Podcasts about Heme

Chemical coordination complex

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Best podcasts about Heme

Latest podcast episodes about Heme

Sigma Nutrition Radio
#466: Iron Absorption from Foods & Supplements – Prof. Paul Sharp

Sigma Nutrition Radio

Play Episode Listen Later Jan 3, 2023 60:55


Iron deficiency is a prevalent issue. Worldwide, it is the leading nutritional deficiency. And although there is lower prevalence in high-income countries, a significant number of people are still affected. Iron deficiency may be a result of too little iron coming in (i.e., via diet choices or low absorption), or from excess losses (e.g., commonly from blood losses). Understanding how these can impact iron status is crucial for both accurate diagnosis and treatment. In relation to dietary iron, the source of iron is a common talking point, as there are two forms of iron that we can consume. Heme iron is found in meat, fish, and poultry, while non-heme iron is found in plant foods. It is known that heme iron is more readily absorbed than non-heme iron. However, there is much more to this story that makes things complicated. To discuss some of the nuances of iron bioavailability, absorption, and metabolism, leading expert in the area Professor Paul Sharp of King's College London is on the podcast. Prof. Sharp discusses crucial aspects of dietary iron sources, bioavailability, supplementation, and impacts in the body. Links: Episode page (with links/resources) Subscribe to Premium Live event: London, UK - March 2023

WolverHeme Happy Hour
Episode 10: ASH Recap Part 2 - Papa Heme + WolverHeme

WolverHeme Happy Hour

Play Episode Listen Later Dec 21, 2022 73:04


In this episode, we are joined by the legendary hematologist and rock star - Dr. Aaron Goodman - aka "Papa Heme"! We discuss which ASH abstracts might be practice changing and which simply don't make the cut. Stay tuned for an entertaining and very educational episode!

Hogares De Pacto
2 Samuel 1: No te alegres cuando Dios castigue a tu adversario.

Hogares De Pacto

Play Episode Listen Later Dec 5, 2022 7:09


2 Samuel 1: No te alegres cuando Dios castigue a tu adversario.2 Samuel 1:1-12: Aconteció que después de la muerte de Saúl, cuando David había vuelto de la derrota de los amalequitas, David se quedó dos días en Siclag. Y al tercer día, he aquí que un hombre vino del campamento de Saúl, con su ropa rasgada y tierra sobre su cabeza. Al llegar a David, se postró en tierra e hizo reverencia. Y David le preguntó: —¿De dónde vienes?Él le respondió: —Me he escapado del campamento de Israel.David le preguntó: —¿Qué ha acontecido? Dímelo, por favor.Él respondió: —El pueblo ha huido de la batalla. Muchos del pueblo también han caído y han muerto. Saúl y su hijo Jonatán también han muerto.David dijo al joven que le informaba: —¿Cómo sabes que Saúl y su hijo Jonatán han muerto?Y el joven que le informaba respondió: —Me encontré por casualidad en el monte Gilboa, y he aquí que Saúl estaba apoyado sobre su lanza y que los carros y los jinetes lo alcanzaban. Entonces Saúl miró hacia atrás y me vio, y me llamó. Yo dije: “Heme aquí”. Me preguntó: “¿Quién eres tú?”. Le respondí: “Soy un amalequita”. Y me dijo: “Por favor, ponte a mi lado y mátame; porque la agonía se ha apoderado de mí, pero mi vida está todavía en mí”. Entonces me puse a su lado y lo maté, porque sabía que él no podría vivir después de su caída. Luego tomé la diadema que tenía en su cabeza y el brazalete que llevaba en su brazo, y los he traído aquí a mi señor. Entonces David agarrando sus vestiduras las rasgó. Lo mismo hicieron todos los hombres que estaban con él. hicieron duelo, lloraron y ayunaron hasta el anochecer por Saúl y por su hijo Jonatán, por el pueblo del SEÑOR y por la casa de Israel; porque habían caído a espada.--------------------------------Hoy comenzamos el segundo libro de Samuel que continúa la historia de Saúl y David. En este capítulo vemos el momento cuando David recibe la noticia de que Saúl y su mejor amigo Jonatán han muerto. También se enteró que muchos del pueblo huyeron despavoridos de sus ciudades al ver que el ejército y su gente fueron derrotados y asesinados. Esto fue una gran derrota para Israel pero la mayor tragedia fue cuando Saúl y sus hijos murieron en la batalla. David se conmovió mucho porque tenía un corazón lleno de compasión. Era un hombre íntegro, con convicciones firmes y demostraba ser noble, caballeroso y honorable. Un hombre quiso buscar honores delante de David al hacerse pasar por el que quitó la vida a Saul. Posiblemente estuvo cerca cuando Saúl se suicidó pero le dijo a David que él había sido el que le dio el último golpe. David se enfureció, pues él tenía una fuerte convicción de que nadie debía tocar al ungido del Señor sin sufrir las consecuencias. El hombre fue juzgado en vez de ser recompensado. Ese hombre tal vez no supo que David pudo haber hecho eso en dos ocasiones y no lo hizo por el gran respeto a la voluntad de Dios. David juzgó a ese hombre por su insolencia, su atrevimiento y su vanagloria, mostrando respeto al rey caído. Además, demostró su genuino dolor al rasgarse las vestiduras, llorando y ayunando en señal de tristeza profunda.Esto fue un gran ejemplo para el pueblo al ver a David que no se alegraba del dolor de su adversario, a pesar de que Saúl lo merecía. Espero que también podamos seguir este ejemplo, que seamos un modelo para nuestra familia de personas que no guardan rencor, que no se alegran del sufrimiento de aquellos que en el pasado trataron de hacernos daño. Recordemos este consejo en Proverbios 24:17-18: “No te alegres cuando caiga tu enemigo; y cuando tropiece no se regocije tu corazón, no sea que lo vea el SEÑOR y le desagrade, y aparte de él su enojo."Es cierto que Dios hace justicia pero no debemos burlarnos o alegrarnos cuando Dios nos defiende trayendo castigo sobre los adversarios. No solo debemos dar gracias a Dios por protegernos, por devolvernos la honra, también debemos pedir misericordia por aquellos que han caído de la gracia de Dios. El apóstol Pablo nos aconseja sobre esto en Romanos 12:17-21 "No paguen a nadie mal por mal. Procuren lo bueno delante de todos los hombres. Si es posible, en cuanto dependa de ustedes, tengan paz con todos los hombres. Amados, no se venguen ustedes mismos sino dejen lugar a la ira de Dios, porque está escrito: Mía es la venganza; yo pagaré, dice el Señor. Más bien, si tu enemigo tiene hambre, dale de comer; y si tiene sed, dale de beber; pues haciendo esto, carbones encendidos amontonarás sobre su cabeza. No seas vencido por el mal sino vence el mal con el bien.” Soy Eduardo Rodríguez.

Daniel Ramos' Podcast
Episode 368: 01 de Diciembre del 2022 - Devoción para la mujer - ¨Sin miedos ni cadenas¨

Daniel Ramos' Podcast

Play Episode Listen Later Nov 30, 2022 4:16


================================================== ==SUSCRIBETEhttps://www.youtube.com/channel/UCNpffyr-7_zP1x1lS89ByaQ?sub_confirmation=1================================================== == DEVOCIÓN MATUTINA PARA MUJERES 2022“SIN MIEDOS NI CADENAS”Narrado por: Sirley DelgadilloDesde: Bucaramanga, ColombiaUna cortesía de DR'Ministries y Canaan Seventh-Day Adventist Church  01 DE DICIEMBRE ENVIA A OTRA"¿Quién forma la boca de una persona? ¿Quién decide que una persona hable o no hable, que oiga o no oiga, que vea o no vea? ¿Acaso no soy yo, el Señor?" (Éxodo 4:11, NTV).Hace ya casi dos años tuve la oportunidad de empezar a trabajar para la Radio Adventista de Londres. Al principio, francamente, estaba paralizada de miedo. Aunque hablo inglés con fluidez, tengo acento extranjero. Yo estaba convencida de que la gente odiaría mi voz y mi programa de radio. Durante varios meses, luché al tratar de tomar la decisión, porque esperaba que no era la persona adecuada. Finalmente, después de llorar y orar mucho, acepté el trabajo y comenzó un nuevo capítulo de mi vida.Dios llamó a Moisés, pero él, convencido de que no era la persona indicada para ese trabajo, respondió: "Oh Señor, no tengo facilidad de palabra; nunca la tuve, ni siquiera ahora que tú me ha hablado. Se me traba la lengua y se me enredan las palabras" (Éxodo 4:10, NTV). ¡cuantas veces nos miramos a nosotros mismos y pensamos que no somos capaces, ni aun cuando Dios mismo nos llama! Vemos todo con ojos humanos y le rogamos a Dios : “Por favor, envía a otra mujer más capaz que yo”.Pero Dios no necesita mujeres u hombres perfectos; él necesita personas dispuestas. Cuando comencé a recibir comentarios de los oyentes de la radio entendí, en parte, por qué Dios me había llamado a mí. Londres es una ciudad cosmopolita, con muchísimos extranjeros de todas partes del mundo. Para ellos, mi acento es familiar e inclusive más fácil de entender que el acento inglés nativo. Lo que pensé que me descalificaría para servir, Dios lo está usando para su gloria. Mi voz imperfecta es mas poderosa que mi silencio perfecto.La autora Eleonore van Haaften, en Vivir en libertad , describe el crecimiento de Moisés con las siguientes palabras: "En los primeros cuarenta años de su vida (en la casa de su familia y después en la corte de Faraón) aprendió a ser alguien; en los siguientes cuarenta años en el desierto, desde su huida hacia Madián hasta su llamamiento por Dios, aprendió a ser nadie; y en los cuarenta años desde la salida del pueblo de Egipto hasta su muerte, aprendió quién era Dios".Cuando el miedo trate de robarte tu futuro, pídele a Dios que, por medio de tus inseguridades, te muestre quién es él.Señor, tú nunca rechazas a los que se acercan a ti, por más débiles que sean. Heme aquí envíame a mí.

