Podcasts about caribbean school

#200 About Cells, Quantumphysics & Epigenetics – mit Dr. Bruce H. Lipton (engl.) Es gibt was zu feiern! Heute erscheint die 200. Folge von Get Happy! und ich freue mich aus diesem Anlass über einen ganz besonderen Gast. Wer tiefer einsteigt in die faszinierende Welt der Epigenetik, der Quantenphysik, von Frequenzen und die unendlichen Möglichkeiten des Universums, der kommt an Dr. Bruce Harold Lipton nicht vorbei. 1971 machte er seinen Doktor für Entwicklungsbiologie an der University of Virginia, lehrte an der University of Wisconsin Anatomie und wurde später Professor für Anatomie an der American University of the Caribbean School of Medicine. Er forschte von 1987 bis 1992 an der Pennsylvania State University und dem medizinischen Forschungszentrum der Stanford University. Seit 1993 hatte er Lehraufträge an mehreren Universitäten und verfasste zahlreiche Forschungsberichte zur Entwicklung von Muskelzellen. Im Jahr 2009 wurde er mit dem Goi Peace Award ausgezeichnet. Für seine Forschung und seine bahnbrechenden Erkenntnisse über Zellen und Gene wurde er viele Jahre angefeindet und diffamiert, heute ist klar: Bruce Lipton war seiner Zeit weit voraus und auch heute gilt er noch als absoluter Pionier in Sachen Epigenetik. Danke für 200 Episoden. Danke für EUCH.

Episode 183: Colorectal Cancer in Young AdultsFuture Dr. Avila and Dr. Arreaza present evidence-based information about the screening and diagnosis of colorectal cancer and explain the increasing incidence among young adult and the importance to screen early in high risk groups.  Written by Jessica Avila, MS4, American University of the Caribbean School of Medicine. Edits and comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.IntroductionJessica: Although traditionally considered a disease only affecting older adults, colorectal cancer (CRC) has increasingly impacted younger adults (defined as those under 50) at an alarming rate. According to the American Cancer Society, CRC is now the leading cause of cancer-related death in men under 50 and the second leading cause in women under 50 (American Cancer Society, 2024). Arreaza: Why were you motivated to talk about CRC in younger patients?Jessica: Because despite advancements in early detection and treatment, younger patients are often diagnosed at later stages, resulting in poorer outcomes. We will discuss possible causes, risk factors, common symptoms, and why early screening and prevention are important. Arreaza: This will be a good reminder for everyone to screen for colorectal cancer because 1 out of every 5 cases of colorectal cancer occur in adults between the ages of 20 and 54. The Case of Chadwick BosemanJessica: Many people know Chadwick Boseman from his role as T'Challa in Black Panther. His story highlights the worrying trend of increasing CRC in young adults. He was diagnosed with stage III colorectal cancer at age 39. This diagnosis was not widely known until he passed away at 43. His case shows how silent and aggressive young-onset CRC can be. Like many young adults with CRC, his symptoms may have been missed or thought to be less serious issues. His death drew widespread attention to the rising burden of CRC among young adults and emphasized the critical need for increased awareness and early screening efforts.Arreaza: Black Panther became a hero not only in the movie, but also in real life, because he raised awareness of the problem in young AND in Black adults. EpidemiologyJessica: While rates of CRC in older populations have decreased since the 1990s, adults under 50 have seen an increase in CRC rates of nearly 50%. (Siegel et al., 2023). Currently, one in five new CRC diagnoses occurs in individuals younger than 55 (American Cancer Society, 2024).Arreaza: What did you learn about the incidence by ethnic groups? Are there any trends? Jessica: Yes, certain ethnic groups are shown to have higher rates of CRC. Black Americans, Native Americans, and Alaskan Natives have the highest incidence and mortality rates from CRC (American Cancer Society, 2024). Black Americans have a 20% higher incidence and a 40% higher mortality rate from CRC compared to White Americans, primarily due to disparities in access to screening, healthcare resources, and early diagnosis. Hispanic and Asian American populations are also experiencing increasing CRC rates, though to a lesser extent.Arreaza: It is important to highlight that Black Americans have the highest rate of both diagnoses and deaths of all groups in the United States. Who gets colorectal cancer?Risk FactorsJessica: Anyone can get colorectal cancer, but some are at higher risk. In most cases, environmental and lifestyle factors are to blame, but early-onset CRC are linked to hereditary conditions. Arreaza: There is so much to learn about colorectal cancer risk factors. Tell us more.Jessica: The following are key risk factors:Modifiable risk factors:Diet and processed foods: A diet high in processed meats, red meat, refined sugars, and low fiber is strongly associated with an increased risk of CRC. Fiber is essential for gut health, and its deficiency has been linked to increased colorectal cancer risk (Dekker et al., 2023).Obesity and sedentary lifestyle: Obesity and physical inactivity contribute to CRC risk by promoting chronic inflammation, insulin resistance, and metabolic disturbances that promote tumor growth (Stoffel & Murphy, 2023).Gut microbiome imbalance: Disruptions in gut microbiota, especially an overgrowth of Fusobacterium nucleatum, have been noted in CRC pathogenesis, potentially causing tumor development and progression (Brennan & Garrett, 2023).Arreaza: As a recap, processed foods, obesity, sedentarism, and gut microbiome. We also have to mention smoking and high alcohol consumption as major risks factors, but the strongest risk factor is a family history of the disease.Non-modifiable risk factors:Genetic predisposition: Although only 20% of early-onset CRC cases are linked to hereditary syndromes such as Lynch syndrome and familial adenomatous polyposis (FAP), individuals with a first-degree relative with CRC are at a significantly higher risk and should undergo earlier and more frequent screening (Stoffel & Murphy, 2023).Arreaza: Also, there is a difference in incidence per gender assigned at birth, which is also not modifiable. The rate in the US was 33% higher in men (41.5 per 100,000) than in women (31.2 per 100,000) during 2015-2019. So, if you are a man, your risk for CRC is slightly higher. Protective factors, according to the ACS, are physical activity (no specification about how much and how often) and dairy consumption (400g/day). Jessica, let's talk about how colon cancer presents in our younger patients.Clinical Presentation and Challenges in DiagnosisJessica: Young-onset CRC is often diagnosed at advanced stages due to delayed recognition of symptoms. Common symptoms include:Rectal bleeding (often mistaken for hemorrhoids)Young individuals may ignore it, believe they do not have time to address it, or lack insurance to cover a comprehensive evaluation.Unexplained weight lossFatigue or weaknessChanges in bowel habits (persistent diarrhea or constipation)This may also be rationalized by dietary habits.Abdominal pain or bloatingIron deficiency anemia.Arreaza: All those symptoms can also be explained by benign conditions, and colorectal cancer can often be present without clear symptoms in its early stages. Jessica: Yes, in young adults, symptoms may be dismissed by healthcare providers as benign conditions such as irritable bowel syndrome (IBS), hemorrhoids, or dietary intolerance, leading to significant diagnostic delays. Arreaza: We must keep a low threshold for ordering a colonoscopy, especially in patients with the risks we mentioned previously. Jessica: We may also be concerned about the risk/benefit of colonoscopy or diagnostic methods in younger adults, given the traditional low likelihood of CRC. Approximately 58% of young CRC patients are diagnosed at stage III or IV, compared to 43% of older adults (American Gastroenterological Association, 2024). Early recognition and prompt evaluation of persistent symptoms are crucial for improving outcomes. Empowering and informing young adults about concerning symptoms is the first step in better recognition and better outcomes for these individuals.Arreaza: This is when the word “follow up” becomes relevant. I recommend you leave the door open for patients to return if their common symptoms worsen or persist. Let's talk about screening. Screening and PreventionJessica: Due to the trend of CRC being identified in younger populations, the U.S. Preventive Services Task Force (USPSTF) lowered the recommended screening age for CRC from 50 to 45 in 2021 (USPSTF, 2021). Off the record, some Gastroenterologists also foresee the USPSTF lowering the age to 40. Arreaza: That is correct, it seems like everyone agrees now that the age to start screening for average-risk adults is 45. It took a while until everyone came to an agreement, but since 2017, the US Multi-Society Task Force had recommended screening at age 45, the American Cancer Society recommended the same age (45) in 2018, and the USPSTF recommended the same age in 2021. This podcast is a reminder that the age of onset has been decreased from 50 to 45, for average-risk patients, according to major medical associations.Jessica: For individuals with additional risk factors, including a family history of CRC or chronic gastrointestinal symptoms, screening starts at age 40 or 10 years before the diagnosis of colon cancer in a first-degree relative. Dr. Arreaza, who has the lowest and the highest rate of screening for CRC in the US? Arreaza: The best rate is in Massachusetts (70%) and the lowest is California (53%). Let's review how to screen:Jessica: Recommended Screening Methods:Colonoscopy: Considered the gold standard for CRC detection and prevention, colonoscopy allows for identifying and removing precancerous polyps.Fecal Immunochemical Test (FIT): A non-invasive stool test that detects hidden blood, recommended annually.Stool DNA Testing (e.g., Cologuard): This test detects genetic mutations associated with CRC and is recommended every three years.Arreaza: Computed tomographic colonography (CTC) is another option, it is less common because it is not covered by all insurance plans, it examines the whole colon, it is quick, with no complications. Conclusion:Colorectal cancer is rapidly emerging as a serious health threat for young adults. The increase in cases over the past three decades highlights the urgent need for increased awareness, early symptom detection, and proactive screening. While healthcare providers must weigh the risk/benefit of testing for CRC in younger adults, patients must also be equipped with knowledge of concerning signs so that they may also advocate for themselves. Early detection remains the most effective tool in preventing and treating CRC, emphasizing the importance of screening and risk factor modification.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:American Cancer Society. (2024). Colorectal Cancer Statistics, 2024. Retrieved fromhttps://www.cancer.orgAmerican Gastroenterological Association. (2024). Delays in Diagnosis of Young-Onset Colorectal Cancer: A Systemic Issue. Gastroenterology Today.Brennan, C. A., & Garrett, W. S. (2023). Gut Microbiota and Colorectal Cancer: Advances and Future Directions. Gastroenterology.Dekker, E., et al. (2023). Colorectal Cancer in Adolescents and Young Adults: A Growing Concern. The Lancet Gastroenterology & Hepatology.Siegel, R. L., et al. (2023). Colorectal Cancer Statistics, 2023. CA: A Cancer Journal for Clinicians.Stoffel, E. M., & Murphy, C. C. (2023). Genetic and Environmental Risk Factors in Young-Onset Colorectal Cancer. JAMA Oncology.U.S. Preventive Services Task Force. (2021). Colorectal Cancer Screening Guidelines.Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

Bill Reichart and Violeta Mora, M3 at American University of the Caribbean School of Medicine, discuss her route to medical school that began in Cuba and continued in the Caribbean and in the US!

