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6 episodes with etiologies
2 episodes with etiologies
2 episodes with etiologies
2 episodes with etiologies
4 episodes with etiologies
2 episodes with etiologies
Alina Ștefănescu, brings three very different examples of "bad" poetry. One struggling with voice, another structure, and one context. Without Dave, Aaron and Alina work through these varying verses to see how ideas sometimes rightly remain in the drafts folders for a later day or a note to something new.My Bad Poetry Episode 7.9: "Asterisk, Etiologies, & Octave with Line from a Lullaby (w/Alina Ștefănescu)"End Poem from a Real Poet: "Tonight as You Pace the Garden" by Alina ȘtefănescuAlina Ștefănescu is an essayist, educator, translator, poet, and short prose author born in Romania and lives in Alabama. Her published anthologies including Dor and the upcoming My Heresies can be found here. You can keep up with her and all her work through her social media or website: https://www.alinastefanescuwriter.com/Podcast Email: mybadpoetry.thepodcast@gmail.com Bluesky: @mybadpoetrythepod.bsky.social Instagram & Threads: @MyBadPoetry_ThePod Website: https://www.mybadpoetry.com
In this episode, we review the high-yield topic of Other Restrictive Etiologies from the Respiratory section.FollowMedbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
Guest: Dr. Christian de Virgilio is the Chair of the Department of Surgery at Harbor-UCLA Medical Center. He is also Co-Chair of the College of Applied Anatomy and a Professor of Surgery at UCLA's David Geffen School of Medicine. He completed his undergraduate degree in Biology at Loyola Marymount University and earned his medical degree from UCLA. He then completed his residency in General Surgery at UCLA-Harbor Medical Center followed by a fellowship in Vascular Surgery at the Mayo Clinic. Resources: Rutherford Chapters (10th ed.): 174, 175, 177, 178 Prior Holding Pressure episode on AV access creation: https://www.audiblebleeding.com/vsite-hd-access/ The Society for Vascular Surgery: Clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access: https://www.jvascsurg.org/article/S0741-5214%2808%2901399-2/fulltext KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update: https://pubmed.ncbi.nlm.nih.gov/32778223/ Outline: Steal Syndrome Definition & Etiology Steal syndrome is an important complication of AV access creation, since access creation diverts arterial blood flow from the hand. Steal can be caused by multiple factors—arterial occlusive disease proximal or distal to the AV anastomosis, high flow through the fistula at the expense of distal arterial perfusion, and failure of the distal arterial networks to adapt to this decreased blood flow. Incidence and Risk Factors The frequency of steal syndrome is 1.6-9%1,2, depending on the vessels and conduit choice Steal syndrome is more common with brachial and axillary artery-based accesses and nonautogenous conduits. Other risk factors for steal syndrome are peripheral vascular disease, coronary artery disease, diabetes, advanced age, female sex, larger outflow conduit, multiple prior permanent access procedures, and prior episodes of steal.3,4 Long-standing insulin-dependent diabetes causes both medial calcinosis and peripheral neuropathy, which limits arteries' ability to vasodilate and adjust to decreased blood flow. Patient Presentation, Symptoms, Grading Steal syndrome is diagnosed clinically. Symptoms after AVG creation occurs within the first few days, since flow in prosthetic grafts tend to reach a maximum value very early after creation. Native AVFs take time to mature and flow will slowly increase overtime, leading to more insidious onset of symptoms that can take months or years. The patient should have a unilateral complaint in the extremity with the AV access. Symptoms of steal syndrome, in order of increasing severity, include nail changes, occasional tingling, extremity coolness, numbness in fingertips and hands, muscle weakness, rest pain, sensory and motor deficits, fingertip ulcerations, and tissue loss. There could be a weakened radial pulse or weak Doppler signal on the affected side, and these will become stronger after compression of the AV outflow. Symptoms are graded on a scale specified by Society of Vascular Surgery (SVS) reporting standards:5 Workup Duplex ultrasound can be used to analyze flow volumes. A high flow volume (in autogenous accesses greater than 800 mL/min, in nonautogenous accesses greater than 1200 mL/min) signifies an outflow issue. The vein or graft is acting as a pressure sink and stealing blood from the distal artery. A low flow volume signifies an inflow issue, meaning that there is a proximal arterial lesion preventing blood from reaching the distal artery. Upper extremity angiogram can identify proximal arterial lesions. Prevention Create the AV access as distal as possible, in order to preserve arterial inflow to the hand and reduce the anastomosis size and outflow diameter. SVS guidelines recommend a 4-6mm arteriotomy diameter to balance the need for sufficient access flow with the risk of steal. If a graft is necessary, tapered prosthetic grafts are sometimes used in patients with steal risk factors, using the smaller end of the graft placed at the arterial anastomosis, although this has not yet been proven to reduce the incidence of steal. Indications for Treatment Intervention is recommended in lifestyle-limiting cases of Grade II and all Grade III steal cases. If left untreated, the natural history of steal syndrome can result in chronic limb ischemia, causing gangrene with loss of digits or limbs. Treatment Options Conservative management relies on observation and monitoring, as mild cases of steal syndrome may resolve spontaneously. Inflow stenosis can be treated with endovascular intervention (angioplasty with or without stent) Ligation is the simplest surgical treatment, and it results in loss of the AV access. This is preferred in patients with repetitive failed salvage attempts, venous hypertension, and poor prognoses. Flow limiting procedures can address high volumes through the AV access. Banding can be performed with surgical cutdown and placement of polypropylene sutures or a Dacron patch around the vein or graft. The Minimally Invasive Limited Ligation Endoluminal-Assisted Revision (MILLER) technique employs a percutaneous endoluminal balloon inflated at the AVF to ensure consistency in diameter while banding Plication is when a side-biting running stitch is used to narrow lumen of the vein near the anastomosis. A downside of flow-limiting procedures is that it is often difficult to determine how much to narrow the AV access, as these procedures carry a risk of outflow thrombosis. There are also surgical treatments focused on reroute arterial inflow. The distal revascularization and interval ligation (DRIL) procedure involves creation of a new bypass connecting arterial segments proximal and distal to the AV anastomosis, with ligation of the native artery between the AV anastomosis and the distal anastomosis of the bypass. Reversed saphenous vein with a diameter greater than 3mm is the preferred conduit. Arm vein or prosthetic grafts can be used if needed, but prosthetic material carries higher risk of thrombosis. The new arterial bypass