Mehlman Medical
HY USMLE Q #604 – Immuno/Heme (very difficult)

Mehlman Medical

Play Episode Listen Later Nov 28, 2022 7:11


Video for this podcast: https://mehlmanmedical.com/hy-usmle-q-604-immunology-hematology Main website: https://mehlmanmedical.com/ Instagram: https://www.instagram.com/mehlman_medical/ Telegram private group: https://mehlmanmedical.com/subscribe/ Telegram public channel: https://t.me/mehlmanmedical Facebook: https://www.facebook.com/mehlmanmedical Podcast: https://anchor.fm/mehlmanmedical Patreon: https://www.patreon.com/mehlmanmedical

The Mission - La Misión
Heme Aquí, Envíame a Mí

The Mission - La Misión

Play Episode Listen Later Nov 28, 2022 31:27


Para apoyar este ministerio y ayudarnos a seguir llegando a personas de todo el mundo, haga clic aquí: https://www.misionebenezer.org/donar Somos una Iglesia que existe para Restaurar, Equipar y Enviar a las personas a impactar el mundo para Cristo!

The Gary Null Show
The Gary Null Show - 11.18.22

The Gary Null Show

Play Episode Listen Later Nov 18, 2022 63:31


Videos : Niall Ferguson – Woke Totalitarianism (0:19 to 18:14) Heather Mac Donald On How The Delusion of Diversity Destroys Our Common Humanity (11:14) Elon Musk: “Klaus Schwab Is LYING!!!” (9:45) Lycopene, lutein supplements show skin protection from within against UV radiation Leibniz Research Institute for Environmental Medicine (Germany), November 10, 2022 The study's findings, published in the British Journal of Dermatology , indicated that oral supplementation with the carotenoids changed the expression of genes that are indicators of oxidative stress, photo-dermatoses and photo-aging. “To the best of our knowledge we show here for the 1st time that (i) tomato nutrient complex as well as lutein do not only protect healthy human skin against UVB/A, but also against long wave UVA1 radiation, and (ii) that oral photo-protection of healthy human skin can be demonstrated at the level of HO-1, ICAM-1 and MMP-1 gene expression,” wrote researchers from IUF – Leibniz Research Institute for Environmental Medicine in Dusseldorf. Heme oxygenase-1 (HO-1), intercellular adhesion molecule-1 (ICAM-1) and matrix metalloproteinase-1 (MMP-1) are reported to be UVA1/UVB radiation-inducible genes. “On top of that, as part of the photo-aging process we have evidence of the effect of our ingredients on the levels of expression of genes involved in collagen degradation, suggesting a link not only to skin health but also to skin appearance. This study suggests an effect of natural antioxidants on overall skin wellness, which is relevant for men and women in all age groups.” The new study included 65 healthy volunteers aged between 18 and 60. The participants were randomly assigned to randomly consume 20 mg per day of the tomato nutrient complex or placebo for 12 weeks, or 20 mg per day of lutein or placebo for 12 weeks. A two-week washout period separated the placebo and active intervention periods. At the beginning and at the end of each phase the skin was irradiated.Results of the placebo-controlled, double blinded, randomized cross-over study indicated that the tomato nutrient complex (TNC) totally inhibited the upregulation of HO-1, ICAM-1 and MMP1 mRNA by both UVA1 and UVA/B. On the other hand, lutein only completely inhibited gene expression if taken during the first 12 weeks (ie. prior to placebo), while a significantly smaller effect was observed if it was taken during the second 12 week phase (ie. after placebo), compared to TNC. (NEXT) Diallyl trisulfide in garlic induces apoptosis in primary effusion lymphoma Kyoto Pharmaceutical University (Japan), November 7, 2022 Reports from Kyoto Pharmaceutical University stated, “The allyl sulfides, including diallyl sulfide (DAS), diallyl disulfide (DAD), and diallyl trisulfide (DAT), contained in garlic and members of the Allium family, have a variety of pharmacological activities. Therefore, allyl sulfides have been evaluated as potential novel chemotherapeutic agents.” Our news editors obtained a quote from the research, “Here, we found that DAT inhibited nuclear factor-kB (NF-kB) signaling and induced apoptosis in primary effusion lymphoma (PEL), a subtype of non-Hodgkin's B-cell lymphoma caused by Kaposi's sarcoma-associated herpesvirus (KSHV). We examined the cytotoxic effects of DAS, DAD and DAT on PEL cells. DAT significantly reduced the viability of PEL cells compared with uninfected B-lymphoma cells, and induced the apoptosis of PEL cells by activating caspase-9. DAT induced stabilization of IkBa, and suppressed NF-kB transcriptional activity in PEL cells. We examined the mechanism underlying DAT-mediated IkBa stabilization. The results indicated that DAT stabilized IkBa by inhibiting the phosphorylation of IkBa by the IkB kinase (IKK) complex. Furthermore, DAT induced proteasomal degradation of TRAF6, and DAT suppressed IKKb-phosphorylation through downregulation of TRAF6. It is known that activation of NF-kB is essential for survival of PEL cells. In fact, the NF-kB inhibitor BAY11-7082 induced apoptosis in PEL cells. In addition, DAT suppressed the production of progeny virus from PEL cells. The administration of DAT suppressed the development of PEL cells and ascites in SCID mice xenografted with PEL cells.” According to the news editors, the research concluded: “These findings provide evidence that DAT has antitumor activity against PEL cells in-vitro and in-vivo, suggesting it to be a novel therapeutic agent for the treatment of PEL.” (NEXT) PTSD May Speed Up Cellular Aging Boston University, November 13, 2022 From birth to death, a lot may change, but our DNA—the long, double-helix molecule that contains all of a person's genetic code—stays the same. The instructions for reading that code can shift, however, as the chemical tags on and around a DNA sequence change throughout our lives, depending on our age, environment, and behavior. This outside influence on how our genes are read and expressed by cells is called epigenetics—and researchers studying it have discovered clues that may show why some veterans live longer than others. In a new study of military veterans published in Translational Psychiatry, researchers report findings that suggest former service personnel with PTSD are at greater risk of early death. “Our study found that PTSD and comorbid conditions, like substance misuse, are associated with a cellular marker of early death found in DNA methylation patterns,” says Erika Wolf, a professor of psychiatry at the Boston University School of Medicine and senior author of the study. The study included two samples of veterans that had representative levels of trauma and other psychiatric conditions, like substance use and personality disorders. One group included 434 veterans in their early 30s, who had served in post-9/11 conflicts; the other group included 647 middle-age veterans and their trauma-exposed spouses. Both groups were assessed for a range of psychological conditions, and had blood drawn to obtain genetic information and to test for levels of a variety of inflammatory molecules. The results indicate PTSD symptoms were a factor in faster cellular aging—.36 of a year faster. So, for every year that the cells of someone without PTSD age, the cells of someone with more severe PTSD symptoms age a year and a third. (NEXT) Higher sense of purpose in life may be linked to lower mortality risk Boston University, November 14, 2022 Growing research indicates that one's purpose—i.e., the extent to which someone perceives a sense of direction and goals in their life—may be linked to health-protective benefits such as better physical functioning and lower risks of cardiovascular disease or cognitive decline. Now, a new study led by a Boston University School of Public Health (BUSPH) researcher found that people with higher levels of purpose may have a lower risk of death from any cause, and that this association is applicable across race/ethnicity and gender. Published in the journal Preventive Medicine, the study results did suggest that this association is slightly stronger among women than it is among men, but there was no significant difference by race/ethnicity. “In another study I led, we found that the effect of purpose on lowering all-cause mortality may differ by socioeconomic status. In this study, we extended the prior evidence and found that the beneficial effect of purpose persisted regardless of gender and race/ethnicity.” For the study, the team assessed self-reported sense of purpose among more than 13,000 people, based on the “purpose in life” of the Ryff Psychological Well-being Scales, a widely used tool that measures different aspects of well-being and happiness. The researchers also examined mortality risk over an eight-year period beginning between 2006-2008. The results showed that people with the highest sense of purpose indicated the lowest risk of death (15.2 percent mortality risk), compared to people with the lowest sense of purpose (36.5 percent mortality risk). The team also gathered data on additional factors that can influence health, such socioeconomic status, other demographic characteristics, baseline physical health, and depression, and found that an increase in these factors was also associated with increases in a higher sense of purpose. (NEXT) Hibiscus compound shows anti-Alzheimer disease activity Pohang University of Science and Technology, November 16 2022. A report published in Alzheimer's Research & Therapy revealed that gossypetin, a flavonoid occurring in the calyx of the hibiscus flower, activates a process that reduces brain accumulation of amyloid beta, a protein that clumps to form toxic brain plaques in people with Alzheimer disease. Gossypetin has been reported to have antioxidant, antiatherosclerotic and anticancer effects. Earlier research had suggested a benefit for gossypetin, which is structurally similar to quercetin, against the aggregation of amyloid beta and tau proteins that occurs in Alzheimer disease. However, gossypetin's action in animal models of the disease had not been evaluated. Researchers at Pohang University of Science and Technology administered gossypetin or a control substance to mice that were bred to develop a condition similar to that of Alzheimer disease in humans. After 13 weeks of daily treatment, mice that received the flavonoid had less amyloid beta in the brain's hippocampus (an area involved in memory and learning) and cortex in comparison with the control mice. Gossypetin-treated animals also demonstrated better spatial learning and memory than untreated mice. Rather than affecting the production of amyloid beta, the research team found that gossypetin helped clear it by enhancing the scavenging ability of the brain's immune cells, which are known as microglia. Microglia normally consume amyloid beta but can become exhausted by continual exposure, which leads to a chronic damaging inflammatory reaction. (NEXT) Over a billion young people are potentially at risk of hearing loss from headphones, earbuds, loud music venues Mayo Clinic, November 15, 2022 More than 1 billion teens and young people are potentially at risk of hearing loss because of their use of headphones and earbuds and attendance at loud music venues, concludes a pooled data analysis of the available evidence, published in the open access journal BMJ Global Health. The World Health Organization (WHO) estimates that over 430 million people worldwide currently have disabling hearing loss. Young people are particularly vulnerable because of their use of personal listening devices (PLDs), such as smartphones, headphones and earbuds, and attendance at loud music venues, amid poor regulatory enforcement. Previously published research suggests that PLD users often choose volumes as high as 105 dB while average sound levels at entertainment venues range from 104 to 112 dB, exceeding permissible levels (80 dB for adults; 75 dB for children) even if for very short periods of time. A group of 33 studies, corresponding to data from 35 records and 19,046 participants, was included; 17 records focused on PLD use and 18 focused on loud entertainment venues. The pooled data analysis indicates that the prevalence of unsafe listening practices from PLD use and attendance at loud entertainment venues is common worldwide—24% and 48%, respectively, among teens and young people. Based on these figures, the researchers estimate that the global number of teens and young adults who could potentially be at risk of hearing loss as a result ranges from 0.67 to 1.35 billion.

