Podcasts about Concomitant

As our understanding of canine osteoarthritis deepens and treatment options continue to expand, there's never been a better opportunity to refine how we approach this disease in practice. In this episode of the Partner Podcast, Dr. Beth invites Dr. Monica Tarantino to explore what's actually happening in the arthritic joint, why inflammation deserves its own place in the treatment conversation, and how she navigates anti-inflammatory options in her senior patients. Sponsored by Elanco Indication Galliprant controls pain and inflammation associated with osteoarthritis in dogs.Important Safety Information For use in dogs only. Keep this and all medications out of reach of children and pets to prevent accidental ingestion or overdose. Galliprant is a non-COX inhibiting NSAID. As a class, NSAIDs may be associated with gastrointestinal, kidney and liver side effects. Evaluation for pre-existing conditions and regular monitoring are recommended. Do not use in dogs that have a hypersensitivity to grapiprant. Concomitant use of Galliprant with other NSAIDs or corticosteroids should be avoided. Concurrent use with other anti-inflammatory drugs or protein-bound drugs has not been studied. The safe use of Galliprant has not been evaluated in dogs younger than 9 months of age and less than 8 lbs (3.6 kg), dogs used for breeding, pregnant or lactating dogs, or dogs with cardiac disease. Owners should be advised to observe for signs of potential drug toxicity. Adverse reactions may include vomiting, diarrhea, decreased appetite, watery or bloody stools, and decreases in serum albumin and total protein. Click here for full prescribing information.  Contact us: Podcast@instinct.vet Where to find us: Website: CliniciansBrief.com/Podcasts YouTube: Youtube.com/@clinicians_brief Facebook: Facebook.com/CliniciansBrief LinkedIn: LinkedIn.com/showcase/CliniciansBrief/ X: @cliniciansbrief Instagram: @clinicians.brief The Team: Beth Molleson, DVM - Host Sarah Pate - Producer & Project Manager, Brief Studio Taylor Argo- Podcast Production & Sound Editing  

Join host Phil Plisky, PT, DSc, ATC, CSCS, as he sits down with Matt Daggett, DO, MBA, a dual fellowship-trained orthopedic surgeon and leading member of the international SANTI research group. Together, they explore the evolving landscape of ACL reconstruction, moving beyond traditional graft debates to discuss the critical role of lateral extra-articular procedures (LEAP) in reducing reinjury rates. You'll gain expert perspective on individualizing graft selection—including the promising rectus tendon autograft—and why addressing the "lateral side" of the knee is essential for long-term stability in high risk athletes. From debunking trends such as the cross-bracing protocol to mastering criteria-based return-to-sport transitions, this conversation provides the practical, evidence-based tools you need to optimize patient outcomes.Learning OutcomesAnalyze the evidence around graft selection for ACL reconstruction and the use of lateral extra-articular procedures (LEAP) to improve rotational stability and reduce graft failureApply evidence-based, practical strategies to actionably address rehabilitation progression, return-to-sport timing, and the management of arthrogenic muscular inhibition (AMI) following ACL reconstructionSolve patient case scenarios involving ACL reconstruction graft selection based on patient demographics, sport-specific demands, and individual risk factorsTimestamps(00:00:00) Welcome(00:00:05) Introduction to ACL reconstruction and graft selection(00:02:18) Diverse perspectives in orthopedic surgery(00:04:20) Types of grafts for ACL reconstruction(00:08:45) Concomitant procedures and lateral knee stability(00:11:19) An overview of LEAP(00:15:25) Understanding combined instabilities in ACL injuries(00:18:44) Consensus statements and recommendations(00:21:48) The evolution of ACL surgery techniques(00:26:26) Cross-bracing protocol: a critical review(00:28:50) Decision-making in surgical procedures(00:32:18) Graft choices: hamstring, quad, and rectus(00:35:05) Rehabilitation perspectives and early activation(00:41:10) Return to sport: psychological readiness and timeframes(00:46:58) Key takeaways and future innovationsRehab and Performance Lab is brought to you by Medbridge. If you'd like to earn continuing education credit for listening to this episode and access bonus takeaway handouts, log in to your Medbridge account and navigate to the course where you'll find accreditation details. If applicable, complete the post-course assessment and survey to be eligible for credit. The takeaway handout on Medbridge gives you the key points mentioned in this episode, along with additional resources you can implement into your practice right away.To hear more episodes of Rehab and Performance Lab, visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.medbridge.com/rehab-and-performance-lab⁠⁠⁠⁠⁠⁠⁠⁠⁠If you'd like to subscribe to Medbridge, visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.medbridge.com/pricing/

A guide to diagnosing, imaging, and managing acute renal colic and nephrolithiasis in the ED. Hosts: Brian Gilberti, MD Avir Mitra, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Nephrolithiasis.mp3 Download Leave a Comment Tags: Kidney Stones, Urology Show Notes 1. CLINICAL CORE & PHYSIOLOGIC FRAMEWORK Epidemiologic Risk Profiles Lifetime incidence parameters hover around 1 in 11, presenting with a prominent male sex skew. Peak demographic manifestation concentrated within the 30–60 age band. High-yield temporal parameter: 50% recurrence vector within a 5-year post-initial-insult window. Mineralogical Composition Vectors Calcium oxalate crystals represent the predominant structural matrix. Struvite configurations (magnesium ammonium phosphate matrix) account for 1–2% of cohorts. Struvite stones function explicitly as infection-driven configurations secondary to upper tract proliferation; higher distribution index noted in female cohorts. Etiological & Modifiable Relational Dynamics Profound systemic dehydration or low baseline fluid throughput states. High-sodium diet structures and heavy animal-protein consumption loads. Positive genetic/familial history variables. Relative risk modulation: Each variable independently operates to expand baseline risk by a factor of 2x to 3x. Pathophysiologic Symptom Complexes Acute, sudden-onset, maximum-intensity (10/10) unilateral flank pain. Classic structural radiation vector tracking downward toward the ipsilateral groin/genitourinary dermatomes. Distinctive behavioral marker: Renal colic pacing/writhing behavior with zero antalgic position availability. Concomitant autonomic triggers: Nausea and emesis manifest in 50% of acute presentations. Physical Exam Discordance Metrics Severe subjective distress contrasted with a characteristically soft, completely non-tender abdominal palpation exam. CVA tenderness is completely variable and lacks reliable negative predictive value. Atypical Presentation Classifications Vague, poorly localized abdominal pain presentations occurring in up to 20% of active cases. Isolated lower urinary tract irritative signs including acute frequency or severe urgency. Incidental & Asymptomatic Dynamics Silent intrarenal or ureteral stones found incidentally. Longitudinal tracking demonstrates up to 33.3% of initially asymptomatic cohorts convert to fully symptomatic renal colic within a multi-year tracking window. 2. EXCLUSION DIAGNOSES & CRITICAL PATHWAY RED FLAGS Vascular Mimics: AAA rupture/expansion. This is a mandatory exclusion pathway in elderly cohorts presenting with acute flank or back pain. Physical tracking requires active exploration for an expansile, pulsatile abdominal mass. Gynecologic Emergencies: Ruptured ectopic pregnancy. Demands universal screening protocols via rapid beta-hCG testing in all female patients of childbearing potential presenting with lower abdominal/pelvic localization. Infectious Upper Tract Decompensation: Acute uncomplicated pyelonephritis. Differentiated via persistent high spikes, high fevers, systemic shaking chills, and profound pyuria. Genitourinary Structural Crises: Acute testicular torsion. Mandates a thorough, explicit scrotal/testicular structural exam if the flank pain radiates into the scrotum. Gastrointestinal and Adnexal Torsional Confounds: Acute appendicitis variants, acute mesenteric/bowel ischemia, and ovarian torsion syndromes. 3. LABORATORY TESTING & PHYSIOLOGIC EVALUATION Urinalysis Interpretation Nuances Microscopic or gross hematuria presents in approximately 66% to 90% of acute cases. Critical Pathological Caveat: Complete absence of hematuria documented in 20% to 33.3% of confirmed, acute obstructing ureteral stones. Diagnostic rule: A pristine urinalysis with zero red blood cells is entirely insufficient to exclude acute ureterolithiasis. Urinary pH as a Composition Clue Consistently low urinary pH parameters (pH < 5.5) point strongly toward a uric acid crystalline composition. Elevated urinary pH parameters (pH > 7.5) indicate the presence of urease-producing microbial pathogens, pointing toward a struvite infection stone. Infectious Screening Metrics Active tracking for marked pyuria, positive leukocyte esterase, and bacterial nitrites to rule out an obstructed, infected upper urinary tract system. BMP Immediate quantification of baseline serum creatinine to establish accurate eGFR values. Targeting detection of post-renal AKI from bilateral obstruction, unilateral obstruction in a single functioning kidney, or severe volume depletion. CBC Evaluation for marked leukocytosis. Physiologic Nuance: Mild-to-moderate white blood cell count elevations frequently represent non-specific stress demargination driven by severe pain and repetitive vomiting. High-grade white blood cell shifts demand immediate exclusion of systemic bacteremia or an infected, obstructed urinary system. Adjunctive Lab Pathways Rapid qualitative urine hCG testing. Reflex urine culture execution whenever urinalysis metrics display significant inflammatory profiles or clinical suspicion of UTI is high. 4. IMAGING MODALITIES & ALGORITHMIC CLINICAL SELECTION Non-Contrast CT Diagnostics Gold standard; diagnostic sensitivity and specificity parameters exceed 95% for stones >2 mm. Provides precise quantification of stone diameter (mm), exact localization (proximal, mid, or distal ureter), and degree of secondary hydronephrosis. Excellent structural visualization for detecting or ruling out alternate retroperitoneal, vascular, or intra-abdominal pathologies. Contrast-Enhanced CT Protocols Indicated when alternative intra-abdominal surgical pathology is highly suspected over isolated renal colic. Retains diagnostic capability to identify urinary tract stones >3 mm even within contrast-enhanced phases. NCCT Structural Architecture Limitations Standard stone protocol CT scans are executed in a prone position without IV contrast enhancement. It does not opacify the ureteral lumen. Presents a cumulative radiation exposure penalty when utilized serially across recurrent ED presentations. POCUS / Radiology Ultrasound Direct stone visualization capabilities are modest, operating at approximately 50% to 60% sensitivity, and is highly dependent on anatomical positioning at the extreme proximal ureter or the UVJ. Secondary obstruction tracking: Demonstration of hydronephrosis operates at a high sensitivity of approximately 80%. POCUS Clinical Utility Metrics Eliminates ionizing radiation exposure and allows immediate, rapid real-time execution directly at the patient’s bedside. Confirmation of significant hydronephrosis within a classic clinical presentation yields high post-test probability for stone presence while lowering suspicion for vascular catastrophes like a AAA. KUB Radiography Extremely poor overall diagnostic sensitivity, hovering around 57%. Fails to image radiolucent configurations (pure uric acid matrices) or small stones measuring

Live from the Arthrex Team Physician Controversies Conference

We discuss the diagnosis and treatment of one of EM's paradoxes: High-Output Heart Failure. Hosts: Nicolas Gonzalez, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/HOHF.mp3 Download Leave a Comment Tags: Cardiology Show Notes Core EM Modular CME Course Maximize your commute with the new Core EM Modular CME Course, featuring the most essential content distilled from our top-rated podcast episodes. This course offers 12 audio-based modules packed with pearls! Information and link below.  Course Highlights: Credit: 12.5 AMA PRA Category 1 Credits™ Curriculum: Comprehensive coverage of Core Emergency Medicine,  with 12 modules spanning from Critical Care to Pediatrics. Cost: Free for NYU Learners $250 for Non-NYU Learners Click Here to Register and Begin Module 1 1. Core Definition & Hemodynamic Profile Clinical Paradox: Congestive symptoms (pulmonary edema, JVD, peripheral edema) in the setting of a hyperdynamic, supranormal cardiac function. Hemodynamic Criteria: Cardiac Index (CI): >4.0 L/min/m2. Cardiac Output (CO): >8 L/min. Systemic Vascular Resistance (SVR): Pathologically low (vasodilated or shunted state). The “Warm” Phenotype: Unlike standard HFrEF/HFpEF (often “Cold and Wet”), HOHF presents as “Warm and Wet” due to low SVR and bounding pulses. 2. Pathophysiology: The Hemodynamic Paradox Primary Insult: Decreased SVR (either via peripheral vasodilation or arteriovenous shunting). Effective Arterial Blood Volume: Paradoxically low despite high total CO. Neurohormonal Cascade: Activation of Renin-Angiotensin-Aldosterone System (RAAS). Increased Sympathetic Nervous System tone. Increased Antidiuretic Hormone (ADH) secretion. Resultant State: Avid renal salt and water retention leading to massive plasma volume expansion. Cardiac Response: Chronic volume overload → eccentric remodeling → chamber dilation → eventual secondary myocardial failure/dilated cardiomyopathy. 3. Differential Diagnosis: Etiological “Buckets” Category A: Increased Metabolic Demand (Systemic) Hyperthyroidism/Thyrotoxicosis: Direct T3 effects: increased chronotropy/inotropy. Indirect effects: metabolic byproduct accumulation causing peripheral vasodilation. Myeloproliferative Disorders: High cell turnover and increased oxygen consumption drive compensatory CO increase. Sepsis (Hyperdynamic Phase): Cytokine-mediated global vasodilation. Note: Often transient; may transition to sepsis-induced myocardial depression. Category B: Peripheral Vascular Effects (Shunting/Vasodilation) Arteriovenous Fistulas (AVF) / Malformations (AVM): Most Common Cause: Iatrogenic AVF for Hemodialysis (ESRD population). Bypasses high-resistance capillary beds, dumping arterial blood directly into venous circulation. Chronic Liver Disease (Cirrhosis): Formation of “spider angiomata” and internal AV shunts. Impaired clearance of endogenous vasodilators (e.g., Nitric Oxide). Thiamine Deficiency (Wet Beriberi): Accumulation of pyruvate/lactate → systemic vasodilation. Histopathology: Vacuolation, myofiber hypertrophy, and interstitial edema. Chronic Lung Disease: Hypoxia/Hypercapnia-driven systemic vasodilation. Concomitant pulmonary HTN (RV remodeling) but preserved/high LV output. Others: Paget's disease of bone (extensive micro-shunting), Carcinoid syndrome, Mitochondrial diseases, Acromegaly, Erythroderma. 4. Special Focus: Hemodialysis Access-Induced HOHF Physiologic Phases of AVF Creation: Acute Phase: Immediate ↓ SVR. ↑ Stroke volume and Heart Rate (SNS-mediated). Endothelial shear stress → Nitric Oxide release → further arterial dilation. Subacute Phase (Days to 2 Weeks): RAAS-driven volume expansion. ↑ Right Atrial, Pulmonary Artery, and LV End-Diastolic Pressures (LVEDP). Natriuretic peptide surge (BNP/ANP) peaks around Day 10. Chronic Phase (Weeks to Months): Adaptive hypertrophy. Decompensation occurs when dilation exceeds contractility limits. 5. Point-of-Care Physical Exam & Maneuvers Nicoladoni-Branham Sign (Pathognomonic for Shunt-driven HOHF): Maneuver: Manually compress the AVF (or inflate cuff to >50 mmHg above SBP) for 30 seconds. Positive Result: Reflexive bradycardia or a transient rise in systemic BP. Significance: Confirms the shunt is a major contributor to the cardiac workload. Peripheral Pulse Assessment: Water Hammer Pulses: Rapid upstroke and collapse. Quincke's Pulse: Visible capillary pulsations in the nail beds. Traube's Sign: “Pistol-shot” sounds auscultated over the femoral arteries. Volume Status: Rales, S3 gallop, peripheral edema (standard HF signs). 6. Diagnostic Workup (Technical Targets) POCUS / Echocardiography: Left Ventricle: Hyperdynamic function; EF typically >60%. Left Atrium: Significant dilation (Left Atrial Volume Index >34 mL/m2; Case study noted 72 mL/m2). IVC: Plethoric with minimal respiratory variation. Doppler: High flow velocities across the AV access if applicable. Laboratory Evaluation: BNP/NT-proBNP: Often markedly elevated (e.g., >70,000 in severe cases), though mean values in literature hover around 700–800 pg/mL. Hematology: CBC to evaluate for severe anemia (trigger for HOHF if Hgb7–8 g/dL to reduce demand. Beriberi: High-dose IV Thiamine (100–500 mg). Thyrotoxicosis: Beta-blockers (Propranolol) + Antithyroid meds (PTU/Methimazole). Phase 3: Surgical/Interventional Salvage (Refractory AVF Cases) Closure of Accessory Sites: If multiple fistulas exist, close the non-dominant/unused sites. Flow Reduction (Banding): Surgical narrowing of the fistula to target flow

In this episode, Antonia and Andrew discuss the January 21, 2026 issue of JBJS, along with an added dose of entertainment and pop culture. Listen at the gym, on your commute, or whenever your case is on hold! Link: JBJS website: https://jbjs.org/issue.php Sponsor: This episode is brought to you by JBJS Clinical Classroom. Subspecialties: Foot & Ankle, Knee, Orthopaedic Essentials, Education & Training, Trauma Chapters (00:00:03) - Cases on Hold(00:01:34) - Permanent Free(00:02:34) - Concomitant ipsilateral upper extremity fractures in pediatric mont(00:06:59) - Dexamethasone(00:13:55) - Will Adding antioxidants to highly crosslinked polyethylene improve knee ar(00:20:44) - Prevalence of subtal arthritis after P-line fractures(00:29:10) - Honorary Mention

Acute cases aren't always simple — and there's often more to think about than you might realize.In Part 2 of this special conversation on Strange, Rare & Peculiar, Denise and Alastair explore the art of clinical decision-making in homeopathy for acute care. From case tools like LoCoMoCo (Location, Complaint, Modality, Concomitant) and CLAMS (Condition, Location, Aetiology, Modality, Sensation), to key concepts from the Organon, they break down what it really takes to prescribe well in acutes.You'll hear:Why understanding the complete symptom is the foundation of good prescribingWhat makes a symptom strange, rare, and peculiar (Aphorism 153)Why Hahnemann insisted we do the work — even in “simple” acute casesWhy AHE students receive intensive training in acute prescribing — and why that matters

On this episode of the Real Life Pharmacology Podcast, I cover albuterol pharmacology, adverse effects, and a rare indication for this classic respiratory medication. Albuterol is a short-acting beta-2 adrenergic agonist (SABA) that works by stimulating beta-2 receptors in the bronchial smooth muscle. This stimulation activates adenylate cyclase, increases cyclic AMP, and leads to relaxation of airway smooth muscle. The end result is rapid bronchodilation, making albuterol effective for quick relief of acute bronchospasm in conditions such as asthma and COPD. Common adverse effects occur due to both beta-2 and some unintended beta-1 receptor stimulation. Patients may experience tremors, nervousness, headache, or tachycardia. Higher doses or frequent use can lead to hypokalemia because beta-2 stimulation drives potassium into cells. Some individuals may also report palpitations or feelings of anxiety. These effects are generally mild and transient but can be more pronounced in older adults, those with cardiovascular disease, or when albuterol is used excessively. Albuterol has several clinically relevant drug interactions. Concomitant use with non-selective beta-blockers (such as propranolol) can blunt its bronchodilatory effect and may precipitate bronchospasm in susceptible individuals. Using albuterol with other sympathomimetics can enhance cardiovascular stimulation, increasing the risk of tachycardia or hypertension. Diuretics, especially loop or thiazide types, may compound albuterol-induced hypokalemia. Additionally, monoamine oxidase inhibitors (MAOIs) or tricyclic antidepressants can potentiate the effects of albuterol and increase the risk of cardiovascular adverse reactions. Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE! Support The Podcast and Check Out These Amazing Resources! NAPLEX Study Materials BCPS Study Materials BCACP Study Materials BCGP Study Materials BCMTMS Study Materials Meded101 Guide to Nursing Pharmacology (Amazon Highly Rated) Guide to Drug Food Interactions (Amazon Best Seller) Pharmacy Technician Study Guide by Meded101

“Every episode is a trace; every sound is a silent testimony in the memory of the profession.” E‑Anesthesia*NEUROMUSCULAR DISEASES**LAMBERT-EATON SYNDROME

Sponsored by Elanco Elise Kelly, DVM, graduated from Eastern Illinois University with a Bachelor of Sciences degree in zoology and a minor in chemistry. She earned her DVM degree from Ross University School of Veterinary Medicine, then practiced in Blue Springs, MO for 9 years before joining Elanco in 2015 as a Regional Consulting Veterinarian.  In her nine years of practice, her special interests included dermatology, small exotics, and reproductive medicine, attaining a certification in canine AI in 2012. Since joining Elanco, Kelly has had the opportunity to train intensively and speak on topics including parasitology, pain management, dermatology and immunology. She has given over 500 presentations and spoken at continuing education events including Kansas City's Frostbite and the annual Missouri Veterinary Medical Association Conference. Kelly is Fear Free Elite, compassion fatigue and Human Animal Bond certified. She supports and works with Elanco sales representatives throughout the Midwest. She is a member of the Missouri Veterinary Medical Association and is Vice Chair for the board of directors at the Kansas City Pet Project. She currently resides in Independence, Missouri with her husband, two children, Sheepadoodle puppy, cat, and four goats.  In her spare time, you might find her cheering for the Kansas City Chiefs, boating, hiking or traveling with her family. Indication Galliprant controls pain and inflammation associated with osteoarthritis in dogs. Important Safety Information For use in dogs only. Keep this and all medications out of reach of children and pets to prevent accidental ingestion or overdose. Galliprant is a non-COX inhibiting NSAID. As a class, NSAIDs may be associated with gastrointestinal, kidney and liver side effects. Evaluation for pre-existing conditions and regular monitoring are recommended.  Do not use in dogs that have a hypersensitivity to grapiprant. Concomitant use of Galliprant with other NSAIDs or corticosteroids should be avoided. Concurrent use with other anti-inflammatory drugs or protein-bound drugs has not been studied. The safe use of Galliprant has not been evaluated in dogs younger than 9 months of age and less than 8 lbs (3.6 kg), dogs used for breeding, pregnant or lactating dogs, or dogs with cardiac disease. Owners should be advised to observe for signs of potential drug toxicity. Adverse reactions may include vomiting, diarrhea, decreased appetite, watery or bloody stools, and decreases in serum albumin and total protein. Click here for full prescribing information Galliprant, Elanco, and the diagonal bar logo are trademarks of Elanco or its affiliates. ©2025 Elanco or its affiliates. PM-US-25-1504

CardioNerds (Drs. Rick Ferraro and Georgia Vasilakis Tsatiris) discuss ATTR cardiac amyloidosis with expert Dr. Justin Grodin. This episode is a must-listen for all who want to know how to diagnose and treat ATTR with current available therapies, as well as management of concomitant diseases through a multidisciplinary approach. We take a deep dive into the importance of genetic testing, not only for patients and families, but also for gene-specific therapies on the horizon. Dr. Grodin draws us a roadmap, guiding us through new experimental therapies that may reverse the amyloidosis disease process once and for all.  Audio editing by CardioNerds academy intern, Christiana Dangas. This episode was developed in collaboration with the American Society of Preventive Cardiology and supported by an educational grant from BridgeBio.  Enjoy this Circulation Paths to Discovery article to learn more about the CardioNerds mission and journey.  US Cardiology Review is now the official journal of CardioNerds! Submit your manuscripts here.  CardioNerds Cardiac Amyloid PageCardioNerds Episode Page Pearls: You must THINK about your patient having amyloid to recognize the pattern and make the diagnosis. Start with a routine ECG and TTE, and look for a disproportionately large heart muscle with relatively low voltages on the ECG.  Before you diagnose ATTR amyloidosis, AL amyloidosis must be ruled out (or ruled in) with serum light chains, serum/urine immunofixation, and/or tissue biopsy.  Genetic testing is standard of care for all patients and families with ATTR amyloidosis, and the future is promising for gene-specific treatments. Current FDA-approved treatments for TTR amyloidosis are TTR stabilizers and TTR silencers, but TTR fibril-depleting agents are on their way.  Early diagnosis of ATTR affords patients maximal benefit from current amyloidosis therapies.   TTR amyloidosis patients require a multidisciplinary approach for success, given the high number of concomitant diseases with cardiomyopathy.  Notes: Notes: Notes drafted by Dr. Georgia Vasilakis Tsatiris.  What makes you most suspicious of a diagnosis of cardiac amyloidosis from the typical heart failure patient?  You must have a strong index of suspicion, meaning you THINK that the patient could have cardiac amyloidosis, to consider it diagnostically. Some characteristics or “red flags” to not miss:   Disproportionately thick heart muscle with a relatively low voltages on EKG   Bilateral carpal tunnel syndrome – estimated that 1 in 10 people >65 years old will have amyloidosis   Previously tolerated antihypertensive medications  Atraumatic biceps tendon rupture   Bilateral carpal tunnel syndrome  Spinal stenosis   Concomitant with other diseases: HFpEF, low-flow low-gradient aortic stenosis  How would you work up a patient for cardiac amyloidosis?   Start with a routine ECG (looking for disproportionally low voltage) and routine TTE (looking for thick heart muscle)  CBC, serum chemistries, hepatic function panel, NT proBNP, and troponin levels  NOTE: It is critical to differentiate between amyloid light chain (AL amyloidosis) and transthyretin ATTR amyloidosis, as both make up 95-99% of amyloidosis cases.   Obtain serum free light chains, serum & urine electrophoresis, and serum & urine immunofixation to rule out AL amyloidosis. (See table below)  AL Amyloidosis ATTR Amyloidosis  → Positive serum free light chains and immunofixation (Abnormal M protein) → Tissue biopsy (endomyocardial, fat pad) to confirm diagnosis → Negative serum free light chains and immunofixation (ruled out AL amyloidosis) → Cardiac scintigraphy (Technetium pyrophosphate with SPECT imaging)  What treatment options do we have to offer now for ATTR CM, and how has this compared to prior years?   Before 2019, treatment options were limited outside of cardiac tr...

Fluphenazine is a high-potency typical antipsychotic that primarily acts as a dopamine D2 receptor antagonist in the mesolimbic pathway, reducing positive symptoms of schizophrenia. Extrapyramidal symptoms (EPS), such as dystonia, akathisia, and parkinsonism, are common due to potent D2 blockade in the nigrostriatal pathway. Neuroleptic malignant syndrome (NMS), though rare, is a life-threatening adverse effect characterized by rigidity, hyperthermia, altered mental status, and autonomic instability. CYP2D6 inhibitors (e.g., fluoxetine, paroxetine) can increase fluphenazine plasma concentrations, potentially raising the risk of toxicity and side effects. Concomitant use of fluphenazine with CNS depressants (e.g., alcohol, benzodiazepines) can enhance sedation and respiratory depression.

On this podcast episode, I discuss quinapril pharmacology, adverse effects, drug interactions, pharmacokinetics, and much more. Quinapril is a prodrug that is converted in the liver to its active metabolite, quinaprilat, which inhibits ACE, leading to decreased formation of angiotensin II and reduced aldosterone secretion. Hyperkalemia can occur with quinapril use due to decreased aldosterone, leading to potassium retention—especially in patients with renal impairment. Concomitant use of potassium-sparing diuretics or potassium supplements with quinapril increases the risk of hyperkalemia. NSAIDs may reduce the antihypertensive effect of quinapril and increase the risk of nephrotoxicity, especially in patients with preexisting renal dysfunction.

The Challenge of Diagnosing Patients Presenting With Signs and Symptoms of Subacromial Pain Syndrome: A Descriptive Study of 741 Patients Seen in a Secondary Care Setting Witten A, Clausen MB, Thorborg K, et al. J Orthop J Sports Med. 2025;13(4):23259671251332944. doi:10.1177/23259671251332942 Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. Brought to you by our sponsors at: CSMi – https://www.humacnorm.com/ptinquest Learn more about/Buy Erik/Jason/Chris's courses – The Science PT Support us on the Patreons! Music for PT Inquest: “The Science of Selling Yourself Short” by Less Than Jake Used by Permission Other Music by Kevin MacLeod – incompetech.com: MidRoll Promo – Mining by Moonlight Koal Challenge – Sam Roux

Bursting into existence in the Pacific Northwest in 1975, the George Jackson Brigade claimed 14 pipe bombings against corporate and state targets, as many bank robberies, and the daring rescue of a jailed member. Combining veterans of the prisoners' women's, gay, and black liberation movements, this organization was also ideologically diverse, consisting of both communists and anarchists. Concomitant with the Brigade's extensive armed work were prolific public communications. In more than a dozen communiqués and a substantial political statement, they sought to explain their intentions to the public while defying the law enforcement agencies that pursued them. Creating a Movement with Teeth makes available this body of propaganda and mediations on praxis, collecting it in one volume for the first time. In addition, the collection assembles corporate media profiles of the organization's members and alternative press articles in which partisans thrash out the heated debates sparked in the progressive community by the eruption of an armed group in their midst. Creating a Movement with Teeth illuminates a forgotten chapter of the radical social movements of the 1970s in which diverse interests combined forces in a potent rejection of business as usual in the United States.Become a supporter of this podcast: https://www.spreaker.com/podcast/the-opperman-report--1198501/support.

The secret to scoring a 170 on the LSAT? Don't finish the section—just slow down and focus on accuracy. Ben and Nathan share an excerpt from their new book, The LSAT Is Easy, that breaks down what it takes to reach score milestones. They also unpack common admissions gimmicks, share tips from a departing demon, and host another round of the Personal Statement Gong Show.Study with our Free PlanDownload our iOS appWatch Episode 503 on YouTube0:37 - The LSAT Is EasyBen and Nathan explain why the LSAT isn't as difficult as it seems. Rushing through questions leads to repeated mistakes, not progress. They encourage slowing down, focusing on accuracy, and carefully solving each question. The episode also introduces their new, budget-friendly book. Improving your score starts with doing questions right, not doing more of them.19:33 – Marketing gimmicks Law schools use tactics like seat deposit deadlines and “priority waitlists” to pressure applicants into accepting full-price offers. Ben and Nathan explain how these strategies work, why they don't reflect actual capacity, and how they help schools find eager, full-paying students.  Their advice?  Ignore the pressure. Focus on scholarships and long-term results.40:50 – Why didn't Ben enjoy his job in the justice department? Ben recalls his time at the DOJ, where much of his work involved revising boilerplate from other lawyers. They also discuss clerkships—what they entail, how they differ, and why federal ones are more significant. For more on clerkships, check out Thinking LSAT Episode 418, Demystifying Federal Clerkships.43:53 – You Don't Need to Explain Every Wrong Answer. Some students waste time trying to explain every wrong answer. Ben and Nathan suggest it's more useful to understand the logic behind the correct ones and focus your review on the questions you missed. The point isn't to memorize everything—it's to build real understanding.48:23 – Personal Statement Gong ShowAngel shares a personal statement for critique. Ben and Nathan emphasize that it needs to focus squarely on the applicant. Highlighting anything other than your skills wastes space that should be used to show why you will succeed in law school and the legal profession. 1:09:16 - Tips from a Departing DemonBlake shares two pieces of advice: every word on the LSAT counts, and practice doesn't make perfect—just better. Ben and Nathan agree with another student who reminds listeners not to take the test until they're truly ready.1:14:16 - Word of the Week - Concomitant"Neurosurgery seemed to present the most challenging and direct confrontation with meaning, identity, and death. Concomitant with the enormous responsibilities they shouldered, neurosurgeons were also masters of many fields: Neurosurgery, ICU Medicine, neurology, radiology."

Commentary by Dr. Jafar Al-Mondhiry.

Read the article here: https://journals.sagepub.com/doi/full/10.1177/30494826241296676

Commentary by Dr. Alexander Maass.

Send us a textChorioamnionitis and Two-Year Outcomes in Infants with Hypoxic-Ischemic Encephalopathy.Cornet MC, Gonzalez FF, Glass HC, Wu TW, Wisnowski JL, Li Y, Heagerty P, Juul SE, Wu YW.J Pediatr. 2024 Nov 20:114415. doi: 10.1016/j.jpeds.2024.114415. Online ahead of print.PMID: 39577760 Free article.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

What happens when patients with psoriasis present with comorbidities and concomitant medical concerns? The availability of numerous treatments with differing mechanisms of action means that prescribers have more opportunity than ever before to help patients manage their disease safely, says April Armstrong, MD, MPH. Plus, Biologic Coordinator Neo Cuellar discusses therapeutic access and Hilary Baldwin, MD discusses skin care for patients with acne and rosacea.Like what you're hearing? Want to learn more about the Dermatology Education Foundation? Explore assets and resources on our website.

I talk about how and why I coach the way that I do, in this emotional episode, celebrating my 50th podcast. Show Notes: Concomitant Coaching: https://www.britannica.com/dictionary/concomitant The #1 Reason Why Inventors Don't Get Licensing Deals Article: https://inventright.com/the-1-reason-why-inventors-dont-get-licensing-deals/#:~:text=A%20licensing%20contract%20is%20like,build%20one%20with%20each%20company Holistic Coaching: https://www.ukcoaching.org/holistic-coaching Developmental Coaching: https://www.linkedin.com/pulse/what-developmental-coaching-thomas-j-pickett/ --- Support this podcast: https://podcasters.spotify.com/pod/show/serial-inventing-podcast/support

Welcome to the latest episode of Cardiology Digest, where we chart a course through groundbreaking studies that are shaping cardiology practice!   STUDY #1: First, we discuss the nuanced world of drug interactions involving diltiazem and direct-acting oral anticoagulants like apixaban and rivaroxaban. Tune in as we scrutinize the study's limitations and practical implications for your patients with atrial fibrillation.  Ray, WA, Chung, CP, Stein, CM, et al. 2024. Serious bleeding in patients with atrial fibrillation using diltiazem with apixaban or rivaroxaban. JAMA. 18: 1565–1575. (https://jamanetwork.com/journals/jama/article-abstract/2817546) STUDY #2: Next, we turn our attention to a case-control study examining the bleeding risks associated with the combination of selective serotonin reuptake inhibitors and anticoagulants in patients with atrial fibrillation. Are the bleeding risks substantial enough to rethink this combination therapy, or are there scenarios where the benefits outweigh the dangers? We'll leave no stone unturned. Rahman, AA, Platt, RW, Beradid, S, et al. 2024. Concomitant use of selective serotonin reuptake inhibitors with oral anticoagulants and risk of major bleeding. JAMA. 3: e243208. (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2816687) STUDY #3: Finally, we explore a fascinating meta analysis that looked at renal denervation and its long-term efficacy in controlling blood pressure. See how renal denervation stacks up against traditional antihypertensive medications and what you need to consider when thinking about incorporating it into your treatment arsenal. Sesa-Ashton, G, Nolde, JM, Muente, I, et al. 2024. Long-term blood pressure reductions following catheter-based renal denervation: A systematic review and meta-analysis. Hypertension. 6: e63–e70. (https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.123.22314) Join us to explore the potential impacts of these studies, the ongoing debates they spark within the cardiology community, and to see how these findings could influence your clinical decisions. Learn more with these courses: Atrial Fibrillation Essentials (1 CME):  Pacemaker Essentials (5 CME) Pacemaker Essentials Workshop (1 CME) Get a Basic or Pro account, or, get a Trial account. Show notes: Visit us at  https://www.medmastery.com/podcasts/cardiology-podcast.

This conversation starts by focusing on the impact of concomitant metabolic therapies in MASH drug development and patient treatment and then moves on to explore some major implications of the earlier conversations. Roger Green begins this conversation by returning to the issue of metabolic drugs. Specifically, he mentions a recent tirzepatide Phase 3 trial that demonstrated efficacy against symptoms of obstructive sleep apnea. Louise Campbell points out that sleep apnea correlates highly with SLD as well as obesity. She suggests this is one more point proving that we need to educate more physician specialties on liver health and educate them more effectively. Will Alazawi agrees with Louise's comment, citing a talk he and a colleague gave at the Diabetes UK conference the previous week that was part of an academic session on liver disease, noting that the session itself was well-attended. Will emphasizes applauding Diabetes UK for arranging and promoting this kind of multidisciplinary academic session of MASLD and MASH. Roger shifts focus by asking what insights investors or other professionals who listen to the episode should take from this discussion. Jörn Schattenberg starts with the most important point: we now know how to get a drug approved. Considering other drugs in development, he adds that the drugs we are studying now may be potent enough to overcome issues that challenged earlier agents. Sven Francque adds that in future years, prior use of incretin double-agonists and triple-agonists will change the nature of the MASH patient population and make drugs like Rezdiffra that have liver-specific modes of action more important and valuable.   

Commentary by Dr. Valentin Fuster

Dr. Eduardo Fernandez discusses with Dr. Hiroaki Sekiya the surprising findings of his study evaluating the presence of concomitant pathologies and how they impact the disease progression in a large cohort of patients with MSA from the Mayo Clinic brain bank. Read the article

durée : 00:05:45 - Le Journal de l'éco - par : Anne-Laure Chouin - 3% du commerce mondial transite par le canal de Panama, 30% par le Canal de Suez or le passage par ces deux passages clés a diminué de 40%. Pour des raisons différentes, mais les conséquences se cumulent, avec des effets néfastes, notamment pour le climat.

References FEMS Microbiol Rev.1998. Oct;22(4):255-75 Discoveries(Craiova). 2017 Jul-Sep; 5(3): e77. J Cell Mol Med. 2015 Jul; 19(7): 1427–1440. Oncogene. 2017 Mar 23; 36(12): 1607–1618. Bach, JS. 1742. Kunst der Fuge , BWV 1080; Marta Czech https://youtu.be/p1Sq1HOYglU?si=2GMF7kf3dLW4rr2O Lennon and MCartney.1968. "Martha my Dear" https://youtu.be/RXawa90YU2s?si=dUPDtTdm4UqrgWit --- Send in a voice message: https://podcasters.spotify.com/pod/show/dr-daniel-j-guerra/message Support this podcast: https://podcasters.spotify.com/pod/show/dr-daniel-j-guerra/support

NEJM 1991;324:781-788Background A hallmark of post-myocardial infarction (MI) care in the 1980's was the monitoring and suppression of premature ventricular contractions (PVCs) via use of antiarrhythmic drugs. The practice was based on pathophysiologic rationale that PVC burden is a strong risk factor for sudden and non-sudden cardiac death following MI and thus, suppression must reduce death. PVC reduction was a seductive surrogate endpoint that was easy to measure and declare victory on, but it had never been tested in a proper RCT. The Cardiac Arrhythmia Suppression Trial (CAST) was sponsored by the National Heart, Lung and Blood Institute (NHLBI) and sought to test the hypothesis that suppression of asymptomatic or mildly symptomatic PVCs with antiarrhythmic therapy with encainide, flecainide, or moricizine after MI would reduce death due to arrhythmia.Patients Patients were eligible for enrollment 6 days to 2 years post MI with an average of ≥6 PVCs per hour on ambulatory monitoring of at least 18 hours duration, and no runs of VT of ≥15 beats at a rate of ≥120 bpm. An ejection fraction (EF) of ≤55% was required within 90 days of MI or ≤40% if recruited after 90 days. There was a run-in phase. Patients were only enrolled in the main trial if they had at least 80% suppression of PVCs and at least 90% suppression of runs of VT during an initial, open-label titration period. Initial open-label drug assignment was based, in part, on the EF. Flecainide was not given to patients with an EF of ≤30%. Moricizine was only used as a second line drug in patients with an EF of ≥30%.Baseline characteristics Baseline characteristics of the patients enrolled in the trial are not provided in the main manuscript and cannot be inferred from the results, tables or figures presented.Procedures Patients in whom arrhythmias were suppressed were randomly assigned to receive either the effective drug or its matching placebo. A detailed description of study procedures is not presented in the main manuscript. Compliance with the study drug was assessed in follow-up visits and based on pill counts of tablets returned but the schedule of these visits is not provided. Concomitant drug therapy was assessed at the time of the last visit, according to a standardized checklist.During the trial, patients could be instructed to discontinue the study drug based on the occurrence of the following events: ventricular tachycardia, significant increase in arrhythmia burden, disqualifying ECG changes including significant QT prolongation or bradycardia, new or worsened congestive heart failure, the need for treatment with an antiarrhythmic agent outside the entry criteria for the study, or any number of other adverse medical events divided into cardiovascular or non-cardiovascular events.Endpoints The primary endpoint of the study was death or cardiac arrest with resuscitation due to arrhythmia. The site PI was responsible for classifying each death without knowledge of the patient's assigned treatment. Secondary endpoints included cardiovascular and non-cardiovascular causes of death, disqualifying ventricular tachycardia without arrest, syncope, pacemaker implantation, recurrent MI, congestive heart failure, angina pectoris or coronary artery revascularization.Results Observation began on the day of randomization to blinded therapy and was censored on April 18, 1989, the date when the use of encainide and flecainide was discontinued by the Data and Safety Monitoring Board because the data indicated it was unlikely that benefit could be demonstrated, and it was likely that the drugs were harmful. The original CAST trial manuscript reports data on patients assigned to the encainide and flecainide groups. Moricizine use was continued and would be reported separately in the revised CAST II trial.1498 participants were randomized to receive either encainide, flecainide or their matching placebo and followed for an average of 10 months. Compliance with the assigned treatments was estimated to be >90% in 70% of all patients and was similar in the active-drug and placebo groups. Antiarrhythmic therapy significantly increased the relative risk of the primary endpoint of death or cardiac arrest due to arrhythmia (RR 2.64; 5.7% vs 2.2%; p=0.0004) and was associated with a number needed to harm (NNH) of approximately 29. It also increased the risk of all deaths and cardiac arrests (RR 2.38; 8.3% vs 3.5%; p=0.0001; NNH = 20); even those not associated with arrhythmia (2.3% vs 0.7%; p=0.01).Conclusions The CAST trial unexpectedly demonstrated that treatment of asymptomatic or mildly symptomatic PVCs in post-MI patients, with encainide and flecainide, increased death and cardiac arrests. From a chronological standpoint, it is the first major trial in cardiovascular medicine (perhaps all of medicine) that “reversed” a standard medical practice. In this case, one that was instituted and broadly adopted on the basis of pathophysiologic reasoning and one that targeted a surrogate endpoint. Thus, more than anything it highlights the importance of testing interventions in properly conducted RCTs prior to adoption and basing the analysis on hard outcomes that are meaningful to patients and society. How many practices in modern medicine are supported by high quality RCTs? It may be as low as 30-40%. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

On this episode, we're going to continue our discussion with Dr. William Bugbee and focus on OCA surgical technique and then discuss clinical outcomes including return to sports.Our conversation picks back up with a recent paper from the July issue of Cartilage this year titled “Young Age and Concomitant or Prior Bony Realignment Procedures are Associated with Decreased Risk of Failure of Osteochondral Allograft Transplantation in the Knee.” This retrospective nationwide database study represents the largest OCA cohort study to date and found that less than 2% of patients required salvage surgery. Young age, less than 29, and having a bony realignment procedure were associated with a significantly lower rate of salvage surgery – include revision cartilage procedures and arthroplasty.We finish up today with an article from the June 2017 issue of AJSM titled “Return to Sport and Recreational Activity after Osteochondral Allograft Transplantation in the Knee.” Dr. Bugbee and colleagues at Scripps Clinic in La Jolla California reported that at a mean follow up of 6 years, 75% of patients were able to return to sport or recreational activity. Patients who did not return were more likely to be female and have a large graft size. 25% of knees underwent further surgery and 9% were considered allograft failures. Of the patients without OCA failure, 91% were satisfied with the results of surgery.

Commentary by Dr. Valentin Fuster

How do concomitant meds affect antidepressant response? Find out about this and more in today's PV Roundup podcast.

The management of atrial fibrillation with rapid ventricular response is often complicated by the presence of heart failure with reduced ejection fraction. The presence of HFrEF limits pharmacologic options for rate control. This podcast will cover a retrospective study looking at the use of metoprolol vs diltiazem in patients with A fib with RVR and concomitant heart failure

Dr. Ami Kapadia, MD, ABFM, ABIHM: https://www.amikapadia.com/ Dr. Rebecca Sand, ND, LAc: https://www.drrebeccasand.com/ Dr. Ilana Gurevich, ND, LAc: https://www.naturopathicgastro.com/ - Kids, nutrition and constipation - Celiac and constipation - Food sensitivity and kids with constipation - Constipation, dairy, and food allergies - Constipation and comprehensive elimination diet - Comprehensive elimination diet options - Lactase deficiency as an underlying cause of constipation in children - Casein intolerance as an underlying cause of constipation - Concomitant conditions that present with constipation in children - Food allergy testing vs food elimination testing - Testing for food allergies in constipation with kids - Discussion on drugs for allergies in children - Supplement discussion for allergies in children

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.03.27.534302v1?rss=1 Authors: Yordanov, T. E., Martinez, M. A. E., Esposito, T., Tefft, J. B., Labzin, L. I., Stehbens, S. J., Rowan, A., Hogan, B. M., Chen, C. S., Lauko, J., Lagendijk, A. K. Abstract: Cerebral Cavernous Malformations (CCMs) are vascular lesions that predominantly form in blood vessels of the central nervous system (CNS) upon loss of the CCM multimeric protein complex. The endothelial cells (ECs) within CCM lesions are characterised by overactive MEKK3 kinase and KLF2/4 transcription factor signalling, leading to pathological changes such as increased EC spreading and reduced junctional integrity. Concomitant to aberrant EC signalling, non-autonomous signals from the extracellular matrix (ECM) have also been implicated in CCM lesion growth and these factors might explain why CCM lesions mainly develop in the CNS. Here, we adapted a three dimensional (3D) microfluidic system to examine CCM1 deficient human micro-vessels in distinctive ECMs. We validate that EC pathological hallmarks are maintained in this 3D model. We further show that supplementing the ECM with distinct forms of Hyaluronic Acid (HA), a major ECM component of the CNS, alters CCM1 biology, independent of KLF2/4. This study provides a proof-of-principle that ECM embedded 3D microfluidic models are ideally suited to identify how changes in ECM structure and signalling impact vascular malformations. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

WE & OUR ENEMIES: FACE-TO-FACEKeep Right with Ralph K. GinorioI am a sinner.  I am also a Christian.  I am therefore keenly aware that no human being has earned the right to cast the first stone.  My clay feet are inescapable.  I try to live from a basis of genuine humility, because I have so very much about which to be humble.Concomitant with this, though, is my duty as a Christian, as a man, and as an American to endeavor to speak truth, serve conscience, and stand against evil.  Christian love and civic duty require that I not be mute and neutral when faced with matters of right and wrong.  I believe we are each called to take sides.Today, as our civilization teeters on the brink, we could drown in the rising tide of controversy.  I cannot think of any area of life that does not have enemies within clamoring for the West to destroy itself in shame over what they say we have done.  Simultaneously, there are outside forces hungering for our decrepitude, enslavement, or outright destruction.The scope of these two types of attack on Judeo-Christian Western Civilization is staggering.  It is traumatic to have every powerful voice mobilized to tell us that we, ourselves, are the world's chief problem.  In fact, our demoralization is their objective.“Confusion to the enemy!” is an old British war toast.  The Greek word for the dark enemy of God literally means “confusion, through-and-through”.  Each and all of these contemporary attacks on our West aim to overwhelm our reason and confuse our certainties.  We are to be made insensible to our own conscience and unable to think clearly about effective ways we can serve it.We are not faced, as we were in the Cold War, with a monolithic creed that intends to replace what we hold dearest in life.  Instead, there is a cacophony of voices raised against our traditions, values, freedoms, and folkways.  Many of these hold mutually-exclusive ideals.  Many hate one another.But, be certain that they hate us more.  Their hatred coalesces this unlikely alliance of LGBTQ+ activists, Islamist Fundamentalists, Feminists, Transnormatives, Academic Deconstructivists, Western Communists, Globalist Plutocrats, Chinese Communists, Anarchists, De-Christianizers, Christian Liberation Theologians, Woke Social Justice Warriors, Anti-White Racists, Hollywood Propagandists, Climate Alarmists, Teachers' Unions, and Legacy Media Moguls.They want to destroy the Judeo-Christian West, with our many denominations, liberal democracy, human rights, freedoms of speech, liberty of conscience, free market, armed citizens, traditional gender roles, national identities, Constitutions, inspirational myths, and insistence on the sanctity of human life.Our enemies are not interested in negotiating a live-and-let-live peace between us.  Their aim is not lassiez-faire mutual toleration with a genuine diversity of peaceably coexisting faiths.  Despite their babble of mutually-exclusive utopias, they are each in their own way religious zealots whose fervor will usher in our Apocalypse.These Millenarians see our world as irredeemably evil.  They see the growing peace, prosperity, freedom, and population ushered in by the post-1945 Pax Americana as the Devil's work.This world will be cleansed by the holy fire of their convictions.  After our society is burned to ash, their proverbial Thousand Years of Peace will be all that remains.  For their New Jerusalem to be born, the West must die.In service to such a purpose, any means are justified.  Our domestic and foreign enemies will enthusiastically lie, cheat, steal, seduce, deceive, imprison, and murder without shame or restraint.  Only their monomaniacal unscrupulousness can forge true Paradise-on-Earth.  Nothing must stand in their way.This is why grown men are cheered when they dress as transvestites and shake their privates in the faces of children.  This is why free expression must be called misinformation, so that only their message can be heard.  This is why our own wealthiest citizens are using their influence to destroy the very way of life that brought them success.  This is why our security agencies have been unleashed against us as a Gestapo.  This is why our culture is deteriorating in decadence.  This is why our schools ardently steal hope and truth from innocents.  This is why,... all of it!We must answer their fanaticism with courage, their lies with truth, their vanity with humility, their zealotry with mercy, their subjectivity with objectivity, their willfulness with faith, their excesses with restraint, their anxiety with trust, and their unscrupulousness with integrity.  We must answer their hatred with God's love.***In Maine and then Idaho, Ralph K. Ginorio has taught the history of Western Civilization to High School students for nearly a quarter century.  He is an “out-of-the-closet” Conservative educator with experience in Special Education, Public Schools, and Charter Schools, Grades 6-12.  He has lived in Coeur d'Alene since 2014.Would you like to share your thoughts with Ralph?  Please email your comments to hello@idahospeaks.com or post your comments on @IdahoSpeaks on Facebook.Idaho Speaks is a listener supported production.  Please visit idahospeaks.com/support to learn more.Do you have something so say?  Interested in learning more about publishing on the Idaho Speaks Network?  Our nation was built on ideas and your idea could be the next political advancement for Idaho.  Call Ed at (208) 209-7170 or email hello@idahospeaks.com to start the conversation.

Dr. Jessica Smith presents her team's work to answer the question whether fluconazole can be used while a patient is receiving a direct oral anticoagulant. The full manuscript is available open access at: https://accpjournals.onlinelibrary.wiley.com/doi/10.1002/phar.2738.

Drs Spider and Jiminez discuss Athletes Undergoing Concomitant Hip Arthroscopy and Periacetabular Osteotomy Demonstrate Greater Than 80% Return-to-Sport Rate at 2-Year Minimum Follow-Up

20221102 Two concomitant by-products and the actual result of chanting the holy name Māyāpur, India © JPS Archives

Commentary by Dr. Arnethea Sutton

Dr. Mark A. Munger shares his team's research on the concomitant use of NSAIDs plus misoprostol and the associated reduced risk of NSAID-induced cardiovascular, cerebrovascular, and renal adverse events. Full text manuscript available at: https://accpjournals.onlinelibrary.wiley.com/doi/10.1002/phar.2708.

Authors Michael Stauff, MD and Ben Mitchell, MD of the University of Massachusetts discuss their paper "Patterns of concomitant injury in thoracic spine fractures" with NASSJ editor in chief Jonathan Grauer, MD. Access the full article here. Disclosures: Grauer, Jonathan: Board of Directors: LSRS (Nonfinancial), NASS (Nonfinancial); Other: NASS (D). Stauff, Michael: Research Support (Staff and/or materials): Empirical Spine (B, Paid directly to institution/employer); Speaking and/or Teaching Arrangements: Spineart (B), Stryker Spine (C). Key: A: $100-$1,000; B: $1001-$10,000; C: $10,001-$25,000; D: $25,001-$50,000; E: $50,001-$100,000; F: $100,001- $500,000; G: $500,001-$1M; H: $1,000,001- $2.5M; I: $2.5M+

In this episode Jimmy and Roya talk about all the new treatments available to help treat or relieve different eye conditions such as the collarette, cataract, demodex and more...SOURCESC3-R-CXLDr. Boxer WachlerCOMING SOON New treatment for demodex blepharitisTea tree harmful to MGD?Concomitant conditions present with demodexWeave

Dr. Juan José Ponce Vázquez's new book, Islanders and Empire: Smuggling and Political Defiance in Hispaniola, 1580-1690 (Cambridge UP, 2020) tracks the importance of smuggling to the society, economy, and politics of the island of Hispaniola in this “long seventeenth century.” Smuggling, in his words, made people's lives on the island, an island that had suffered from imperial commercial neglect and a declining sugar industry. Concomitant with this endemic smuggling, local elites began asserting their authority over local and imperial institutions on the island, taking advantage of royal officials' isolation from the Spanish metropole and their need for local alliances. These factors, Dr. Ponce Vásquez argues, allowed local elites to gain immense wealth and power, alter the course of European inter-imperial struggles, limit, redirect, and suppress the Spanish crown's policies, and thus take control of the destinies of Hispaniola, other Spanish Caribbean territories, and the Spanish Empire in the region during this period. R. Grant Kleiser is a Ph.D. candidate in the Columbia University History Department. His dissertation researches the development of the free-port system in the eighteenth-century Caribbean, investigating the rationale for such moves towards “free trade” and the impact these policies had on subsequent philosophers, policy-makers, and revolutionaries in the Atlantic world. 

Dr. Juan José Ponce Vázquez's new book, Islanders and Empire: Smuggling and Political Defiance in Hispaniola, 1580-1690 (Cambridge UP, 2020) tracks the importance of smuggling to the society, economy, and politics of the island of Hispaniola in this “long seventeenth century.” Smuggling, in his words, made people's lives on the island, an island that had suffered from imperial commercial neglect and a declining sugar industry. Concomitant with this endemic smuggling, local elites began asserting their authority over local and imperial institutions on the island, taking advantage of royal officials' isolation from the Spanish metropole and their need for local alliances. These factors, Dr. Ponce Vásquez argues, allowed local elites to gain immense wealth and power, alter the course of European inter-imperial struggles, limit, redirect, and suppress the Spanish crown's policies, and thus take control of the destinies of Hispaniola, other Spanish Caribbean territories, and the Spanish Empire in the region during this period. R. Grant Kleiser is a Ph.D. candidate in the Columbia University History Department. His dissertation researches the development of the free-port system in the eighteenth-century Caribbean, investigating the rationale for such moves towards “free trade” and the impact these policies had on subsequent philosophers, policy-makers, and revolutionaries in the Atlantic world.  Learn more about your ad choices. Visit megaphone.fm/adchoices

During the First Annual Texas Virtual MPN Workshop, the MPN Hub spoke to our Steering Committee members Laura Michaelis, Medical College of Wisconsin, Milwaukee, US, and Tiziano Barbui, Papa Giovanni XXIII Hospital, Bergamo, IT. We asked, What do we know about the outcome of concomitant MPN and COVID-19?In this podcast, Tiziano Barbui starts by giving some background to the COVID-19 pandemic in Europe. Prof. Barbui has focused on how to help his patients with myeloproliferative neoplasms (MPN) during the outbreak. As a member of the European LeukemiaNet Working party on MPN, Prof. Barbui launched a study in 38 European centers, collecting 180 patients with both MPN and COVID-19. Laura Michaelis asks, are patients with MPN more susceptible to COVID-19 infection? Prof. Barbui discusses this question with reference the prevalence of people infected with COVID-19, who are asymptomatic but show serum-positivity.Then, Prof. Michaelis asks what the fatality rate was in patients with MPN who also contracted COVID-19. Tiziano Barbui speaks about the results that he found in his hospital and in the study he commissioned. Laura Michaelis highlights that the stage of the epidemic also impacts on case fatality. They go on to comment on the type of comorbidities present in patients with MPN and how this effects their risk of severe disease with COVID-19. This leads to a discussion of the important variables identified during analysis of the data from Prof. Barbui's study. Prof. Michaelis in particular asks about how ruxolitinib modifies the risk for patients with MPN. Tiziano Barbui answers this, paying particular attention to the inflammatory environment in patients with COVID-19. Hosted on Acast. See acast.com/privacy for more information.

In the initial podcast episode of the LEADfluncer Podcast, Drs. David W. Rausch and Christopher F. Silver discuss what the listeners can expect regarding topics and themes, including how each and every one of us has the potential to influence change in an organization for good or bad. The hosts discuss how to find influencers and the impact each person has on an organization. Many times, these people are completely unaware of their influence. The podcast will discuss theories, research, and cultural trends in higher education and business organizations. Welcome to the listeners.

Bursting into existence in the Pacific Northwest in 1975, the George Jackson Brigade claimed 14 pipe bombings against corporate and state targets, as many bank robberies, and the daring rescue of a jailed member. Combining veterans of the prisoners' women's, gay, and black liberation movements, this organization was also ideologically diverse, consisting of both communists and anarchists. Concomitant with the Brigade's extensive armed work were prolific public communications. In more than a dozen communiqués and a substantial political statement, they sought to explain their intentions to the public while defying the law enforcement agencies that pursued them. Creating a Movement with Teeth makes available this body of propaganda and mediations on praxis, collecting it in one volume for the first time. In addition, the collection assembles corporate media profiles of the organization's members and alternative press articles in which partisans thrash out the heated debates sparked in the progressive community by the eruption of an armed group in their midst. Creating a Movement with Teeth illuminates a forgotten chapter of the radical social movements of the 1970s in which diverse interests combined forces in a potent rejection of business as usual in the United States.Become a supporter of this podcast: https://www.spreaker.com/podcast/the-opperman-report--1198501/support.