Episode 156: Obesity, Fertility, and PregnancyFuture Dr. Hamilton defines obesity and explains the pathophysiology of obesity and its effects on fertility and pregnancy. Dr. Arreaza adds some input about the impact of epigenetics on newborn babies.  Written by Shelby Hamilton, MS3, American University of the Caribbean School of Medicine. Editing by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Definition of obesityObesity is a multifactorial chronic disease that is increasing in prevalence across the globe. It can be defined as a body mass index (or BMI) greater than 30 kg/m2. According to the CDC from 2017-March 2020, the prevalence of obesity in United States adults was 41.9%.Classification of obesity by BMI.Obesity can further be divided into three classes: class I which is a BMI between 30-34.9; class II which is a BMI between 35-39.5; and class III which is a BMI greater than 40. We recommend avoiding the term “morbid obesity” because of the negative connotation of the word “morbid.” Class III or severe are better terms in those cases. This classification is based on the individual risk of cardiovascular disease. One of the greatest health consequences affecting individuals with obesity is the cardiovascular effects including hypertension, dyslipidemia, and coronary artery disease. Other effects include insulin resistance and diabetes, cholelithiasis, non-alcoholic fatty liver disease, osteoarthritis, and even depression.How Does Obesity Affect Fertility?Obesity can have an extensive effect on the overall health of an individual. In addition to these commonly discussed effects, obesity can also influence a person's fertility. This is especially observed in women with polycystic Ovary Syndrome (PCOS) who have a greater BMI and also have symptoms of anovulation. Excess adipose tissue plays a role in the effects that obesity has on fertility. White adipose tissue can secrete a specific group of cytokines known as ‘adipokines'. These adipokines include leptin, ghrelin, resistin, visfatin, chemerin, omentin, and adiponectin. With a greater percentage of adipose tissue, there are higher rates of hypothalamic gonadotropin hormonal dysregulation, which can be combined with insulin-related disorders, low sex hormone binding proteins, and high levels of androgens. The combination of these factors can result in decreased ovarian follicle development and decreased progesterone levels.Hormonal changesObesity is an endocrine disorder. One specific adipokine that affects the hypothalamic-gonadotropin axis is chemerin. Chemerin impairs the release of follicle-stimulating hormone (FSH) from the pituitary gland. This reduction in FSH release consequently leads to anovulation, meaning that no egg will be released from an ovarian follicle, contributing to infertility. Shelby: Another adipokine affecting fertility is adiponectin. The receptors of adiponectin are predominantly expressed in reproductive tissues, including the ovaries and endometrium. In individuals with a greater BMI, a decrease in adiponectin secretion has been observed, resulting in decreased stimulation of its receptors, especially in the endometrium, which has been linked to recurrent implantation failure. Adiponectin has also been shown to affect glucose uptake in the liver. With reduced adiponectin levels, there is reduced hepatic glucose uptake, leading to insulin resistance. As tissues become less sensitive to insulin, the body compensates by secreting higher amounts of insulin, leading to hyperinsulinemia. Higher levels of circulating insulin have also been proven to cause hyperandrogenemia in women by blocking the hepatic production of sex hormone-binding globulin. Insulin can also act on the IGF-1 receptors in the theca cells, increasing steroidogenesis, and thus, increasing androgens. With hyperandrogenemia, there is also increased granulosa cell apoptosis as well as increased peripheral conversion of androgens into estrogen. This creates negative feedback to the hypothalamic-pituitary axis to decrease the release of gonadotropins such as FSH which are critical in ovulation.Leptin is another adipokine that is shown to be increased in obesity. Studies on mice have shown that leptin impairs the development of ovarian follicles, resulting in a decrease in ovulation. In these studies, it was also observed that leptin reduces the production of estriol by the granulosa cells in the ovarian follicles as well as increases the rate of apoptosis in granulosa cells, both of which affect ovulation. Leptin decreases hunger, but persons with obesity may be resistant to its effects and that's why they have higher levels than a person with normal weight. They have high levels of leptin but are still hungry because they have leptin resistance.Studies have also shown that the fatty acid composition of follicular fluid found in ovarian follicles also plays a role in fertility. In individuals with a high BMI, this fluid contains high levels of oleic acid, which can cause embryo fragmentation after fertilization occurs. Stearic acid is another fatty acid found in elevated levels in the follicular fluid of women with a greater BMI, which can also affect the quality of the embryo while in the blastomere stage.The bottom line is obesity decreases fertility. It does not mean that patients with obesity will not get pregnant, but it can make it harder to get pregnant. Female patients who are losing weight must be warned about their improved fertility once they start to lose weight.What effect does obesity have on pregnancy?While obesity may make it more difficult for a woman to get pregnant, it is not impossible. However, there are potential risks both to the mother's health as well as the baby's health. Therefore, it is very important to monitor these patients even more carefully.Women who have a greater BMI pre-pregnancy are at a greater risk of developing gestational hypertension. Gestational hypertension is defined as blood pressure greater than 140/90 on more than one reading in the second half of pregnancy. Hypertension during pregnancy can also have serious complications such as kidney failure, stroke, myocardial infarction, or even heart failure. Gestational hypertension can also result in preterm birth or low birth weight.Treatment of mild hypertension in pregnancyRecent studies published in the AFP Journal support the treatment of mild hypertension in pregnancy. It states that “evidence and expert opinion support treating mild chronic hypertension in pregnancy with approved antihypertensives, with a strength of recommendation: B”. There was a randomized control trial with about 2,000 women who were randomized to receive antihypertensive treatment vs no treatment. The treatment group had a lower incidence of preeclampsia with severe features, preterm birth, placental abruption, and neonatal or fetal death. There was not an increase in fetal growth restriction or maternal or neonatal complications. So, it is advisable to treat chronic, mild hypertension in pregnancy, according to the AFP Journal.PreeclampsiaPreeclampsia is another condition that is at a higher risk in women with obesity, which is a more serious manifestation of hypertension in the second half of pregnancy. Along with high blood pressure, there are also effects on the kidneys and liver. Hypertension accompanied by proteinuria is indicative of preeclampsia and should be taken seriously. Preeclampsia can become eclampsia, where the patient also experiences seizures. There is also the risk for stroke, HELLP syndrome, placenta abruption, preterm birth, and fetal growth restriction.Gestational diabetesAnother risk is gestational diabetes. Elevated blood glucose during pregnancy can result in a larger baby and delivery by cesarean. There may also be a greater risk of the mother and child developing diabetes mellitus later on in life.OSAWomen with a greater BMI may also be at risk of developing obstructive sleep apnea during pregnancy. Not only can this result in fatigue but can also contribute to the development of gestational hypertension and preeclampsia.Effect of obesity on the fetusAs mentioned, there are some risks to the fetus in women with a greater pre-pregnancy BMI. There is a greater risk for these babies to be born with birth defects such as congenital heart defects and neural tube defects. Another risk previously discussed is macrosomia, or large for gestational age. Larger babies are also at increased risk for shoulder dystocia during delivery as well as resulting clavicle fractures, brachial plexus injuries, and nerve palsies. Preterm birth is another risk, which also increases the risk of short-term and long-term health complications. Lastly, a higher BMI is directly correlated with the risk of spontaneous abortion or stillbirth.SummaryAs the prevalence of obesity increases, it is important to discuss the health risks that are associated with this disease. In our patients of childbearing age and who may be hoping to conceive, it is even more important to discuss how a higher BMI may affect fertility and pregnancy. While discussing these topics with patients, it is important to try our best to build rapport with the patient so that the discussion is seen more as one of concern and support rather than one of criticism regarding their weight. We may want to help by not only telling patients to “lose weight” or “diet”, but we can also provide them with resources regarding dietary adjustments and ways they can incorporate physical activity into their lives without just telling them to eat less and move more. Stay tuned for our episode on the management of obesity in pregnancy.ConclusionNow we conclude episode number 156, “Obesity, fertility, and pregnancy.” Future Dr. Hamilton explained how obesity affects the hormonal regulation of fertility. She also explained the obstetrical risks associated with obesity. Primary care professionals need to educate our patients about the benefits of preconception weight control. Dr. Arreaza explained that hypertension is a common condition in pregnant patients with obesity and mentioned the benefits of treating mild hypertension in pregnancy. We hope to bring you an episode on the management of obesity in pregnancy soon, so stay tuned! This week we thank Hector Arreaza and Shelby Hamilton. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Gautam, D., Purandare, N., Maxwell, C., Rosser, M., O'Brien, P., Mocanu, E., McKeown, C., Malhotra, J., & McAuliffe, F. (2023) The challenges of obesity for fertility: A FIGO literature review. International Journal of Gynecology & Obstetrics, 160(S1), 50-55. https://doi.org/10.1002/ijgo.14538Pandey, S., Pandey, S., Maheshwari, A., & Bhattacharya, S. (2010). The impact of female obesity on the outcome of fertility treatment. Journal of Human Reproductive Science, 3(2), 62-67. https://doi.org/10.4103/0974-1208.69332.Perreault L. Obesity in adults: Prevalence, screening, and evaluation. In: UpToDate, Pi Sunyer FX (Ed) Wolters Kluwer. https://www.uptodate.com (Accessed on October 6, 2023).Obesity and Pregnancy FAQ, The American College of Obstetricians and Gynecologists (ACOG), https://www.acog.org/womens-health/faqs/obesity-and-pregnancy, Accessed on October 10, 2023.Adult Obesity Facts, Centers for Disease Control and Prevention (CDC), https://www.cdc.gov/obesity/data/adult.html, Accessed on October 7, 2023. Dresang L, Vellardita L. Should Medication Be Prescribed for Mild Chronic Hypertension in Pregnancy?. Am Fam Physician. 2023;108(4):411-412. Royalty-free music used for this episode: "I Think We Have a Chance."  downloaded on November 11, 2023,  from https://www.videvo.net/.

Impression: Interventional Radiology's very own Dr. Mohammed Loya talks to Saad and Travis about growing up in the 301, attending University of Maryland Baltimore County, transferring and graduating a Terrapin before making the decision to attend the American University of the Caribbean School of Medicine but eventually proving it correct by matching into Diagnostic Radiology residency at Nassau County Medial Center and completing a fellowship at Emory University Hospital.