The Medbullets Step 2 & 3 Podcast
Heme | Disseminated Intravascular Coagulation (DIC)

The Medbullets Step 2 & 3 Podcast

Play Episode Listen Later Nov 18, 2022 9:32


In this episode, we review the high-yield topic of Disseminated Intravascular Coagulation (DIC) from the Heme section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

The Medbullets Step 2 & 3 Podcast
Heme | Anemia of Renal Failure

The Medbullets Step 2 & 3 Podcast

Play Episode Listen Later Nov 17, 2022 8:23


In this episode, we review the high-yield topic of Anemia of Renal Failure from the Heme section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

The Medbullets Step 2 & 3 Podcast
Heme | Protein C/S Deficiency

The Medbullets Step 2 & 3 Podcast

Play Episode Listen Later Nov 16, 2022 8:07


In this episode, we review the high-yield topic of Protein C/S Deficiency from the Heme section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

Everyone's A Critic
Ep 222: Peas and Heme

Everyone's A Critic

Play Episode Listen Later Nov 16, 2022 65:23


So quick fact check: Impossible uses heme, and Beyond uses peas. Thus, peas and heme have never truly met in America's many meat departments. But they have met in our hearts. If you like the show, PLEASE TELL A FRIEND? That's our advertising for the moment.  Buy our shirts and cups: https://www.designbyhumans.com/shop/CriticEveryone/ Yell at us: foreveracritic@gmail.com Tweet at us: @CriticEveryone Allow conspiracies to fester with us: Facebook Fan Page: https://www.facebook.com/Everyones-a-Critic-2327696304154655/ Listen to the other great shows on our network: https://xraypod.com/ I did really hug Tommy Wiseau once.       

The Medbullets Step 2 & 3 Podcast
Heme | Von Willebrand Disease

The Medbullets Step 2 & 3 Podcast

Play Episode Listen Later Nov 15, 2022 8:31


In this episode, we review the high-yield topic of Von Willebrand Disease from the Heme section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

Daniel Ramos' Podcast
Episode 365: 01 de Noviembre del 2022 - Devoción matutina para Adultos - ¨Nuestro maravilloso Dios¨

Daniel Ramos' Podcast

Play Episode Listen Later Oct 31, 2022 4:46


================================================== ==SUSCRIBETEhttps://www.youtube.com/channel/UCNpffyr-7_zP1x1lS89ByaQ?sub_confirmation=1================================================== == DEVOCIÓN MATUTINA PARA ADULTOS 2022“NUESTRO MARAVILLOSO DIOS”Narrado por: Roberto NavarroDesde: Chiapas, MéxicoUna cortesía de DR'Ministries y Canaan Seventh-Day Adventist Church 01 DE NOVIEMBRE«SEÑOR, ¡AQUÍ ESTOY!»«Después de la voz del Señor, que decía: "¿A quién enviaré y quién irá por nosotros?" Entonces respondí yo: "Heme aquí, envíame a mi"». Isaías 6:8«INCULTA, INSIGNIFICANTE Y ORDINARIA». Así se vio a Gladys. El problema era que su descripción estaba incompleta: si bien a ella le faltaba el grado de educación que otros poseían, en cambio le sobraba lo que a otros les faltaba: DETERMINACIÓN.Gladys Aylward (1902-1980) nació en el seno de una familia pobre en el norte de Londres y, durante sus años de adolescente, trabajó como doméstica. Siendo todavía joven, se despertó en ella el sueño de servir a Jesús como misionera en China. El problema era, ¿cómo podría hacer realidad ese sueño sin recursos y sin preparación académica?La oportunidad se presentó cuando supo de China Inland Mission (Misión al Interior de China), una institución que preparó y financió a misioneros. Sin embargo, después de tres meses de entrenamiento, no aprobar aprobar los exámenes correspondientes. Desilusionada, pero no derrotada, Gladys volvió a su trabajo como empleada doméstica y ahorró cuanto pudo para adquirir su boleto. *Una noche, después de leer en las Escrituras los dos primeros capítulos del libro de Nehemías, Gladys sintió que Dios la estaba llamando a ir a China. Entonces, colocando sobre su cama la Biblia abierta, y el poco dinero que poseía, dijo: «Señor, aquí está mi Biblia; aquí está mi dinero, y aquí estoy yo. ¡Úselo, señor!». **Con ayuda de otras empleadas domésticas, Gladys vio comprar su boleto. Cuando llegó a Yangchen, sin dinero, y sin amigos, fue objeto de desprecio por su condición extranjera, pero tampoco se dio por vencida. Aprendió el idioma y, con otra misionera -Jeannie Lawson-, abrió La posada de la octava felicidad (llamada «de la sexta felicidad» en la película de Alan Burgess, de 1958). En poco tiempo, la posada se convirtió en favorita de los viajeros, entre otras cosas, por la narración de historias de la Biblia. Cuando regresaban a sus hogares, los viajeros diseminaban las buenas nuevas del evangelio.Después de hacerse ciudadana china, en 1936, Gladys Aylward comenzó a cuidar huérfanos y ayudar a los necesitados. Gracias a su inquebrantable espíritu de servicio, pronto se convirtió en embajadora del amor de Dios. Cuando en 1940 los japoneses invadieron Yangchen, milagrosamente lograron salvar a más de cien niños que estaban bajo su cuidado. Para ello tuvo que atravesar peligrosas montañas en un viaje de unos ciento sesenta kilómetros que duró 27 días.Gladys Aylward murió en 1970, a los 67 años, pero su obra es un testimonio de todo lo que Dios puede hacer cuando, en respuesta a su llamado, uno de sus hijos dice: «Señor, ¡aquí estoy!». Señor Jesús, no poseo muchos talentos; pero hoy quiero decirte que puedes contarme para que otros sepan que eres un maravilloso Salvador.* John Hudson Tiner, Para los que se atreven, Master Books, 2002, p. 254. **Clyde M. Naramore, Psicología de la felicidad, Unilit, 1958, p. 139.

Plenary Session
5.24 - Gerald Hsu MD PhD UCSF Heme Onc Program Director

Plenary Session

Play Episode Listen Later Oct 28, 2022 68:27


Learn about UCSF Hematology Oncology Program with Dr. Gerald Hsu, MD PhD Malignant Heme and Program Director

En su reposo
En su reposo. Brevedad y eternidad. T23. E14.

En su reposo

Play Episode Listen Later Oct 24, 2022 4:03


En su reposo. 24/10/2022. T23. E14. "Entonces llamarás, y yo te responderé; tendrás afecto a la hechura de tus manos". Job 14:15 Brevedad y eternidad El sufrimiento de Job llo lleva a reflexionar sobre la brevedad de la vida. Y aunque discurre sobre la forma en que el hombre recorre su corto camino sobre la tierra, Job también entiende que este pequeño espacio de tiempo que pasamos aquí, tiene esperanza en la comunión que el ser humano pueda alcanzar con su creador. Somos flores cortadas, sombras que huyen, ríos secos y mares sin agua. No hay esperanza para el hombre más que el final de sus días señalados y contados por el Eterno. Ante semejante visión desalentadora, la esperanza de Job está en el día que Dios "tendrá afecto a la hechura de sus manos". Ese día, el llamado de Dios retumbará en nuestros oídos, y el momento glorioso de la liberación habrá llegado. Ese día, la brevedad de nuestros días llegará a su fin, para dar paso a la eternidad gloriosa. Ese día, es el día que anhelamos, que esperamos, que deseamos con ansias. Al menos todos aquellos que, como Job, encuentran en la presencia de Dios consuelo, esperanza y vida. Los que han entendido que los días de sufrimiento son breves, muy breves, comparados con la eternidad. Que ni siquiera hay forma de igualarlos. Que el afecto del cielo llevará a la gloria eterna a quienes hayan puesto su confianza en Dios, tal como el patriarca. Sufrimos, lloramos, padecemos, pero por un corto tiempo. Mientras esto acontece, nos tomamos de la mano de Dios para atravesar los días oscuros, las tormentas impetuosas irán y vendrán con Dios a nuestro lado; y después, cuando este lapso de tiempo haya llegado a su fin, la dulce voz del Todopoderoso nos llamará a la eternidad a su lado. Se acordará de nosotros (no como que nos haya olvidado sino como hermosa metáfora que nos confirma que el día de nuestra redención está marcado); y nos atraerá a si mismo para nunca más separarnos de él. Oh días grises corran presurosos, No sufriré sus quebrantos; Pues tras la efímera vida de dolor, Me esperan los brazos del Salvador. Déjame oír tu tierna voz, Yo responderé: Heme aquí Señor. Obedeceré raudo y veloz, Y habitaré así, en tu eterno amor. Isaí Rodríguez Ruiz

