Effects of BMI on BP "Stronger" in Overweight Kids

(Washington DC) — US doctors have discovered that small changes in body-mass index (BMI) can make bigger differences in blood pressure among overweight and obese children compared with normal-weight kids [1]. Dr Wanzhu Tu (Indiana University, Indianapolis) reported the findings last week here at theAmerican Heart Association High Blood Pressure Research 2010 Scientific Sessions.

The effect on both systolic and diastolic BP of overweight children's BMI was over four times that of normal-weight children. "Clinicians should therefore pay close attention to already-overweight children, because BP in the prehypertensive or hypertensive range is a bad thing at such a young age and really sets the stage for later diseases in adulthood," Tu explained to heartwire .

Also, the findings have implications for future research, says Tu. Because BMI and BP studies typically don't separate normal-weight and overweight children, results will tend to overestimate the effects on BP in those of normal weight but underestimate the effects in heavier children, so "we have to somehow accommodate such differential effects going forward," he comments.

BMI Effects on BP Stronger Above the 90th Percentile

Tu and his colleagues tracked the blood pressure, height, and weight of just over 1000 children from local schools over time, with the mean age at enrollment being 10.2 years (range four to 17 years) and the longest follow-up exceeding 10 years.

"What we have done differently is essentially to provide two sets of estimates, one for normal-weight children and one for overweight and obese children," Tu told heartwire .

Children with BMIs in the 85th percentile or higher are considered overweight. "Below the 85th percentile, BMI effects on BP appear to be fairly linear," says Tu. But after the 85th percentile, and particularly after the 90th percentile, "BMI effects are noticeably stronger."

The message here is that parents and doctors need to pay close attention to children's weight, particularly if a child is already in the overweight or obese category, says Tu.

"For family physicians, if you keep seeing this child who already has increased weight, that should set off an alarm, you should look after the child more closely and be mindful not just that the child is heavier but also that there is a dramatically increased risk of hypertension."

"And because the BMI effect is so much greater in overweight and obese children, for a small reduction in BMI you might actually have a lot of benefit in BP; on the other hand, for a small increase, you could dramatically increase the risk of prehypertension or hypertension in children."

Commenting on the new findings in a European Society of Cardiology statement [2], Dr Joep Perk (Linnaeus University, Sweden) says: "Overweight children usually grow into overweight adults, with all the risks this carries of cardiovascular disease. The study reinforces that we must maintain our focus on relevant campaigns to promote weight loss and control in all sections of society, but particularly among the young."

11-Year WHI Data Show Increase in More Advanced Breast Cancers

With median of 11 years of follow-up now in hand, investigators from the landmark Women Health Initiative (WHI) confirm that estrogen-plus-progestin hormone therapy is associated with greater breast cancer incidence than placebo. In short, they now say that the effect is long-term.

The new follow-up data are published in the October 20 issue of theJournal of the American Medical Association.

The data also provide other insights — that the cancers of combined hormone therapy users are more commonly node-positive than those of placebo users, and that breast cancer mortality seems to be increased with hormone therapy.

These data and others "dictate caution in the current approach to the use of hormone therapy," according to an editorial by Peter Bach, MD, which accompanies the study. Dr. Bach is from the Memorial Sloan-Kettering Cancer Center in New York City.

Dr. Bach says that this current approach, which employs hormone therapy for "brief periods" to relieve menopausal symptoms, has not had its safety proven in "rigorous clinical trials."

Clinicians cannot present patients with a risk/benefit analysis of short-term hormone therapy because no such data exist, he points out; the current WHI provides no information on short-term use.

Caution is especially advised for clinicians, says Dr. Bach, "because one of the lessons from the WHI is that physicians are ill-equipped to anticipate the effect of hormone therapy on long-term health."

However, the WHI authors seem concerned about longer-term use of combined hormone therapy — not short-term use.

They write that the "use of combined hormone therapy — other than short-term therapy in women with climacteric symptoms not ameliorated by other therapies — seems unwarranted."

