Dr. Chang Extensively Quoted in Outpatient Surgery Magazine Article

In the August 2011 edition of Outpatient Surgery Magazine, Dr. Chang was extensively quoted for an article describing use of image-guided sinus surgery.

In the article titled "The Benefits of Image-Guided Sinus Surgery," Dr. Chang described the advantages such technology brings to endoscopic sinus surgery.

Click here to read the full article.

Click here to read more about chronic sinusitis as well as watch a video of this technology being used.

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What is the Perfect Tablet Computer for Healthcare?

Many would argue (as I have) that the Apple iPad is THE perfect tablet computer for healthcare professionals. And for many of the mundane tasks of looking up or inputting information into an electronic medical records, that may be true. (Watch a video using the iPad to access MediTech as well as PACS here.)

However, there is a vast area of healthcare that the iPad just does not work at all.

That area is connecting to surgical equipment. Especially in the ENT world, there is a lot of microscopic and endoscopic work that is done. The software that records imagery from such devices are ALL based on the windows platform. Yes... we can record on to a CD, DVD, USB Memory Drive, etc and transfer the file to the iPad for viewing, but there's a lot of steps involved with that:

1) Record the video/image
2) Transfer to media of choice (CD, DVD, USB memory stick, etc)
3) Transfer file to PC/Mac
4) Move it iTunes/iPhoto
5) Synch with iPad

Geez louise!!!

I am currently aching for a highly portable tablet computer to connect to my JedMed Digicam in order to video-record fiberoptic endoscopy, ear work under the microscope, etc. The software the Digicam works with is only Windows compatible (and from my conversations with JedMed, there's no plans to make it work on any other platform in the foreseeable future).

As such, at this time, the Windows (and not iPad) world is the current way to go to address this deficiency. Not Google Android, iPad, Blackberry, etc.

In my mind, the best tablet for video work in the healthcare setting must have the following properties:

1) Windows 7 operating system for compatibility with surgical hardware
2) USB port
3) 10" Tablet for portability
4) Cheap (comparable to iPad)
5) Fast boot (SSD drive)

And WOW... I was amazed at the plethora of tablets introduced at the 2011 CES Convention Jan 6-9, 2011 in Las Vegas.

There were over 80 tablets that were introduced from big name companies to nobodies. Surely, there will a be a few which fits the bill?

Sadly, there were only a few that may fit my needs.

These include:

1) Samsung Note PC Series 7
2) Motion CL900 Windows Tablet

The Dell Inspiron Duo may possibly work, but the swinging screen just looks way too fragile.

What do others think? I'm pinning my hope on the Samsung model as the Motion tablet price is a bit much. The Samsung tablet is suppose to go on sale in March 2011 with a price tag around $699.

Watch a video the demonstrates the Samsung Note PC:

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Zyrtec (OTC) and Xyzal (Rx) Contain the SAME Active Ingredient? Prilosec (OTC) and Nexium (Rx) Too!

If zyrtec and xyzal (allergy medications) both contain the same active ingredient (cetirizine), why are they "different" and one is sold over-the-counter (zyrtec) and the other available only by prescription (xyzal)? This is also true for reflux medication prilosec (OTC) and nexium (prescription) which contain the same active ingredient omeprazole.

It's because of mirror images of the same active ingredient molecule... with one being biologically active and the other inactive.

In nature, there is a "doppelganger" of sorts for every protein, compound, molecule, and even drug ingredients. This doppelganger is what is known as a stereoisomer and is an exact mirror image copy of the original. As such, they look the same, but are actually very different, just like a pair of hands. Though both hands appear to be an exact copy of the other, one is left and the other is right and that's why you can't wear a right glove with a left hand.

Still confused? Take a look at the picture below...

The two structures are an EXACT replica of each other with the colored balls in the exact same location relative to each other.

NOW... take a look at this picture below:

The two structures are an exact MIRROR image of each other and though they appear to be the same, the colored balls cannot be overlain on top of each other due to different relative locations.

What does this have to do with medications? Well in nature... ALL living things contain and utilize only the LEFT-handed structure (also known as L-isomer). The right-handed structure (or R-isomer) either is inactive biologically or in some cases, even poisonous. (Rarely, the R-isomer is the biologically effective structure.)

ZYRTEC contains the active ingredient cetirizine, but both the L and R-isomers.
XYZAL also contains the active ingredient cetirizine, but only the biologically active L-isomer.

Same goes for PRILOSEC which contains the active ingredient omeprazole, but both isomer shapes. NEXIUM contains only the L-isomer shape.

Now wait a minute... if you look at the box for NEXIUM, the active ingredient is esomeprazole and not omeprazole. Note that depending on the convention used, L-isomer may be called S-isomer; R-isomer may be called D-isomer. SO... "S"-isomer omeprazole is Nexium. "S"omeprazole sounds like esomeprazole.

Same goes for xyzal which has as it's active ingredient levocetirizine and not cetirizine. "Levo" is latin for left (from laevus). So L-ceterizine when not abbreviated turns into levo-cetirizine.

Sneaky...

Now why in the world would a drug company sell a product that contains an inactive stereoisomer when it is a known fact that only the L-isomers are biologically active?

It's because of money...

A patent on a drug only lasts 10 years. After that, it goes off patent (generic) and other companies can start making and selling it. However, by making and selling a "dirty" version first (containing both L and R-isomers), they can reserve for a later time the "purified" version (L-isomer only) and get another 10 years of patent protection after the dirty version goes off-patent.

So when you see a commercial, read literature, or talk with a sales representative that xyzal is more effective than zyrtec, that nexium is more effective than prilosec... it IS true... but only because xyzal and nexium contain only the purified mirror-image of the active ingredient.

This story is played out over and over again... sometimes with horrific consequences. Most notoriously, there was the drug thalidomide sold in the 1950s...

Thalidomide was a widely prescribed sedative drug which was later found to cause horrible birth defects... well... only the S-isomer caused the birth defects. The R-isomer did not... But guess what? The thalidomide that was sold contained both isomers.

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