Daniel Ramos' Podcast
Episode 364: 15 de Octubre del 2022 - Notas de Elena - Material complementario de ES para adultos

Daniel Ramos' Podcast

Play Episode Listen Later Oct 14, 2022 5:41


================================================== ==SUSCRIBETEhttps://www.youtube.com/channel/UCNpffyr-7_zP1x1lS89ByaQ?sub_confirmation=1================================================== == NOTAS DE ELENAMaterial complementario de la escuela Sabática para adultosNarrado por: Patty CuyanDesde: California, Estados UnidosUna cortesía de DR'Ministries y Canaan Seventh-Day Adventist Church SÁBADO, 15 DE OCTUBRELA ESPERANZA DEL ANTIGUO TESTAMENTOY antes de mucho las puertas del cielo se abrirán para recibir a los hijos de Dios, y de los labios del Rey de gloria resonará en sus oídos, como la música más dulce, la invitación: "Venid, benditos de mi Padre, poseed el ¡destinado para vosotros desde la fundación del mundo!" Mateo 24:34.Entonces los redimidos recibirán con gozo la bienvenida al hogar que el Señor Jesús les está preparando. Allí su compañía no será la de los viles de la tierra, ni la de los mentirosos, idólatras, impuros e incrédulos, sino la de los que hayan vencido a Satanás y por la gracia divina hayan adquirido un carácter perfecto. Toda tendencia pecaminosa, toda imperfección que los aflige aquí, habrá sido quitada por la sangre de Cristo, y se les comunicará la excelencia y brillantez de su gloria, que excederá con mucho a la sol (Exaltada Jesús, p. 48). Abraham creía que Isaac era el hijo de la promesa. También creía que Dios había hablado con claridad cuando le molestaba que lo ofreciera en holocausto. No dudó de la promesa de Dios; en cambio creyó que si el Señor, que en su providencia había permitido que Sara tuviera un hijo en su vejez, le había pedido que tomara la vida de su hijo, se la podría dar de nuevo y levantar a Isaac de entre los muertos.. .Y cuando la mano [de Abraham] se levantó para quitar la vida de su hijo, un ángel de Dios, que había estado observando toda la fidelidad de Abraham en su camino al monte Moña, lo llamó desde el cielo y le dijo: "Abraham , Abraham. Y él respondió: Heme aquí. Y dijo: No extiendas tu mano sobre el muchacho, ni le hagas nada; porque ya sé que temes a Dios, por cuanto no me rehusaste tu hijo, tu único" Génesis 22:11, 12 (La historia de la redención, págs. 83, 84). Para los que están perdiendo a sus amados en este mundo, cuán preciosas son su fe y esperanza en las promesas de Dios que les abren la vida inmortal futura. Sus esperanzas pueden fijarse en realidades invisibles del mundo futuro. Cristo ha resucitado de la muerte: las primicias de los muertos. La esperanza y la fe fortalecen al alma para que pase por las negras sombras de la tumba, con plena fe de surgir a la vida inmortal en la mañana de la resurrección. ¡El paraíso de Dios, el hogar de los salvados! Allí toda lágrima será quitada de todos los rostros. Cuando Cristo venga por segunda vez, para "ser admirado en todos los que creen" (2 Tesalonicenses 1:10), la muerte será sorbida con victoria, y no habrá más enfermedad, más aflicción, más muerte.El Dador de la vida llamará a su posesión adquirida en la primera resurrección, y hasta esa hora triunfante, cuando resuene la trompeta final y el vasto ejército avance hacia la victoria eterna, cada santo que duerme será mantenido en seguridad y guardado como una joya preciosa , como quien es conocido por Dios por su nombre (That I May Know Him, p. 362; parcialmente en A fin de conocerle, pp. 360, 361, y en Mensajes selectos, t. 2, pp. 309, 310). 

Música Cristiana (Gratis)
Heme aquí, envíame a mí

Música Cristiana (Gratis)

Play Episode Listen Later Oct 11, 2022 26:26


¿Te has arrepentido de tus pecados? ¿Estás seguro de que Dios te ha perdonado? De su serie clásica La santidad de Dios, escucha esta semana en Renovando Tu Mente como R.C. Sproul describe la manera que Dios usó para limpiar a Su profeta Isaías.

Tu Historia Preferida
Heme aquí, envíame a mí

Tu Historia Preferida

Play Episode Listen Later Oct 11, 2022 26:26


¿Te has arrepentido de tus pecados? ¿Estás seguro de que Dios te ha perdonado? De su serie clásica La santidad de Dios, escucha esta semana en Renovando Tu Mente como R.C. Sproul describe la manera que Dios usó para limpiar a Su profeta Isaías.

Dr. Stanley – Ministerios En Contacto
Heme aquí, envíame a mí

Dr. Stanley – Ministerios En Contacto

Play Episode Listen Later Oct 11, 2022 26:26


¿Te has arrepentido de tus pecados? ¿Estás seguro de que Dios te ha perdonado? De su serie clásica La santidad de Dios, escucha esta semana en Renovando Tu Mente como R.C. Sproul describe la manera que Dios usó para limpiar a Su profeta Isaías.

Gracia a Vosotros | Ps. John MacArthur
Heme aquí, envíame a mí

Gracia a Vosotros | Ps. John MacArthur

Play Episode Listen Later Oct 11, 2022 26:26


¿Te has arrepentido de tus pecados? ¿Estás seguro de que Dios te ha perdonado? De su serie clásica La santidad de Dios, escucha esta semana en Renovando Tu Mente como R.C. Sproul describe la manera que Dios usó para limpiar a Su profeta Isaías.

Música Cristiana
Heme aquí, envíame a mí

Música Cristiana

Play Episode Listen Later Oct 11, 2022 26:26


¿Te has arrepentido de tus pecados? ¿Estás seguro de que Dios te ha perdonado? De su serie clásica La santidad de Dios, escucha esta semana en Renovando Tu Mente como R.C. Sproul describe la manera que Dios usó para limpiar a Su profeta Isaías.

Transformando la mente
Heme aquí, envíame a mí

Transformando la mente

Play Episode Listen Later Oct 11, 2022 26:26


¿Te has arrepentido de tus pecados? ¿Estás seguro de que Dios te ha perdonado? De su serie clásica La santidad de Dios, escucha esta semana en Renovando Tu Mente como R.C. Sproul describe la manera que Dios usó para limpiar a Su profeta Isaías.

Plenary Session
5.18 Lecture to Heme Onc Fellows - POLO; Javelin 100 bladder

Plenary Session

Play Episode Listen Later Oct 8, 2022 46:43


Polo Javelin 100 bladder Crossover Control arms How to read and keep up with the literature

The Bacon Podcast with Brian Basilico | CURE Your Sales & Marketing with Ideas That Make It SIZZLE!
Episode 817 – The 5 Half-Truths of B2b Sales and Marketing (You Have Probably Been Fed)

The Bacon Podcast with Brian Basilico | CURE Your Sales & Marketing with Ideas That Make It SIZZLE!

Play Episode Listen Later Oct 3, 2022 10:00


Have you ever eaten an "Impossible Burger"? They do a pretty good job of making plants taste like meat, but why do they call it Impossible? Because meat has heme. Heme is the molecule that gives blood its red color and helps carry oxygen in living organisms. Unlike other plant-based burgers and meats, it was thought to be impossible to make it look and taste like real meat. So no matter your carnivore or vegan status, you could be fooled that the burger you are eating is meat. in business, we have all been fed a lot of "Impossible" meals. You often see ads or hear sales pitches that promise results that should satisfy our business sales hunger. It's not a lie if it only works for some businesses. It's a half-truth. We have all been fed these meals when it comes to sales and marketing. Today I want to explore some of those "Impossible" half-truths that often hamper our success when marketing our businesses online. These include: Cookie Cutter Competition Your Website Is A Bro (sure) Traffic Trumps Trust Ads Add Profits Social Media Sells Spending End Of Year Budgets - Many corporate clients have annual budgets. When I worked in corporate, we had to spend the rest of our budget before the end of the year. If we did not use it all, it often would lower our budget in the coming year. Do your clients have money that has to be spent before the year ends? New Year Positioning - New years mean new beginnings. Often businesses like to promote new products or services to kick off a new year. Does anything you provide clients offer them a way to help position them as new or innovative to start out a new year? So how can you maximize your opportunities to stay top of mind and help your clients achieve their end-of-year or end-of-quarter goals? You can nudge them along by providing them with marketing that promotes ideas while reminding them of the time crunch. "A lie gets halfway around the world before the truth has a chance to get its pants on." - Winston Churchill In this episode, we will discuss how to avoid falling for those sales & marketing half-truths. It's not "Impossible" to tase success for yourself! Want To See How To Market BETTER? - Click Here

