RxPG - the perfect Rx for medical Post Graduate entrance blues!
Mobile Edition | Help/Newbie? | 24/7 Support
HOT | PrePG | MCQ | DNB | Careers | Books | Colleges | Dental | DocIndia | PLAB |  USMLE  | Australia | Canada | GLOBAL | OffBeat!
Articles | Forums | MCQ Crammer | Downloads | Mnemonics | Revision Tools | Recent Shouts | All Features


medicine updates!

Author: akil, Posted on Tuesday, September 14 @ 22:56:49 IST by RxPG  

 FRIEND Add to My Pages   PRINTER Printer Friendly   FRIEND Email Story  FRIEND Download Story  Medicine alerts 

Medicine

the following are some latest medicine updates. new drugs and treatment protocols as well as some diagnostic approaches of diseases are compiled below!(only index is listed in display, to read the details "Read More")
1. Drug-Related Pemphigus
2. Tryptase as a Marker for Anaphylaxis
3. Treating Persistent Urticaria
4. New Therapies for Sepsis
5. Best Tests for Inhalational Anthrax
6. Hyponatremia: Measure Glucose, Too
7. New Scan for Epilepsy
8. Therapy for Narcoleptic Sleep Attacks
9. Drug-Related Muscle Paralysis
10. Cardiac Complications of Smallpox Vaccination
11. Treating Herpesvirus Infections
12. Definitive Therapy for Aplastic Anemia
13. Treating Pernicious Anemia, with and without Needles
14. Folic Acid Deficiency from Inadequate Absorption
15. Beyond Vancomycin for MRSA
16. Linezolid
17. Daptomycin
18. Quinolones
19. supreventricular tachycardia
20. Long-term Drug Therapy for AV Node Reentry Tachycardia
21. Catheter Ablation for AV Node Reentry Tachycardia
22. Treating Bell Palsy
23. Peripheral Neuropathy from Drugs
24. Influenza Vaccine Preview 2004-2005
25. A Future Alternative to Corticosteroids?
26. How the Body Recognizes Nonprotein Antigens

1. Drug-Related Pemphigus
Thiol drugs (e.g., captopril), as well as so-called masked thiol drugs (e.g., penicillins and cephalosporins), are more likely to induce pemphigus foliaceus, which is more likely to regress spontaneously when the drug is discontinued. Nonthiol drugs (e.g., enalapril) are more likely to trigger pemphigus vulgaris, which can persist even after the drug is stopped.

2. Tryptase as a Marker for Anaphylaxis

Tryptase levels peak in the circulation 15 minutes to 2 hours after mast cell degranulation and decline, with a half-life of about 2 hours. Peak levels during insect-sting-induced anaphylaxis correlate closely to the drop in mean arterial blood pressure. For that reason, serum or plasma tryptase levels are a clinically useful marker for the diagnosis of systemic anaphylaxis

3. Treating Persistent Urticaria

An effective cocktail for persistent urticaria is fexofenadine, 180 mg, or loratadine, 10 mg, in the early morning and cetirizine, 10 to 20 mg, in the early evening. If this is insufficient, the tricyclic antidepressant doxepin, 10 to 50 mg, can be added at bedtime.

4. New Therapies for Sepsis

After 15 years of disappointing results in the search for new experimental agents in the treatment of septic shock, two approaches have emerged. Recombinant human activated protein C (drotrecogin alfa activated [Xigris]) has received Food and Drug Administration approval for the treatment of adults with severe sepsis who have an especially high risk of dying from sepsis. In patients with refractory septic shock and evidence of adrenal inadequacy, low-dose corticosteroids appear to be a cost-effective, readily available, and relatively safe treatment option.

5. Best Tests for Inhalational Anthrax

There is no rapid screening test to diagnose inhalational anthrax in its early stages. In suspected cases, the appropriate tests are a chest x-ray, a chest CT scan, or both, and culture and smear of peripheral blood. Mediastinal widening or hyperdense mediastinal lymphadenopathy on a nonenhanced CT scan should raise the suspicion of pulmonary anthrax.

6. Hyponatremia: Measure Glucose, Too

Hyperglycemia lowers the plasma sodium concentration. To evaluate hyponatremia in the presence of hyperglycemia, the serum sodium concentration must be "corrected" for the osmotic effect of glucose. The correction factor most commonly used today is a 1.6 mEq/L decrease in serum sodium concentration for every 100 mg/dl increase in blood glucose.