Pfizer, which bought Wyeth in 2009 and with it Prempro combination hormone therapy, issued a statement as the media embargo on the WHI data was lifted. "We stand behind the current, science-based guidance in Prempro's label, which advises doctors to prescribe the medicine at the 'lowest effective dose and for the shortest duration consistent with treatment goals and risks for the individual woman'," the company stated.

FDA Approves Dabigatran for Stroke Prevention, Embolism in AF Patients

October 20, 2010 (Silver Spring, Maryland)— Late Tuesday, Boehringer Ingelheim announced that the US FDA has approveddabigatran (Pradaxa) for the prevention of stroke and systemic embolism in patients with atrial fibrillation [1].

As previously reported by heartwire , an advisory panel in September voted 9 to 0 to recommend that the oral antithrombin be approved. The drug will be available in two doses: 150 mg twice daily and, for a small subset with severe renal impairment, 75 mg twice daily. Debates about the approved dosing have already begun (see the discussion in the heartwire forum).

In the large the 18 000-patient Randomized Evaluation of Long-Term Anticoagulant Therapy (RE-LY) study, on which the drug's approval is primarily based, investigators compared dabigatran 110 mg twice daily and 150 mg twice daily against a conventional warfarin regimen. The 75-mg twice-daily dose, now approved by the FDA, was not studied in RE-LY.

During the advisory committee meeting in September, there were discussions about dosing, with some panelists arguing in favor of approving just the 150-mg dose, while others wanted a lower dose approved for selected patients at special risk for bleeding complications, such as the very elderly. In RE-LY, the 150-mg dose was superior to standard warfarin therapy, whereas the 110-mg twice-daily dose was comparable to warfarin in effectiveness. As a result, some panel members felt the 110-mg twice-daily dose shouldn't be part of the approval.

In an email to heartwire , advisory panel member Dr Sanjay Kaul (Cedars Sinai Medical Center, Los Angeles, CA) said the 75-mg twice-daily dose will be recommended for individuals with poor renal function, while the 150-mg twice-daily dose will be reserved for patients with creatinine clearance 15 to >30 mL/min.

"The 110-mg dose, while associated with reduced bleeding, had a 12% higher incidence of ischemic stroke," said Kaul. "In my opinion, it would not offer much of an advantage over warfarin and would likely be an ineffective alternative."

Asked about the approved doses, FDA spokesperson Sandy Walsh said that FDA reviewers felt the data strongly support the 150-mg dose, noting that it was superior to warfarin on the primary end point and similar in terms of bleeding rates. In reviewing the data, FDA officials noted, like Kaul, there were numerically more ischemic strokes in the dabigatran 110-mg arm when compared with warfarin, and this dose was only statistically noninferior to warfarin in terms of efficacy.

"Moreover, if we accept the validity of the post hoc analysis showing that the 150-mg dose is statistically superior to the 110-mg dose in preventing stroke, it could be argued that it wouldn’t even be ethical to use the lower dose," said Walsh, in explanation of the FDA decision. "The data in favor of a 110-mg dose were suggestive, but not entirely convincing."

With the absence of the 110-mg dose, FDA officials felt that treatment options were limited for patients with severe renal insufficiency. Pharmacokinetic data from RE-LY and other studies led them to conclude that a dosing regimen of 75 mg twice daily is appropriate for patients with a creatinine clearance 15 to 30 mL/min, a dose already made by Boehringer Ingelheim and currently marketed in the European Union.

As with other approved anticlotting drugs, bleeds, both life-threatening and fatal, were among the most common adverse reactions reported by patients treated with dabigatran in studies, an FDA press release notes. Other side effects, including gastrointestinal symptoms, dyspepsia, stomach pain, nausea, heartburn, and bloating also were reported.

Dabigatran was approved with a medication guide that details the risk of serious bleeding for patients.

On the whole, however, the cardiology community has expressed few major reservations about the RE-LY trial. And for a generation, it has longed for an oral antithrombin that's at least as safe and effective as warfarin but is more consistent in its effects and doesn't require cumbersome anticoagulation monitoring.