Episode 148: Leg CrampsFuture Dr. Weller explains the pathophysiology, management, and prevention of leg cramps. Hector Arreaza adds comments and anecdotes about leg cramps.  Written by Olivia Weller, MS4, American University of the Caribbean School of Medicine. Comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Definition: Known also as “Charlie horses,” leg cramps are defined as recurrent, painful, involuntary muscle contractions. They can last anywhere from seconds to several minutes, with an average of nine minutes per episode. They are usually nocturnal and thus may be associated with secondary insomnia. Location: A muscle cramp can happen in any muscle in the body, but they occur most commonly in the posterior calf muscles, but they can also involve the thighs or feet. They are more common in women than men and the risk increases with age.Although they are experienced by 7% of children and up to 60% of adults, the exact mechanism remains unknown and there is no definitive treatment at this time. PathophysiologyThere is one leading hypothesis for nocturnal cramps that occur in the posterior calf muscles, and it is related to your sleeping position. When you are laying down in bed your toes are pointed which causes passive plantar flexion while the muscle fibers are shortened maximally. This causes uninhibited nerve stimulation with high-frequency involuntary discharge from lower motor neurons, which causes cramping. Another possible etiology is nerve damage because neurologic conditions such as Parkinson's disease are associated with a higher-than-normal incidence of cramps. Peripheral neuropathy, or damage to the connection between motor nerves and the brain can lead to hyperactive nerves when they are not being properly regulated. Thus, diabetes mellitus is a major risk factor for nocturnal cramps due to the high blood sugar levels damaging the small blood vessels which supply the muscles. Decreased blood flow has also been attributed as a cause of leg cramps. People with diseases that affect their vasculature, such as varicose veins or peripheral arterial disease also have a higher incidence of leg cramps. Decreased blood flow to the muscles means less delivery of oxygen and nutrients to the muscles which makes them more susceptible to fatigue. Muscle overuse is one of the dominant explanations for cramping. This can be related to doing too much high-intensity exercise without adequate stretching before and after. Pregnant women have added weight which puts extra strain on the muscles, along with sitting or standing for long periods of time, poor posture and flat feet. Notably, when we age, our tendons naturally shorten and they cannot work as hard, or as quickly which makes them more susceptible to overuse. Additionally, there are mineral deficiencies such as magnesium and potassium or decreased levels of B and D vitamins. With this in mind, people with renal failure that are on hemodialysis have an increased risk of nocturnal leg cramps. And finally, we have medications, some of which are related to mineral deficiencies. The main contributors are statins, diuretics, conjugated estrogens, gabapentin or pregabalin, Zolpidem, clonazepam, albuterol, fluoxetine, sertraline, raloxifene, and teriparatide (analog for parathyroid hormone). Management and preventionThere is no magic treatment to make them go away immediately, however, there are different remedies you can try to help facilitate. My Grandma told me about an old wives' tale, that if you put a bar of soap in your bed at your feet while you sleep, you won't get cramps at night. Maybe it works by the placebo effect, maybe there's a mechanism going on there I don't understand who knows, I'll have to do a study on it. If you get them very often, you can keep a foam roller or a heating pad next to your bed in preparation for when they come. Stretching the muscle is known to be very effective, as well as applying heat or ice to the affected area. You can also try massaging the muscle with your hands or getting out of bed to stand or walk around. Elevating the leg while laying down in bed can also be beneficial. In terms of prevention, you can try out different sleeping positions to see if one works better for you. If you usually sleep on your back, you can stick a pillow under your feet to help keep your toes pointed upward. Or, if you sleep on your stomach you can try to keep your feet hanging off the bed. Another tip is loosening the sheets or blankets around your feet. Daily stretching, especially before and after exercise as well as before bed is useful. Make sure to exercise, stay hydrated, and limit your alcohol and caffeine consumption. You also want to wear supportive shoes or use orthotic inserts in your shoes, especially if you spend lots of time on your feet during the day. Medications/supplements: Since various deficiencies can cause cramps, one way to prevent them is to take supplements such as magnesium, vitamin D, and B12 complex. And as a last resort, you can try medications. Calcium channel blockers such as diltiazem or verapamil have been used, and muscle relaxants including Orphenadrine (Norflex®) and Carisoprodol (Soma®). Gabapentin is an anticonvulsant commonly used as a neuropathic pain medication; this used to be used to treat leg cramps but later it was found that they can actually increase the frequency of muscle cramps so they are no longer used. Quinine was also used for many years to treat leg cramps; however, it is no longer recommended because of drug interactions and serious hematologic effects such as immune thrombocytopenic purpura (ITP) and hemolytic uremic syndrome (HUS). Summary: Leg cramps are common, the pathophysiology is unclear, but may be related to problems with blood flow, the nervous system, sleeping position, and muscle overuse. Treatment includes nonpharmacologic therapies such as changes in sleeping position, heat, and massaging; and medications/supplements that may be useful include Carisoprodol (Soma®), diltiazem, gabapentin (Neurontin), magnesium, orphenadrine (Norflex®), verapamil, and vitamin B12 complex.____________________________Conclusion: Now we conclude episode number 148, “Leg Cramps.” Future Dr. Weller explained that the etiology of leg cramps is multifactorial. Some theories about why leg cramps happen include poor circulation, muscle overuse, dysfunctions in the nervous and musculoskeletal systems, electrolyte imbalances, mineral deficiencies, and more. Some therapies were discussed, including changes in position while sleeping, massage, heat pads, and medications such as calcium channel blockers, muscle relaxants, and supplements of magnesium and Vitamin B12. Gabapentin is a medication that can cause leg cramps, but some sources recommend it as a treatment as well. This week we thank Hector Arreaza and Olivia Weller. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Leg Cramps. Cleveland Clinic. (2023, May 6). https://my.clevelandclinic.org/health/diseases/14170-leg-crampsAllen, R. E., & Kirby, K. A. (2012, August 15). Nocturnal leg cramps. American Family Physician. https://www.aafp.org/pubs/afp/issues/2012/0815/p350.htmlMayo Foundation for Medical Education and Research. (2023, March 2). Night leg cramps. Mayo Clinic. https://www.mayoclinic.org/symptoms/night-leg-cramps/basics/definition/sym-20050813Royalty-free music used for this episode: Simon Pettersson - Good Vibes_Sky's The Limit_Main. Downloaded on July 29, 2023, from https://www.videvo.net/ 

Episode 137: Heart Transplant and LVADFuture Doctor My explains two treatments for advanced heart failure, heart transplant and Left Ventricle Assist Device (LAVD). Dr. Arreaza adds historical information about the first artificial heart implant and the first LAVD.  Written by My Chau Nguyen, MSIV, American University of the Caribbean School of Medicine. Comments by Hector Arreaza, MD.  You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Introduction: Advanced heart failure is a major concern in the United States. Heart failure has a high 1-year mortality average of 33%. Although medical therapies have improved survival rates, some patients with progressive and advanced heart failure may still require heart transplantation or mechanical support such as left ventricular assist devices (LVADs) to prolong survival and improve quality of life.It is estimated that 23 million people in the world have heart failure, and many of them are in end-stage heart failure. When it comes to treating severe heart failure, there are two main options: heart transplantation and left ventricular assist devices (LVADs). Heart transplant: The operation to perform a heart transplant typically lasts between five to six hours but may take longer in patients who have undergone previous open-heart surgery or have an LVAD in place. However, because donors' hearts are a scarce resource, not all patients are eligible for transplantation. The following are absolute indications for referral for Heart Transplant listing:Cardiogenic shock requiring continuous intravenous inotropic therapy (i.e., dobutamine, milrinone, etc.) or circulatory support with intra-aortic balloon pump counterpulsation devices or left ventricular assist device (LVAD) to maintain adequate organ perfusion.Peak oxygen consumption VO2 (VO2max) less than 10 mL/kg per minute.New York Heart Association NYHA class III or IV despite maximized medical and resynchronization therapy.Recurrent life-threatening arrhythmias unresponsive to medical therapy such as an implantable cardiac defibrillator, medical therapy, or catheter ablation.End-stage congenital heart failure with no evidence of pulmonary hypertension.Refractory severe angina without potential medical or surgical therapeutic options.Selected patients with restrictive and hypertrophic cardiomyopathies.My experience with a heart transplant: I consider myself extremely fortunate for witnessing the whole complex procedure involved in lung and heart transplantation at Jackson Memorial Hospital in Miami, FL. It was an incredible experience to join the transplant team in retrieving a donor organ. Timing plays a critical role in heart transplants. When a suitable donor becomes available, every second counts. We must quickly arrange transport and secure an operating room. It is essential that the distance between the donor and the hospital is within our designated region. For example, we are in Region 5, including Arizona, California, Nevada, New Mexico, and Utah. Once everything is in order, we divide into two teams. One team sets off to retrieve the donor while the other prepares the patient in the operating room. It is a race against time, as hearts and lungs must be transplanted within approximately four hours of removal from the donor. It was remarkable to see how everything was so precisely scheduled, from the arrival and departure of the teams to the transplantation of the organs. It is an inspiring experience to witness these life-saving procedures in action.History of the artificial heart.Arreaza: It is great to hear about your experience, but we know that not everyone can have a heart transplant. So, let us talk about other options. For example, an artificial heart. I lived in Utah for several years and I heard something about the first artificial heart being implanted there, so here is the information. William DeVries was the surgeon who led the implantation of the first artificial heart, the Jarvik-7, at the University of Utah on December 1, 1982. The patient was a retired dentist, Barney Bailey Clark, who survived 112 days connected to the device. Today, the modern version of the Jarvik-7 is known as the SynCardia temporary Total Artificial Heart. It has been implanted in more than 1,350 people as a bridge to transplantation.Left Ventricular Assist Device (LVAD):In recent years, LVADs have become increasingly popular as a viable alternative to transplantation, as they have demonstrated improved durability by using wear-free components, greatly improving mortality rates in heart failure patients. Arreaza: The first left ventricular assist device (LVAD) system was created by Domingo Liotta at Baylor College of Medicine in Houston, Texas, in 1962. It is basically a pump that is used for patients who are on end-stage heart failure. The LVAD is surgically implanted, it is a battery-operated pump that helps the left ventricle pump blood to the rest of the body. LVADs can be used as a temporary treatment while patients are waiting for a transplant. It is called a “bridge-to-transplant therapy”. In some cases, an LVAD may restore a failing heart and eliminate the need for a transplant. An LAVD may also be used as a “destination therapy” in patients who are not candidates for heart transplants. LVAD can prolong and improve patients' quality of life.My: The purpose of an LVAD is to support patients with heart failure by increasing perfusion and reducing filling pressures in the heart. It is important to note, however, that LVADs only partially assist the pumping action of the diseased ventricle and cannot fully replace the function of the heart. Therefore, the decision to have an LVAD or heart transplant must be taken after careful discussion between the patient and the cardiologist to determine which option is best to reach the patient's goals of care.Example of an LVAD:Recently, The Berlin Heart Ventricular Assist Device (VAD) has been a game-changer in saving children with severe heart conditions. As you may guess from the name, it is developed in Germany. It is recently approved by US FDA in 2011. This type of LVAD has been used in approximately 1,000 children worldwide, including 12 cases in the United States. The Berlin Heart is a simple air-driven pump that takes over the work of one or both sides of a child's own heart. It pumps blood around the body to keep the brain and other organs healthy, allowing the child to grow and get stronger. The use of this device is required until the child is transplanted, or for a small number of children until their own heart recovers. I once again had the privilege of witnessing the procedure performed by one of the inventors, my preceptor, Dr. Loebe in the NICU at Jackson Memorial Hospital.Conclusion: Now we conclude episode number 137, “Heart Transplant and LVAD.” My explained two options for the treatment of advanced heart failure: Heart transplant and Left Ventricular Assist Device, or LVAD. She shared her recent experience in her surgery rotation at Jackson Memorial Hospital. Dr. Arreaza added the history of the first artificial heart implanted in Utah and the first LAVD. We hope you enjoyed it.This week we thank Hector Arreaza, and future doctor My Chau Nguyen. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________Sources:Theochari CA, Michalopoulos G, Oikonomou EK, Giannopoulos S, Doulamis IP, Villela MA, Kokkinidis DG. Heart transplantation versus left ventricular assist devices as destination therapy or bridge to transplantation for 1-year mortality: a systematic review and meta-analysis. Ann Cardiothorac Surg. 2018 Jan;7(1):3-11. doi: 10.21037/acs.2017.09.18. PMID: 29492379; PMCID: PMC5827119. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5827119/.Alraies MC, Eckman P. Adult heart transplant: indications and outcomes. J Thorac Dis. 2014 Aug;6(8):1120-8. doi: 10.3978/j.issn.2072-1439.2014.06.44. PMID: 25132979; PMCID: PMC4133547. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4133547/.Birks, E. J., & Mancini, D. (2022, November 9). Treatment of advanced heart failure with a durable mechanical circulatory support device. UpToDate. Retrieved April 21, 2023. https://www.uptodate.com/contents/treatment-of-advanced-heart-failure-with-a-durable-mechanical-circulatory-support-device.Drews T, Loebe M, Hennig E, Kaufmann F, Müller J, Hetzer R. The ‘Berlin Heart' assist device. Perfusion. 2000;15(4):387-396. doi:10.1177/026765910001500417.Middleton, J. (2021, August 26). What is the time frame for transplanting organs? Donor Alliance. Retrieved April 21, 2023, from https://www.donoralliance.org/newsroom/donation-essentials/what-is-the-time-frame-for-transplanting-organs/.The Bridge to Transplant Team, The Child and Family Information Group. (2017, July). Berlin Heart Mechanical Heart Assist. NHS choices. Retrieved April 21, 2023, from https://www.gosh.nhs.uk/conditions-and-treatments/procedures-and-treatments/berlin-heart-mechanical-heart-assist/.Royalty-free music used for this episode: "Tempting Tango." Downloaded on October 13, 2022, from https://www.videvo.net/

About Dr. Bardach Reut Bardach, MD, FACOG, is a board-certified OB-GYN at Orange Blossom Women's Group in Trinity, Florida. In addition to healthy and high-risk pregnancy and routine gynecology care, Dr. Bardach specializes in advanced, robotic-assisted gynecological surgery. Her goal is to provide the best care possible in a timely and reasonable manner. She makes sure the patient's needs come first, and she strives to provide the best service to obtain the utmost in patient satisfaction. Dr. Bardach earned her undergraduate degree at the University of Central Florida, in Florida, in 2000. She then went on to earn her graduate degree at the American University of the Caribbean School of Medicine, in Coral Gables, Florida, in 2008. Following graduation, she completed a residency at St. John Hospital and Medical Center. To better serve her patients, Dr. Bardach is fluent in English, Hebrew, and Spanish. She looks forward to meeting new patients and ensuring they receive the best gynecological care possible. Learn more https://www.orangeblossomwomensgroup.com/ ----------------------- Dr. Sharon Mclaughlin is board certified plastic surgeon. She is founder of the Female Physician Entrepreneurs Network and Business Program where she empowers women physicians by helping them turn their idea into profitable businesses so that they can have the freedom to live their best life. She is also the founder of Mind Lull, which helps others slow down by providing tools and journals which help small business owners improve their focus and have more fulfillment. Her latest book, Thriving After Burnout, is a compilation of stories from women physicians who share tips and strategies on what helped them during burnout. Thriving After Burnout https://amzn.to/3XAhfd3 You can find Dr Mclaughlin's planners here https://amzn.to/3MnMhPK Her website https://sharonmackconsuting,.com You can reach her at smclaughlinmdfacs@yahoo.com For women physicians https://fpestrong.com Social Media Instagram https://www.instagram.com/sharonmclaughlinmd/ Tik Tok https://www.tiktok.com/@smclaughlinmd Linkedin https://www.linkedin.com/in/sharonmclaughlinmd/ Facebook Female Physician Entrepreneurs Group https://www.facebook.com/groups/FemalePhysicianEntrepreneurs #womenphysician #physicianmotivation #physiciansuccess #physicianmom #timemanagement #physicianentrepreneur #privatepractice #ob/gyn

About Dr. Bardach Reut Bardach, MD, FACOG, is a board-certified OB-GYN at Orange Blossom Women's Group in Trinity, Florida. In addition to healthy and high-risk pregnancy and routine gynecology care, Dr. Bardach specializes in advanced, robotic-assisted gynecological surgery. Her goal is to provide the best care possible in a timely and reasonable manner. She makes sure the patient's needs come first, and she strives to provide the best service to obtain the utmost in patient satisfaction. Dr. Bardach earned her undergraduate degree at the University of Central Florida, in Florida, in 2000. She then went on to earn her graduate degree at the American University of the Caribbean School of Medicine, in Coral Gables, Florida, in 2008. Following graduation, she completed a residency at St. John Hospital and Medical Center. To better serve her patients, Dr. Bardach is fluent in English, Hebrew, and Spanish. She looks forward to meeting new patients and ensuring they receive the best gynecological care possible. Learn more https://www.orangeblossomwomensgroup.com/ ----------------------- Dr. Sharon Mclaughlin is board certified plastic surgeon. She is founder of the Female Physician Entrepreneurs Network and Business Program where she empowers women physicians by helping them turn their idea into profitable businesses so that they can have the freedom to live their best life. She is also the founder of Mind Lull, which helps others slow down by providing tools and journals which help small business owners improve their focus and have more fulfillment. Her latest book, Thriving After Burnout, is a compilation of stories from women physicians who share tips and strategies on what helped them during burnout. Thriving After Burnout https://amzn.to/3XAhfd3 You can find Dr Mclaughlin's planners here https://amzn.to/3MnMhPK Her website https://sharonmackconsuting,.com You can reach her at smclaughlinmdfacs@yahoo.com For women physicians https://fpestrong.com Social Media Instagram https://www.instagram.com/sharonmclaughlinmd/ Tik Tok https://www.tiktok.com/@smclaughlinmd Linkedin https://www.linkedin.com/in/sharonmclaughlinmd/ Facebook Female Physician Entrepreneurs Group https://www.facebook.com/groups/FemalePhysicianEntrepreneurs #womenphysician #physicianmotivation #physiciansuccess #physicianmom #timemanagement #physicianentrepreneur #privatepractice #ob/gyn

Episode 126: Caffeine and AKI.  January 20, 2023. Olivia and Janelli explain that caffeine intake during pregnancy may cause short height in babies, and Anthony discusses the definition, evaluation, and management of AKI with Dr. Kooner. Introduction: Caffeine consumption during pregnancy. Written by Olivia Weller, MS3, American University of the Caribbean School of Medicine; and Janelli Mendoza, MS3, Ross University School of Medicine.Current Guidelines about caffeine during pregnancy: The American College of Obstetricians and Gynecologists (ACOG) current recommendations are to limit caffeine consumption during pregnancy to 200 mg of caffeine per day. Anything exceeding a moderate level of caffeine intake has been linked to an increased risk for preterm birth and miscarriage. [8 oz of brewed coffee has approximately 137mg of caffeine. Other drinks and foods contain caffeine: Brewed tea 48mg; Decaf coffee (12 oz), 9-15 mg; caffeinated soft drink (12 oz) 37mg, Dark chocolate (1.45 oz) 30mg] New Evidence: More recent data disclosed that moderate levels of caffeine consumed during pregnancy led to newborns being small for gestation age (SGA). This information was taken further, and scientists began to monitor these children as they aged. Researchers studied newborns born to mothers who consumed zero caffeine during pregnancy versus women who consumed moderate levels of caffeine. They tracked height, weight, BMI, and obesity risk but only found statistical differences in height. So far, they have only investigated children up to the age of 8 and found that the variance in height increased as the children got older. Therefore, even consuming a moderate level of caffeine during pregnancy can have lasting effects on a child's height, which likely persists into adulthood. Some professionals are now saying there may be no amount of caffeine that is safe to consume during pregnancy. American Family Physician Journal, 2009: “Caffeine intake is directly correlated with small but notable fetal growth restriction. Although a safe threshold cannot be determined, maternal caffeine intake of less than 100 mg per day minimizes the risk of fetal growth restriction.”Why does smaller birth size matter? Caffeine crosses the placenta and acts as a vasoconstrictor which reduces the blood supply to the fetus and thus hinders proper growth. It is a sympathomimetic agent that can affect fetal stress hormones and increase the risk for rapid weight gain after birth. Although height is not a pressing issue, children are potentially more susceptible to increased risk for certain conditions later in life, such as obesity, heart disease, and diabetes. More research is needed on this front to make the conclusion that these differences do in fact persist into adulthood and lead to adverse health outcomes. Conclusions and limitations. Pregnant women and children remain as a group with the least amount of research due to the potential adverse life outcomes. For this reason, the studies that have been done on caffeine consumption during pregnancy are comprised of self-reported data. Due to the association between high caffeine consumption and smoking, it is difficult to distinguish the two. Therefore, there is no clear cause-and-effect relationship between caffeine and intrauterine growth restriction (IUGR), leading to shorter stature later in life. However, the potential adverse health outcomes outweigh the psychological benefits of caffeine during the gestational period. If mothers can give up alcohol, drugs, smoking, raw fish, and so much more during pregnancy, why not caffeine too? With the emergence of this new information, perhaps it is time for a review of those guidelines. Welcome: You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Acute Kidney Injury. January 20, 2023. Written by Anthony Floresca, MS4, American University of the Caribbean School of Medicine; edited by Hector Arreaza, MD; recording done with Gagan Kooner, MD.Definition of Acute Kidney Injury (AKI): Acute kidney injury is a clinically relevant disease process that often occurs during hospitalizations but can also occur as a result of pre-existing diseases such as diabetes mellitus, hypertension, and congestive heart failure, usually referred to as “AKI on CKD,” i.e., acute kidney injury can present as a worsening of renal function in a patient who already has decreased renal function at baseline. AKI is defined as a sudden onset decrease in renal function that can be diagnosed as early as 6 hours from disease onset. To diagnose AKI, specific parameters to consider are creatinine and urine output. Kidney Disease: Improving Global Outcomes or KDIGO established criteria in 2012 for diagnosing AKI:An increase in serum creatinine of ≥ 0.3 mg/dL within 48 hours, [for example, a serum creatinine increasing from 1.3 (baseline) to 1.6]An increase in serum creatinine ≥ 1.5 times baseline within the past week, [for example, an increase in serum creatinine from 1.3 (baseline) to 1.95]A decrease in urine output < 0.5 mL/kg/hr within 6 hours, [for example, a man who weighs 70 kg and is urinating less than 35mL of urine per hour]Classification:The severity of AKI is defined under the 2012 KDIGO guidelines: Stage ICreatinine 1.5-1.9 times greater than baseline or  ≥ 0.3 mg/dL increase in serum creatinine.Urine volume < 0.5 mL/kg/hr for ≥ 6-12 hoursStage IICreatinine 1.5-1.9 times greater than baseline or  ≥ 0.3 mg/dL increase in serum creatinine.Urine volume < 0.5 mL/kg/hr for ≥ 6-12 hoursStage IIICreatinine 3 times higher than baseline OR ≥ 4.0 mg/dL increase in serum creatinine(Kooner: For example, if a creatinine at baseline is 0.8 and it increases to 2.4, it is stage III)Anthony: Yes, it is stage III if the patient initiates renal replacement therapy (hemodialysis), OR a decrease in GFR to < 35 mL/min per 1.73 m^2 in patients

On today's show we discuss Stephen Soloway's new book “Medical Politics: How to Protect Yourself from Bad Doctors, Insurance Companies, and Big Government”. GUEST OVERVIEW: Originally from New York City, Dr. Stephen Soloway completed undergraduate studies at Stony Brook University. He attended the American University of the Caribbean School of Medicine, Montserrat, British West Indies, London, England, Boston, MA, and Omaha, NE, with postgraduate training at Mercy Catholic Medical Center, Misericordia Hospital Division (both in Philadelphia), Medical College of Pennsylvania, Philadelphia Veterans Administration Medical Center, St. Christopher's Hospital for Children. GUEST WEBSITE: https://www.badmedicinebook.net/ 

Episode 104: What is Monkeypox. Monkeypox is a rare disease caused by the monkeypox virus that belongs to the orthopoxvirus (smallpox) family. Nabhan, Dr. Schlaerth, and Dr. Arreaza discuss the basics of what is known about this disease. Introduction: Monkeypox By Hector Arreaza, MD. As of June 29, 2022, there are 5,115 confirmed cases of monkeypox in the world. The country with the most cases is the United Kingdom with >1,000 cases. In the United States, there are 351 confirmed cases, distributed in 28 states, and the state with the highest number of cases is California with 80 cases. Today we will briefly discuss the history, epidemiology, transmission, and management of monkeypox. By the way, by the time you listen to this episode, this disease may have a different name, as the World Health Organization is planning to rename it to minimize stigma and racism. Monkeypox is still rare, but because of the current outbreak, we need to include it in our list of differentials when we see rashes. Symptoms of monkeypox can include fever, chills, headache, myalgias, lymphadenopathies, and general malaise. The rash resembles pimples or blisters that appear on the face, inside the mouth, and on other parts of the body, like the hands, feet, chest, genitals, or anus. The rash goes through different stages before healing completely. The illness typically lasts 2-4 weeks. Monkeypox spreads by direct or indirect contact with rash, respiratory secretions, and vertical transmission from mother to fetus. Sometimes, people get a rash first, followed by other symptoms. Others only experience a rash. Currently, there is not a formal treatment for the disease. The information will continue to evolve in the future. This is the Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.___________________________What is monkeypox. By Nabhan Kamal, MS3, American University of the Caribbean School of Medicine. Comments by Katherine Schlaerth. Moderated by Hector Arreaza, MD. Background.Monkeypox is a viral zoonotic infection that results in a rash similar to smallpox. It is estimated that humans have been infected by the monkeypox virus for centuries in sub-Saharan Africa. Monkeypox is an orthopoxvirus that was first isolated in the decade of 1950s from a colony of sick monkeys. The variola virus and the vaccinia virus are in the same genus as the monkeypox virus. Variola is the smallpox virus, and vaccinia is the virus in the smallpox vaccine. The virion that has been seen in cells infected with the monkeypox virus looks exactly the same as the virions of variola or vaccinia viruses. It has a characteristic brick-like appearance.  The two strains of monkeypox identified in different regions of Africa are Central Africa and Western Africa. It seems like the strain of Western Africa is less virulent and lacks a number of genes present in the Central African strain. Transition to talking about Epidemiology Why is understanding the epidemiology of monkeypox important? I think it's important to touch on the epidemiology of the virus because it will help healthcare providers better understand the disease and have a more productive discussion with their patients about this illness if they, unfortunately, happen to fall victim to it.  Epidemiology In the 70s, the first time monkeypox was identified as a cause of disease in humans. It happened in the Democratic Republic of the Congo (formerly the Republic of Zaire). After that, only 59 cases of human monkeypox were identified in the decade between 1970 and 1980, with a mortality rate of 17%. All of these cases occurred in the rain forests of Western and Central Africa. These cases occurred in people exposed to rodents, squirrels, and monkeys. An important fact to note is that despite the virus being called “monkeypox”, monkeys and humans are incidental hosts; the reservoir remains unknown but is likely to be rodents. Despite the current common belief that this is the first outbreak of monkeypox in the US, the actual first outbreak of monkeypox in the Western Hemisphere occurred in the United States in 2003.  Transition to talking about Transmission Is the monkeypox virus extremely virulent and transmissible just like SARS COV-2? All people born after 1972 have not been vaccinated against smallpox. Routine vaccination of the American public against smallpox stopped in 1972 after smallpox was eradicated in the United States. The virus can spread between animals and humans, just like COVID-19 is believed to be. Transmission Animal-to-human transmission – A person gets infected by monkeypox by contact with body fluids coming from an infected animal or through a bite. Monkeypox infection has been found in many types of animals in Africa, including rope squirrels, tree squirrels, Gambian poached rats, dormice, and different species of monkeys. Human-to-human transmission – In general, humans get infected from other humans through large respiratory droplets, which are produced during cough or sneezing. Also, a person can get infected by close contact with infectious skin lesions and particles or from sexual contact with skin lesions. Currently, transmission from person-to-person is very low. An outbreak of monkeypox was reported in May 2022 in non-endemic countries with over 90 confirmed cases. Non-endemic countries are all countries outside of Central and Western Africa. However, in this new outbreak, it appears that close contact with infectious skin lesions during sexual contact may be the most likely mode of transmission based on the majority of initial cases in Europe being recorded amongst men who have sex with men.  As of this recording on June 8, 2022, there are a total of 1088 cases in 29 countries. The UK leads the world with 302 confirmed cases while the US only has 34 confirmed cases.  Incubation periodThe classic incubation period of monkeypox virus infection is usually from 6 to 13 days but can range from 5 to 21 days. Important to note, however, is that persons with a history of an animal bite or scratch may have a shorter incubation period than those with tactile exposures (9 versus 13 days, respectively). So, the infection shows up earlier in people who get an animal bite or scratch. Management Most patients with monkeypox will have mild disease and recover without medical intervention. For patients who are symptomatic, most of them will not require hospitalization. Unlike chickenpox, the vesicular rash caused by monkeypox occurs all at once rather than new lesions appearing as old ones start to crust over and heal. Antivirals: In some rare cases, antiviral medications can be used for patients that become severely ill as a result of being immunocompromised from HIV, various cancers, organ transplant recipients, etc. The antiviral drug of choice is Tecovirimat. It's a potent inhibitor of an orthopoxvirus protein required for dissemination within an infected host. This medication protects nonhuman primates from lethal monkeypox virus infections and is also likely to be efficacious against infection in humans. It's interesting that these medications have been approved for smallpox treatment.  In patients that have severe disease, dual therapy with Tecovirimat and Cidofovir is recommended. It has in vitro activity against monkeypox and has been shown to be effective against lethal monkeypox in animal models. However, there isn't any clinical data regarding Cidofovir's efficacy against monkeypox infection in humans specifically, and it also has significant side effects including nephrotoxicity. In June 2021, brincidofovir was approved for use in the US for the treatment of smallpox. Brincidofovir is an analog of cidofovir (meaning that it is almost the same with some small tweaks) that can be given orally. Given how new it is, however, its clinical availability is uncertain at this time. ____________________________Conclusion: Now we conclude our episode number 104 “What is Monkeypox.” Monkeypox is a developing story and we have presented information that may become obsolete in the future. For now, remember to rule out monkeypox in your patients who are highly suspicious to have it, for example, patients with STI-related rashes or with a viral illness followed by a papular rash. Even without trying, every night you go to bed being a little wiser.This week we thank Hector Arreaza, Katherine Schlaerth, Nabhan Kamal, and Lillian Petersen.Thanks for listening to Rio Bravo qWeek Podcast. If you have any feedback, contact us by email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. Audio edition: Suraj Amrutia. See you next week! _____________________References:Centers for Disease Control and Prevention, CDC.gov, https://www.cdc.gov/poxvirus/monkeypox/, accessed on June 30, 2022.  Muller, Madison, WHO Will Rename Monkeypox Virus to Minimize Stigma and Racism, TIME, June 14, 2022. Isaacs, Stuart, MD, Monkeypox, UpToDate, https://www.uptodate.com/contents/monkeypox, accessed on Jun 06, 2022. 

In this episode, we will talk about our sister school American University of the Caribbean School of Medicine. AUC's mission is to train tomorrow's physicians, whose service to their communities and their patients is enhanced by international learning experiences, a diverse learning community, and an emphasis on social accountability and engagement.

Dr. Kay-Anne Darlington is an assistant professor of Communication at the University of Rio Grande, where she was recently selected as the winner of the 2020-2021 Edwin A. Jones Excellence in Teaching Award. She received her Bachelor's degree in Media and Communication from the Caribbean School of Media and Communication (CARIMAC) at the University of the West Indies in Kingston, Jamaica; her MA in International Studies and her Ph.D. in Mass Communication from Ohio University where she also completed the Women's Gender and Sexuality Studies (WGSS) graduate certificate. Prior to graduate school, she worked throughout the Caribbean on social development projects that addressed HIV workplace policy implementation, teenage pregnancy, parenting, and early childhood development. In this episode, Dr. Darlington is going to share tips to financial wellness and career planning as international students.

In this episode, SZV welcomes Dr. Humphrey, Assistant Dean of Community Engagement at AUC, to share more about their program, where students are provided practical experience through community engagement activities on Sint Maarten. Charonne and Parveen also take a moment to reflect on the year 2021, where data management and employee wellness were focus areas for SZV, amidst the ongoing pandemic.  This episode of Me & SZV featured SZV hosts: Charonne Holder & Parveen Boertje.Guest: Dr. Natalie Humphrey, Ph.D., CEAP from the American University of the Caribbean School of Medicine (AUC)For more information about SZV: www.szv.sx    Follow us!LinkedIN: https://www.linkedin.com/company/social-&-health-insurances-szvFacebook: https://www.facebook.com/SZV.orgYouTube: https://www.youtube.com/channel/UCeE1fPIDAmA0qzHJ6oOUFWwContact us: info@szv.sx  

By the numbers, a solid percentage of you are listening to this 29th episode of Back Talk Doc on your mobile device or in front of your computer. You may be hunched over peeping at the show notes on the screen, a noticeable strain rippling down your back. Whether you’re experiencing back or neck pain as you’re reading these words, this episode is here to help. On today's episode of Back Talk Doc, our host Dr. Sanjiv Lakhia is accompanied by Dr. Sameer Vemuri, a partner at Carolina Neurosurgery and Spine Associates. Dr. Vemuri works at the Ballantyne and Mathews offices. Board-certified in physical medicine and rehabilitation, Dr. Vermuri received his medical training at the American University of the Caribbean School of Medicine, then went on to intern at Providence Hospital and Medical Center in Michigan. (2:27) Dr. Lakhia and Dr. Vemuri discuss the burden of spine care in the United States. Both men care for a tremendous number of patients suffering from neck and back pain, with many patients suffering from both. Dr. Vemuri reveals four common factors leading to back pain: (1) genetics, (2) day-to-day stresses, (3) acute injuries, and (4) a big factor both doctors see: the use and overuse of technology devices. (8:59) "Technology and our phones and our devices has really taken over our life and forced all of us to be looking down constantly and promoting somewhat of a rounded posture." (9:31) Dr. Vemuri explains that these postures place strain on the structural cervical spine in the neck region. "Eventually, you're going to have some changes in the structural anatomy of that spine, and afterwards, you're going to have more chances of irritation of some of these nerves that come through that spinal area." (10:27)   More topics discussed on this episode include: Providing patients with realistic expectations during the healing process (23:43) The importance of mind-body connections when discussing back and neck pains. (26:36) When a headache is more than just a headache: how to know when back and neck problems are leading to headaches. (31:36)   For more information on Dr. Sanjiv Lakhia and the podcast visit BackTalkDoc.com. Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.

Listen Up Premeds! Julio Sierra is the Associate Director of Admissions for the Northeastern US and Puerto Rico for American University of Caribbean School of Medicine (AUC)

Lisa Lewis, MD and author of Feed the Baby Hummus, joins Carla Marie Manly, PhD for this week's podcast! https://www.familius.com/book/feed-the-baby-hummus/ ABOUT LISA: A practicing pediatrician for twenty years, Dr. Lisa Lewis currently serves the Fort Worth community at Kid Care Pediatrics. She has traveled the world extensively experiencing medical and parenting philosophies in various countries. In 2016 and 2017, Fort Worth Child magazine gave her a Mom-Approved Pediatrician designation based on patient votes. In addition to her pediatric practice, Dr. Lewis contributes to various blogs and websites including Bloggy Moms and the website for New Parent Magazine. She is an active member of and contributor to Multicultural Kid Blogs, where readers from all over the world convene to share multicultural parenting information. She also reaches out to hundreds of followers via Facebook and via her website, lisalewismd.com. Dr. Lewis is an international medical graduate, attending medical school at the American University of the Caribbean School of Medicine. During her third and fourth years of medical studies, she performed her clinical rotations at London Hospital Medical College in England, where she received clinical honors. She completed her pediatric residency at Texas A & M University Health Science Center, Scott and White Memorial Hospital, in Temple, Texas. While at Texas A & M University Health Science Center, she also served as chief resident. She then stayed on staff for two years, as assistant professor in the Department of Pediatrics. She left academia in 1998 to take care of children in a primary care setting. Dr. Lewis is board-certified in pediatrics by the American Board of Pediatrics and a Fellow of the American Academy of Pediatrics. An active member of the Writers's League of Texas, her writing focuses on helping families enjoy cultured, healthy futures. ABOUT THE BOOK: Parenting practices vary widely between countries and cultures. For example, in countries such as the Philippines, breastfeeding after age one year is common, and parents can make their own decision about what is right for their family. In Korea, babies eat a variety of spices and flavors, helping them develop a diverse palate and healthy eating habits.  And in Italy, parents prevent separation anxiety by taking their babies to markets, restaurants, and churches and passing them around from person to person. Feed the Baby Hummus teaches parents to confidently incorporate various multicultural practices into their own caretaking plan. Pediatrician Lisa Lewis offers the wisdom and proven caretaking practices of the cultures of the world, drawn from her own training, research, travel, and clinical experience. Although certain standards of care must exist for babies to thrive and be happy, Feed the Baby Hummus offers a variety of cross-cultural parenting information and baby care guidance from a trusted source.     

Shelly-Anne Tulia Scot, AIA and Shani Chambers, AIA are both graduated from the Caribbean School of Architecture and graduated from Florida A&M University. In this episode, they share their Caribbean experiences, culture shock and racism. Become an insider by supporting the show at https://glow.fm/archispolly where you can support the show on a recurring or one-time basis! Shani Chambers is a Virginia based architect with over 15 years' experience in the planning, design and construction industry. Her specialties include Federal, Public Safety and Industrial Architecture. She excels at the integration of complex processes and user needs into high performance design. She also enjoys dabbling in weaving for lessons in architecture. Ms. Chambers graduated from Florid A&M University and The Caribbean School of Architecture University of Technology, Jamaica. Shelly-Anne Tulia Scott is the Director of Architecture at Sizemore Group in Atlanta GA. She is a Trinidadian born architect who started her architectural education at the Caribbean School of Architecture after completing an Associate of Arts degree in Interior Design. She worked both in Miami, Trinidad & Barbados before returning to do complete her M. Arch degree at Florida A&M University. She has seventeen years combined experience in Architecture and Interior Design with a broad range of experience in Award winning Libraries, Mixed Use Development, Religious, and Academic Buildings as well as in Feasibility Studies and Concept Design Projects. As an added bonus to her creative flare she is also a photographer with an eye for unique perspectives in the building environment and in the emotions of people. See some of her photography work here (http://tuliascott.com). She is also active with community and professional groups like USGBC Equity Committee, AIS HSDC, NOMA, Globalbike, Southern Scholarship Foundation Alumni and a graduate of the Leadership Greenville Class 42 and 2017 Greenville Dreams Grassroots Development Program with training in community leadership and leveraging community assets.

In this episode we speak with Dr. Lenny Cohen about his use of integrative therapies for promoting brain health. Dr. Cohen is a top-ranked, award-winning neurologist who leads the practice at Chicago Neurological Services in Chicago and Oak Park, Illinois. Dr. Cohen is an expert physician who has spent more than a decade committed to personalized care that helps each of his Chicagoland patients understand their condition, feel their best, and live each day comfortably. He offers the latest technology for treatment and stays up to date with the latest research. Dr. Cohen started his medical education in Russia where he was born and raised. At the age of 20, he moved to New York City to pursue his passion for medicine. He earned his medical degree from the American University of the Caribbean School of Medicine in Saint Maarten. He completed his residency in neurology at Virginia Commonwealth University in Richmond, Virginia, and is a diplomate of the American Board of Psychiatry and Neurology. Since 2007, Dr. Cohen has been on staff at Rush Oak Park Hospital in Oak Park. He is highly respected amongst his peers and patients and in addition to founding Chicago Neurological Services, Dr. Cohen is also the founder of Lakeshore Hyperbaric Center in Chicago. Dr. Cohen’s quality of care has been recognized with numerous honors, including Patients’ Choice and On-Time Doctor awards. Dr. Cohen uses advanced science and a devotion to personalized care to offer men and women a unique approach focused on their long-term health and well-being. His focus is merging traditional medicine with alternative therapy. He’s fluent in Russian, as well as English, and welcomes new patients to Chicago Neurological Services. Dr. Cohen recently released an e-book titled Modern Brain Longevity: Understanding Brain Health in a Complex World where he explores brain wellness and provides an overview of the various treatments that have helped his patients live optimal lives. Learning Points: 1. How does oxidative stress promote aging? 2. What are some novel therapies being used to promote brain health? 3. What is physical therapy for our brain? Social Media: https://www.chicagoneurodoc.com/

Back in the day, being computer literate was a specifically highlighted skill or requirement in job descriptions for a broad range of positions. Now, the requirement is digital literacy. David Soutar, of the Slashroots Foundation, and of the Caribbean School of Data (CSOD) discusses digital literacy: What it is, and why it is important How it is different from computer literacy The digital/data literacy programme offered by the CSOD; and How CSOD might evolve within the context of the future of work.   Show notes and links to some of the things mentioned during the episode can be found at www.ict-pulse.com/category/podcast/ Do subscribe and leave us a review!