creates a low resistance pathway that increases flow to distal arterial beds, and interval arterial ligation eliminates retrograde flow through the distal artery. The major risk of this procedure is bypass thrombosis, which results in loss of native arterial flow and hand ischemia. Other drawbacks of DRIL include procedural difficulty with smaller arterial anastomoses, sacrifice of saphenous or arm veins, and decreased fistula flow. Another possible revision surgery is revision using distal inflow (RUDI). This procedure involves ligation of the fistula at the anastomosis and use of a conduit to connect the outflow vein to a distal artery. The selected distal artery can be the proximal radial or ulnar artery, depending on the preoperative duplex. The more dominant vessel should be spared, allowing for distal arterial beds to have uninterrupted antegrade perfusion. The nondominant vessel is used as distal inflow for the AV access. RUDI increases access length and decreases access diameter, resulting in increased resistance and lower flow volume through the fistula. Unlike DRIL, RUDI preserves native arterial flow. Thrombosis of the conduit would put the fistula at risk, rather than the native artery. The last surgical revision procedure for steal is proximalization of arterial inflow (PAI). In this procedure, the vein is ligated distal to the original anastomosis site and flow is re-established through the fistula with a PTFE interposition graft anastomosed end-to-side with the more proximal axillary artery and end-to-end with the distal vein. Similar to RUDI, PAI increases the length and decreases the diameter of the outflow conduit. Since the axillary artery has a larger diameter than the brachial artery, there is a less significant pressure drop across the arterial anastomosis site and less steal. PAI allows for preservation of native artery's continuity and does not require vein harvest. Difficulties with PAI arise when deciding the length of the interposition graft to balance AV flow with distal arterial flow. 2. Ischemic Monomelic Neuropathy Definition Ischemic monomelic neuropathy (IMN) is a rare but serious form of steal that involves nerve ischemia. Severe sensorimotor dysfunction is experienced immediately after AV access creation. Etiology IMN affects blood flow to the nerves, but not the skin or muscles because peripheral nerve fibers are more vulnerable to ischemia. Incidence and Risk Factors IMN is very rare; it has an estimated incidence of 0.1-0.5% of AV access creations.6 IMN has only been reported in brachial artery-based accesses, since the brachial artery is the sole arterial inflow for distal arteries feeding all forearm nerves. IMN is associated with diabetes, peripheral vascular disease, and preexisting peripheral neuropathy that is associated with either of the conditions. Patient Presentation Symptoms usually present rapidly, within minutes to hours after AV access creation. The most common presenting symptom is severe, constant, and deep burning pain of the distal forearm and hand. Patients also report impairment of all sensation, weakness, and hand paralysis. Diagnosis of IMN can be delayed due to misattribution of symptoms to anesthetic blockade, postoperative pain, preexisting neuropathy, a heavily bandaged arm precluding neurologic examination. Treatment Treatment is immediate ligation of the AV access. Delay in treatment will quickly result in permanent sensorimotor loss. 3. Perigraft Seroma Definition A perigraft seroma is a sterile fluid collection surrounding a vascular prosthesis and is enclosed within a pseudomembrane. Etiology and Incidence Possible etiologies include: transudative movement of fluid through the graft material, serous fluid collection from traumatized connective tissues (especially the from higher adipose tissue content in the upper arm), inhibition of fibroblast growth with associated failure of the tissue to incorporate the graft, graft “wetting” or kinking during initial operation, increased flow rates, decreased hematocrit causing oncotic pressure difference, or allergy to graft material. Seromas most commonly form at anastomosis sites in the early postoperative period. Overall seroma incidence rates after AV graft placement range from 1.7–4% and are more common in grafts placed in the upper arm (compared to the forearm) and Dacron grafts (compared to PTFE grafts).7-9 Patient Presentation and Workup Physical exam can show a subcutaneous raised palpable fluid mass Seromas can be seen with ultrasound, but it is difficult to differentiate between the types of fluid around the graft (seroma vs. hematoma vs. abscess) Indications for Treatment Seromas can lead to wound dehiscence, pressure necrosis and erosion through skin, and loss of available puncture area for hemodialysis Persistent seromas can also serve as a nidus for infection. The Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines10 recommend a tailored approach to seroma management, with more aggressive surgical interventions being necessary for persistent, infected-appearing, or late-developing seromas. Treatment The majority of early postoperative seromas are self-limited and tend to resolve on their own Persistent seromas have been treated using a variety of methods-- incision and evacuation of seroma, complete excision and replacement of the entire graft, and primary bypass of the involved graft segment only. Graft replacement with new material and rerouting through a different tissue plane has a higher reported cure rate and lower rate of infection than aspiration alone.9 4. Infection Incidence and Etiology The reported incidence of infection ranges 4-20% in AVG, which is significantly higher than the rate of infection of 0.56-5% in AVF.11 Infection can occur at the time of access creation (earliest presentation), after cannulation for dialysis (later infection), or secondary to another infectious source. Infection can also further complicate a pre-existing access site issue such as infection of a hematoma, thrombosed pseudoaneurysm, or seroma. Skin flora from frequent dialysis cannulations result in common pathogens being Staphylococcus, Pseudomonas, or polymicrobial species. Staphylococcus and Pseudomonas are highly virulent and likely to cause anastomotic disruption. Patient Presentation and Workup Physical exam will reveal warmth, pain, swelling, erythema, induration, drainage, or pus. Occasionally, patients have nonspecific manifestations of fever or leukocytosis. Ultrasound can be used to screen for and determine the extent of graft involvement by the infection. Treatments In AV fistulas: Localized infection can usually be managed with broad spectrum antibiotics. If there are bleeding concerns or infection is seen near the anastomosis site, the fistula should be ligated and re-created in a clean field. In AV grafts: If infection is localized, partial graft excision is acceptable. Total graft excision is recommended if the infection is present throughout the entire graft, involves the anastomoses, occludes the access, or contains particularly virulent organisms Total graft excision may also be indicated if a patient develops recurrent bacteremia with no other infectious source identified. For graft excision, the venous end of the graft is removed and the vein is oversewn or ligated. If the arterial anastomosis is intact, a small cuff of the graft can be left behind and oversewn. If the arterial anastomosis is involved, the arterial wall must be debrided and ligation, reconstruction with autogenous patch angioplasty, or arterial bypass can be pursued. References 1. Morsy AH, Kulbaski M, Chen C, Isiklar H, Lumsden AB. Incidence and Characteristics of Patients with Hand Ischemia after a Hemodialysis Access Procedure. J Surg Res. 1998;74(1):8-10. doi:10.1006/jsre.1997.5206 2. Ballard JL, Bunt TJ, Malone JM. Major complications of angioaccess surgery. Am J Surg. 1992;164(3):229-232. doi:10.1016/S0002-9610(05)81076-1 3. Valentine RJ, Bouch CW, Scott DJ, et al. Do preoperative finger pressures predict early arterial steal in hemodialysis access patients? A prospective analysis. J Vasc Surg. 2002;36(2):351-356. doi:10.1067/mva.2002.125848 4. Malik J, Tuka V, Kasalova Z, et al. Understanding the Dialysis access Steal Syndrome. A Review of the Etiologies, Diagnosis, Prevention and Treatment Strategies. J Vasc Access. 