Breast-Feeding Link Should Figure Into Bed-Sharing Advice

The value of breast-feeding should be considered before advising mothers not to share their beds with their infants, according to a British study published online October 18 and in the November issue of Pediatrics.

Nearly half of all English infants sleep in a parent's bed at times; one fifth does so regularly during their first year. The practice has been linked to sudden infant death syndrome, and many professionals and organizations, including the American Pediatric Society, advise against it.

However, bed sharing is also known to support breast-feeding.

"Both cross-sectional epidemiological and sleep laboratory studies showed close links between the frequency and duration of breastfeeding and the practice of bed sharing," write Peter Blair, PhD, Community-Based Medicine and Social Medicine, University of Bristol, United Kingdom, and colleagues.

The researchers sought to further the knowledge about bed sharing and breast-feeding through a longitudinal, population-based study using data gathered in 1991 and 1992 for the Avon Longitudinal Study of Parents and Children. To that end, they examined bed-sharing and breast-feeding habits during 5 periods (0 - 2 months, 6 - 8 months, 17 - 20 months, 30 - 33 months, and 42 - 45 months) in 7447 children.

Patterns of bed sharing were broken down into 4 unique groups: parents who never shared their beds with infants (66%), those whose babies slept with them in their beds only in infancy (13%), those who shared their bed with a child only after the first year (15%), and parents who shared their beds consistently for 4 years (6%).

Bed-Sharing Associated With Breast-Feeding

The results showed that mothers who shared a bed with their newborns were better educated and of a higher socioeconomic status, and that those whose children routinely slept in their beds during the first 15 months of life reported a significantly greater incidence of breast-feeding, among other findings:

• all 3 categories of bed sharing had an important relationship with breast-feeding at 12 months (P < .001), whether the bed sharing occurred late (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.36 - 2.18), early (OR, 2.36; 95% CI, 1.87 - 2.97), or during the entire 4 years (OR, 5.29; 95% CI, 4.05 - 6.91);
• 29% of the mothers who slept with their infants at 0 to 2 months (251/872 mothers) had university degrees compared with 14% of mothers (888/6464) whose babies slept separately during that period (P < .0001); and
• the finding for education lessened for those who shared a bed with their 6- to 8-month-old-infants (17% vs 15%; P = .17) and there was a negative relationship with education for those sleeping with their 17- to 20-month-olds (11% vs 16%; P < .0001).

Because bed-sharing mothers of newborns were found to be better educated and more socioeconomically advantaged, their babies are at lower risk for sudden infant death syndrome because they will likely follow other infant safety guidelines, the researchers reasoned. Therefore, more lives could be saved if preventive messages focused on behaviors other than sharing a bed.

"Given the likely beneficial effects of bed sharing on breastfeeding rates and duration, risk reduction messages to prevent sudden infant deaths would be targeted more appropriately to unsafe infant care practices such as sleeping on sofas, bed sharing after the use of alcohol or drugs, or bed sharing by parents who smoke," the authors write.

Limitations to the study include the fact that using 5 time periods reduced the number of infants who could be studied (of the 14,062 mother–infant pairs on whom data was collected, only 53% [7447] provided information for all time points). In addition, most longitudinal studies have a larger dropout rate for socioeconomically disadvantaged participants — a situation that could skew the results toward those of higher socioeconomic status.

Regardless, the bottom line of the study results is a simple one: "Advice on whether bed sharing should be discouraged needs to take into account the important relationship with breastfeeding," the authors write.

Pediatrics. Published online October 18, 2010.

