it means that we get to babysit a patient that really doesn't want to be here and often causes just as much of a problem for the ED as they were out in public or at home.

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  Medicaid Preferred Provider
Posted by: dbrosnahan - 07-09-2016, 12:05 AM - Forum: General Discussion - No Replies

I called in a perscription for Bactrim the other day for someone's child in another state who was covered on their state Medicaid program.  I found that since I was not a "preferred provider", they were forced to pay an inflated price for what should be a relatively cheap antibiotic.

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  Clogs and Lower Back Pain
Posted by: dbrosnahan - 07-06-2016, 01:15 AM - Forum: General Discussion - No Replies

Nurses in the ED and other units in hospitals and clinics throughout the world wear a unique style of shoe called a clog.  Nurses and doctors routinely work in environments with concrete floors covered in tile or linoleum.  This hard flooring can wear on joins and the lower back and neck. So, why do so many health professionals wear clogs and how does the shoe work to decrease strain on the lower back, knees and hips?

Clogs have a stiff, blocky, medium raised heel as opposed to a tennis shoe with a squishy padded heel.  Research has shown that no amount of heel cushion makes any difference in terms of strain on the lower back and joints.  Clogs use a different and more effective mechanism to decrease strain on the back and joints.  By having a raised heel, Clogs shift the wearer's weight forward onto their forefoot.   Instead of absorbing the impact of every step with their heel, which is then transferred up the spine to the joints, back and neck; Clog wearers absorb the impact of each step with their forefoot, transferring the impact to the calf muscle.

Clogs typically do not have a back or have a false back to the shoe so that the shoe does not ride on the heel.  This feature helps change how you walk in a clog.  A clog wearer cannot walk on their heels in a clog or they will either 1. turn their ankle because of the medium heel, or 2. the shoe will flip off.  So, the design of the clog shoe has 2 features (raised firm medium heel, and false or no back) that changes how the wearer walks.  Preventing heal strikes works to transfer the impact of each step to the calf muscles instead of the skeleton.  When you wear out your calf muscle, it will quickly repair itself.  When you wear out your knee, hip or back, then in many cases, that joint remains chronically worn out.  With the increase of hardwood floors and tile at home, many patients can receive significant benefits wearing clogs around the house.

Some people claim they do not like clogs because they hurt their feet. This usually is a consequence of buying too small a pair.  Chronic heel walkers tend to resist changing how they walk and buy tight fitting clogs so the shoe doesn't feel like its going to fall off. The clogs should be a little big which helps the wearer walk correctly with a more forward gait, striking with the ball of the foot instead of the heel.

Clogs are not the only shoe which conveys these advantages. Other shoes which achieve a similar advantages are cowboy boots, logger work boots, flip-flops, Crocks, Birkenstalks (without heel strap), etc. Cowboy and Logger boots have the medium raised heel while some sandals do not have the heel strap.

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  3 Stages of Mental Illness
Posted by: dbrosnahan - 07-01-2016, 04:51 AM - Forum: General Discussion - No Replies

1. Accept that there is an illness.
2. Accept the need for medication ...
and that side-effects are better than the alternative. 
3. Accept that they are not completely disabled.

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  Valium vs. Flexeril
Posted by: dbrosnahan - 06-28-2016, 03:06 AM - Forum: General Discussion - No Replies

In my opinion, Flexeril (cyclobenzaprine) is a rather ineffective muscle relaxer. Patients tell me it produces drowsiness more than anything else.  If a patient is experiencing significant muscle spasm and tightness,  5-10 mg valium (diazepam) is more effective as a muscle relaxer.  I also find that providing an effective muscle relaxer can reduced the amount of opioid analgesia a patient may require for pain control.

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  Mildronate Carnitine Blocker
Posted by: dbrosnahan - 06-27-2016, 06:26 AM - Forum: General Discussion - No Replies

The professional tennis star Maria Sharapova was recently suspended for taking Mildronate, a carnitine blocker used to treat ischemic heart failure.  I thought this was an interesting performance enhancing drug because many protein shakes and supplements contain carnitine.  Many professional athletes, movie stars, and weight lifters take anabolic steroids.  Bodybuilders do not tend to like longer than the regular population.  In fact, many die much earlier than the regular population mainly due to heart failure and other heart issues. Most of people who have lived the longest tend to associated their longevity to low stress, gardening, and daily walking and not bodybuilding and supplements.  Anyways, I was wondering if more elite athletes and stars were using mildronate and avoiding carnitine.

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  Mebendazole Anticancer Agent BCL-2 Inhibitor
Posted by: dbrosnahan - 06-23-2016, 09:15 AM - Forum: General Discussion - No Replies


Mebendazole turns out to be a potent BCL-2 inhibitor and anticancer agent.  Too bad it is has suddenly become hard to find. 

Metformin: Several studies suggest that tumours grow more slowly in cancer patients who take this anti-diabetic drug. Early-stage clinical trials are investigating its potential to prevent various cancers including prostate, breast, colorectal and endometrial.
Statins: Preclinical studies suggest these cholesterol-lowering heart drugs may prevent various cancers and stop them spreading. One recent meta-analysis associated a daily statin with a significant risk reduction of liver cancer.
Mebendazole: There is evidence this drug – usually prescribed to treat parasitical worm infections — may inhibit cancer cell growth and secondary tumours, though no clinical trials have been completed.
Cimetidine: This over-the-counter antacid has direct anti-proliferative effects on cancer cells, inhibits cell adhesion, reduces tumour angiogenesis (growth of blood vessels essential to a developing tumour) and also boosts anti-cancer immunity in various cancers.
Itraconazole: The common anti-fungal treatment is also thought to be anti-angiogenic and has shown promise as an agent for prostate cancer, non-small cell lung cancer and basal cell carcinoma, the most common kind of skin cancer.
Isotretinoin: This acne drug, marketed as Accutane, is occasionally used to treat certain skin cancers and neurological cancers as well as to prevent the recurrence of some brain tumours, although some studies suggest it is ineffective.

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  Squalene Adjuvant in Flu Vaccine
Posted by: dbrosnahan - 06-23-2016, 08:53 AM - Forum: General Discussion - No Replies


The FDA has approved the use of a squalene-based adjuvant developed by Swiss pharmaceutical company Novartis, FLUAD, also known as MF59. MF59 is expected to be used in the 2016 Flu vaccine.  A similar squalene-based adjuvant was used in the experimental Anthrax vaccine given to Gulf War veterans.  Preliminary research showed veterans with Gulf War Syndrome had anti-squalene antibioties which may have been linked to the use of squalene adjuvant used in the Anthrax vaccine.  Traditional vaccine adjuvants are alum (aluminum) based.  Squalene is a precursor to Vitamin D, cholesterol, and sex and stress hormones and in my opinion has no business being used as a component of any vaccine. Squalene is not even immunogenic but just part of the oil-in-water carrier. Therefore, I just don't know why the developers can't just use something else that is not such an important precursor.


CNN is reporting today that the CDC is urging against the use of the FluMist live attenuated vaccine. CDC claims that FluMist is not as effective as the injectable. However, the diffence in effectiveness was only slight and has varied over the years. it is my opinion both vaccines have been poor performers which I believe is more a consequence of failing to identify the correct emerging flu strains then anything else.  Also, it is my opinion that using a live attenuated vaccine would provide a longer-term cellular immunity as opposed to a shorter-term humeral immunity. 


Anti-squalene antibody testing has been patented and is controlled by the company at the link above and no testing can be conducted at this time.

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