There’s nothing like folklore and superstition as a true cultural snapshot. For episode 20  of #MikesMomentOf my special guest is Journalist and Cultural Icon, Fae Ellington @fae.ellington .This was truly a blast and I’m sure there will be a sequel. #Jamaica #Myths #Superstitions #Folklore #Proverbs Fae A. Ellington (Ms.) CD; MA.  Born in the 50s; shaped by the 60s; fired and glazed throughout the 70s. With that background the ensuing decades took care of themselves.  She’s a patriot and passionate about Jamaica. Fae Ellington’s career in Broadcast Media and Journalism started in 1974, that was three years after she established herself as an actress. Since 1971 she has put her stamp of excellence and professionalism, and demonstrated her versatility through her work in theatre, media and culture. As a sought-after orator and master of ceremonies at home and abroad, she has established herself as a household name in Jamaica and the diaspora for over four decades.  Fae is a communication consultant, trainer and speaking coach for companies, groups and individuals in the public and private sectors. She holds a Master of Arts degree in Communication Studies from the University of the West Indies, Mona. She has taught in the Journalism programme at the Caribbean School of Media and Communication (CARIMAC) from 1985 until retirement in 2018 (33 years). After retiring at the end of July 2018 she continues at CARIMAC as adjunct senior lecturer.  She is a British Broadcasting Corporation, (BBC) certified trainer. Miss Ellington has been a director of several boards over the past 25 years. At present she serves on the following boards and entities:  • National Integrity Action (NIA) Chairman (May 28, 2020) • St. Hugh’s High School    • Member of the Access to Information Appeal Tribunal (in the second 5-year term) • Patron of the Clarendon 4 H Clubs    Profile – Fae assumed the role of host and producer of the Television Jamaica programme on April 1, 2018  Awards and Honours  • Bronze Musgrave Medal  • St. Hugh’s High School Distinguished Past Student  • National Honour – Officer of the Order of Distinction, Commander Class (CD) • Outstanding Contribution to Media and Communication Award 2019 - University of the West Indies Institute for Gender and Development Studies • Culture Icon - Ministry of Education, Youth and Information, Jamaica Day 2020  • Award-winning actor and journalist IG: @fae.ellington Twitter: @FaeEllington Facebook: @FaeAEllington

Episode 13: Treat the Partner(s): EPT The sun rises over the San Joaquin Valley, California, today is May 22, 2020. The COVID 19 pandemic has created a limited access to PPE in many health centers around the nation. Last week, Amazon also prioritized individual physicians for COVID-19 Supplies in providing much needed PPE for private practices. As a result, AAFP members and others working on the front lines of the pandemic have direct access to hundreds of items related to PPE, disinfectants, sanitizing products, diagnostic equipment and other materials. Way to go Amazon! Thank you for your business. Welcome to Rio Bravo qWeek, the podcast of the Rio Bravo Family Medicine Residency Program. We train residents and students to prevent illnesses and bring healing and hope to our community. Our mission: To Seek, Teach and Serve. Sponsored by Clinica Sierra Vista, Providing compassionate and affordable care to patients throughout Kern and Fresno counties since 1971. “Don't let success determine your happiness but instead let your happiness determine your success” –Salah Barhoum What a great quote. When you are happy, you are successful. We can see our happiness as the highest level of our success. Today our guest is a successful man, Joseph Gomes. He is a very entertaining guy with a great sense of humor and very intelligent, he is known by his friends as Joe. Welcome Dr Gomes. 1. Question number 1: Who are you? My name is Dr. Joseph Gomes, I am a father of 2 twin munchkins and R2 in the Rio Bravo Family Medicine Residency program in Bakersfield, CA. I was most recently bestowed the honor of being elected as one of the 3 chief resident physicians for the 2020-2021 academic year, which I am quite excited about. I completed my undergraduate degree, a BS in Biomedical Sciences at CSUS in Sacramento, CA and completed medical school via the American University of the Caribbean School of Medicine. I like playing with my kids and eating cupcakes. 2. Question number 2: What did you learn this week? I think if I were to attempt to list all that I learned, or forgot and was reminded of this past week we would run out of time. However, I am here to talk about a topic that I don’t think gets very much attention and that’s the subject of Expedited Partner Therapy, or EPT for short. I was exposed to this concept for the first time during my intern year and was shocked that it was something that wasn’t more well-known or discussed in the resident community. EPT Definition EPT is “the clinical practice of treating the sex partners of patients diagnosed with chlamydia or gonorrhea by providing prescriptions or medications to the patient to take to his/her partner without the health care provider first examining the partner.” Patient’s sex partners from the past 60 days should be treated. EPT is for gonorrhea and chlamydia only. How would you write the prescription to treat gonorrhea if the treatment is IM Ceftriaxone? The current recommended treatment for gonorrhea is an IM dose of ceftriaxone AND a single dose of oral azithromycin 1 gram. The CDC recommends using cefixime and azithromycin in EPT. General Guidelines for EPT • Prescribe treatment for gonorrhea and chlamydia under the index patient’s name or their partners’ names. • Prescription should be accompanied by treatment instructions and warnings about taking medications • Gonorrhea health education and counseling • A statement advising that partners seek personal medical evaluation, particularly women with symptoms of PID. • No sexual intercourse for 7 days after treatment (ACOG, 2018) EPT is not recommended for: • MSM (high risk for coexisting infections, especially undiagnosed HIV infection) • Suspected child abuse • Sexual assault • Any other situation when patient safety is compromised • EPT has lower evidence in HSV, scabies, pubic lice, and trichomonas. 3. Question number 3: Why is that knowledge important for you and your patients? Per the Kern County Health Department website, based on published data from 2017, Kern County alone has approximately 1 new STI case per hour, each day. With the vast majority of these cases being Chlamydia, followed by Gonorrhea, Syphilis and lastly HIV. Of note, Hep B data was not published in 2017, but I fully expect its inclusion in the forthcoming publication. And specifically, regarding Chlamydia, Kern County is the 3rd worst in the state, following San Francisco and Alpine counties and as a county has a 38% increased average number of cases compared to other counties in the state. For syphilis, Kern is actually a bit worse. Kern County syphilis rates in 2017 were 333% higher when compared to other counties in the state. More disappointing than that, Kern County had 313% increase in CONGENITAL syphilis cases and ranked the 2nd worst in the state behind Fresno. This is a big deal. Not just in this county, but nation-wide. STI rates continue to climb and this is just one mechanism by which we can help prevent the continued spread of infection.  Why is this important? To prevent what is referred to as the “Ping Pong” effect. The phenomenon in which sexual partners re-infect each other with the same sexually transmitted disease (STD). First, an individual who has the STD infects his or her partner. The partner may then re-infect the individual, after the individual has been cured from that particular STD. This often occurs because individuals and their partners may or may not be aware that they have an STD, since symptoms are not always present. The 3 major players include Gonorrhea, Chlamydia and Trichomoniasis.  EPT is permitted in all 50 states, save for one, South Carolina. Get it together South Carolina! 4. Question number 4: How did you get that knowledge? I prefer self-study and read by myself the topics that interest me. Also, I enjoy watching videos such as the AAFP 2020 Lectures Series for Board Review. 5. Question number 5: Where did that knowledge come from? Websites used: CDC website, Kern County Public Health Website, Z-dogg MD podcast, which I highly recommend, published as Incident Report 197 in 2018. Additional information: Something I did not know is that through the Kern County Public Health department, those who have been diagnosed with an STI can anonymously notify their sexual partner via their website at KernPublicHealth.com (https://dontspreadit.com/). This is a fantastic resource as a myriad of factors contribute to neglecting to notify sexual partners, including, but not limited to undue shame, guilt, hostility and the obvious avoidance of confrontation. The public health department eliminates much of this through their website. Speaking Medical (Medical word of the Week): Fasciculation by Dr Monica Kumar A fasciculation is a small involuntary muscle contraction and relaxation also known as a muscle twitch. Approximately 70 percent of fasciculations are benign in etiology. However, the remaining 30 percent of the cases can be due to hypomagnesemia, benzodiazepine withdrawals, acetylcholinesterase inhibitor use, caffeine use, rabies, and other lower motor neuron disorders such as ALS, poliomyelitis, and spinal muscular atrophies. In order to further evaluate the etiology behind the fasciculations, a thorough neuromuscular examination should be performed. Further evaluation with an electrolyte panel, electromyography, nerve conduction studies, neuromuscular ultrasound, or muscle biopsy can also be performed in determining the cause. If you have a patient with eye twitching, it may be a fasciculation, but it also could be them winking at you. Espanish Por Favor (Spanish Word of the Week): Enfermo by Dr Claudia Carranza The Spanish word of this week is enfermo. Enfermo or enferma means ill/sick in Spanish. This word comes from Latin root “infirmus”, which can be broken down into “in” and “firmus” meaning “not firm”. This is understood as “not standing” or “not well”. Patients can come to you with the complaint: “Doctor, estoy enfermo” or “Doctor, me siento enfermo o enferma”, which means: “Doctor I’m ill, or I feel sick”. At this point, you will know they do not feel well and you can start investigating what’s going on. Now you know the Spanish word of the week, “ENFERMO”. Have a great week! For Your Sanity (Joke of the Week) by Dr Verna Marquez and Dr Steven Saito Teacher: "Kids, what does the chicken give you?" Student: "Meat!" Teacher: "Very good! Now what does the pig give you?" Student: "Bacon!" Teacher: "Great! And what does the fat cow give you?" Student: "Homework!" —What’s the difference between a rectal thermometer and an oral thermometer? —The taste. —Doctor, my ear is ringing, what should I do? —You should answer it! Now we conclude our episode number 13 “Treat the Partner(s): EPT”. For partners who are unlikely to seek medical attention, Cefixime and Azithromycin is the current recommended regimen for gonorrhea; and azithromycin 1-gram single dose is the recommended treatment for chlamydia. This practice is not only permissible, but it is endorsed by the CDC, AAFP, ACOG, and many other organizations. Also, next time a patient winks at you, think of the word fasciculation. If your patient tells you they are enfermos, don’t panic, you are being trained to cure your ill patients. This is the end of Rio Bravo qWeek. We say goodbye from Bakersfield, a special place in the beautiful Central Valley of California, United States, a land where growing is happening everywhere. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. Our podcast team is Hector Arreaza, Claudia Carranza, Monica Kumar, Verna Marquez, and Steven Saito. Audio edition: Suraj Amrutia. See you soon! References:  “Expedited Partner Therapy”, Centers for Disease Control and Prevention, https://www.cdc.gov/std/ept/default.htm, accessed on May 18, 2020.  ACOG Committee Opinion, Number 737, June 2018, https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/06/expedited-partner-therapy, accessed on May 18, 2020.  “Treating an STD Patient’s Partner WITHOUT Seeing Them??”, ZDogg MD, November 5th, 2018, https://zdoggmd.com/incident-report-197/  STDs in Kern County 2017 Data Update, Kern County Public Health Department: https://kernpublichealth.com/wp-content/uploads/STDs-in-Kern-County-update-2017-web.pdf  Anonymous Partner Notification: https://dontspreadit.com/