Pharmacology Secrets

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Global HIV/AIDS Medicine

Edited By 
Paul Volberding, MD, Professor and Vice-Chair of Medicine, UCSF; Chief, Medical Service, San Francisco Veterans Affairs Medical Center; Co-Director, UCSF-GIVI Center for AIDS Research, San Francisco, CA, USA
Merle Sande, MD, Professor, Department of Medicine, Co-Chair of the Academic Alliance for AIDS Care in Africa, University of Utah, Salt Lake City, UT, USA
Joep Lange, MD, President, International AIDS Society, Director, National Aids Therapy Evaluation Center, University of Amsterdam, Netherlands; former Chief, Clinical Research and Drug Development, Global Program on AIDS, World Health Organization
Warner Greene, MD, PhD, Director, Gladstone Institute of Virology and Immunology, University of California-San Francisco, San Francisco, CA, USA
Joel Gallant, MD, MPH, Associate Professor of Medicine; Associate Director, Johns Hopkins AIDS Service; Director, Garey Lambert Research Center, Johns Hopkins University, Baltimore, MD, USA

HIV/AIDS management poses many different challenges around the world, and the therapies available in the West are often not economically feasible in developing countries. This new book is the first to address the myriad of clinical difficulties faced by health practitioners worldwide in managing HIV/AIDS. Edited by the same authorities responsible for the highly respected reference "The Medical Management of AIDS," with Associate Editors that include the President of the International AIDS Society and a preeminent opinion leader in the fight against AIDS in Africa, and authored by a "who's who" of current global experts on HIV and AIDS medicine, this visionary text presents all the practical, indispensable information that clinicians everywhere need to offer their patients the best possible care.



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Manual of Gastroenterology: Diagnosis and Therapy

Tufts Univ. Medical School, Boston, MA. Updated edition of a pocket manual for residents and students on the clinical management of digestive system disorders. Outline format. Previous edition: c1994. Softcover. DNLM: Gastrointestinal Diseases--diagnosis--Handbooks.


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Manual of Gastroenterology: Diagnosis and Therapy

Tufts Univ. Medical School, Boston, MA. Updated edition of a pocket manual for residents and students on the clinical management of digestive system disorders. Outline format. Previous edition: c1994. Softcover. DNLM: Gastrointestinal Diseases--diagnosis--Handbooks.


































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The Washington Manual Pulmonary Medicine Subspecialty Consult

Written by residents, fellows, and attending physicians, this handbook is ideal for residents called on to do an inpatient consult, for students working on an inpatient medicine service, and for specialists seeking information on pulmonology and general internal medicine management. The book covers inpatient and outpatient approaches, symptoms and diseases, and acute and chronic problems with the same front-lines practicality as the world-famous Washington Manual® of Medical Therapeutics.

Chapters cover pulmonary function testing, respiratory failure, hemoptysis, solitary pulmonary nodule, community-acquired pneumonia, pulmonary embolus, and much more. Coverage includes a section on the appropriate conduct and approach of a medical consultant and reviews of selected clinical trials.

The Washington Manual® is a registered mark belonging to Washington University in St. Louis to which international legal protection applies. The mark is used in this publication by LWW under license from Washington University.

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Pharmacy Technician Training Online.

Learn To Read Doctor's Handwriting! This Online Training Program Teaches The Basic Skills To Become A Pharmacy Tech.

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Long-Term Metformin Raises Risk for B12 Deficiency

Paul S. Mueller, MD, MPH, FACP
Authors and Disclosures
Posted: 07/23/2010; Journal Watch © 2010 Massachusetts Medical Society
Abstract and Introduction
Abstract
Routine B12 monitoring is recommended.
Introduction
Metformin — the most commonly prescribed oral drug for patients with type 2
diabetes — induces vitamin B12 malabsorption and therefore can raise risk for
vitamin B12 deficiency. In this multicenter randomized trial, Dutch investigators
assessed risk for B12 deficiency (blood level, <150 pmol/L), low vitamin B12 level
(blood level, 150–220 pmol/L), and elevated blood homocysteine levels in patients
with type 2 diabetes who were treated with metformin.
Overall, 390 patients received metformin (850 mg) or placebo three times daily for
4.3 years. Compared with placebo, metformin was associated with a significant 19%
decrease in baseline vitamin B12 concentration. The absolute risks for vitamin B12
deficiency and low vitamin B12 level were significantly higher in the metformin group
than in the placebo group: 7% and 11% higher, with numbers needed to harm of 14
and 9 per 4.3 years, respectively. Blood homocysteine levels were correspondingly
and significantly elevated. Notably, the effect of metformin on lowering B12 levels
increased with duration of therapy.

