TEXT A.
In the last few years, the concept of aspirin resistance has been largely emphasised in the medical literature, although its definition, mechanism, and specific guidelines for its management remain unclear. Aspirin displays good antithrombotic activity. Various laboratory parameters assessing the efficacy of aspirin like bleeding time, platelet reactivity, thromboxane-A2 (TX-A2) production, and measurement of platelet aggregation, have confirmed the lack of its uniform effect on the platelets. Few studies have reported aspirin resistance to the tune of 5 – 45%. Various extrinsic and intrinsic factors influence the resistance. Numerous studies reveal that aspirin resistance can be overcome by combining it with another antithrombotic agent, i.e., clopidogrel. Further, clopidogrel resistance has also been reported. So, much is expected in the field of diagnostic tests in order to know the true picture of aspirin resistance.

TEXT B Mechanisms of aspirin resistance
The exact mechanisms are not clear: True aspirin resistance:
The proposed factors for this type of resistance include:
a. Decreased bioavailability of aspirin.
b. Accelerated platelet turnover introducing newly f armed, non-aspirinated platelets into the blood stream.
c. Competition of aspirin with other NSAIDs(like ibuprofen)preventing aspirin access at Serine 530 of Cox-I.
d. Transcellular formation of TxA2 by aspirinated platelets from PGH2 released by other blood cells or vascular cells.
e. TxA2 production by aspirin insensitive Cox-2 in newly formed platelets or other cells.
f. (Theoretical) presence of variant Cox-I which is less sensitive to aspirin inhibition.
g. Poor compliance by the patient.

TEXT C ·Aspirin dosage
According to the Antithrombotic Trialists’ Collaboration, daily doses of aspirin (75 – 150 mg) are as effective as higher doses for prevention of thrombotic events and are associated with low risk of bleeding. Bornstein et al in their study have shown that even 100 mg of aspirin completely inhibits Cox-1 enzyme, thus further substantiating the f act that patients with resistance established during low dose aspirin therapy may respond to higher doses. The results of this study showed that aspirin in doses of 500 mg/day- significantly prolonged the time between first and second stroke (p= 0.002) compared with lower doses. Helgasonetal revealed that an increase in the dose of aspirin to 625 that suboptimal reduction of urinary 11-dehydro TxB2 level during aspirin treatment is associated with increased risk for future MI and cardiovascular death, thereby suggesting that “true aspirin resistance” may be a clinically relevant phenomenon. Inadequate inhibition of TxA2 biosynthesis by aspirin can be seen in patients on ibuprofen therapy, because of competition of these 14 mg/day in five patients who were aspirin resistant with 325 mg/day showed aspirin sensitivity. Another study has revealed that these patients remained resistant with aspirin 1,300 mg. This shows that inadequate dose cannot explain aspirin resistance in all subjects.

TEXT D Management of aspirin resistance
Currently there are no specific guidelines for the management of aspirin resistance. The first step is to enquire about the patient’s compliance. Regarding optimal aspirin dosing, it is controversial. No convincing data are available showing that the antithrombotic effect of aspirin is dose related. The meta-analysis by Anti-Thrombotic Trialist’ s Collaboration refuted the claim that high doses of aspirin (500 – 1,500 mg/day) were effective than low doses (75 – 150 mg/day). Other method to manage aspirin resistance is by addition of another antiplatelet agent – clopidogrel, because CAPRI£ trial has shown greater benefit of combination of- aspirin and clopidogrel compared with aspirin alone. The combination of aspirin with clopidogrel is an ideal one since clopidogrel inhibits another pathway of platelet activation. However, till date, it is not clear whether the superiority of a combination of clopidogrel and aspirin over aspirin is due to clopidogrel compensation for aspirin non-responders. Resistance to even clopidogrel has been reported, which is associated with an increased risk of recurrent thrombotic events in patients with acute MI.

Part A. TIME: 15 minutes. Questions 1-7. For 1-7, choose(A, B, C or D) In which text can you find information

1. what are the factors of true aspirin resistance?
2. how much of aspirin completely inhibits Cox-1 enzyme?
3. what will happen if aspirin compete with other NSAIDs?
4. how the true picture of aspirin resistance is revealed?
5. what are the parameters for assessing the efficacy of aspirin?
6. list the methods to manage aspirin resistance?
7. whether true aspirin resistance is a clinically relevant phenomenon?