2008;9(3):155-166. doi:10.1177/112972980800900301 5. Sidawy AN, Gray R, Besarab A, et al. Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg. 2002;35(3):603-610. doi:10.1067/mva.2002.122025 6. Thermann F, Kornhuber M. Ischemic Monomelic Neuropathy: A Rare but Important Complication after Hemodialysis Access Placement - a Review. J Vasc Access. 2011;12(2):113-119. doi:10.5301/JVA.2011.6365 7. Dauria DM, Dyk P, Garvin P. Incidence and Management of Seroma after Arteriovenous Graft Placement. J Am Coll Surg. 2006;203(4):506-511. doi:10.1016/j.jamcollsurg.2006.06.002 8. Gargiulo NJ, Veith FJ, Scher LA, Lipsitz EC, Suggs WD, Benros RM. Experience with covered stents for the management of hemodialysis polytetrafluoroethylene graft seromas. J Vasc Surg. 2008;48(1):216-217. doi:10.1016/j.jvs.2008.01.046 9. Blumenberg RM, Gelfand ML, Dale WA. Perigraft seromas complicating arterial grafts. Surgery. 1985;97(2):194-204. 10. Lok CE, Huber TS, Lee T, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis. 2020;75(4):S1-S164. doi:10.1053/j.ajkd.2019.12.001 11. Padberg FT, Calligaro KD, Sidawy AN. Complications of arteriovenous hemodialysis access: Recognition and management. J Vasc Surg. 2008;48(5):S55-S80. doi:10.1016/j.jvs.2008.08.067
Buckle up, PGY-1's! Intern year is starting whether you're ready or not. Don't fret, BTK has your back to make sure you dominate the first year of residency. Today, we're hitting the wards and tackling some of the scary clinical scenarios you will see as an intern. Hosts: Shanaz Hossain, Nina Clark Tips for new interns: THINGS TO REMEMBER · BREATHE. In most cases, you have a little bit of time – at least enough to take a breath and calm down outside the room before heading into an emergency. Panic doesn't help anybody. · See the patient. Getting a bunch of pages? Worried about someone? Confused as to what's going on? Go see the patient and chat with the bedside team. · Know your toolbox. There are a ton of people around who can help you in the hospital, and knowing the basic labs/imaging studies and when to use them can help you to triage even the sickest patients. · Load the boat. You've heard this one from us all week! Loop senior level residents in early. HYPOTENSION · Differential: measurement error, patient's baseline, and don't miss – SHOCK. - Etiologies of shock: hemorrhagic, hypovolemic, · On the phone: full set of vitals, accurate I/Os, · On the way: recent notes, PMH/PSH including from this hospital stay, and vitals/I&Os/studies from earlier in the day · In the room: ABCDs – rapidly gives you a sense of how high acuity the patient is · Get more info: labs, consider imaging, work up specific types of shock based on clinical concern. · Initial management: depends on etiology of hypotension; don't forget to consider peripheral or central access, foley catheterization for close monitoring of urine output, and level of care HYPOXEMIA · Differential: atelectasis, baseline pulmonary disease, pneumonia, PE, hemo/pneumothorax, volume overload · On the phone: full set of vitals, amount of supplemental oxygen required and delivery device, rate of escalation in oxygen requirement · On the way: review PMH/PSH, known injuries (known hemothorax/pneumothorax? Rib fractures? Chest tubes in already?), risk factors for DVT/PE, review I/Os for evidence of volume status, vitals and labs for evidence of infection · In the room: ABCDs, pulmonary and cardiac exam, volume status exam · Get more info: basic labs, ABG if worried about oxygenation, CXR, consider bedside US of the lungs/heart, if high suspicion for PE consider CTA chest · Initial Management: supplemental O2, higher level of care, consider intubation or other supplemental oxygenation adjuncts, additional management dependent on suspected etiology · ABG Vs VBG (IBCC): https://emcrit.org/ibcc/vbg/ ALTERED MENTAL STATUS · Differential: stroke, medication effect, hypoxemia or hypercarbia, toxic or medication effect, endocrine/metabolic, stroke or MI, psychiatric illness, or infections, delirium · On the way: review PMH/PSH, recent notes for evidence of altered mentation or agitation, or signs hinting at above etiologies · In the room: ABCDs, focal neuro deficits?, alert/oriented? Be sure the patient's mental status is adequate for airway protection! · Get more info: basic labs, blood gas/lactate, CT head noncontrast if concerned for stroke. · Initial management: rule out above; if concerned about delirium, optimize sleep/wake cycles, pain control, and lines/drains/tubes. OLIGURIA · Differential: prerenal due to hypovolemia or low effective circulating volume, intrinsic renal disease, post-renal obstruction · On the phone: clarify functional foley or bladder scan results, full set of vitals · On the way: review PMH/PSH, known injuries (known hemothorax/pneumothorax? Rib fractures? Chest tubes in already?), risk factors for DVT/PE, review I/Os for evidence of volume status, vitals and labs for evidence of infection · In the room: ABCDs, confirm functioning foley catheter · Get more info: basic labs, urine electrolytes, consider fluid challenge to evaluate responsiveness, consider adjuncts including renal US · Initial management: typically consider IVF bolus initially, but if patient not volume responsive, don't overload them -- look for other etiologies! TACHYCARDIA · Differential: sinus tachycardia (pain, hypovolemia, agitation, infection), cardiac arrhythmia, MI, PE · On the phone: full set of vitals, acuity of change in heart rate, updated I/Os · On the way: Review PMH/PSH, known cardiac history, cardiac and PE risk factors, volume resuscitation, signs concerning for infection, updated I/Os · In the room: ABCDs, cardiac/pulmonary exam, evaluate for any localizing signs for infection · Get more info: basic labs, EKG, consider CXR, troponins · Initial management: depends heavily on etiology Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/
In this “Breathe Easy Critical Perspective” podcast, Dr. Dominique Pepper interviews Dr. William Checkley. They discuss outcomes in critically ill patients with pneumonia due to SARS-CoV-2 compared to other etiologies. Dr. Checkley is an Associate Professor of Medicine in the Division of Pulmonary and Critical Care at the Johns Hopkins School of Medicine, Baltimore Maryland.