Autism Parenting Secrets
GENETICS Loads The Gun, ENVIRONMENT Pulls the Trigger

Autism Parenting Secrets

Play Episode Listen Later Sep 22, 2022 60:28


Welcome to Episode 118 of Autism Parenting Secrets. The topic this week is on genes and how better understanding your genetic makeup can lead to better focus and decision making.  Bob Miller is our guest and he's back with some exciting new insights.  This discussion will build on our first discussion - see Episode 109.So please watch that episode first in order to get the most out of this one.Bob Miller is a Traditional Naturopath specializing in the field of genetic-specific nutrition. In 1993, he opened the Tree of Life practice and he has served as a traditional naturopath for 27 years. He created an online certification course on genetic nutrition that has empowered over 900 health professionals and he founded Functional Genomic Analysis, an online software program that organizes and analyzes genetic SNPS for functional health professionals across the world.This is going to be more of a presentation than a discussion because of the nature of the material.  While genes are important, there's something even more impactful. The secret this week is…GENETICS Loads The Gun, ENVIRONMENT Pulls the TriggerYou'll Discover:A Potential Root Cause You Can't Overlook (3:28)The Combination of Factors That Makes People Very Sick (7:31)Why Some People Have Symptoms From Toxic Exposure And Others Don't (10:45)What is the NADPH Steal (13:33)Why Heme Oxygenase and Bilirubin Are Worth Looking At (18:34)What Might Be Behind “Hangry” (24:02)How Software Makes Connections We Couldn't Make Before (38:01)When Ice Cream Helps (44:12)A Misconception That Is Absolutely False (49:25)About Our Guest:For the past several years, Bob Miller has been engaged exclusively with functional nutritional genetic variants and related research, specializing in nutritional support for those with chronic Lyme disease.Bob lectures nationally and internationally at seminars to educate health care practitioners about genetic variants and nutritional supplementation for achieving optimal health, and holds live webinars every other Thursday evening for health professionals. In 2016, he created an online certification course on genetic nutrition for health professionals now training over 900 health professionals in the program.Bob is a frequent guest on many podcasts such as Dr. Jill Carnahan, Better Health Guy, Dr. Joseph Mercola, and many others.To support his growing genetic research efforts, in 2015, Bob founded and personally funds, the NutriGenetic Research Institute to research the relationship between genetic variants and presenting symptoms.His first research project on genetic variants in those with chronic Lyme disease, was one of two winners for research by the ILADS international meeting held in Helsinki, Finland. His Phase II study of Lyme disease was presented at the American ILADS conference in November 2016, Phase III was presented at the International ILADS conference in Paris, France in May 2017 and his Phase IV study on mTOR and Autophagy in Lyme disease was presented in Boston, November 2017. Phase V was presented in Warsaw, Poland in June 2018 and his Phase VI was another winner presented in Chicago, Illinois in November of 2018 which showed increased variants in the Heme pathway and Mast Cell genes. Phase VII presented in Madrid, Spain in June of 2019 research showed how genetic variants in genes related to the production of and utilization of NAD+ and NADPH are creating what is now referred to as the ‘NADPH Steal'. In 2020, he presented his research at the online ILADS conference on genetic mutations in the synthesis and utilization of bile.Bob has created 72 nutritional supplement products exclusively for health professionals for Professional Health Products and Functional Genomic Nutrition through Compounded Nutrients.  The products he formulated are based upon his genetic research and are designed to support function that may be impaired by genetic weakness.Bob is the founder and president of Functional Genomic Analysis, an online software program that organizes and analyzes genetic SNPS for functional health professionals across the world.Memberships:National Association of Certified Natural Health ProfessionalsAmerican Association of Nutritional ConsultantsBoard Certified Naturopath - American Naturopathic Certification & Accreditation BoardBob MillerTree of Life References In This Episode:Watch the VIDEO version of this discussion hereAccess the complete presentation PDF hereAutism Parenting Secrets Episode 109, Genes are CLUES, Not Destiny Additional Resources:Take The Quiz: What's YOUR Top Autism Parenting Blindspot?Free Resource: 33 Mistakes Most Autism Parents Make and How To Avoid ThemGot a Picky Eater? - this can helpTo learn more about Cass & Len, visit us at www.autismparentingsecrets.comBe sure to follow Cass & Len on Instagram If you enjoyed this episode, share it with your friends.Don't forget to subscribe to the show on Apple Podcasts to get automatic episode updates for our "Autism Parenting Secrets!"And, finally, please take a minute to leave us an honest review and rating on Apple Podcasts. They really help us out when it comes to the ranking of the show and we read every single one of the reviews we get. Thanks for listening!

Blood Podcast
Tranexamic acid prophylaxis in heme malignancies, N-glycosylation as a therapeutic vulnerability in CALR-mutant MPN, and myocardial fibrosis in sickle cell anemia

Blood Podcast

Play Episode Listen Later Sep 15, 2022 21:01


In this week's episode we'll discuss the efficacy of tranexamic acid prophylaxis in patients with hematological malignancies, learn more about N-glycosylation as a therapeutic vulnerability in CALR-mutant MPN, and discuss how early initiation of disease-modifying therapy may be able to reduce myocardial fibrosis in sickle cell anemia.

The Medbullets Step 2 & 3 Podcast
Heme | Polycythemia Rubra Vera

The Medbullets Step 2 & 3 Podcast

Play Episode Listen Later Aug 14, 2022 11:01


In this episode, we review the high-yield topic of Polycythemia Rubra Vera from the Heme section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

The Medbullets Step 2 & 3 Podcast
Heme | Acute Hemolytic Reaction

The Medbullets Step 2 & 3 Podcast

Play Episode Listen Later Aug 14, 2022 10:00


In this episode, we review the high-yield topic of Acute Hemolytic Reaction from the Heme section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

The Medbullets Step 2 & 3 Podcast
Heme | Lead Poisoning

The Medbullets Step 2 & 3 Podcast

Play Episode Listen Later Aug 13, 2022 9:29


In this episode, we review the high-yield topic of Lead Poisoning from the Heme section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

The Medbullets Step 2 & 3 Podcast
Heme | Autoimmune Hemolysis

The Medbullets Step 2 & 3 Podcast

Play Episode Listen Later Aug 12, 2022 14:29


In this episode, we review the high-yield topic of Autoimmune Hemolysis from the Heme section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

The Medbullets Step 1 Podcast
Biochemistry | Heme Metabolism

The Medbullets Step 1 Podcast

Play Episode Listen Later Aug 12, 2022 13:05


In this episode, we review the high-yield topic of Heme Metabolism from the Biochemistry section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbulletsIn this episode --- Send in a voice message: https://anchor.fm/medbulletsstep1/message

The Medbullets Step 2 & 3 Podcast
Heme | Paroxysmal Nocturnal Hemoglobinuria (PNH)

The Medbullets Step 2 & 3 Podcast

Play Episode Listen Later Aug 11, 2022 13:26


In this episode, we review the high-yield topic of Paroxysmal Nocturnal Hemoglobinuria (PNH) from the Heme section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

Patriots With Grit
29. Why Blood Clots Are On The Rise | Dr. Penelope Harris MD, Heme/Onc

Patriots With Grit

Play Episode Listen Later Aug 11, 2022 57:39


Blood clots are on the rise and doctors are seeing alarming problems and issues at an exponential rate.  What's causing all this?  Why are there so many strokes, heart attacks and aneurisms in young people?  Why such a spike in cancer diagnosis and death?  Why is the media, the CDC, the WHO, and FDA so quiet?  Dr. Penelope Harris, MD, Heme/Onc pulls back the curtain and reveals her findings and what she believes is the main issue behind this nonsense.-------------------------------------SUPPORT OUR SPONSORS FOR THIS SHOWGet accurate, honest and true news by reading The Epoch Times. Visit: www.IReadEpoch.com Enter promo code GRIT and get your first month for just $1.-------------------------------------STAY IN THE LOOP AND UP TO DATEVisit Website https://patriotswithgrit.com/ Help Support Patriots With Grit https://patriotswithgrit.com/donate/ Recommend Patriots To Interview https://patriotswithgrit.com/recommend/ Grab Some Fun Merch https://patriotswithgrit.com/shop/-------------------------------------SUBSCRIBE TO PODCASThttps://podcasts.apple.com/us/podcast/patriots-with-grit/id1615813244-------------------------------------HANG OUT WITH US ON THESE SOCIAL MEDIA PLATFORMSRUMBLE: https://rumble.com/c/c-1011237 YOUTUBE: https://youtube.com/channel/UCPq8tmHN8_Mn1M_wHs8xYiQFACEBOOK Page: https://www.facebook.com/patriotswithgritCLOUT HUB: https://app.clouthub.com/#/users/u/PatriotsWithGrit/posts TELEGRAM: https://t.me/PatriotsWithGritGAB: https://gab.com/darynrossTRUTH SOCIAL: https://truthsocial.com/@patriotswithgritLINKS TO ALL SOCIAL MEDIA: http://patriotswithgrit.com/links/-------------------------------------

The Medbullets Step 2 & 3 Podcast
Heme | Pathological RBC Forms

The Medbullets Step 2 & 3 Podcast

Play Episode Listen Later Aug 10, 2022 8:56


In this episode, we review the high-yield topic of Pathological RBC Forms from the Heme section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

The Medbullets Step 2 & 3 Podcast
Heme | Diamond-Blackfan Anemia

The Medbullets Step 2 & 3 Podcast

Play Episode Listen Later Aug 9, 2022 14:30


In this episode, we review the high-yield topic of Diamond-Blackfan Anemia from the Heme section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

Mehlman Medical
HY USMLE Q #536 – Obgyn / Heme

Mehlman Medical

Play Episode Listen Later Jul 23, 2022 5:02


Video for this podcast: https://mehlmanmedical.com/audio-qbank-hy-usmle-q-536-obgyn-heme Main website: https://mehlmanmedical.com/ Instagram: https://www.instagram.com/mehlman_medical/ Telegram private group: https://mehlmanmedical.com/subscribe/ Telegram public channel: https://t.me/mehlmanmedical Facebook: https://www.facebook.com/mehlmanmedical Podcast: https://anchor.fm/mehlmanmedical Patreon: https://www.patreon.com/mehlmanmedical