Today's special guest is one of the most sought after physicians for reference on Coronavirus as an infectious disease team member on the John Hopkins Health Emergency collaboration focusing on COVID-19.  Dr. Adalja is a Senior Scholar at the Johns Hopkins University Center for Health Security. His work is focused on emerging infectious disease, pandemic preparedness, and biosecurity. Dr. Adalja has served on US government panels tasked with developing guidelines for the treatment of plague, botulism, and anthrax in mass casualty settings and the system of care for infectious disease emergencies, and as an external advisor to the New York City Health and Hospital Emergency Management Highly Infectious Disease training program, as well as on a FEMA working group on nuclear disaster recovery. He is currently a member of the Infectious Diseases Society of America’s (IDSA) Precision Medicine working group and is one of their media spokespersons; he previously served on their public health and diagnostics committees. Dr. Adalja is a member of the American College of Emergency Physicians Pennsylvania Chapter’s EMS & Terrorism and Disaster Preparedness Committee as well as the Allegheny County Medical Reserve Corps. He was formerly a member of the National Quality Forum’s Infectious Disease Standing Committee and the US Department of Health and Human Services’ National Disaster Medical System, with which he was deployed to Haiti after the 2010 earthquake; he was also selected for their mobile acute care strike team. Dr. Adalja’s expertise is frequently sought by international and national media. Dr. Adalja is an Associate Editor of the journal Health Security. He was a coeditor of the volume Global Catastrophic Biological Risks, a contributing author for the Handbook of Bioterrorism and Disaster Medicine, the Emergency Medicine CorePendium, Clinical Microbiology Made Ridiculously Simple, UpToDate’s section on biological terrorism, and a NATO volume on bioterrorism. He has also published in such journals as the New England Journal of Medicine, the Journal of Infectious Diseases, Clinical Infectious Diseases, Emerging Infectious Diseases, and the Annals of Emergency Medicine. Dr. Adalja is a Fellow of the Infectious Diseases Society of America, the American College of Physicians, and the American College of Emergency Physicians. He is a member of various medical societies, including the American Medical Association, the HIV Medicine Association, and the Society of Critical Care Medicine. He is a board-certified physician in internal medicine, emergency medicine, infectious diseases, and critical care medicine. Dr. Adalja completed 2 fellowships at the University of Pittsburgh—one in infectious diseases, for which he served as chief fellow, and one in critical care medicine. He completed a combined residency in internal medicine and emergency medicine at Allegheny General Hospital in Pittsburgh, where he served as chief resident and as a member of the infection control committee. He was a Clinical Assistant Professor at the University of Pittsburgh School of Medicine from 2010 through 2017 and is currently an adjunct assistant professor there. He is a graduate of the American University of the Caribbean School of Medicine, and he obtained a bachelor of science degree in industrial management from Carnegie Mellon University. Dr. Adalja is a native of Butler, Pennsylvania, and actively practices infectious disease, critical care, and emergency medicine in the Pittsburgh metropolitan area, where he also serves on the City of Pittsburgh’s HIV Commission and on the advisory group of AIDS Free Pittsburgh.

In today's headlines- The Division of Human Services embarks on capacity building activities And Students from the Caribbean School of Architecture in Jamaica visit Saint Lucia

In this bonus interview episode of the Saturday Brunch Podcast, R&B vocalist John Skweird, chats about his body of work, and the creative communities that he emerged out of; including Youth Pulse choir, the stomping ground of several other brilliant artists in the late 1990s. Speaking honestly on finding his place in the local music scene and the challenges therein, the St. Barbs native considers experimentation with calypso, his love for hip hop music and the social impact of the 1990 attempted coup on his community environment.   Eagerly returning as principal to the dance school she was trained at, Bridgette Wilson of the Caribbean School of Dance speaks on her work as a choreographer, her involvement in shaping the movement magic of The Lost Tribe Carnival band and her musings as educator transforming young lives. Both artists describe their relationship to music during childhood and how it has framed both their memory and realities.   Catch the Saturday Brunch radio show live from 9am-1pm every Saturday with DJ Rawkus on Talk City 91.1 fm.

In this full episode of "Exploring Minds", Amesh Adalja provides his professional insight on a range of topics from infectious diseases, pandemics, epidemics, endemics, vaccines, and the threat of bio-terrorism. - Dr. Adalja, a Senior Scholar at the Johns Hopkins Center for Health Security, was named one of STAT's "13 Clinicians to Follow on Twitter and in 2015 named one of 5 "Pennsylvanians to Watch" by the Pittsburgh Tribune Review. Dr. Adalja is currently a member of the Infectious Diseases Society of America’s (IDSA) Precision Medicine working group, as well as one of their media spokespersons; he previously served on their public health and diagnostics committees. He is also a member of the American College of Emergency Physicians Pennsylvania Chapter’s EMS & Terrorism and Disaster Preparedness Committee as well as the Allegheny County Medical Reserve Corps. He was formerly a member of the National Quality Forum’s Infectious Disease Standing Committee, where he currently is an expert reviewer, and the US Department of Health and Human Services’ National Disaster Medical System, with which he was deployed to Haiti after the 2010 earthquake; he was also selected for their mobile acute care strike team. He has served on US government panels tasked with developing guidelines for the treatment of botulism and anthrax in mass casualty settings, the system of care for infectious disease emergencies, and as an external advisor to New York City Health and Hospital Emergency Management Highly Infectious Disease training program, as well as on a FEMA working group on nuclear disaster recovery. Dr. Adalja is an Associate Editor of the journal Health Security. He was a contributing author for the Handbook of Bioterrorism and Disaster Medicine and is also a contributing author to the upcoming edition of Clinical Microbiology Made Ridiculously Simple. He has published in such journals as the New England Journal of Medicine, the Journal of Infectious Diseases, Clinical Infectious Diseases, Emerging Infectious Diseases, and the Annals of Emergency Medicine. Dr. Adalja is a Fellow of the Infectious Diseases Society of America, the American College of Physicians, and the American College of Emergency Physicians. He is a member of various medical societies, including the American Medical Association, the HIV Medicine Association, and the Society of Critical Care Medicine.. Dr. Adalja completed 2 fellowships at the University of Pittsburgh—one in infectious diseases, for which he served as chief fellow, and one in critical care medicine. He completed a combined residency in internal medicine and emergency medicine at Allegheny General Hospital in Pittsburgh, where he served as chief resident and as a member of the infection control committee. He was a Clinical Assistant Professor at the University of Pittsburgh School of Medicine from 2010 through 2017. He is a graduate of the American University of the Caribbean School of Medicine, and he obtained a bachelor of science degree in industrial management from Carnegie Mellon University. Dr. Adalja is a native of Butler, Pennsylvania, and actively practices infectious disease, critical care, and emergency medicine in the Pittsburgh metropolitan area, where he also serves on the City of Pittsburgh’s HIV Commission and on the advisory group of AIDS Free Pittsburgh. - SUPPORT US ON PATREON: https://www.patreon.com/exploringmindsshow FOLLOW ALONG FOR UPDATES AND NEW EPISODES: Discord - https://discord.gg/YhaAcN3 Facebook - https://www.facebook.com/exploringmindsshow Twitter - https://twitter.com/ExploreMinds_TV Instagram - https://www.instagram.com/exploreminds_tv/ Website - exploringminds.show — Exploring Minds with Michele Carroll is the online show committed to exploring the world beyond talking points. Thank you for listening! Support the show.

Dr. Hure is a Caribbean medical school grad who went on to complete a Derm residency in the US. Here her advice for those thinking about offshore med schools. Links: Full Episode Blog Post Specialty Stories podcast episode 1 PMY episode 51: The Journey to a Caribbean School

Session 48 In today's episode, Ryan sheds light on a question related to getting into a US-based medical school when you previously went to a Caribbean school, failed the first semester, and then dropped out. What are the chances? Your questions, answered here on the OldPreMeds Podcast. Ryan and Rich again dive into the forums over at OldPreMeds.org where they pull a question and deliver the answers right on to you. Sign up for an account to join the collaborative community of students. OldPreMeds Question of the Week: Poster applied to medical school after completing an MPH and didn't get into any US medical school. He then decided to forego reapplication and went to a Caribbean medical school; didn't pass the first semester and had to repeat the entire first semester but thinking through, found that they're not in a conducive environment for studying plus residency chances in the US wouldn't be great. So poster bailed and decided to work harder, get smarter, and reapply in the US. Is it worth taking a chance and reapply to medical schools? What else can be done and how can you address the fact that you started medical school and then dropped out? Here are the insights from Ryan and Rich: How MPH is viewed by medical schools: MPH isn't that strong of a masters degree to hold a lot of water for medical schools Why students go to Caribbean medical schools and then eventually decide to drop out: Offshore schools are attractive to students being publicly traded companies. Offshore medical schools have reasonably decent and rigorous medical education programs that people are not prepared for that. Some questions to consider: Is it worth the expense of going through a Special Master's Program (SMP) at this point? Can you take higher level biomedical courses (high level undergraduate or beginning graduate courses) not for the degree but just to show them you can do well? How to discuss your case of dropping out: Getting allured in your desire to be a doctor and not thinking, you rushed in. Then you realized for many reasons that it was not going to be an environment that you were going to do well in and look well for the future. In short, you just have to lay it all out there. Don't try to hide something you can't hide or even try to minimize it. Should you discuss this in your personal statement? Make your medical school application a coherent, concise, and compelling narrative showing your motivation, commitment, and achievement to become a doctor. This is a glaring red flag that you HAVE to discuss in a paragraph in your personal statement on the primary. What are your chances? Your chances are low but that doesn't mean you don't stand any chance. You can't change your past but you have to go with the best you can. So many schools are now giving completely unscreened secondaries so you have more of a chance to develop it and discuss it in words. Advocate for yourself. Build those relationships with people that can open some doors for you. Links and Other Resources: Check out The Premed Years Podcast at www.medicalschoolhq.net.