Episode 106: Weight Loss Meds. Anti-obesity medications are FDA-approved drugs to support your patient's efforts to lose weight. It is important for primary care providers to learn about these medications to continue fighting against obesity in our communities.Introduction: Obesity is a chronic disease.By Hector Arreaza, MD. Obesity has all the characteristics of a chronic disease. Let's use our imagination and think about a patient with hypertension, for example. Let's imagine you are the doctor or Mr. Lee. He is 45 years old and his blood pressure has been persistently high, around 150/100, even after lifestyle modifications. You decide to start chlorthalidone 25 mg and Mr. Lee takes chlorthalidone every day. Four weeks later you see Mr. Lee again and you review his labs with him. He has normal renal function and normal electrolytes. His blood pressure is now 119/75. He is feeling great and reports no side effects to chlorthalidone. Would you stop the medication at this time? Think about it. The most obvious answer is NO, you will not stop chlorthalidone. Today you will listen to a discussion about anti-obesity medications, common indications, contraindications, cautions, and more. We will learn that obesity requires chronic treatment with medications just like any other chronic disease. I hope you enjoy it.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.___________________________Weight Loss Meds. By Sapna Patel, MS4; and Danish Khalid, MS$. Ross University School of Medicine. Moderated by Hector Arreaza, MD. S: Hello and welcome back to our nutrition series! If you haven't already listened to our previous episodes, pause this and make sure to give them a listen. We have talked about physical activity, meal plans, and intermittent fasting. Today we are going to talk about the clinical management of obesity, specifically the pharmacotherapy that is used. We will divide these drugs into drugs that reduce food intake primarily acting on the CNS, drugs that reduce fat absorption and medications that are associated with weight gain. D: Can anyone who is considered obese take medications to help them lose weight? Pharmacotherapy should be considered if the patient will be taking the medication in conjunction with the overall weight management program, including changes in eating habits, increased physical activity, and realistic expectations of the medication therapy. Adjuvant pharmacologic treatments should be considered for patients with a BMI >30 kg/m2 or with BMI >27 kg/m2 who have concomitant obesity related diseases. A: You are going to find doctors who are pretty much against anti-obesity drugs, but that's not my case. S: Drugs that reduce food intake primarily acting on the CNS: Let's start with Phentermine and other sympathomimetic drugs A: Phentermine has been in the market over 60 years and it is well tolerated by most patients. It is effective, expect 5-8 lbs weight loss a month when taken with dietary changes and increased physical activity. The weight loss happens mostly the first 3-6 months when you take anti-obesity medications. S: One of the longest clinical trials of the drugs in this group lasted 36 weeks and compared placebo treatment to treatment with continuous phentermine and intermittent phentermine. Both the continuous and intermittent phentermine therapy produced more weight loss than placebo. D: Other options are Phentermine and topiramate ER which is known as “Qsymia”. These drugs combine a catecholamine releaser and anticonvulsant respectively. Topiramate is currently approved by the USFDA as an anticonvulsant for treatment of epilepsy and for prophylaxis of migraine headaches. Weight loss was seen as an unintentional side effect during clinical trials for epilepsy.The mechanism responsible for this is thought to be mediated through the modulation of GABA receptors, inhibition of carbonic anhydrase and antagonism of glutamate to reduce food intake The common adverse effects include cognitive impairment, paresthesia, and increased risk for kidney stones. Topiramate is also a teratogenic drug, so patients need to be in a good birth control to take it. It causes cleft palate in the fetus.The 2 phase-III trials called EQUIP and CONQUER, both 1 year randomized placebo-controlled double-blinded clinical trials, 3 different strengths of a once-a day formulation were tested: full strength dose (15 mg of phentermine and 92 mg of topiramate ER), mid-dose (7.5mg of phentermine and 92 mg topiramate ER) and low dose (3.75mg of phentermine and 23 mg of topiramate ER). Subjects randomized to the full strength dose in EQUIP and CONQUER trials lost an average of 10.9% and 9.8% body weight in 1 year compared to 1.6% and 1.2% loss for placebo subjects respectively. Significant improvement in fasting glucose, insulin, Hemoglobin A1C and lipid profile were seen.Due to the dose dependent side effects of the medications an initial dose of 3.75/23 mg is prescribed daily for the first 14 days then increased to 7.5/23mg daily. These patients should be re-evaluated after 3 months. If 3% weight loss is not achieved by that time, either discontinue or escalate the dose to 15/92mg for 12 weeks. S: Drugs that reduce fat absorption:Orlistat. What