Autism Parenting Secrets
Genes are CLUES, Not Destiny

Autism Parenting Secrets

Play Episode Listen Later Jul 21, 2022 62:18


Welcome to Episode 109 of the Autism Parenting Secrets. This week we have an amazing guest who provides a compelling, cutting-edge approach that you likely have not heard of.  We're talking about genetic-specific nutrition.Our guest is Bob Miller. In 1993, he opened the Tree of Life practice and he has served as a traditional naturopath for 27 years. In 2016, he created an online certification course on genetic nutrition for health professionals now training over 900 health professionals in the program.Bob is the founder and president of Functional Genomic Analysis, an online software program that organizes and analyzes genetic SNPS for functional health professionals across the world.Getting more informed so you can take better actions to support your child and yourself is the opportunity.  And the secret this week is…Genes are CLUES, Not Destiny You'll Discover:What is Functional Genomics? (5:00)What The Science Says (7:39)How Mold Wreaks Havoc (14:42)Why You Need To Be Careful With Omega 3s and Fish Oil (18:22)Even More Reasons To Avoid High Fructose Corn Syrup (21:02)The Link Between Inflamation, Histamine and Mast Cell Activation (30:07)What You Need To Know About MTHFR (34:03)The Miracle Molecule (38:54)Minimizing Exposure To Glyphosate Is Essential (41:51)How Glutamine and Glutamate Play A Role (53:58)The 3D Chess Game Played Underwater (58:34)About Our GuestFor the past several years, Bob Miller has been engaged exclusively with functional nutritional genetic variants and related research, specializing in nutritional support for those with chronic Lyme disease.Bob lectures nationally and internationally at seminars to educate health care practitioners about genetic variants and nutritional supplementation for achieving optimal health, and holds live webinars every other Thursday evening for health professionals. In 2016, he created an online certification course on genetic nutrition for health professionals now training over 900 health professionals in the program.Bob is a frequent guest on many podcasts such as Dr. Jill Carnahan, Better Health Guy, Dr. Joseph Mercola, and many others.To support his growing genetic research efforts, in 2015, Bob founded and personally funds, the NutriGenetic Research Institute to research the relationship between genetic variants and presenting symptoms.His first research project on genetic variants in those with chronic Lyme disease, was one of two winners for research by the ILADS international meeting held in Helsinki, Finland. His Phase II study of Lyme disease was presented at the American ILADS conference in November 2016, Phase III was presented at the International ILADS conference in Paris, France in May 2017 and his Phase IV study on mTOR and Autophagy in Lyme disease was presented in Boston, November 2017. Phase V was presented in Warsaw, Poland in June 2018 and his Phase VI was another winner presented in Chicago, Illinois in November of 2018 which showed increased variants in the Heme pathway and Mast Cell genes. Phase VII presented in Madrid, Spain in June of 2019 research showed how genetic variants in genes related to the production of and utilization of NAD+ and NADPH are creating what is now referred to as the ‘NADPH Steal'. In 2020, he presented his research at the online ILADS conference on genetic mutations in the synthesis and utilization of bile.Bob has created 72 nutritional supplement products exclusively for health professionals for Professional Health Products and Functional Genomic Nutrition through Compounded Nutrients.  The products he formulated are based upon his genetic research and are designed to support function that may be impaired by genetic weakness.Bob is the founder and president of Functional Genomic Analysis, an online software program that organizes and analyzes genetic SNPS for functional health professionals across the world.Memberships:National Association of Certified Natural Health ProfessionalsAmerican Association of Nutritional ConsultantsBoard Certified Naturopath - American Naturopathic Certification & Accreditation BoardBob MillerTree of LifeReferences in This Episode:Rantes Overview PDF - use this to follow along with the discussionWatch the video version of this presentation hereOmegaQuantDr. Jill CarnahanAdditional Resources:Free Resource: 33 Mistakes Most Autism Parents Make and How To Avoid ThemGot a Picky Eater? - this can helpTo learn more about Cass & Len, visit us at www.autismparentingsecrets.comBe sure to follow Cass & Len on InstagramIf you enjoyed this episode, share it with your friends.Don't forget to subscribe to the show on Apple Podcasts to get automatic episode updates for our "Autism Parenting Secrets!"And, finally, please take a minute to leave us an honest review and rating on Apple Podcasts. They really help us out when it comes to the ranking of the show, and we read every single one of the reviews we get. Thanks for listening!

The Fellow on Call
Episode 019: Heme/Onc Emergencies, Pt. 8: APL

The Fellow on Call

Play Episode Listen Later Jun 22, 2022


Emergencies happen in hematology and oncology. This is a fact. But how do we manage these emergencies? Look no further. In this episode, we'll talk about one of the key hematologic malignancies that you'll encounter as a fellow, one that requires immediate action to reduce mortality: acute promyelocytic leukemia (APL or APML)- Acute Promyelocytic leukemia (APL or APML):**Stay tuned for our upcoming “part two” and “chemotherapy basics” episodes for more information on non-acute management of this disease**APL is a true hematologic emergency! Although this is a very curable form of leukemia, it is associated with high rates of severe DIC and high mortality in the period immediately following diagnosis***Untreated, can see pulmonary or cerebrovascular hemorrhage in up to 40% of patients***10-20% incidence of hemorrhage-related mortality in the initial period***Statistically significant increase in mortality at 30 days with just a 12-hour delay in initial hematologist consultation- Disease basics:** Rare subtype of AML(

The Fellow on Call
Episode 018: Heme/Onc Emergencies, Pt. 7: TTP

The Fellow on Call

Play Episode Listen Later Jun 17, 2022


Emergencies happen in hematology and oncology. This is a fact. But how do we manage these emergencies? Look no further. In this episode, we talk all about our fourth hematologic emergency: thrombotic thrombocytopenic purpura (TTP). Thrombotic thrombocytopenic purpura (TTP):- Be sure to check out episode 009 on thrombocytopenia for a general approach and differential!- New anemia and thrombocytopenia should raise concerns for TTP! Workup: - Peripheral smear - concern for schistocytes. Look at this first! Example of these cells from ASH image bank here- ADAMTS13 level - always draw ASAP before any intervention- Repeat CBC- Reticulocyte count - will have elevated retic count- Citrated platelet count - CMP- PT, PTT, INR- Fibrinogen- Haptoglobin - LDH- Viral serologies Clinical manifestations: - Fever, Anemia, Thrombocytopenia, Renal (AKI), Altered Mental Status- If you see this - the patient is in bad shapeMechanism:- Tiny blood clots form in the body, causing platelet shearing- Loss of ADAMTS13 - This protein normally is responsible for chopping up von Willebrand's factor (vWF)- In the absence of ADAMTS13, vWF multimers are extra long, therefore interacting with platelets/collagen more and causing activation of platelets and clotting system- This causes red blood cell shearing due to small vessel microthrombi (brain, kidneys, heart)- Cytokine release causes fevers Management:- Do not reflexively transfuse platelets; can make situation worse - PLASMIC Score: helps to stratify likelihood of TTP; MDCalc link (https://www.mdcalc.com/plasmic-score-ttp)Treatment: - Plasma exchange: replacing ADATMS13-deficient plasma with ADAMTS13-rich plasma- This is different than plasmapheresis, where we replace plasma with albumin- Steroids: 1mg/kg prednisone daily to stop auto-antibody (against ADAMTS13) production- Confirm with ADAMTS13 levels; if

The Fellow on Call
Episode 017: Heme/Onc Emergencies, Pt. 6: Heparin-Induced Thrombocytopenia (HIT)

The Fellow on Call

Play Episode Listen Later Jun 15, 2022


Emergencies happen in hematology and oncology. This is a fact. But how do we manage these emergencies? Look no further. In this episode, we talk all about our third hematologic emergency: heparin-induced thrombocytopenia (HIT)!Be sure to check out episode 009 on thrombocytopenia for a general approach and differential!HIT:- Any time a patient with heparin exposure and now with a new thrombotic event, you need to think about HIT!What is HIT?- Type 1: a transient drop in platelets after heparin is started- Type 2: **The scary one! Antibody-mediated process**Heparin molecules bind to platelet-factor 4 (PF4)**This complex activates platelets, which then further releases more PF4 from the plateletsWhat is the difference between HIT and HITT?- HITT is when there is also thrombosis (HIT + Clot) Why is this more common in the cardiac ICU?- It is believed that IgM interacts with ultra-long complexes, which heparin is- Lots of heparin is required for cardiac surgery- Therefore lots of exposure to heparin increases likelihood, increasing likelihood for IgM to IgG class-switching; HIT is IgG-mediated process** Remember - since this is antibody-mediated, therefore it takes a few days for the antibodies to form in patient with a new diagnosis of HIT!How to stratify?4-T score (MDCalc Link: https://www.mdcalc.com/4ts-score-heparin-induced-thrombocytopenia)Workup: - Sent HIT ELISA test in patient with high suspicion - ELISA just suggests if the HIT antibody is present- If ELISA positive, then do confirmatory assay, i.e., is this antibody actually doing anything, is the "serotonin-release assay” - Send 4 extremity dopplers to look for thrombosis - STOP heparin/heparin-derived products and SWITCH anticoagulant, such as argatroban, fondaparinux, bivalirudin (do not wait for a positive test if your suspicion is high enough!)If HIT positive: - Add heparin to their allergy list- Continue anticoagulation until platelets are recovered (>150K)- Continue anticoagulation for 3-6 months for patients with HITTWords of wisdom: If patient comes from outside hospital and starts having decreasing platelets, consider HIT in your differential! References: https://ashpublications.org/blood/article/119/10/2209/29530/How-I-treat-heparin-induced-thrombocytopenia- great review article from ASH on HITPlease visit our website (TheFellowOnCall.com) for more information Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

La Voz Apostolica
Sermon | Heme Aqui Enviame a Mi | Pastor Alberto Sarabia

La Voz Apostolica

Play Episode Listen Later Jun 13, 2022 36:12


Hogares De Pacto
Números 1: Listos para la guerra y el servicio a Dios.