7. New Scan for Epilepsy

Magnetoencephalography (MEG) is the only imaging modality approved by the Food and Drug Administration that can provide noninvasive imaging of the motor cortex, the sensory cortex, and language function. MEG identifies the location of activated sets of neurons on the basis of the associated magnetic flux on the head surface and projects the location onto an MRI for visualization of the activated region. MEG has an emerging role in the preoperative evaluation of patients with refractory epilepsy.

8. Therapy for Narcoleptic Sleep Attacks

The administration of a stimulant is the treatment of choice for narcoleptic sleep attacks. In newly diagnosed patients, the drug most commonly used initially is modafinil, a novel wakefulness-promoting agent, or methylphenidate. Dextroamphetamine and methamphetamine are used in those patients who do not respond satisfactorily to these stimulant drugs. Because of hepatotoxicity, pemoline is now rarely used.

9. Drug-Related Muscle Paralysis

Paralysis lasting several hours can occur after a single dose of succinylcholine in patients with reduced functional pseudocholinesterase, as seen in those with severe liver disease, myxedema, or malnutrition; pregnant patients; and patients with a genetic deficiency. A syndrome of prolonged muscle paralysis or weakness can develop after the extended administration of postsynaptic paralytic agents to facilitate mechanical ventilation, especially in patients with renal failure.

10. Cardiac Complications of Smallpox Vaccination

In 2003, cases of myocarditis and pericarditis (myopericarditis) occurred at higher than expected rates in both the civilian and the military smallpox vaccination programs. Cases of cardiac ischemic events, including myocardial infarction and angina, were also reported in persons who had received vaccinations; however, the rates of ischemic events were not clearly elevated above expected background rates, and the association between smallpox vaccination and cardiac ischemic events is unclear.1,2

Symptoms of myopericarditis after smallpox vaccination began 7 to 19 days after vaccination (range, 1 to 42 days). Symptoms included prodromal myalgias, arthralgias, or both, as well as subsequent pleuritic precordial chest pain with variable shortness of breath, dry cough, or both. Electrocardiogram findings varied; such findings included ST segment and T wave abnormalities and dysrhythmias, including paroxysmal atrial fibrillation, atrial ectopy, supraventricular tachycardia, and ventricular ectopy. ECG findings included pleural effusion and wall motion abnormalities; these findings were not seen in all patients. All patients among the United States military vaccinees, as well as one civilian patient, were reported to have had elevated cardiac enzyme levels. All the patients who were reported to have myopericarditis recovered. In cases where alternative etiologies were sought, none were established, and in no case was a virologic diagnosis made. The biologic mechanism for myopericarditis after smallpox vaccination is not established; it may involve the viral cytopathic effect, an immune-mediated reaction, or both.2 A surveillance case definition for myopericarditis has been developed to monitor smallpox vaccine adverse events (this definition is not to be used for clinical diagnosis). That surveillance case definition is available on the Internet.1

In response to these reports, new cardiovascular screening and exclusion criteria were published for use of smallpox vaccine in persons not exposed to smallpox.3 Vaccinees experiencing chest pain, shortness of breath, or other symptoms of cardiac disease within 2 weeks after smallpox vaccination are advised to seek medical attention.

11. Treating Herpesvirus Infections

Two decades of carefully controlled trials and clinical experience have made acyclovir the treatment standard for herpesvirus (HSV) infections, although the prodrug valacyclovir (which is converted to acyclovir) and famciclovir (which is converted to penciclovir) now provide alternative options [see Table]. Either oral acyclovir (200 mg five times daily) or intravenous acyclovir (5 mg/kg three times daily) for 7 to 10 days is recommended for treatment of primary genital herpes or mucocutaneous herpes (HSV-1 or HSV-2). Alternative therapies are valacyclovir (500 to 1,000 mg twice daily) and famciclovir (250 mg three times daily). Short-term (1 to 3 days), high-dose acyclovir or valacyclovir regimens are promising therapies for both genital and orolabial recurrent HSV infections.1,2

Suppression of severe and frequently recurring genital herpes can also be accomplished by the administration of oral acyclovir (200 to 400 mg twice daily), oral famciclovir (250 mg twice daily), or oral valacyclovir (500 to 1,000 mg daily) [see Table]. Intravenous acyclovir, in a dosage of 10 to 15 mg/kg three times daily for 14 to 21 days, is the treatment of choice for herpes encephalitis.