Questions 8-13. Answer each of the questions, 8-13, with a word or short phrase from one of the texts.

8. How much mg of aspirin is minimum required to completely inhibit Cox-1 enzyme?
9. Which patients show inadequate inhibition of TxA2 biosynthesis by aspirin?
10. Name the antiplatelet agent used to manage aspirin resistance?
11. What are responsible for transcellular formation of TxA2?
12. What is the daily doses range of aspirin according to the Antithrombotic Trialists’ Collaboration?
13. Which trial has shown greater benefit of combination of aspirin and clopidogrel?

Questions 14-20. Complete each of the sentences, 14-20, with a word or short phrase from one of the texts.

14. Aspirin displays good___________ activity.
15. Few studies have reported aspirin resistance to the tune of ___________
16. TxA2 may be produced by aspirin insensitive _________in newly formed platelets or other cells.
17. Increase in the dose of aspirin to 625 is associated with increased risk for future MI and_____________
18. Inadequate inhibition of TxA2 __________ by aspirin can be seen in patients on ibuprofen therapy.
19. The first step in management of aspirin resistance is to enquire about the patient’s _________________
20. The combination of ______________ with clopidogrel is an ideal one.

PART B. For questions 1-6, choose the answer (A, B or C)

Anaesthetic Machines: The anaesthetic machine (or anaesthesia machine in America) is used by anaesthesiologists and nurse anaesthetists to support the administration of anaesthesia. The most common type of anaesthetic machine is the continuous-flow anaesthetic machine, which is designed to provide an accurate and continuous supply of medical gases (such as oxygen and nitrous oxide), mixed with an accurate concentration of anaesthetic vapour (such as halothane or isoflurane), and deliver this to the patient at a safe pressure and flow. Modern machines incorporate a ventilator, suction unit, and patient monitoring devices.
1. The manual is giving information about
A. how to use anaesthetic machines
B. types of anaesthetic machines
C. an overview of anaesthetic machines

Autoclaves and Sterilizers: Sterilization is the killing of microorganisms that could harm patients. It can be done by heat (steam, air, flame or boiling) or by chemical means. Autoclaves use high pressure steam and sterilizers use boiling water mixed with chemicals to achieve this. Materials are placed inside the unit for a carefully specified length of time. Autoclaves achieve better sterilization than boiling water sterilizers. Heat is delivered to water either by electricity or
flame. This generates high temperature within the chamber. The autoclave also contains high pressure when in use, hence the need for pressure control valves and safety valves. Users must be careful to check how long items need to be kept at the temperature reached.

2. Why autoclaves are better than boiling water sterilizers?
A. Heat is transferred to water by electricity or flame
B. Autoclaves use high pressure steam
C. Autoclaves generates high temperature within the chamber

ECG: How it works: The electrical activity is picked up by means of electrodes placed on the skin. The signal is amplified, processed if necessary and then ECG tracings displayed and printed. Some ECG machines also provide preliminary interpretation of ECG recordings. There are 12 different types of recording displayed depending upon the points from where the recordings are taken. Care must be taken to make the electrode sites clean of dirt before applying electrode jelly. Most problems occur with the patient cables or electrodes.

3. The guidelines establish that the healthcare professional should
A. aim to make patients fully aware of how ECG works.
B. carefully clean the electrode sites.
C. respect the wishes of the patient above all else.

Benefits of electronic health records: EHR systems are complex applications which have demonstrated benefits. Their complexity makes it imperative to have good application design, training, and implementation. Studies have evaluated EHR systems and reported on various benefits and limitations of these systems. Benefits included increase in immunization rates, improved data collection, increased staff productivity, increased visitor satisfaction with services, improved communication, quality of care, access to data, reduced medical errors, and more efficient use of staff time. Some of the disadvantages noted were: time- consuming data entry, slow access of data and decreased quality of patient- doctor interaction.

4. The notice is giving information about
A. pros and cons of electronic health records
B. necessity of electronic health records
C. demonstrated benefits of electronic health records

mHealth: The use of mobile technologies for data collection about individuals and interactive information services are a part of a growing area of eHealth called mHealth. The GOe published a volume on this subject in 2011which documents the uptake of mHealth worldwide by types of initiatives and main barriers to scale. Mobile technologies are emerging as a powerful tool for health information transfer including making patient information portable. Such technologies can be more fully utilized through electronic patient information such as EMRs and EHRs. Electronic records will work best, however, if there are standards in place for their use and interoperability.

5. The note tells us that the mHealth
A. is a published volume on the GOe
B. is a powerful tool for information transfer
C. makes patient information portable

Systematized Nomenclature of Medicine (SNOMED): SNOMED was designed to provide a comprehensive nomenclature of clinical medicine for the purpose of describing records of clinical care in human medicine. It is a multi-axial and hierarchical classification system. It is multi¬ axial in that any given clinical condition can be described through multiple axes such as topography (anatomy), morphology, organisms such as bacteria and viruses, chemicals such as drugs, function (signs and symptoms), occupation, diagnosis, procedure, physical agents or activities, social context, and syntactic linkages and qualifiers. SNOMED is hierarchical in that each of the axes has a hierarchical tree that proceeds from general terms to more specific ones. For example, topography (anatomic) terms are first divided into major organs such as lung, heart, and then into the smaller components of each.

6. What does this extract from a handbook tell us about Systematized Nomenclature of Medicine?
A. is a multi-axial and hierarchical classification system
B. is a comprehensive nomenclature of trial medicines
C. is used to described any clinical condition through axis

PART C. TEXT 1. Choose the answer (A, B, C or D) which you think fits best according to the text.

Paragraph 1: All life is connected Cancer in Humans and Wildlife. WILDLIFE-HUMAN LINKS
It may be that biologists, rather than physicians, will be the major contributors to the health of our wildlife caused by the combined action of pesticides planet and its people. It was Rachel Carson, a biologist, who researched and wrote of the harm to wildlife caused by the combined action of pesticides and radiation. In the tradition of the observant biologist is Theo Colborn, who, with her colleagues, provided a significant breakthrough in understanding the hormonal effects of environmental contaminants. In July 1991, a gathering of some of the world’s most astute, – scientists were held at the Wingspread Conference Center in Wisconsin, where they defined the pattern of diverse endocrine malfunction seen throughout the animal · kingdom. They revealed a gm”: picture of the Brave New World we should m rigorously seek net to leave as a legacy to our children.

Paragraph 2: The conferees, studying wildlife over the globe, described ominous findings of disease are linked to environmental pollution. Exposure to toxic chemicals that possess unintended h actions has resulted in anatomic, physiologic, reproductive, carcinogenic, and behavioural abnormalities across all forms of animal life: in mollusks, fish, birds, seals, and rodents. These creatures are to we humans as canaries were to the miners. We must understand that the destruction of eons of evolutionary function and development in wildlife ‘ foreshadows destruction of the entire biosphere, humans included.

Paragraph 3: These widespread adverse effects were attributed to xenoestrogens. Xeno – comes from a Greek origin, meaning “foreign.” Foreign itself is not bad: how else do we share and spread culture and ideas? But xenoestrogens are less foreigners than invaders, gaining entrance by the Trojan horse of seemingly harmless routes: milk, meat; cheese, fish, the products we use to nourish ourselves and families. Like the invaders of Troy, after the xenoestrogens gain entrance to the bodies of animals and humans alike, they weaken defences and wreak their harm of cancer, hormonal disruption, immunological abnormalities, and birth defects.

Paragraph 4: Xenoestrogens are an insidious enemy, but they have had help from powerful allies: the purveyors of products and chemicals, and legislators, regulators, and scientists reluctant to bite the money- laden hands that feed them.
Wingspread researchers found that birds exposed to xenoestrogens show reproductive failure, growth retardation, life-threatening deformities, and alterations in their brains and liver functions.” There is direct experimental evidence for permanent [organizational] effects of gonadal steroids on the brain as well as reproductive organs throughout life. This means that offspring whose brains have been altered are unable to function as had their parents. They become different in ability or function.

Paragraph 5: This means that the sea of hormonally active chemicals in which the fetus develops may change forever the health and function of the adult, and in some cases, may alter the course of an entire species. Worldwide there are reports of declining sperm counts and reduced ratio in births of male babies. Without the capacity to reproduce, a species ceases to exist. Extinction is forever; a species loss has never been reversed.

Paragraph 6: The data derived from animal observations are unequivocal: breast and genital cancers, _ital abnormalities, interference with sexual development, and changes in reproductive behaviour all expressions of a root cause. A possible connection between women with breast cancer and those having children with reversed sexual orientation is a question that bears study. This is n n. from science fiction, considering what we have learned from observing wildlife and the effects inappropriate hormonal influence upon the breast, brain, and reproductive organs. If an unequivocal answer were to emerge from human observation, it could have a significant impact upon the prevailing political and economic landscape, and may finally settle the nature or nu issue of sexual orientation.

Paragraph 7, SILENT SPRING-SILENT WOMEN. Considering the accumulated knowledge linking chemical and radioactive contamination environment with increasing breast cancer rates means we must focus our energies and prevention. Early were the eloquent words and pleas for prevention from Rachel Carson. Her book, Silent Spring, originally published in 1962, while she herself was suffering from breast cancer, is still a best seller. Ms. Carson documented wholesale killing of species; animals, birds, fish, insects; the destruction of food and shelter for wild creatures; failure of reproduction; damage to the nervous system; tumors in wild animals; increasing rates of leukemia in children; and chronicled the pesticides and chemicals known at that time to cause cancer. This was over 30 years ago!

Paragraph 8: Carson’s is a book for every citizen, for without understanding of our collective actions and permissions, we cannot govern democratically. In Australia, a citizen is required to vote. In the United States, proclaimed by some politicians as the “greatest democracy on earth,” often fewer than 50% bother to vote in a major election. Of those who do take the time to register and vote, few are sufficiently alert and/or educated to vote with intelligence, thought, and compassion. Requiring participation in the governance of one’s own country is not a bad idea. Requiring thoughtful voting may be more difficult, especially when it comes to such issues as cancer, pesticide use, consumer products, nuclear radiation, toxic chemicals, and environmental destruction. Taking this thought one step further; this democracy could do far worse than to require reading of Silent Spring as a requirement to vote! Radical? Perhaps. But is the ongoing cancer epidemic any less radical?

Paragraph 9: One successor to Ms. Carson has emerged in the person of Sandra Steingraber, an ecologist, poet, and scientist. In her book, Living Downstream, she writes eloquently of the connections between environmental contamination and cancer. Dr. Steingraber was diagnosed with bladder cancer at age 20, a highly unusual diagnosis in a woman, a young woman, a non-smoker and non-drinker. She pursued the question, why? She realized a connection with our wild relations and she asks: Tell me, does the St. Lawrence beluga drink too much alcohol and does the St. Lawrence beluga smoke too much and does the St. Lawrence beluga have a bad diet. . . is that why the beluga whales are ill? …Do you think you are somehow immune and that it is only the beluga whale that is being affected?

Paragraph 10: The portion of Dr. Steingraber’s book that struck me most personally was when she says: First, even if cancer never comes back, one’s life is utterly changed. Second, in all the years I have been under medical scrutiny, no one has ever asked me about the environmental conditions where I grew up, even though bladder cancer in young women is highly unusual. I was once asked if I had ever worked with dyes or had been employed in the rubber industry. (No and no.) Other than these questions, no doctor, nurse, or technician has ever shown interest in probing the possible causes of my disease-even when I have introduced the topic. From my conversations with other cancers, patients, I gather that such lack of curiosity in the medical community is usual.

Paragraph 11: I take her words as an indictment of the medical and scientific establishment, whose point of view must be changed. Certainly, the lack of curiosity among physicians, scientists, policymakers and politicians has contributed to the epidemic of illness among humans and wildlife alike. An equally talented woman is Terry Tempest Williams, an ecologist and wildlife researcher whose book, Refuge: An Unnatural History of Family and Place, tells the story of her Utah family, whom she “labels “a clan of one-breasted women.” Ms. Williams contrasts the life-affirming awareness Great Salt Lake wildlife refuge against the erosion-of-being, as cancer takes away the women in her family: her mother, her grandmothers, and six aunts. She writes: “I cannot prove that my mother Diane Dixon Tempest, or my grandmothers, Lettie Romney Dixon and Kathryn Blackett Tempest along with my aunts, developed cancer from nuclear fallout in Utah. But I can’t prove that didn’t.”

Paragraph 12: Times are changing. It is becoming impossible to ignore the carnage of endocrine-disruption chemicals, nuclear radiation, and chemical carcinogens, alone and in combination, invading nearly every family with cancer. Facing this reality may be too much for some people, afraid to look, or afraid of being the next victim. The story of cancer is not an easy one, and neither is cancer. But if we do not exert our efforts to prevent this disease, we doom our children and grandchildren to repeat our collective errors. What does it take to change from environmental destruction and random killing to affirmation of life? Can the protection of life for ourselves and our environment be accomplished by women with breast cancer; the women at risk for breast cancer; the families of breast cancer victims? Who should lead? If we citizens can’t and don’t try, what are our alternatives?

QUESTIONS

Q1. The author’s main contention is that
A. wildlife all around the world is being linked to environmental pollution
B. fish, birds, seals and canaries are being exposed to toxic chemicals
C. humans need to understand the link between destroying the planet’s wildlife, through exposure to toxic chemicals, and the destruction of the entire biosphere -which includes human life itself.
D. humans need to understand the link between destroying the planet’s wildlife, through exposure to toxic chemicals, and behavioural abnormalities across all forms of life. ”

Q2. The author states that in an environment of “hormonally active chemicals”
A. males with higher sperm counts may result ‘
B. more male babies are born
C. lower sperm count in males may result in a particular species being wiped out ‘
D. males with more sperm count may result

Q3. Dr Sandra Steingraber, ecologist, poet and scientist:
A. realised that contracting bladder cancer was not due to her alcohol drinking
B. realised her bladder cancer was not due to her smoking
C. believed her bladder cancer was due to environmental contamination
D. doctors, nurses and technicians were very interested in her unusual cancer

Q4. The wildlife researcher, Terry Tempest Williams, sees the dichotomy which exists in the Salt Lake wildlife refuge area:
A. many women in her family have died from breast cancer after a nuclear fallout in Utah
B. many men in her family have died from breast cancer
C. her family have many one-breasted women -unusual for Utah
D. such wide-spread cancer is probably due to environmental, not genetic causes

Q5. Animal observations show:
A. changes in sexual maturity are not only due to a root cause
B. genital abnormalities may be due to a root cause
C. inappropriate hormones adversely affect the development of breast, brain and reproductive organs
D. humans are not similarly affected.

Q6. The author puts forward several ideas about governance except for one of the following:
A. People who participate in elections are not alert and educated enough
B. Unless the wants and needs of the population are known, it is difficult for politicians to govern democratically
C. People being required to vote, to participate in the decision-making process, is a good idea
D. Reading Carson’s book, Silent Spring, should be made compulsory for all voters.

Q7. Rachel Carson’s book Silent Spring, written in 1962, revealed:
A. more had to be done to prevent chemical contamination of the environment
B. there was a link between pesticides, chemicals and cancer
C. chemicals were leading to an inability to reproduce leading to the eradication of entire species of insects, birds, fish and animals
D. all of the above

Q8. Research about xenoestrogens reveals
A. they are everywhere
B. they are harmless
C. they are in our everyday foods
D. they are in our everyday foods and disrupt hormonal function

PART C. TEXT 2

Paragraph 1: A compilation of articles within the British Medical Journal meticulously scrutinises the effectiveness of oseltamivir, more commonly referred to as Tamiflu. This assemblage of scholarly works collectively arrives at a nuanced and significant conclusion — casting an intricate shadow of doubt over the previously asserted efficacy of Tamiflu. The skepticism arises from a meticulous analysis encompassing ten pivotal drug company trials. Specifically, these trials were intended to substantiate the claims that oseltamivir diminishes the risk of complications in otherwise healthy adults grappling with influenza. The intricacies unearthed in this comprehensive examination intricately challenge the hitherto uncontested efficacy of Tamiflu, injecting a layer of uncertainty into its purported ability to stave off complications, particularly in individuals without pre-existing health conditions.

Paragraph 2: The use of meta-analysis is governed by the Cochrane review protocol. Cochrane Reviews investigate the effects of interventions for prevention, treatment and rehabilitation in a healthcare setting. They are designed to facilitate the choices that doctors, patients, policy makers and others face in health care. Most Cochrane Reviews are based on randomized controlled trials, but other types of evidence may also be taken into account, if appropriate.

Paragraph 3: If the data collected in a review are of sufficient quality and similar enough, they are summarised statistically in a meta-analysis, which generally provides a better overall estimate of a clinical effect than the results from individual studies. Reviews aim to be relatively easy to understand for non-experts (although a certain amount of technical detail is always necessary). To achieve this, Cochrane Review Groups like to work with “consumers”, for example patients, who also contribute by pointing out issues that are important for people receiving certain interventions. Additionally, the Cochrane Library contains glossaries to explain technical terins.

Paragraph 4: Briefly, in updating their Cochrane review, published in late 2009. Tom Jefferson and colleagues failed to verify claims, based on an analysis of 10 drug company trials, that oseltamivir reduced the risk of complications in healthy adults with influenza. These claims have farmed a key part of decisions to stockpile the drug and make it widely available.

Paragraph 5: Only after questions were put by the BMJ and Channel 4 News has the manufacturer Roche committed to making “full study reports” available on a password protected site. Some questions remain about who did what in the Roche trials, how patients were recruited, and why some neuropsychiatric adverse events were not reported. A response from Roche was published in the BMJ letters pages and their full point by point response is published online.

Paragraph 6: Should the BMJ be publishing the Cochrane review given that a more complete analysis of the evidence may be possible in the next few months? Yes, because Cochrane reviews are by their nature interim rather than definitive. They exist in the present tense, always to be superseded by the next update. They are based on the best information available to the reviewers at the time they complete their review. The Cochrane reviewers have told the BMJ that they will update their review to incorporate eight unpublished Roche trials when they are provided with individual patient data.

Paragraph 7: Where does this leave oseltamivir, on which governments around the world have spent billions of pounds? The papers in last year’s journal relate only to its use in healthy adults with influenza. But they say nothing about its use in patients judged to be at high risk of complications- pregnant women, children under 5, and those with underlying medical conditions; and uncertainty over its role in reducing complications in healthy adults still leaves it as a useful drug for reducing the duration of symptoms. However, as Peter Doshi points out on this outcome it has yet to be compared in head-to-head trials with non-steroidal inflammatory drugs or paracetamol. And given the drug’s known side effects, the risk-benefit profile shifts considerably if we are talking only in terms of symptom relief.

Paragraph 8: We don’t know yet whether this episode will turn out to be a decisive battle or merely a skirmish in the fight for greater transparency in drug evaluation. But it is a legitimate scientific concern that data used to support important health policy strategies are held only by a commercial organisation and have not been subject to full external scrutiny and review. It can’t be right that the public should have to rely on detective work by academics and journalists to patch together the evidence for such a widely prescribed drug. Individual patient data from all trials of drugs should be readily available for scientific scrutiny.

QUESTIONS

Q1. A cluster of articles on oseltamivir in the British Medical Journal conclude—–
a. complications are reduced in healthy people by oseltamivir
b. the efficacy of Tamiflu in now in doubt
c. complications from pandemic influenza are currently uncertain
d. a series of articles supporting Tamiflu

Q2. Cochrane Reviews are designed to _
a. set randomized controlled trials to specific values
b. compile literature meta-analysis
c. peer review articles
d. influence doctors’ choice of prescription

Q3. According to the article, which one of the following statements about Tamiflu is FALSE?
a. The use of randomized controls is suspect
b. The efficacy of Tamiflu is certain
c. Oseltamivir induces complications in healthy people
d. Cochrane reviews are useful when examining the efficacy of Tamiflu

Q4. According to the article, Cochrane Review Groups _
a. like to work for “consumers”.
b. are being overhauled.
c. use language suitable for expert to expert communication.
d. evaluate a clinical effect better than individual studies.

Q5. Which would make the best heading for paragraph 4?
a. Analysis of 10 drug company trials
b. The stockpiling of Oseltamivir
c. Risk of complications in healthy adults
d. Tamiflu claims fail verification

Q6. According to the article, which one of the following statements about Roche is TRUE?
a. Full study reports were made freely available on the internet
b. Patients were recruited through a double-blind trial
c. The identities and roles of researcher in the Roche trials are not fully accounted for
d. Not all neuropsychiatric adverse events were reported

Q7. Cochrane reviews should _
a. use a more complete analysis
b. not be published until final data is available
c. be considered interim rather than definitive advice
d. be superseded by a more reliable method of reporting results

Q8. Which would make the best heading for paragraph 7
a. Risk-benefit profile of Tamiflu
b. Studies limited to healthy adults
c. High risk of complications –
d. Oseltamivir only for high-risk patients

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