Kochar's Clinical Medicine for Students

Doody's Book Review Service, 03-NOV-08, Vincent F. Carr, DO, MSA, FACC, FACP, Uniformed Services University of the Health Sciences -- "This is one of the top books available for medical students heading into their internal medicine rotations. It is a very easy read, with right-to-the-point information."-Doody's Book Review Service (Weighted Numerical Score: 97; 5 Stars) Weighted Numerical Score: 97 - 5 Stars! Journal of the American Medical Association (JAMA), 21-JAN-09, Volume 301, Issue 3, Victoria S.S. Wong, MD, Department of Neurology, University of California, Davis, Medical Center, Sacramento, CA -- "Kochar's Clinical Medicine for Students serves as an excellent segue for the third-year medical student who must start learning how to apply knowledge in a practical fashion on the wards. The book has 3 main sections: 'Key Manifestations and Presentations of Diseases,' 'Diseases and Disorders,' and 'Ambulatory Medicine.' By dividing the topic of internal medicine into these main categories rather than by organ system alone, the book already has a leg up on others of its kind. It prepares the medical student to recognize the common presentations of a disease and to learn about the differential diagnosis, then provides information about the diagnosis itself. The book also separates inpatient and outpatient medicine topics, providing complete overviews of each... "The extensive amount of information this book covers while maintaining its size as a relatively portable paperback is impressive. That a single book contains detailed chapters on the management of smoking cessation, the interpretation of heart sounds, and an overview of acromegaly demonstrates the panorama of clinical topics and attests to the conciseness of the book. A careful review shows that no significant topic has been left out-even sections discussing outpatient management of women's health issues, geriatrics, and orthopedic problems are appropriately included... "Kochar's Clinical Medicine for Students is both concise and complete, an excellent resource for the current medical student and for the resident in training-and perhaps a pragmatic, worthwhile review for the practicing physician."-Journal of the American Medical Association (JAMA)

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Kochar's Clinical Medicine for Students

Doody's Book Review Service, 03-NOV-08, Vincent F. Carr, DO, MSA, FACC, FACP, Uniformed Services University of the Health Sciences -- "This is one of the top books available for medical students heading into their internal medicine rotations. It is a very easy read, with right-to-the-point information."-Doody's Book Review Service (Weighted Numerical Score: 97; 5 Stars) Weighted Numerical Score: 97 - 5 Stars! Journal of the American Medical Association (JAMA), 21-JAN-09, Volume 301, Issue 3, Victoria S.S. Wong, MD, Department of Neurology, University of California, Davis, Medical Center, Sacramento, CA -- "Kochar's Clinical Medicine for Students serves as an excellent segue for the third-year medical student who must start learning how to apply knowledge in a practical fashion on the wards. The book has 3 main sections: 'Key Manifestations and Presentations of Diseases,' 'Diseases and Disorders,' and 'Ambulatory Medicine.' By dividing the topic of internal medicine into these main categories rather than by organ system alone, the book already has a leg up on others of its kind. It prepares the medical student to recognize the common presentations of a disease and to learn about the differential diagnosis, then provides information about the diagnosis itself. The book also separates inpatient and outpatient medicine topics, providing complete overviews of each... "The extensive amount of information this book covers while maintaining its size as a relatively portable paperback is impressive. That a single book contains detailed chapters on the management of smoking cessation, the interpretation of heart sounds, and an overview of acromegaly demonstrates the panorama of clinical topics and attests to the conciseness of the book. A careful review shows that no significant topic has been left out-even sections discussing outpatient management of women's health issues, geriatrics, and orthopedic problems are appropriately included... "Kochar's Clinical Medicine for Students is both concise and complete, an excellent resource for the current medical student and for the resident in training-and perhaps a pragmatic, worthwhile review for the practicing physician."-Journal of the American Medical Association (JAMA)

To Download

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Oxford Handbook of Tropical Medicine 3rd Edition

A comprehensive signs and symptoms based guide to medical problems commonly seen in the tropics. Coverage is wide including almost all the familiar tropical diseases, together with malnutrition and other non-infectious conditions such as diabetes mellitus and cardiovascular disease. The new edition includes a fully updated section on HIV/AIDS, increased emphasis on paediatrics and public health and new material on avian flu.






























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Cecil Essentials of Medicine 6th Edition

Univ. of Arkansas, Little Rock. Brandon/Hill Medical List selection (#322). Presents the core knowledge of internal medicine providing a state-of-the-art foundation for diagnosis and treatment. Features new chapters on men's health and bioterrorism. Highlights new scientific developments in clinical management. Full-color design. Previous edition: c2001. Softcover.




























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Cecil Medicine 23rd Edition

Ranks among the best medical textbooks in longevity, comprehensiveness, tradition, and use by practitioners and students alike". JAMA


Goldman and Ausiello have given the 22nd edition of this venerable textbook a 21st-century remodeling, which sets a new standard that others are sure to follow.

A doctors bible...It is an incredibly useful resource, it's so detailed you may only feel the benefits of it from 3rd year and even in 3rd year it's pretty comprehensive. Covering pretty much every disease I have heard of so far, it includes an array of less common infectious diseases all accompanied by appropriate clinical images, extensive treatment and pathology sections.










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Kumar & Clark's Clinical Medicine 7th Edition

By 
Parveen Kumar, CBE, BSc, MD, FRCP, FRCP(Edin), Professor of Clinical Medical Education, Barts and The London Hospitals NHS Trust, Queen Mary's School of Medicine and Dentistry, University of London, and Honorary Consultant Physician; Gastroenterologist, Barts and The London Hospitals NHS Trust and Homerton Hospital NHS Foundation Trust, London, UK
Michael Clark, MD, FRCP, Honorary Senior Lecturer, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK; Consultant Physician and Gastroenterologist, Princess Grace Hospital, London, UK.
Parveen Kumar, CBE, BSc, MD, FRCP, FRCP(Edin), Professor of Clinical Medical Education, Barts and The London Hospitals NHS Trust, Queen Mary's School of Medicine and Dentistry, University of London, and Honorary Consultant Physician; Gastroenterologist, Barts and The London Hospitals NHS Trust and Homerton Hospital NHS Foundation Trust, London, UK
Michael Clark, MD, FRCP, Honorary Senior Lecturer, Barts and The London, Queen Mary's School of Medicine and Dentistry, University of London, UK

The 7th edition of Kumar and Clark's Clinical Medicine is a thoroughly updated, reworked and revised new edition of the first-prize winner in the Medicine category in the BMA 2006 Medical Book Competition. It is the market-leading comprehensive and authoritative single-volume textbook of internal medicine, consulted by students and doctors alike throughout the world. Covering the management of disease, based on an understanding of scientific principles, and including the latest developments in treatment, it is written for medical students and doctors preparing for specialist exams, but it is an ideal general reference text for all practising doctors. The new edition is part of Elsevier's StudentConsult electronic community. StudentConsult titles come with full text online, a unique image library, case studies, questions and answers, online note-taking, and integration links to content in other disciplines - ideal for problem-based learning.


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Harrison's Board Review 17th Edition

Introducing the most dramatically revised edition of Harrison's ever!

Now with NEW bonus DVD with 37 chapters and more than 500 brand new images and video clips!

A Doody's Core Title ESSENTIAL PURCHASE!

5 STAR DOODY'S REVIEW
"The book is for anyone who has the remotest association with the practice of medicine, be they internists, surgeons, nurses, technical staff, or counselors. This is the authority, and in a time of readily available but not always accurate information, this is the one source that can be relied upon....This is one of the absolute pillars of any medical library. It is the final word in internal medicine and we all owe a debt of gratitude to the editors and contributors who have created this extraordinary authority in medicine."--Doody's Review Service

MORE THAN TRUSTED, BEYOND ESSENTIAL . . .

The #1 selling medical textbook worldwide, Harrison's has defined internal medicine for millions of clinicians and students. The new 17th Edition retains Harrison'sacclaimed balance of pathobiology, cardinal signs and manifestations of disease, and best approaches to patient management, yet has been massively updated to give you an innovative array of bold new features and content. If ever there was one must-have resource for clinicians and students -- this is it!

UNMATCHED EXPERTISE AT YOUR FINGERTIPS

As an unprecedented amount of medical information bombards you and your patients, where do you go to sort it out and make sense of it all? When your patients request clarification on something they've “printed off,” where do you turn for expert explanations? The same trusted resource physicians and students have turned to for more than fifty years: Harrison's Principles of Internal Medicine. Now more than ever, trust Harrison's to filter and clarify the exploding knowledge base, to highlight the breakthroughs, and to deliver a clear, balanced distillation of the best and most current information on which to base clinical decisions.

THE MOST EXCITING AND EXTENSIVELY REVISED EDITION EVER!

Here are just a few of the reasons why the new 17th Edition of Harrison's is the best edition yet:

• Bonus companion DVD featuring: 37 new “e-chapters”; over 500 brand-new radiological, laboratory, and clinical images, including complete atlases; state-of-the-art video clips; an Image Bank of nearly all the illustrations contained in the parent text, and much more
• Expanded, modernized illustration program with more than 800 brand-new, additional illustrations--a 60% increase over the previous edition
• Dozens of brand new chapters on vital topics in medical education and clinical practice: Global Issues in Medicine: Patient Safety and Health Quality; Health Disparities: Atlas of EKGs; Clinical Management of Obesity; Atlas of Hematology; Atlases of Chest, Neurological, and Cardiovascular Radiology; and much more! Also included is a complete new section on biological foundations and emerging clinical applications of regenerative medicine!
• Brand new, reader-friendly text design optimizes the full-color format
• An expanded, innovative focus on global health
• NEW Global Advisory Board comprising 11 prominent medical experts from Asia, India, Europe, and South America
• Revision of the popular On Line Learning Center, which offers more skill-sharpening self-assessment questions and answers, plus additional case studies for helping you apply Harrison's content to the daily care of patients
• Harrison's related products are available in a full suite of formats to meet all your educational and clinical needs. Harrison's Practice of Medicine is a complete database of more than 700 clinical topics formatted for use at the point of care. The Harrison's Manual of Medicine is one of the most popular and heavily used handbook-sized resources in internal medicine. The Harrison's Self-Assessment and Board Review features more than 1000 board-type cases and questions and highlights the use of Harrison's as a great board prep resource.

To Download:

Link: http://www.ziddu.com/download/9605786/HBR17.rar.html

Harrison's Board Review 17th Edition

Introducing the most dramatically revised edition of Harrison's ever!

Now with NEW bonus DVD with 37 chapters and more than 500 brand new images and video clips!

A Doody's Core Title ESSENTIAL PURCHASE!

5 STAR DOODY'S REVIEW
"The book is for anyone who has the remotest association with the practice of medicine, be they internists, surgeons, nurses, technical staff, or counselors. This is the authority, and in a time of readily available but not always accurate information, this is the one source that can be relied upon....This is one of the absolute pillars of any medical library. It is the final word in internal medicine and we all owe a debt of gratitude to the editors and contributors who have created this extraordinary authority in medicine."--Doody's Review Service

MORE THAN TRUSTED, BEYOND ESSENTIAL . . .

The #1 selling medical textbook worldwide, Harrison's has defined internal medicine for millions of clinicians and students. The new 17th Edition retains Harrison'sacclaimed balance of pathobiology, cardinal signs and manifestations of disease, and best approaches to patient management, yet has been massively updated to give you an innovative array of bold new features and content. If ever there was one must-have resource for clinicians and students -- this is it!

UNMATCHED EXPERTISE AT YOUR FINGERTIPS

As an unprecedented amount of medical information bombards you and your patients, where do you go to sort it out and make sense of it all? When your patients request clarification on something they've “printed off,” where do you turn for expert explanations? The same trusted resource physicians and students have turned to for more than fifty years: Harrison's Principles of Internal Medicine. Now more than ever, trust Harrison's to filter and clarify the exploding knowledge base, to highlight the breakthroughs, and to deliver a clear, balanced distillation of the best and most current information on which to base clinical decisions.

THE MOST EXCITING AND EXTENSIVELY REVISED EDITION EVER!

Here are just a few of the reasons why the new 17th Edition of Harrison's is the best edition yet:

• Bonus companion DVD featuring: 37 new “e-chapters”; over 500 brand-new radiological, laboratory, and clinical images, including complete atlases; state-of-the-art video clips; an Image Bank of nearly all the illustrations contained in the parent text, and much more
• Expanded, modernized illustration program with more than 800 brand-new, additional illustrations--a 60% increase over the previous edition
• Dozens of brand new chapters on vital topics in medical education and clinical practice: Global Issues in Medicine: Patient Safety and Health Quality; Health Disparities: Atlas of EKGs; Clinical Management of Obesity; Atlas of Hematology; Atlases of Chest, Neurological, and Cardiovascular Radiology; and much more! Also included is a complete new section on biological foundations and emerging clinical applications of regenerative medicine!
• Brand new, reader-friendly text design optimizes the full-color format
• An expanded, innovative focus on global health
• NEW Global Advisory Board comprising 11 prominent medical experts from Asia, India, Europe, and South America
• Revision of the popular On Line Learning Center, which offers more skill-sharpening self-assessment questions and answers, plus additional case studies for helping you apply Harrison's content to the daily care of patients
• Harrison's related products are available in a full suite of formats to meet all your educational and clinical needs. Harrison's Practice of Medicine is a complete database of more than 700 clinical topics formatted for use at the point of care. The Harrison's Manual of Medicine is one of the most popular and heavily used handbook-sized resources in internal medicine. The Harrison's Self-Assessment and Board Review features more than 1000 board-type cases and questions and highlights the use of Harrison's as a great board prep resource.

To Download:

Link: http://www.ziddu.com/download/9605786/HBR17.rar.html

Harrison's Principles of Internal Medicine 16th Edition

HUNDREDS OF DIAGRAMS AND CLINICAL PHOTOS INTEGRATED INTO THE TEXT – FOR THE FIRST TIME IN FULL COLOR

*This description refers to the single-volume of Harrison's Principles of Internal Medicine, 16/e.

The Harrison's name is synonymous with internal medicine. HPIM continues to be the most authoritative and #1 selling medical textbook throughout the world. From its unique section on signs and symptoms through to the most comprehensive coverage of most all conditions seen by physician’s, Harrison's is the internal medicine reference of choice. Harrison's 16th Edition features new, expanded, revised and updated material on the key topics in medical practice today. From the latest research findings to up-to-the-minute advances in diagnostic and treatment methodologies, Harrison's puts the facts you need at your fingertips.

The 16th Edition improves on a winning formula with:
*State-of-the-art coverage of over 4,700 diseases and disorders—more than any other internal medicine text – in the areas of oncology and hematology; infectious diseases; cardiology; pulmonology; gastroenterology; clinical immunology; rheumatology; endocrinology; and neurology
*A brand new full color format—665 full color drawings, 175 clinical and laboratory images, and hundreds of boxes, tables, and algorithms that use color to guide you to the information you need ASAP in everyday patient care
*Thorough revision and updates of virtually all chapters
*The addition of key new chapters – including extensive new coverage of Critical Care Medicine
*145 algorithms for making accurate clinical decisions fast at the point of care
*1,160 easy-access tables for immediate access to vital information and formulas
*Cardinal manifestations of disease/signs and symptoms in 55 chapters (you’ll find yourself turning to this section over and over again). Here you will find all the major manifestations, such as fever, pain, aches and rash, presented in depth, with a referral that takes you to the disease section for the complete chapter.

To Download

Link: http://www.ziddu.com/download/9210818/HPIM.rar.html