In immunocompromised persons and, in rare instances, in immunocompetent persons, acyclovir-resistant HSV-2 may lead to chronic progressive infections.3 Intravenous foscarnet (40 mg/kg two to three times daily for 2 to 3 weeks) is useful against acyclovir-resistant HSV-2 infection. Topical preparations of foscarnet, cidofovir, and trifluridine are also under study for acyclovir-resistant HSV.

12. Definitive Therapy for Aplastic Anemia

Transplantation from a matched sibling, together with the use of methotrexate and cyclosporine for prophylaxis against graft versus host disease, is a very effective regimen for aplastic anemia. Current results suggest a cure rate greater than 90%. Results with mismatched or unrelated matched donors are somewhat worse; therefore, patients with aplastic anemia who are without sibling donors are often given a trial of immunosuppressive therapy before transplantation.

Three forms of immunosuppression have been shown to produce partial remission in aplastic anemia: antithymocyte globulin, high-dose corticosteroids, and cyclosporine. Although each of these agents can be used individually or consecutively in the treatment of aplastic anemia, results may be better when all three are used simultaneously.

13. Treating Pernicious Anemia, with and without Needles

Standard therapy of pernicious anemia is with weekly dosages of 1,000 ug of parenteral cobalamin for 6 weeks, followed by parenteral dosages of 1,000 ug monthly for life. Because a small amount of cobalamin is absorbed even in the absence of intrinsic factor and because only 1 ug/day is required, however, oral cobalamin has proved adequate for replacement in patients with pernicious anemia, freeing the patient from monthly injections; 2,000 ug/day is recommended.

14. Folic Acid Deficiency from Inadequate Absorption

Folic acid deficiency can result from inadequate intake or absorption or from interference with metabolism . A number of intestinal disorders interfere with absorption. These include severe pancreatic disease and small bowel disease, such as malabsorption, ileal disease, Crohn disease, resection, and bypass. When there is no apparent cause of cobalamin deficiency, it may be practical to suspect an undiagnosed disease of malabsorption. In one prospective study of patients who had laboratory-defined folate deficiency, 10.9% were positive for celiac disease antibodies and 4.7% had histologically confirmed celiac disease.1

15. Beyond Vancomycin for MRSA

In the past, vancomycin has been the only alternative for treating methicillin-resistant Staphylococcus aureus (MRSA). Linezolid, daptomycin, teicoplanin, and quinupristin-dalfopristin are newer antibiotics with activity against MRSA. With the increased use of vancomycin, strains of S. aureus with reduced susceptibility to vancomycin have begun to appear. Daptomycin and linezolid have excellent activity against vancomycin-intermediate and vancomycin-resistant Staphylococcus. Daptomycin is approved for skin and soft tissue infection, but because it is rapidly bactericidal, it needs to be studied as a treatment for endocarditis caused by MRSA. Linezolid has been approved for skin and soft tissue infections, as well as for pneumonia caused by MRSA; evidence is accumulating that, like clindamycin, it is a potent suppressor of staphylococcal toxin production. Because of this characteristic, it may be a more suitable agent to use in patients with staphylococcal toxic-shock syndrome. Quinupristin-dalfopristin often causes phlebitis and myopathy. Thus, its use requires placement of a central line.

16. Linezolid

Linezolid is the first member of the oxazolidinone class to be approved for clinical use in the United States. A synthetic antibiotic that inhibits protein synthesis, linezolid has a unique mechanism of action, and no cross-resistance with other antimicrobials has been reported. Intravenous and oral preparations of linezolid are available; the usual dosage is 600 mg every 12 hours regardless of the choice of route.

Linezolid has been used successfully in the therapy of multidrug-resistant gram-positive bacterial infections, including vancomycin-resistant Enterococcus (VRE), penicillin-resistant pneumococci, and methicillin-resistant Staphylococcus aureus (MRSA),1,2 but clinical experience with deep-seated infections such as endocarditis and osteomyelitis is limited. Although resistance is uncommon, it can develop during therapy. As a result, it may be wise to reserve this unique antibiotic for serious infections caused by MRSA, VRE, or coagulase-negative staphylococci that do not respond to vancomycin. It also has a role in decreasing hospital stay for some patients with resistant gram-positive infections,3 although these patients require close outpatient monitoring.

17. Daptomycin

Daptomycin is a cyclic lipopeptide naturally produced by Streptomyces roseosporus. It has a unique mechanism of action: it binds to bacterial membranes and causes a rapid depolarization of membrane potential, which leads to the inhibition of protein, DNA, and RNA synthesis, resulting in bacterial death. It is active against most gram-positive aerobic bacteria, including VRE, MRSA, glycopeptide intermediately susceptible S. aureus, coagulase-negative staphylococci, and penicillin-resistant Streptococcus pneumoniae. It also has activity against S. pyogenes, S. agalactiae, S. dysgalactiae, and Corynebacterium jeikeium. It is currently approved only for complicated skin and skin-structure infections.1 The role of daptomycin in therapeutics is currently limited, given its narrow indications and the availability of alternative agents, including vancomycin and linezolid.

18. Quinolones

Since the introduction of ciprofloxacin more than a decade ago, the quinolones have continued to evolve, and the class now includes agents that differ from one another significantly with regard to activity, as well as pharmacokinetic and pharmacodynamic properties. The first-generation fluoroquinolones (e.g., ciprofloxacin, ofloxacin, and norfloxacin) are primarily active against gram-negative and a few gram-positive organisms. The second-generation fluoroquinolone levofloxacin has improved activity against gram-positive bacteria and atypical bacteria but is less potent against certain gram-negative bacteria, such as Pseudomonas aeruginosa. The newer quinolones (i.e., gatifloxacin, gemifloxacin, and moxifloxacin) have enhanced coverage of gram-positive, atypical, and anaerobic organisms, compared with the first-generation and second-generation fluoroquinolones.1 In particular, these new agents appear to be more active against S. pneumoniae and may have decreased potential for the development of resistance.

19. supreventricular tachycardia

If carotid massage fails to convert supraventricular tachycardia, the drug of choice is intravenous adenosine, which is effective in 95% of cases. The initial dose is given as a rapid bolus infusion; if administration is too slow, the adenosine may be metabolized before it reaches the atrioventricular (AV) node. Atrial, ventricular, and junctional premature beats are commonly observed after adenosine. In 3% to 5% of cases, the atrial premature complex triggers atrial fibrillation, which may result in serious problems for patients with accessory pathways. If possible, an external defibrillator should be readily available when adenosine is administered.

The use of intravenous adenosine may be diagnostic, therapeutic, or both . The drug will almost always terminate tachycardia from AV node reentry or reentry involving an accessory pathway, but focal atrial tachycardia may also terminate abruptly after use of adenosine. Hence, the use of adenosine does not reliably distinguish those disorders from atrial tachycardia unless it produces AV block. The most common reason for failure to respond to adenosine is that multiple premature beats are retriggering the tachycardia. In this setting, a longer-acting intravenous preparation (i.e., 5 mg of metoprolol or 0.1 mg/kg of verapamil) is indicated.

20. Long-term Drug Therapy for AV Node Reentry Tachycardia

A wide variety of drugs have proved effective for controlling episodes of atrioventricular node reentry (AVNRT), including beta blockers, calcium channel blockers, and digoxin . Long-term drug therapy is associated with frequent recurrences and adverse effects, however. In patients without structural cardiac disease, class IC antiarrhythmic agents (e.g., flecainide, propafenone) are more effective than drugs that act by blocking AV nodal conduction, but recurrence rates nevertheless range from 25% to 35%. For patients who have episodes infrequently and who tolerate them well, some cardiologists prescribe medication for use as neededβ€”the "pill in the pocket" approach. For example, single-dose diltiazem (120 mg) and propranolol (80 mg) have been shown to be more effective than placebo or flecainide in patients with paroxysmal supraventricular tachycardia.

21. Catheter Ablation for AV Node Reentry Tachycardia

Current catheter ablative techniques involve placement of an electrode catheter between the tricuspid annulus and coronary sinus in the so-called slow-pathway region. One or more applications of radiofrequency energy are delivered through the catheter to destroy or attenuate the slow pathway. The success rate of ablation is over 96%; the only significant complication is AV block, which occurs in approximately 1% of patients.

Catheter ablation for AVNRT has proved so safe and effective that it is clearly the procedure of choice for patients in whom drug therapy fails. Moreover, it can be offered to those with milder symptoms who prefer to avoid long-term drug therapy. Precise recommendations for drug therapy versus ablative therapy are provided in the American College of Cardiology/American Heart Association/European Society of Cardiology guidelines.1

22. Treating Bell Palsy

Because of the presumed role of an inflammatory response, Bell palsy is often treated with glucocorticoids. Several studies have suggested that glucocorticoid therapy speeds recovery. However, a meta-analysis of the few placebo-controlled trials concluded that clear evidence for the efficacy of glucocorticoids had not been demonstrated.1 Nevertheless, for patients seen within a few days after onset of Bell palsy, it is reasonable to follow the common practice of prescribing a short, tapering course of glucocorticoids (e.g., prednisone, 60 mg/day for 5 days, tapering to zero over the next 10 days). In addition, the combination of acyclovir and prednisone can reasonably be considered for most patients with Bell palsy, although the natural history of the condition is generally benign, regardless of treatment.

Prevention of corneal desiccation with an eye patch is important for patients who cannot fully close the eye. Facial nerve decompression has been largely abandoned because its efficacy is unproved. Injections of botulinum toxin are helpful in treating hemifacial spasm.

23. Peripheral Neuropathy from Drugs

Drug-induced neuropathy is a common problem, particularly in a hospital-based practice. A careful drug history is an important part of the investigation of any polyneuropathy. Peripheral neuropathy is a well-established adverse effect of many drugs. In ideal circumstances, before a drug is labeled as potentially neurotoxic, the affected patient should be found to be free of other potential causes of neuropathy, and cessation of the drug should lead to some clinical improvement. It is important to realize that recovery may take many months. In some toxic neuropathies, the patient experiences the phenomenon known as coasting, in which the neuropathy continues to worsen for some weeks after exposure has ceased.

24. Influenza Vaccine Preview 2004-2005

The Advisory Committee on Immunization Practices (ACIP) has issued an update to the past year's recommendations regarding the influenza vaccine.

Vaccination of children

Vaccination of healthy children from the ages of 6 to 23 months, as well as vaccination of close contacts of children from the ages of 0 to 23 months, is recommended because such children are at increased risk for influenza-related complications.

Severely immunosuppressed persons

Inactivated vaccine is preferred over live, attenuated influenza vaccine (LAIV) for household members, health care workers, and others who have close contact with severely immunosuppressed persons. Any health care worker who receives LAIV should refrain from contact with severely immunosuppressed patients for 7 days after being vaccinated. There is no preference for inactivated vaccine use by health care workers or other persons who have close contact with persons with lesser degrees of immunosuppression. Severely immunosuppressed persons should not administer LAIV.

The 2004-2005 strains

This season's trivalent vaccine includes A/Fujian/411/2002 (H3N2)-like, A/New Caledonia/20/99 (H1N1)-like, and B/Shanghai/361/2002-like antigens. For the A/Fujian/411/2002 (H3N2)-like antigen, manufacturers may use the antigenically equivalent A/Wyoming/3/2003 [H3N2] virus; for the B/Shanghai/361/2002-like antigen, manufacturers may use the antigenically equivalent B/Jilin/20/2003 virus or B/Jiangsu/10/2003 virus.

Vaccine supply

The CDC and other agencies will assess the vaccine supply throughout the manufacturing period and will make recommendations regarding the need for tiered timing of vaccination of different risk groups before the start of the 2004-2005 influenza season.

25. A Future Alternative to Corticosteroids?

Migration inhibitory factor (MIF) derives its name from the fact that it inhibits the random migration of macrophages in vitro. MIF acts as an endogenous hormone that counterregulates glucocorticoid action; it is released by macrophages and T cells in response to glucocorticoids and other inflammatory stimuli. MIF then overrides the immunosuppressive effects of steroids on macrophage and T cell cytokine production. MIF has been shown to play a pathogenic role in several experimental models of inflammation and autoimmunity, including glomerulonephritis, arthritis, inflammatory bowel disease, atherogenesis, and acute lung injury; it also inhibits p53 and enhances carcinogenesis.

Anti-MIF therapies are under development. The goal is to increase the immunosuppressive and anti-inflammatory properties of endogenously released glucocorticoids, thereby reducing the need for steroid therapy in a variety of autoimmune and inflammatory conditions. Anti-MIF therapy should also have a role in treating some gram-negative infections and preventing septic shock.