Hogares De Pacto

Play Episode Listen Later Jun 8, 2022 6:13


Números 1: Listos para la guerra y el servicio a Dios.Números 1:44‭-‬54 RVA2015:Estos fueron los contados, a los cuales contaron Moisés, Aarón y los doce jefes de Israel (un hombre por cada tribu). Así todos los hijos de Israel fueron contados según sus casas paternas, de veinte años para arriba, todos los que en Israel podían ir a la guerra. Todos los contados fueron seiscientos tres mil quinientos cincuenta. Pero los levitas no fueron contados con ellos según los clanes de sus padres, porque el SEÑOR había hablado a Moisés diciendo: “Solo la tribu de Leví no contarás; no harás un censo de ellos entre los demás hijos de Israel. Más bien, pondrás a los levitas a cargo del tabernáculo del testimonio, de todos sus utensilios y de todo lo que se relaciona con él. Ellos llevarán el tabernáculo y todos sus utensilios. Estarán al servicio del tabernáculo y acamparán alrededor de él. Cuando el tabernáculo tenga que trasladarse, los levitas lo desarmarán; y cuando se detenga, los levitas lo armarán. El extraño que se acerque morirá. Los hijos de Israel instalarán sus tiendas cada uno en su campamento, cada uno junto a su estandarte, según sus escuadrones. Pero los levitas acamparán alrededor del tabernáculo del testimonio. Así no habrá ira contra la congregación de los hijos de Israel. Los levitas estarán a cargo del tabernáculo del testimonio”. Los hijos de Israel hicieron conforme a todas las cosas que el SEÑOR había mandado a Moisés. Así lo hicieron.---------------------------El título de este libro, Números, fue escogido por los traductores de la versión griega del Antiguo Testamento, por la lista exhaustiva de las genealogías de las tribus de Israel que son presentadas aquí con detalles.En el libro original en hebreo es titulado "en el desierto", haciendo referencia a que la mayoría de los detalles y eventos narrados en este libro sucedieron en el desierto en el área del Sinaí y de Moab.Al estudiar Números, podemos dividirlo en tres secciones: la primera es cuando el pueblo está delante de Dios en el monte Sinaí; en la segunda veremos el largo camino de Israel durante su travesía en el desierto; y por último, escucharemos o leeremos las instrucciones que Moisés le da al pueblo estando a la orilla del río Jordán y dispuestos a conquistar la tierra que Dios les prometió.Tal vez te parezca un poco aburrido o incomprensible leer tantos nombres o leer las etapas donde el pueblo de Israel tuvo que pasar en el desierto pero todo esto es importante para entender el proceso en que Dios tuvo que pasar a Israel; y en medio de estos registros, encontraremos datos importantes de la vida de Moisés, Aarón, Josué, los líderes que fueron fieles y los que fueron infieles. En este libro vamos a ver varias historias, algunas positivas y otras negativas del comportamiento de Israel delante de Dios. Comencemos hoy examinando la importancia de tener un censo de los que tenían la edad de convertirse en soldados. Debían tener mínimo 20 años. Cada tribu fue censada, y podemos ver el número de guerreros. ¡Aquí vemos la importancia de convertirnos en guerreros espirituales con la armadura de Jesucristo! Somos los que debemos estar al frente de la batalla. Por eso, cuando Isaías escuchó la voz divina que preguntó: "¿A quién enviaré? ¿Y quién irá por nosotros?” Él respondió: “Heme aquí, envíame a mí."También vemos que los sacerdotes no eran censados. Era prohibido contarlos, pues ellos eran una tribu especial. Esto es un simbolismo de multitud incontable. Ellos representaban al Dios infinito, que bendice en abundancia y sin límite. Ese era el deseo del Señor, que hubiera en medio del pueblo sacerdotes en abundancia para que ministren al pueblo de Dios. Conviértete en un sacerdote de Dios, adorándolo y exaltándolo continuamente. ¡En el libro de Apocalipsis encontramos un ejemplo similar de una gran multitud que nadie podía contar, adorando al Señor! (Apocalipsis 7:9).Que tu hogar sea un hogar lleno de guerreros que luchen contra el adversario, y también que sean un grupo de adoradores que adoren en espíritu y en verdad, que intercedan por el débil y fortalezcan al cansado. Soy tu amigo y hermano Eduardo Rodríguez. Que el Señor escuche tu oración y te capacite como guerrero y sacerdote.==========Numbers 1: Ready for war and service to God.Numbers 1:44:54:These are the ones who were numbered, whom Moses and Aaron numbered, with the leaders of Israel, twelve men, each one representing his father's house. So all who were numbered of the children of Israel, by their fathers' houses, from twenty years old and above, all who were able to go to war in Israel— all who were numbered were six hundred and three thousand five hundred and fifty.But the Levites were not numbered among them by their fathers' tribe; for the Lord had spoken to Moses, saying: “Only the tribe of Levi you shall not number, nor take a census of them among the children of Israel; but you shall appoint the Levites over the tabernacle of the Testimony, over all its furnishings, and over all things that belong to it; they shall carry the tabernacle and all its furnishings; they shall attend to it and camp around the tabernacle. And when the tabernacle is to go forward, the Levites shall take it down; and when the tabernacle is to be set up, the Levites shall set it up. The outsider who comes near shall be put to death. The children of Israel shall pitch their tents, everyone by his own camp, everyone by his own standard, according to their armies; but the Levites shall camp around the tabernacle of the Testimony, that there may be no wrath on the congregation of the children of Israel; and the Levites shall keep charge of the tabernacle of the Testimony.”Thus the children of Israel did; according to all that the Lord commanded Moses, so they did.-------------------------The title of this book, Numbers, was chosen by the translators of the Greek version of the Old Testament, because of the exhaustive list of the genealogies of the tribes of Israel which are presented here in detail.In the original book in Hebrew it is titled "in the desert", referring to the fact that most of the details and events narrated in this book happened in the desert in the area of ​​Sinai and Moab.As we study Numbers we can divide it into three sections: the first is when the people stand before God on Mount Sinai; in the second we will see the long road of Israel during its journey in the desert; and finally, we will listen or read the instructions that Moses gives to the people standing on the banks of the Jordan River and ready to conquer the land that God promised them.It may seem a bit boring or incomprehensible to you to read so many names or to read the stages where the people of Israel had to go through in the desert, but all this is important to understand the process in which God made Israel to go through; and in the midst of these records, we will find important data on the lives of Moses, Aaron, Joshua, the leaders who were faithful and those who were unfaithful.In this book we are going to see various stories, some positive and some negative of Israel's behavior before God.Let's start today by examining the importance of having a census of those who were old enough to become soldiers. They must be at least 20 years old. Each tribe was censused, and we can see the number of warriors. Here we see the importance of becoming spiritual warriors with the armor of Jesus Christ! We are the ones who should be at the forefront of the battle. That is why when Isaiah heard the divine voice that asked: "Whom shall I send? And who will go for us?" He answered: "Here am I, send me."We also see that the priests were not counted. It was forbidden to count them, because they were a special tribe. This is a symbolism of countless multitudes. They represented the infinite God, who blesses abundantly and without limit. That was the desire of the Lord, that there be in the midst of the people priests in abundance to minister to the people of God. Become a priest of God, continually worshiping and exalting Him. In the book of Revelation we find a similar example of a great multitude that no one could count, worshiping the Lord! (Revelation 7:9).May your home be a home full of warriors who fight against the adversary, and also may they be a group of worshipers who worship in spirit and in truth, who intercede for the weak and strengthen the weary. I am your friend and brother Eduardo Rodríguez. May the Lord hear your prayer and empower you as a warrior and a priest.#Numeros #Numeros1#IglesiaElReino #KingdomChurch #IPUH#HogaresDePacto #HogaresDePactoPodcast #PastorCarlos #CarlosRodriguez #EduardoRodriguez

Mehlman Medical
HY USMLE Q #501 – Weird heme but it's on NBME

Mehlman Medical

Play Episode Listen Later Jun 7, 2022 3:12


Video for this podcast: https://mehlmanmedical.com/audio-qbank-hy-usmle-q-501-weird-heme-but-its-on-nbme Main website: https://mehlmanmedical.com/ Instagram: https://www.instagram.com/mehlman_medical/ Telegram private group: https://mehlmanmedical.com/subscribe/ Telegram public channel: https://t.me/mehlmanmedical Facebook: https://www.facebook.com/mehlmanmedical Podcast: https://anchor.fm/mehlmanmedical Patreon: https://www.patreon.com/mehlmanmedical

The Fellow on Call
Episode 016: Heme/Onc Emergencies, Pt. 5: DIC and Intro to TMAs