is orlistat? Well it's a selective inhibitor of pancreatic lipase that reduces the intestinal digestion of fat. The mean weight loss when compared to a placebo was 2.51kg at 6 months and 2.75kg at 12 months. A: It is one of the few anti-obesity medications approved to be used in children 12 years and older. D: GLP-1 Receptor Agonist (-glutide): Semaglutide and Liraglutide - Only two that have been approved for treatment of obesity. A 20-week randomized trial, comparing Liraglutide, placebo, and orlistat, showed that patients assigned to liraglutide lost significantly more weight than those assigned to both. When compared to placebo, those on liraglutide lost a mean weight loss of 2.8 kg. Whereas compared to orlistat lost an average of 5.8kg, however this was on the higher doses of liraglutide. A 56-weeks trial, comparing liraglutide with placebo, showed a mean weight loss was significantly greater in the liraglutide group (8.0 kg vs 2.6 kg). Furthermore, those who initially lost weight with diet and exercise, a greater proportion of those taking liraglutide maintained the weight loss. Similarly, clinical trials favored semaglutide, with a weight loss greater in the semaglutide group versus placebo. For both, weight loss occurred in patients with and without diabetes. Note: Semaglutide: once a week. Helps induce weight loss. Liraglutide: daily. A: We dedicated a whole episode on Semaglutide and another whole episode on Tirzepatide. Tirzepatide (dual agonist: GLP-1 and GIP) seems promising for weight loss and it is likely to be approved soon for obesity treatment. So, when do we discontinue anti-obesity medications? We can ask the same question for other chronic diseases: When do we stop medication for hypertension or diabetes? When we have a patient is unable to keep their weight off, we can't see him/her as someone who has lost their motivation to keep their weight off. Really what's happened is that their hormones have changed in a way that is promoting weight gain and it's very hard to lose weight. We should be at the patient's side to fight it off. Conclusion: Now we conclude our episode number 106 “Weight Loss Meds.” Phentermine is the most widely used anti-obesity medication. It is a stimulant, and it is a safe and effective medication for most patients who are fighting obesity. Make sure you learn the contraindication, side effects, and precautions when you prescribe it. Also, learn about other meds that are very effective, including GLP-1 receptor agonists, and your patients will thank you. This week we thank Hector Arreaza, Danish Khalid, and Sapna Patel. Audio by Sheila Toro.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. See you next week! _____________________References: Perreault, L., Apovian, C. (2021). Obesity in adults: Overview of management. Pi-Sunyer, F.X., Seres, D., & Kunins, L. (Eds.) Uptodate. Available from: https://www-uptodate-com.rossuniversity.idm.oclc.org/contents/obesity-in-adults-overview-of-management?search=weight%20loss%20medications&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2 Perreault, L. (2022). Obesity in adults: Drug therapy. Pi-Sunyer, F.X., & Kunins, L. (Eds.) Uptodate. Available from: https://www-uptodate-com.rossuniversity.idm.oclc.org/contents/obesity-in-adults-drug-therapy?search=weight%20loss%20medications&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 Dungan, K., DeSantis, A. (2022) Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus. Nathan, D.M., & Mulder, J.E. (Eds.) Uptodate. Available from: https://www-uptodate-com.rossuniversity.idm.oclc.org/contents/glucagon-like-peptide-1-based-therapies-for-the-treatment-of-type-2-diabetes-mellitus?search=glp%201%20receptor%20agonists&source=search_result&selectedTitle=2~97&usage_type=default&display_rank=1 Perreault, L., Bessesen, D. (2022). Obesity in adults: Etiologies and risk factors. Pi-Sunyer, F.X., & Kunins, L. (Eds.) Uptodate. Available from: https://www-uptodate-com.rossuniversity.idm.oclc.org/contents/obesity-in-adults-etiologies-and-risk-factors?search=medication%20associated%20with%20weight%20gain§ionRank=1&usage_type=default&anchor=H1612312650&source=machineLearning&selectedTitle=1~150&display_rank=1#H1612312650. Royalty-free music used for this episode: Salsa Trap by Caslo, downloaded on July, 20, 2022 from https://freemusicarchive.org/music/caslo/caslo-vol-1/salsa-trap/. Space Orbit by Scott Holmes, downloaded on July, 20, 2022 from https://freemusicarchive.org/music/Scott_Holmes/.
Join us as Dr. Sicolo shares her expertise, experience, and factors to consider when diagnosing pediatric bowel dysfunctions. Guest bio: Dr. Sicolo is the Clinical Assistant Professor of Pediatrics at the Keck School of Medicine at University of Southern California. She serves as the Medical Director of Gastrointestinal Neuromuscular and Motility Disorders Program at Children's Hospital Los Angeles. Her areas of special interest include chronic intestinal pseudo-obstruction, general gastroenterology, motility studies & children with Spina Bifida. She is passionate about education and sharing her expertise with patients and other clinicians. Visit https://www.coloplast.us/professional/ for more educational offerings.
Episode 370: In this episode you'll learn about…The simple solution to happiness. (0:46)Adverse childhood events: ACE's (8:20)Lift the veil and continue exploring. (18:42)Adding more tools to the toolkit. (28:30)Ensuring children are truly listened to. (36:59)Finding people who love you for your honesty. (43:38)
Welcome to PICU Doc On Call, a podcast dedicated to current and aspiring intensivists. My name is Pradip Kamat. And my name is Rahul Damania, we come to you from Children's Healthcare of Atlanta/Emory University School of Medicine. Today's episode is dedicated to Noninvasive and Invasive ventilation in children post-hematopoietic cell transplantation. We are delighted to be joined by Dr. Courtney Rowan, MD, MSCR, Associate Professor of Pediatrics, and the Director of the Pediatric Critical care Fellowship at Indiana University School of Medicine/Riley Children's Health. Dr. Rowan's research interest is in improving the outcomes of immunocompromised children with respiratory failure. She is active in this field of research and has led and participated in multi-centered studies. She is the co-chair of the committee of the hematopoietic cell transplantation subgroup of the Pediatric acute lung injury and sepsis investigators network. In our podcast today we will be asking Dr. Rowan about the findings of her recent study published in the journal-Frontiers in Oncology reporting on the risk factors for noninvasive ventilation failure in children post hematopoietic cell transplant. She is on twitter @CmRowan. Patient CaseI will turn it over to Rahul to start with our patient case... A 15-year-old female with a history of AML s/p Allogeneic hematopoietic stem cell transplantation T+15 days presents with tachypnea and a new O2 requirement. She has been on the BMT floor for 48 hrs after being admitted for respiratory distress and fevers. Her blood cultures are negative but she is febrile intermittently. Her CXR shows nonspecific haziness, no focal opacity, and underinflation. Her weight is up 2KG in the last 48 hours. She is found to have increased work of breathing and mild desaturations to 88%. She is placed on HFNC and continued on broad-spectrum antibiotics. A respiratory viral panel and Sars-CoV-2 PCR is sent. Transfer to the Pediatric ICU is initiated. Episode DialogueDr. Rowan, welcome to our PICU Doc on-call podcast. Dr. Rowan: Thanks Rahul & Pradip for having me. I am delighted to be here to discuss one of my favorite topics. I have no conflicts of interest but I have funding from the NHLBI. Today we will be discussing the up-to-date evidence for NIV (HFNC and NIPPV) use in children who have had BMT. Additionally, we will also be discussing the use of invasive MV strategies including HFOV in the pediatric BMT population. To start us off, Dr. Rowan, why is the BMT cohort different from other patients admitted to the PICU? There is an increase in the # of patients undergoing BMT as indications for BMT are being expanded to different disease processes. The Etiologies for lung disease in BMT patients can be infectious (common organisms as well as opportunistic organisms). They can have lung disease from non-infectious causes and even fluid overload from renal dysfunction/medications given and there is a constant threat of alloreactivity which can manifest as GVHD or engraftment syndrome. 75% of PICU admits of immunocompromised children come from the heme-onc inpatient services. BMT patients have a higher risk to progress to ARDS. Recent reports show the incidence of ARDS in the intubated BMT population reaching upwards of 92%. These patients are also at high risk for MODS and can have a mortality rate close to 60%.
In this episode, we review the high-yield topic of Other Restrictive Etiologies from the Respiratory section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets --- Send in a voice message: https://anchor.fm/medbulletsstep1/message
Stanley Cohan, MD, Neurologist, Providence Neurological Specialties West
Stanley Cohan, MD, Neurologist, Providence Neurological Specialties West
Discuss different Etiologies of UTI in Children.Describe Bladder and Bowel Dysfunction in children.Explain Neurogenic bladder and Caudal Regression Syndrome.
This episode covers etiologies of hypoxemic respiratory failure!
This episode covers etiologies of hypercarbic respiratory failure!
ADHD is a well-known disorder characterised by inattention, hyperactivity, and/or impulsivity. But, is that all it entails? In this episode, we discuss the symptoms of ADHD, how it can affect our brain and behaviour, and the misconceptions many of us have come to believe. So, grab your bat and hardhat as we get to smashing some myths!References Websites https://www.additudemag.com/adhd-neuroscience-101/ https://www.addrc.org/dsm-5-criteria-for-adhd/ https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml https://www.verywellmind.com/the-adhd-brain-4129396 https://www.understood.org/en/learning-thinking-differences/child-learning-disabilities/add-adhd/adhd-and-the-brain Journal Articles Barkley, Russell A. (2015). Etiologies of ADHD. In R. A. Barkley (Ed.), Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, 4th ed. (pp. 356–390). New York, NY: Guilford Press. Biederman, Joseph et al. (2012). Adult Outcome of Attention-Deficit/Hyperactivity Disorder: A Controlled 16-Year Follow-Up Study. Journal of Clinical Psychiatry 73(7):941–950. Gershon, J., & Gershon, J. (2002). A meta-analytic review of gender differences in ADHD. Journal of attention disorders, 5(3), 143-154. Kross, E., Egner, T., Ochsner, K., Hirsch, J., & Downey, G. (2007). Neural dynamics of rejection sensitivity. Journal of Cognitive Neuroscience, 19(6), 945-956. Lange, K. W., Reichl, S., Lange, K. M., Tucha, L., & Tucha, O. (2010). The history of attention deficit hyperactivity disorder. ADHD Attention Deficit and Hyperactivity Disorders, 2(4), 241-255. Mattison, R. E., & Mayes, S. D. (2012). Relationships between learning disability, executive function, and psychopathology in children with ADHD. Journal of Attention Disorders, 16(2), 138-146. Owens, Elizabeth et al. (2015). Developmental Progression and Gender Differences among Individuals with ADHD. In R. A. Barkley (Ed.), Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, 4th ed. (pp. 223–255). New York, NY: Guilford Press. Pastor, Patricia N. et al. (2015). Association between diagnosed ADHD and selected characteristics among children aged 4–17 years: United States, 2011–2013. NCHS Data Brief, no 201. Hyattsville, MD: National Center for Health Statistics. Sklar, R. H. (2013). Hyperfocus in adult ADHD: An EEG study of the differences in cortical activity in resting and arousal states (Doctoral dissertation, University of Johannesburg). Wigal, S. B., Emmerson, N., Gehricke, J. G., & Galassetti, P. (2013). Exercise: applications to childhood ADHD. Journal of Attention Disorders, 17(4), 279-290.
This episode covers endocarditis etiologies!
This episode covers the etiologies of fecal incontinence!
Dr. Silva comments on several diagnostic dilemmas where the pathology pattern leads to a plethora of possibilities.
Dr. Silva comments on several diagnostic dilemmas where the pathology pattern leads to a plethora of possibilities.
Final podcast on Arthritis
In this podcast episode, Celina Tobias-Grasso, Senior Training Manager in the Education and Training department, and Reinhold Schatzer, Team Leader in the Signal Processing and Fitting team, focus on cochlear implantation in single-sided deafness. Reinhold, explains in detail what is single-sided deafness and elaborates on the history of cochlear implantation for SSD. Etiologies and successes stemming from clinical evidence and documented in the literature are also covered in this episode.
This week, Anna and Amber talk about those pesky Big Questions: How are we here? Why are we here? Where do dragons come from? Turns out, people have been coming up with explanations, myths, and stories for questions like this since prehistory. Links Here There Be Dragons: Etiologies Creation Stories from around the World: Encapsulations of some traditional stories explaining the origin of the Earth, its life, and its peoples The Origin of Dragons (Anthropos) Dragons: A Brief History of the Mythical, Fire-Breathing Beasts (LiveScience) Cyclops Myth Spurred by 'One-Eyed' Fossils? (National Geographic) 10 Mythological Perspectives On Menstruation (Listverse) Religion and Women (via Google Books) Menstruation (Transactions and Proceedings of the Royal Society of New Zealand 1868-1961) Star Gods of the Maya: Astronomy in Art, Folklore, and Calendars (via Google Books) Ancient mantis-man petroglyph discovered in Iran (Phys.org) Iconography of the Indus Unicorn: Origins and Legacy (Harappa.com) Now we know the reason for the narwhal's tusk (Mother Nature Network) The Travels of Marco Polo (Wikisource) Contact Email the Dirt Podcast Affiliates Wildnote TeePublic Timeular
This week, Anna and Amber talk about those pesky Big Questions: How are we here? Why are we here? Where do dragons come from? Turns out, people have been coming up with explanations, myths, and stories for questions like this since prehistory. Links Here There Be Dragons: Etiologies Creation Stories from around the World: Encapsulations of some traditional stories explaining the origin of the Earth, its life, and its peoples The Origin of Dragons (Anthropos) Dragons: A Brief History of the Mythical, Fire-Breathing Beasts (LiveScience) Cyclops Myth Spurred by 'One-Eyed' Fossils? (National Geographic) 10 Mythological Perspectives On Menstruation (Listverse) Religion and Women (via Google Books) Menstruation (Transactions and Proceedings of the Royal Society of New Zealand 1868-1961) Star Gods of the Maya: Astronomy in Art, Folklore, and Calendars (via Google Books) Ancient mantis-man petroglyph discovered in Iran (Phys.org) Iconography of the Indus Unicorn: Origins and Legacy (Harappa.com) Now we know the reason for the narwhal's tusk (Mother Nature Network) The Travels of Marco Polo (Wikisource) Contact Email the Dirt Podcast Affiliates Wildnote TeePublic Timeular
Um caso de Febre de Origem Indeterminada (FOI)! O Frederico trouxe esse caso desafiador pra gente discutir e estruturar uma abordagem. A FOI é uma síndrome clássica da clínica médica, um mistério repleto de pistas falsas e verdadeiras. Vem com a gente tentar descobrir a causa dessa febre! REFERÊNCIAS: PETERSDORF, ROBERT G., and PAUL B. BEESON. "Fever of unexplained origin: report on 100 cases." Medicine 40.1 (1961): 1-30. DURACK, D. T. Fever of unknown origin-reexamined and redefined. Current Clinical Topics in Infectious Disease, v. 11, p. 35-51, 1991. BLEEKER-ROVERS, Chantal P. et al. Clinical value of FDG PET in patients with fever of unknown origin and patients suspected of focal infection or inflammation. European journal of nuclear medicine and molecular imaging, v. 31, n. 1, p. 29-37, 2004. DE KLEIJN, Elisabeth MHA; VAN DEN BROUCKE, Jan P.; VAN DER MEER, Jos WM. Fever of unknown origin (FUO): I. A prospective multicenter study of 167 patients with FUO, using fixed epidemiologic entry criteria. 1997. HOROWITZ, Harold W. Fever of unknown origin or fever of too many origins?. The New England journal of medicine, v. 368, n. 3, p. 197, 2013. BLEEKER-ROVERS, Chantal P. et al. A prospective multicenter study on fever of unknown origin: the yield of a structured diagnostic protocol. Medicine, v. 86, n. 1, p. 26-38, 2007. PETERSDORF, Robert G. Fever of unknown origin: an old friend revisited. Archives of internal medicine, v. 152, n. 1, p. 21-22, 1992. DRENTH, Joost PH et al. Metastatic breast cancer presenting as fever, rash, and arthritis. Cancer, v. 75, n. 7, p. 1608-1611, 1995. BOR, David H. Approach to the adult with fever of unknown origin. UPTODATE Jan 2020. BOR, David H. Etiologies of fever of Unknown origin in adults. UPTODATE Jan 2020. DHALIWAL, Gurpreet; DETSKY, Allan S. The evolution of the master diagnostician. JAMA, v. 310, n. 6, p. 579-580, 2013. HOT, Arnaud et al. Yield of bone marrow examination in diagnosing the source of fever of unknown origin. Archives of internal medicine, v. 169, n. 21, p. 2018-2023, 2009. Knockaert, Daniel C., Laurent J. Vanneste, and Herman J. Bobbaers. "Fever of unknown origin in elderly patients." Journal of the American Geriatrics Society 41.11 (1993): 1187-1192.
Clinical Journal of the American Society of Nephrology (CJASN)
Professor Jean-Michel Halimii summarizes the article entitled, "Etiologies and Outcomes of Thrombotic Microangiopathies" on behalf of his co-authors.
Clinical Journal of the American Society of Nephrology (CJASN)
Professor Jean-Michel Halimii summarizes the article entitled, "Etiologies and Outcomes of Thrombotic Microangiopathies" on behalf of his co-authors.
January 2019 See acast.com/privacy for privacy and opt-out information.
"I find it very gratifying to treat because you can see the effects of your treatment right in front of your eyes. And your patients can go from very sick to well within a matter of hours." - Marc Probst, MD Who is Marc Probst, MD? Courtesy of Marc Probst, MD Marc Probst, MD, MS is an Academic Emergency Physician at The Mount Sinai Hospital in New York City. Dr. Probst is funded by a career development grant from the National Institutes of Health (NIH). His interests include syncope, shared decision-making, and Halloween. Twitter @probstMD Diabetic Ketoacidosis (DKA) Biochemical Findings Hyperglycemia Ketosis (High anion gap) Metabolic Acidosis Parameters to treat DKA Blood glucose >250mg/dL Elevated anion gap w/albumin adjustment >10 Serum bicarbonate
Le syndrome d’apnées centrales du sommeil : Etiologies et thérapeutiques Les Jeudis de la SPLF © SPLF 2017 Quoi de neuf docteur permet aux médecins pneumologues, ou d’autres spécialités d’écouter un expert francophone parler d’un sujet pointu de pneumologie en 5 minutes.
Le syndrome d’apnées centrales du sommeil : Etiologies et thérapeutiques Jean-Claude Meurice
Fred Gorelick
Fred Gorelick
Host: Matt Birnholz, MD Guest: John Y.K. Lee, MD Guest: Jason G. Newman, MD, FACS Joining Dr. Matt Birnholz to discuss innovative surgical approaches to cranial base disorders are Doctors John Y. K. Lee and Jason G. Newman. Dr. Lee is Medical Director of the Gamma Knife Center and Associate Professor of Neurosurgery and Otorhinolaryngology-Head and Neck Surgery at the Pennsylvania Hospital. Dr. Newman is Associate Professor of Otorhinolaryngology-Head and Neck Surgery at the Center for Cranial Base Surgery at the University of Pennsylvania.
Host: Matt Birnholz, MD Guest: John Y.K. Lee, MD Guest: Jason G. Newman, MD, FACS Joining Dr. Matt Birnholz to discuss innovative surgical approaches to cranial base disorders are Doctors John Y. K. Lee and Jason G. Newman. Dr. Lee is Medical Director of the Gamma Knife Center and Associate Professor of Neurosurgery and Otorhinolaryngology-Head and Neck Surgery at the Pennsylvania Hospital. Dr. Newman is Associate Professor of Otorhinolaryngology-Head and Neck Surgery at the Center for Cranial Base Surgery at the University of Pennsylvania.
Host: Matt Birnholz, MD Guest: John Y.K. Lee, MD Guest: Jason G. Newman, MD, FACS Joining Dr. Matt Birnholz to discuss innovative surgical approaches to cranial base disorders are Doctors John Y. K. Lee and Jason G. Newman. Dr. Lee is Medical Director of the Gamma Knife Center and Associate Professor of Neurosurgery and Otorhinolaryngology-Head and Neck Surgery at the Pennsylvania Hospital. Dr. Newman is Associate Professor of Otorhinolaryngology-Head and Neck Surgery at the Center for Cranial Base Surgery at the University of Pennsylvania.
In this second part of the Clinical Presentation and Acquired Causes of Rhabdomyolysis podcast, Dr. Ted Burns interviews Drs. Jessica Nance and Andrew Mammen about their paper Diagnostic evaluation of rhabdomyolysis from the June 2015 issue of Muscle and Nerve. Rhabdomyolysis is characterized by severe acute muscle injury resulting in muscle pain, weakness, and/or swelling with release of myofiber contents into the bloodstream. Symptoms develop over hours to days after an inciting factor and may be associated with dark pigmentation of the urine. This podcast focuses on the inherited etiologies. For the article in Muscle and Nerve refer to Muscle Nerve 51: 793-810, 2015.
In this second part of the Clinical Presentation and Acquired Causes of Rhabdomyolysis podcast, Dr. Ted Burns interviews Drs. Jessica Nance and Andrew Mammen about their paper Diagnostic evaluation of rhabdomyolysis from the June 2015 issue of Muscle and Nerve. Rhabdomyolysis is characterized by severe acute muscle injury resulting in muscle pain, weakness, and/or swelling with release of myofiber contents into the bloodstream. Symptoms develop over hours to days after an inciting factor and may be associated with dark pigmentation of the urine. This podcast focuses on the inherited etiologies. For the article in Muscle and Nerve refer to Muscle Nerve 51: 793-810, 2015.
In this second part of the Clinical Presentation and Acquired Causes of Rhabdomyolysis podcast, Dr. Ted Burns interviews Drs. Jessica Nance and Andrew Mammen about their paper Diagnostic evaluation of rhabdomyolysis from the June 2015 issue of Muscle and Nerve. Rhabdomyolysis is characterized by severe acute muscle injury resulting in muscle pain, weakness, and/or swelling with release of myofiber contents into the bloodstream. Symptoms develop over hours to days after an inciting factor and may be associated with dark pigmentation of the urine. This podcast focuses on the inherited etiologies. For the article in Muscle and Nerve refer to Muscle Nerve 51: 793-810, 2015.
Acquire knowledge re: where pain derives, the progression of chronic pain and how it is perceived by the patient and the physician.
We interview Dr. Christian Fossum DO of Norway on several topics relating to back pain. We cover etiologies, pathophysiolgies, osteopathic treatments as well as an intervational take on Osteopathy. Back pain interview with Dr Fossum
Host: Shira Johnson, MD Guest: Brian Durie, MD Noted hematologist Dr. Brian Durie is interviewed by host Dr. Shira Johnson on the role of environmental toxins in the development of multiple myeloma (MM). Dr. Durie discusses the increased incidence of MM in firefighters who participated in rescue and cleanup efforts after the terrorist attacks on 9/11, as well as the changing demographics of the disease.
Sural Neuropathy: Etiologies and Predisposing Factors by David Stickler, MD and Wayne Massey, MD
An Interview with David Stickler, MD and Wayne Massey, MD authors of Sural neuropathy: etiologies and predisposing factors Muscle and Nerve 2006;34:482-484 Stickler ED, Morley KN, Massey EW Interviewed by Ted Burns, MD and Vern Juel, MD
An Interview with David Stickler, MD and Wayne Massey, MD authors of Sural neuropathy: etiologies and predisposing factors Muscle and Nerve 2006;34:482-484 Stickler ED, Morley KN, Massey EW Interviewed by Ted Burns, MD and Vern Juel, MD
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