26. How the Body Recognizes Nonprotein Antigens

CD1 molecules are related to major histocompatibility class I molecules but bind lipid and glycolipid antigens for presentation to T cells. For example, CD1 molecules present glycolipids from Mycobacterium tuberculosis to a restricted group of T cells. This ability to recognize nonprotein microbial antigens suggests that T cells recognize a broader range of antigens than was once thought. A subset of CD1+ T cells often reacts to self-antigens; these cells have been implicated in such autoimmune diseases as type 1 diabetes mellitus and systemic lupus erythematosus.



4 (Excellent) 3(Good) 2(Good) 1(Bad)   


Recommended Books for Medicine
• Books to read for Medicine by RxPG

Related Medicine articles
• 'CAT' RELATED POINTS IN MEDICINE
• Types of Tongues in Various Medical Conditions
• Signs in Meningitis
• How To Read Harrison And Make The Most Of It?
• Examination of nails in medicine
• Triads in Medicine: A Quick Revision List
• Medical Conditions affecting Nails
• Diagnosis of diffuse lung disease
• Common simple emergencies
• Wilson's disease
• medicine updates!
• Abnormal colours of urine
• ACANTHOSIS NIGRICANS
• Noonan's syndrome
• Medicine; Online Mock Test (PGI Pattern)
• Characteristic Feature of Hypocalcaemia
• diagnosis of pulmonary microembolism.
• CHAPTER WISE CHANGES IN HARRISON’S PRINCIPLES OF INTERNAL MEDICINE
• CHANGES IN HARRISON’S PRINCIPLES OF INTERNAL MEDICINE CATEGORISED.
• Differentiating features of Leukemias (Leukaemias)

Related Medicine Discussions

Other articles by akil
• TRANSPLANT MEDICINE: PART-1
• Red and white lesions of the oral cavity: Part 2
• RED AND WHITE LESIONS OF THE ORAL MUCOSA - Part1
• medicine updates!
• MAXILLOFACIAL IMAGING
• Radiation Biology, radiation injury and tissue susceptibility notes!
• SYLLABUS FOR TNPSC- DENTAL MEDICINE -DEGREE STANDARD
• Gingival displacement forfixed partial denture impression techniques
• Vitamin B1 - Thiamin
• Vitamin B2 - Riboflavin
• diagnosis of pulmonary microembolism.
• Common Laboratory Tests
• Principles of Diagnostic Tests
• CHAPTER WISE CHANGES IN HARRISON’S PRINCIPLES OF INTERNAL MEDICINE
• CHANGES IN HARRISON’S PRINCIPLES OF INTERNAL MEDICINE CATEGORISED.
• Career Plan for BDS graduates: Part 3-Overseas Post Graduation
• Career plan for BDS graduates:part 2-POST GRADUATION.
• Career plans for BDS graduates-Part1:An introduction.
• Drugs causing pemphigus like eruptions
• How to read pharmacology for Dental PG Entrance Exams?

 Medicine FAQ
  Browse all FAQs


Write an Article on Medicine
You can share your exam experiences, preparation strategies, books you have read or just any information about Medicine on RxPG website and we will publish it under your name.

Article Rating
Average Score: 4.9
Votes: 20




Most Read Article
How To Read Harrison And Make The Most Of It?

Related Links
· MRCP books at Amazon.com
· Clinical Skills
· Medicine Books at Amazon.com
· Medicine Forum
· Discuss Past Papers
· Harrison's Free Trial






ARTICLE TOOLS

· Medicine section
· Articles by akil
· Add to my pages
· Printer friendly version
· PDF version
· Email article
· Feedback on this article
· Medical tutorials
· Related forum posts
· Related articles
· Related downloads
· Submit article
· Medicine alerts
· Medicine books
· Medicine past papers


Most read story about Medicine:
How To Read Harrison And Make The Most Of It?



Server Status: 84 pages served in last minute. Page generation time: 0.040 seconds

Site Maps: [Books] [News] [Forums] [Reviews] [Mnemonics]

sitemap - top30 - centuries - testimonials


About Us :: Disclaimer :: Contact Us :: Reporting abuse :: Terms of Services :: Privacy Policy

Advertise with RxPG!
Made in India by RxPG Medical Solutions Private Limited

"RxPG" is a Registered Trademark

Chrome Web Store YouTube Twitter LinkedIn Wikipedia Facebook