The Fellow on Call

Play Episode Listen Later May 25, 2022


Emergencies happen in hematology and oncology. This is a fact. But how do we manage these emergencies? Look no further. In this episode, we talk all about our second hematologic emergency: disseminated intravascular coagulation (DIC) with an added bonus of an intro to thrombotic microangiopathic anemias (TMAs).Be sure to check out episode 009 on thrombocytopenia for a general approach and differential!Disseminated intravascular coagulation (DIC):Workup: CBCCMPPT, PTT, INRFibrinogenPeripheral smear - concern for schistocytes. Example of these cells from ASH image bank: https://imagebank.hematology.org/image/60306/schistocytes?type=upload#:~:text=A%20schistocyte%20is%20present%20in,angles%20and%2For%20straight%20borders.Basic mechanism of DIC is consumption of clotting factors leading to coagulopathy Need to be weary of thrombotic microangiopathy: Small blood clots forming in the small vessels leading to endothelial damage, which cause shear stress on the RBCs, which then break down into a schistocyte (AKA triangulocyte or helmet cell) Examples: thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS)Management (our opinion!): - Repeat coags q4-6 hours initially (but base interval based on patient) NOTE: INR Is NOT a good assessment of “clotting status” in these situations- Repeat fibrinogen q4-6 hours initially (but base interval based on patient); keep fibrinogen >100 with cryoprecipitate in more stable patients; consider higher thresholds for more acutely ill patients (such as >150) - Repeat CBC q6-8 hours initially; can provide platelets if low, especially if they are bleeding - Workup and treatment for trigger of DIC (infection, trauma, medications, etc.)How does cirrhosis affect data interpretation?- Use clinical context to determine if labs are acutely abnormal or if they have signs/symptoms to suggest underlying liver dysfunction- In the acute setting, always just replace what is missing! How can you tell the difference between nutritional deficiencies vs. consumption (as in with DIC?)- Factor activity levels! Consider checking: Factor 8 (made in endothelium), Factor 5 (Vit K independent), Factor 7 (vitamin K dependent) - If all down, then consider DIC- If Vit K-dependent low, then nutritional deficiency Reference:https://ashpublications.org/blood/article/131/8/845/104418/How-I-treat-disseminated-intravascular-coagulation - Great How I Treat article from Blood Please visit our website (TheFellowOnCall.com) for more information Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

The Fellow on Call
Episode 015: Heme/Onc Emergencies, Pt. 4: Immune thrombocytopenic purpura

The Fellow on Call

Play Episode Listen Later May 18, 2022


Emergencies happen in hematology and oncology. This is a fact. But how do we manage these emergencies? Look no further. In this episode, we talk all about our first hematologic emergency: immune thrombocytopenic purpura (ITP).Immune thrombocytopenic purpura (ITP):Be sure to check out episode 009 on thrombocytopenia for a general approach and differential!Specific instances where there may be close to undetectable platelet count: * Lab artifact (clumping)* Very severe DIC* Thrombotic thrombocytopenic purpura - though usually higher platelets in these cases * Heparin induced thrombocytopenia (in very severe cases) - though usually higher platelets in these cases * ITP ITP: Diagnosis of exclusion How to confirm it is ITP?* Post-transfusion CBC - a repeat CBC 30-60 mins after a platelet transfusion. In ITP, the platelet count will likely not budge. (Not perfect test!)* Immature platelet fraction (if available) - this will be elevated if mature platelets are being destroyed. (Again - not a perfect test) Treatment in acute cases: IVIG 1g/kg daily x2 days + Dexamethasone 40mg daily x4 daysReference:https://ashpublications.org/blood/article/106/7/2244/21649/How-I-treat-idiopathic-thrombocytopenic-purpura - Great How I Treat article from Blood Please visit our website (TheFellowOnCall.com) for more information Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

The Fellow on Call
Episode 014: Heme/Onc Emergencies, Pt. 3: Cord compression

The Fellow on Call

Play Episode Listen Later Apr 27, 2022


Emergencies happen in hematology and oncology. This is a fact. But how do we manage these emergencies? Look no further. In this episode, we talk all about our third oncologic emergency: new brain mets. Cord compression:- If someone has a pathologic fracture, think about the following differential as underlying etiologies: - Females: rule out breast cancer - Males: Prostate cancer- Others: multiple myeloma, lymphoma, lung cancer, renal cell carcinoma, bladder - If cord compression, administer steroids; may require radiation to help with shrinking; also may need involvement of neurosurgery if there is lack of spine stability. Role of radiation in cord compression: -MRI is beneficial to help with radiation planning-Where is the disease in proximity to the spinal cord? In the bone? In the epidural space? Or pushing against the spinal cord +/- blocking CSF?-Is the spine stable? Use SINS scoring (https://radiopaedia.org/articles/spinal-instability-neoplastic-score-sins-2?lang=us) -If good spine stability (low SINS) or is not surgical candidate or radio-sensitive tumor: radiation up front-If poor spine stability (high SINS) then may need surgery up frontRadiosensitive tumors examples:LymphomaGerm cell tumors Small cell lung cancer Radio-resistant tumor examples (resistant does not mean that radiation cannot be used, however):MelanomaColorectal Renal cell Continue steroids as they are undergoing radiation to prevent flare up from inflammation and acute worsening from the mass on the spinal cordRole of neurosurgery: - What is a reasonable time that we can wait before operating for a new cord compression?- As noted above, cord compression has various degrees- Questions to ask: What neurologic symptoms? Over what time period? - Asymptomatic: You have time! Perhaps investigate why mass may be there. - Progressive over a couple of weeks: You have a little bit of time (a few days to get them to surgery)- Acutely having symptoms: You should intervene. - Spinal stability: are the weight-bearing components (ligaments) intact? Assessed via upright X-rays - If the tumor is radio-sensitive, may opt for radiation first (if diagnosis is known)A HUGE thank you to our special guests:Ryan Miller, MD, MS: PGY5 in Radiation Oncology at Thomas Jefferson University Hospital, Philadelphia, PAJoshua Lowenstein, MD, MBA: Neurosurgery Attending, REX Neurosurgery and Spine Specialists, Raleigh, NC Please visit our website (TheFellowOnCall.com) for more information Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

The Fellow on Call
Episode 013: Heme/Onc Emergencies, Pt. 2: Brain Mets

The Fellow on Call

Play Episode Listen Later Apr 20, 2022


Emergencies happen in hematology and oncology. This is a fact. But how do we manage these emergencies? Look no further. In this episode, we talk all about our second oncologic emergency: new brain mets. Brain mets:Strongly consider steroids, particularly with the presence of vasogenic edema associated with brain mets Stereotactic radiosurgery (SRS): use of high dose radiation delivered in a single treatment (“fraction”) that is delivered focally to the area of disease seen on imaging (typically MRI); great option for brain mets; can be performed by radiation oncology What to do to expedite Rad Onc planning: Thin-cut MRIStart patient on steroids Interpreting MRI imaging: T1 post-contrast sequence: to look for brain massT2 sequence: looking for vasogenic edema surrounding brain massMidline shift is an issue more so when it is acute; this is very different than slow changes over timeWho to operate on? Functional status prior to surgery; not in an area that can cause other harm; no other good alternative treatment optionsWhat to tell your NSGY colleague during a consult: A quick neuro exam (consciousness, strength, sensation, focal neurologic issues)Brief cancer historyUnderlying organ dysfunction Antiplatelet/anticoagulants A HUGE thank you to our special guests:Ryan Miller, MD, MS: PGY5 in Radiation Oncology at Thomas Jefferson University Hospital, Philadelphia, PAJoshua Lowenstein, MD, MBA: Neurosurgery Attending, REX Neurosurgery and Spine Specialists, Raleigh, NC Please visit our website (TheFellowOnCall.com) for more information Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

The Fellow on Call
Episode 012: Heme/Onc Emergencies, Pt. 1: SVC Syndrome

The Fellow on Call

Play Episode Listen Later Apr 13, 2022


Emergencies happen in hematology and oncology. This is a fact. But how do we manage these emergencies? Look no further. In this episode, we talk all about first oncologic emergencies: superior vena cava (SVC) syndrome.Superior vena cava syndrome: Important: although we focus on a possible malignant mass in this discussion about SVC, other things can also cause SVC syndrome. How do you know about the chronicity of someone's possible SVC syndrome? Compare to a recent picture!Image of patient with collateralization with SVC syndrome: DOI: 10.1056/NEJMicm1311911Workup: Need to determine the etiology; imaging is important: CT of chest (CT venogram)Consider ultrasound to rule out thrombosis Get biopsy (eventually) if this is malignancy DDx of mediastinal masses: 5Ts:ThymomaTerrible lymphoma (B or T-cell)Testicular cancerTeratoma Thyroid malignancies Central line (causing occlusion) +/- clotSo now what? Yes, an answer to what is causing the issue is important, but we need to ensure that patient has a stable airway and temporize the situationOften requires input of specialists, such as Interventional Radiology or Radiation Oncology How to treat patients with SVC syndrome?- Chemotherapy: Important in chemo-responsive tumors (ex. germ cell tumors, lymphomas, small cell lung cancer); This can take a while to work -Placement of stents: Provides more immediate relief, but more invasive -Radiation treatment: Not always possible - Laryngeal edema/cerebral edema: steroids for life-threatening complications; Can affect diagnostic yield of sample and affect diagnosis, but may be required in emergent situations When is more emergent treatment indicated and consultants definitely need to be called (TELL YOUR CONSULTANT IF ANY OF THESE ARE SEEN!):Hemodynamic instabilityWorsening respiratory statusWorsening neurological status Final decision for what to do is often a multi-disciplinary discussion Stents: Provides quick reliefDoes not prohibit a diagnosis and curative treatment for the underlying malignancy Radiation: Takes several days or weeks; depending on underling histologyIf they have received prior radiation, they may not be eligible for more radiation A HUGE thank you to our special guests:Ryan Miller, MD, MS: PGY5 in Radiation Oncology at Thomas Jefferson University Hospital, Philadelphia, PA (https://www.jefferson.edu/university/jmc/departments/radiation_oncology/education/residency/residents/miller.html)Rupal Parikh, MD: PGY6 in Diagnostic/Interventional Radiology at the Hospital of the University of Pennsylvania, Philadelphia, PA (https://www.pennmedicine.org/departments-and-centers/department-of-radiology/education-and-training/residency-programs/current-residents/ir-integrated-residents/ir-dr-fifth-year/rupal-parikh-md)Please visit our website (TheFellowOnCall.com) for more information Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

The Medbullets Step 2 & 3 Podcast
Heme | Mechanical Destruction: Fragmentation Hemolysis

The Medbullets Step 2 & 3 Podcast

Play Episode Listen Later Apr 11, 2022 10:59


In this episode, we review the high-yield topic of Mechanical Destruction: Fragmentation Hemolysis from the Heme section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets